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Sample records for distributed prognostic health

  1. A DISTRIBUTED PROGNOSTIC HEALTH MANAGEMENT ARCHITECTURE

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper introduces a generic distributed prognostic health management (PHM) architecture with specific application to the electrical power systems domain. Current...

  2. Distributed Prognostic Health Management with Gaussian Process Regression

    Science.gov (United States)

    Saha, Sankalita; Saha, Bhaskar; Saxena, Abhinav; Goebel, Kai Frank

    2010-01-01

    Distributed prognostics architecture design is an enabling step for efficient implementation of health management systems. A major challenge encountered in such design is formulation of optimal distributed prognostics algorithms. In this paper. we present a distributed GPR based prognostics algorithm whose target platform is a wireless sensor network. In addition to challenges encountered in a distributed implementation, a wireless network poses constraints on communication patterns, thereby making the problem more challenging. The prognostics application that was used to demonstrate our new algorithms is battery prognostics. In order to present trade-offs within different prognostic approaches, we present comparison with the distributed implementation of a particle filter based prognostics for the same battery data.

  3. Distributed Prognostics and Health Management with a Wireless Network Architecture

    Science.gov (United States)

    Goebel, Kai; Saha, Sankalita; Sha, Bhaskar

    2013-01-01

    A heterogeneous set of system components monitored by a varied suite of sensors and a particle-filtering (PF) framework, with the power and the flexibility to adapt to the different diagnostic and prognostic needs, has been developed. Both the diagnostic and prognostic tasks are formulated as a particle-filtering problem in order to explicitly represent and manage uncertainties in state estimation and remaining life estimation. Current state-of-the-art prognostic health management (PHM) systems are mostly centralized in nature, where all the processing is reliant on a single processor. This can lead to a loss in functionality in case of a crash of the central processor or monitor. Furthermore, with increases in the volume of sensor data as well as the complexity of algorithms, traditional centralized systems become for a number of reasons somewhat ungainly for successful deployment, and efficient distributed architectures can be more beneficial. The distributed health management architecture is comprised of a network of smart sensor devices. These devices monitor the health of various subsystems or modules. They perform diagnostics operations and trigger prognostics operations based on user-defined thresholds and rules. The sensor devices, called computing elements (CEs), consist of a sensor, or set of sensors, and a communication device (i.e., a wireless transceiver beside an embedded processing element). The CE runs in either a diagnostic or prognostic operating mode. The diagnostic mode is the default mode where a CE monitors a given subsystem or component through a low-weight diagnostic algorithm. If a CE detects a critical condition during monitoring, it raises a flag. Depending on availability of resources, a networked local cluster of CEs is formed that then carries out prognostics and fault mitigation by efficient distribution of the tasks. It should be noted that the CEs are expected not to suspend their previous tasks in the prognostic mode. When the

  4. Communication Optimizations for a Wireless Distributed Prognostic Framework

    Data.gov (United States)

    National Aeronautics and Space Administration — Distributed architecture for prognostics is an essential step in prognostic research in order to enable feasible real-time system health management. Communication...

  5. Distributed Prognostics Based on Structural Model Decomposition

    Data.gov (United States)

    National Aeronautics and Space Administration — Within systems health management, prognostics focuses on predicting the remaining useful life of a system. In the model-based prognostics paradigm, physics-based...

  6. A Distributed Approach to System-Level Prognostics

    Science.gov (United States)

    Daigle, Matthew J.; Bregon, Anibal; Roychoudhury, Indranil

    2012-01-01

    Prognostics, which deals with predicting remaining useful life of components, subsystems, and systems, is a key technology for systems health management that leads to improved safety and reliability with reduced costs. The prognostics problem is often approached from a component-centric view. However, in most cases, it is not specifically component lifetimes that are important, but, rather, the lifetimes of the systems in which these components reside. The system-level prognostics problem can be quite difficult due to the increased scale and scope of the prognostics problem and the relative Jack of scalability and efficiency of typical prognostics approaches. In order to address these is ues, we develop a distributed solution to the system-level prognostics problem, based on the concept of structural model decomposition. The system model is decomposed into independent submodels. Independent local prognostics subproblems are then formed based on these local submodels, resul ting in a scalable, efficient, and flexible distributed approach to the system-level prognostics problem. We provide a formulation of the system-level prognostics problem and demonstrate the approach on a four-wheeled rover simulation testbed. The results show that the system-level prognostics problem can be accurately and efficiently solved in a distributed fashion.

  7. Distributed Prognostics System Implementation on Wireless Embedded Devices

    Data.gov (United States)

    National Aeronautics and Space Administration — Distributed prognostics is the next step in the evolution of prognostic methodologies. It is an important enabling technology for the emerging Condition Based...

  8. Communication Optimizations for a Wireless Distributed Prognostic Framework

    Science.gov (United States)

    Saha, Sankalita; Saha, Bhaskar; Goebel, Kai

    2009-01-01

    Distributed architecture for prognostics is an essential step in prognostic research in order to enable feasible real-time system health management. Communication overhead is an important design problem for such systems. In this paper we focus on communication issues faced in the distributed implementation of an important class of algorithms for prognostics - particle filters. In spite of being computation and memory intensive, particle filters lend well to distributed implementation except for one significant step - resampling. We propose new resampling scheme called parameterized resampling that attempts to reduce communication between collaborating nodes in a distributed wireless sensor network. Analysis and comparison with relevant resampling schemes is also presented. A battery health management system is used as a target application. A new resampling scheme for distributed implementation of particle filters has been discussed in this paper. Analysis and comparison of this new scheme with existing resampling schemes in the context for minimizing communication overhead have also been discussed. Our proposed new resampling scheme performs significantly better compared to other schemes by attempting to reduce both the communication message length as well as number total communication messages exchanged while not compromising prediction accuracy and precision. Future work will explore the effects of the new resampling scheme in the overall computational performance of the whole system as well as full implementation of the new schemes on the Sun SPOT devices. Exploring different network architectures for efficient communication is an importance future research direction as well.

  9. Requirements Flowdown for Prognostics and Health Management

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by...

  10. Requirements Flowdown for Prognostics and Health Management

    Science.gov (United States)

    Goebel, Kai; Saxena, Abhinav; Roychoudhury, Indranil; Celaya, Jose R.; Saha, Bhaskar; Saha, Sankalita

    2012-01-01

    Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by providing a reliable estimate of future system states. This estimate is a key for planning and decision making in an operational setting. While technology solutions have made considerable advances, the tie-in into the systems engineering process is lagging behind, which delays fielding of PHM-enabled systems. The derivation of specifications from high level requirements for algorithm performance to ensure quality predictions is not well developed. From an engineering perspective some key parameters driving the requirements for prognostics performance include: (1) maximum allowable Probability of Failure (PoF) of the prognostic system to bound the risk of losing an asset, (2) tolerable limits on proactive maintenance to minimize missed opportunity of asset usage, (3) lead time to specify the amount of advanced warning needed for actionable decisions, and (4) required confidence to specify when prognosis is sufficiently good to be used. This paper takes a systems engineering view towards the requirements specification process and presents a method for the flowdown process. A case study based on an electric Unmanned Aerial Vehicle (e-UAV) scenario demonstrates how top level requirements for performance, cost, and safety flow down to the health management level and specify quantitative requirements for prognostic algorithm performance.

  11. A Distributed Approach to System-Level Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics, which deals with predicting remaining useful life of components, subsystems, and systems, is a key tech- nology for systems health management that leads...

  12. Power Management for A Distributed Wireless Health Management Architecture

    Data.gov (United States)

    National Aeronautics and Space Administration — Distributed wireless architectures for prognostics is an important enabling step in prognostic research in order to achieve feasible real-time system health...

  13. Accelerated Aging Experiments for Capacitor Health Monitoring and Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper discusses experimental setups for health monitoring and prognostics of electrolytic capacitors under nominal operation and accelerated aging conditions....

  14. Research on prognostics and health management of underground pipeline

    Science.gov (United States)

    Zhang, Guangdi; Yang, Meng; Yang, Fan; Ni, Na

    2018-04-01

    With the development of the city, the construction of the underground pipeline is more and more complex, which has relation to the safety and normal operation of the city, known as "the lifeline of the city". First of all, this paper introduces the principle of PHM (Prognostics and Health Management) technology, then proposed for fault diagnosis, prognostics and health management in view of underground pipeline, make a diagnosis and prognostics for the faults appearing in the operation of the underground pipeline, and then make a health assessment of the whole underground pipe network in order to ensure the operation of the pipeline safely. Finally, summarize and prospect the future research direction.

  15. Prognostics Design Solutions in Structural Health Monitoring Systems

    Data.gov (United States)

    National Aeronautics and Space Administration — The chapter describes the application of prognostic techniques to the domain of structural health and demonstrates the efficacy of the methods using fatigue data...

  16. Prognostics and health management of engineering systems an introduction

    CERN Document Server

    Kim, Nam-Ho; Choi, Joo-Ho

    2017-01-01

    This book introduces the methods for predicting the future behavior of a system’s health and the remaining useful life to determine an appropriate maintenance schedule. The authors introduce the history, industrial applications, algorithms, and benefits and challenges of PHM (Prognostics and Health Management) to help readers understand this highly interdisciplinary engineering approach that incorporates sensing technologies, physics of failure, machine learning, modern statistics, and reliability engineering. It is ideal for beginners because it introduces various prognostics algorithms and explains their attributes, pros and cons in terms of model definition, model parameter estimation, and ability to handle noise and bias in data, allowing readers to select the appropriate methods for their fields of application. Among the many topics discussed in-depth are: • Prognostics tutorials using least-squares • Bayesian inference and parameter estimation • Physics-based prognostics algorithms including non...

  17. Prognostics and health management system for hydropower plant based on fog computing and docker container

    Science.gov (United States)

    Xiao, Jian; Zhang, Mingqiang; Tian, Haiping; Huang, Bo; Fu, Wenlong

    2018-02-01

    In this paper, a novel prognostics and health management system architecture for hydropower plant equipment was proposed based on fog computing and Docker container. We employed the fog node to improve the real-time processing ability of improving the cloud architecture-based prognostics and health management system and overcome the problems of long delay time, network congestion and so on. Then Storm-based stream processing of fog node was present and could calculate the health index in the edge of network. Moreover, the distributed micros-service and Docker container architecture of hydropower plants equipment prognostics and health management was also proposed. Using the micro service architecture proposed in this paper, the hydropower unit can achieve the goal of the business intercommunication and seamless integration of different equipment and different manufacturers. Finally a real application case is given in this paper.

  18. Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics has received considerable attention recently as an emerging sub-discipline within SHM. Prognosis is here strictly defined as “predicting the time at...

  19. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2016-10-04

    This presentation was given at the 2016 Annual Conference of the Prognostics and Health Management Society. It covers the current status and challenges and opportunities of prognostics and health management of wind turbines.

  20. A Distributed Approach to System-Level Prognostics

    Science.gov (United States)

    2012-09-01

    the end of (useful) life ( EOL ) and/or the remaining useful life (RUL) of components, subsystems, or systems. The prognostics problem itself can be...system state estimate, computes EOL and/or RUL. In this paper, we focus on a model-based prognostics approach (Orchard & Vachtse- vanos, 2009; Daigle...been focused on individual components, and determining their EOL and RUL, e.g., (Orchard & Vachtsevanos, 2009; Saha & Goebel, 2009; Daigle & Goebel

  1. Prognostics and health management of photovoltaic systems

    Science.gov (United States)

    Johnson, Jay; Riley, Daniel

    2018-04-10

    The various technologies presented herein relate to providing prognosis and health management (PHM) of a photovoltaic (PV) system. A PV PHM system can eliminate long-standing issues associated with detecting performance reduction in PV systems. The PV PHM system can utilize an ANN model with meteorological and power input data to facilitate alert generation in the event of a performance reduction without the need for information about the PV PHM system components and design. Comparisons between system data and the PHM model can provide scheduling of maintenance on an as-needed basis. The PHM can also provide an approach for monitoring system/component degradation over the lifetime of the PV system.

  2. Machine health prognostics using the Bayesian-inference-based probabilistic indication and high-order particle filtering framework

    Science.gov (United States)

    Yu, Jianbo

    2015-12-01

    Prognostics is much efficient to achieve zero-downtime performance, maximum productivity and proactive maintenance of machines. Prognostics intends to assess and predict the time evolution of machine health degradation so that machine failures can be predicted and prevented. A novel prognostics system is developed based on the data-model-fusion scheme using the Bayesian inference-based self-organizing map (SOM) and an integration of logistic regression (LR) and high-order particle filtering (HOPF). In this prognostics system, a baseline SOM is constructed to model the data distribution space of healthy machine under an assumption that predictable fault patterns are not available. Bayesian inference-based probability (BIP) derived from the baseline SOM is developed as a quantification indication of machine health degradation. BIP is capable of offering failure probability for the monitored machine, which has intuitionist explanation related to health degradation state. Based on those historic BIPs, the constructed LR and its modeling noise constitute a high-order Markov process (HOMP) to describe machine health propagation. HOPF is used to solve the HOMP estimation to predict the evolution of the machine health in the form of a probability density function (PDF). An on-line model update scheme is developed to adapt the Markov process changes to machine health dynamics quickly. The experimental results on a bearing test-bed illustrate the potential applications of the proposed system as an effective and simple tool for machine health prognostics.

  3. Stress testing on silicon carbide electronic devices for prognostics and health management.

    Energy Technology Data Exchange (ETDEWEB)

    Kaplar, Robert James; Brock, Reinhard C.; Marinella, Matthew; King, Michael Patrick; Smith, Mark A.; Atcitty, Stanley

    2011-01-01

    Power conversion systems for energy storage and other distributed energy resource applications are among the drivers of the important role that power electronics plays in providing reliable electricity. Wide band gap semiconductors such as silicon carbide (SiC) and gallium nitride (GaN) will help increase the performance and efficiency of power electronic equipment while condition monitoring (CM) and prognostics and health management (PHM) will increase the operational availability of the equipment and thereby make it more cost effective. Voltage and/or temperature stress testing were performed on a number of SiC devices in order to accelerate failure modes and to identify measureable shifts in electrical characteristics which may provide early indication of those failures. Those shifts can be interpreted and modeled to provide prognostic signatures for use in CM and/or PHM. Such experiments will also lead to a deeper understanding of basic device physics and the degradation mechanisms behind failure.

  4. Data Fusion for Enhanced Aircraft Engine Prognostics and Health Management

    Science.gov (United States)

    Volponi, Al

    2005-01-01

    Aircraft gas-turbine engine data is available from a variety of sources, including on-board sensor measurements, maintenance histories, and component models. An ultimate goal of Propulsion Health Management (PHM) is to maximize the amount of meaningful information that can be extracted from disparate data sources to obtain comprehensive diagnostic and prognostic knowledge regarding the health of the engine. Data fusion is the integration of data or information from multiple sources for the achievement of improved accuracy and more specific inferences than can be obtained from the use of a single sensor alone. The basic tenet underlying the data/ information fusion concept is to leverage all available information to enhance diagnostic visibility, increase diagnostic reliability and reduce the number of diagnostic false alarms. This report describes a basic PHM data fusion architecture being developed in alignment with the NASA C-17 PHM Flight Test program. The challenge of how to maximize the meaningful information extracted from disparate data sources to obtain enhanced diagnostic and prognostic information regarding the health and condition of the engine is the primary goal of this endeavor. To address this challenge, NASA Glenn Research Center, NASA Dryden Flight Research Center, and Pratt & Whitney have formed a team with several small innovative technology companies to plan and conduct a research project in the area of data fusion, as it applies to PHM. Methodologies being developed and evaluated have been drawn from a wide range of areas including artificial intelligence, pattern recognition, statistical estimation, and fuzzy logic. This report will provide a chronology and summary of the work accomplished under this research contract.

  5. Prognostics and Health Monitoring: Application to Electric Vehicles

    Science.gov (United States)

    Kulkarni, Chetan S.

    2017-01-01

    As more and more autonomous electric vehicles emerge in our daily operation progressively, a very critical challenge lies in accurate prediction of remaining useful life of the systemssubsystems, specifically the electrical powertrain. In case of electric aircrafts, computing remaining flying time is safety-critical, since an aircraft that runs out of power (battery charge) while in the air will eventually lose control leading to catastrophe. In order to tackle and solve the prediction problem, it is essential to have awareness of the current state and health of the system, especially since it is necessary to perform condition-based predictions. To be able to predict the future state of the system, it is also required to possess knowledge of the current and future operations of the vehicle.Our research approach is to develop a system level health monitoring safety indicator either to the pilotautopilot for the electric vehicles which runs estimation and prediction algorithms to estimate remaining useful life of the vehicle e.g. determine state-of-charge in batteries. Given models of the current and future system behavior, a general approach of model-based prognostics can be employed as a solution to the prediction problem and further for decision making.

  6. Embedded diagnostic, prognostic, and health management system and method for a humanoid robot

    Science.gov (United States)

    Barajas, Leandro G. (Inventor); Sanders, Adam M (Inventor); Reiland, Matthew J (Inventor); Strawser, Philip A (Inventor)

    2013-01-01

    A robotic system includes a humanoid robot with multiple compliant joints, each moveable using one or more of the actuators, and having sensors for measuring control and feedback data. A distributed controller controls the joints and other integrated system components over multiple high-speed communication networks. Diagnostic, prognostic, and health management (DPHM) modules are embedded within the robot at the various control levels. Each DPHM module measures, controls, and records DPHM data for the respective control level/connected device in a location that is accessible over the networks or via an external device. A method of controlling the robot includes embedding a plurality of the DPHM modules within multiple control levels of the distributed controller, using the DPHM modules to measure DPHM data within each of the control levels, and recording the DPHM data in a location that is accessible over at least one of the high-speed communication networks.

  7. Structural health and prognostics management for offshore wind turbines :

    Energy Technology Data Exchange (ETDEWEB)

    Myrent, Noah J.; Kusnick, Joshua F.; Barrett, Natalie C.; Adams, Douglas E.; Griffith, Daniel

    2013-04-01

    Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling approach developed in prior work is used to identify how the underlying physics of the system are affected by the presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Based on simulations of damage in the turbine model, the operational measurements that demonstrated the highest sensitivity to the damage/faults were the blade tip accelerations and local pitching moments for both imbalance and shear web disbond. The initial cost model provided a great deal of insight into the estimated savings in operations and maintenance costs due to the implementation of an effective SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability, revenue, and overall profit.

  8. Structural health and prognostics management for offshore wind turbines :

    Energy Technology Data Exchange (ETDEWEB)

    Griffith, Daniel; Resor, Brian Ray; White, Jonathan Randall; Paquette, Joshua A.; Yoder, Nathanael C.

    2012-12-01

    Operations and maintenance costs for offshore wind plants are expected to be significantly higher than the current costs for onshore plants. One way in which these costs may be able to be reduced is through the use of a structural health and prognostic management system as part of a condition based maintenance paradigm with smart load management. To facilitate the creation of such a system a multiscale modeling approach has been developed to identify how the underlying physics of the system are affected by the presence of damage and how these changes manifest themselves in the operational response of a full turbine. The developed methodology was used to investigate the effects of a candidate blade damage feature, a trailing edge disbond, on a 5-MW offshore wind turbine and the measurements that demonstrated the highest sensitivity to the damage were the local pitching moments around the disbond. The multiscale method demonstrated that these changes were caused by a local decrease in the blades torsional stiffness due to the disbond, which also resulted in changes in the blades local strain field. Full turbine simulations were also used to demonstrate that derating the turbine power by as little as 5% could extend the fatigue life of a blade by as much as a factor of 3. The integration of the health monitoring information, conceptual repair cost versus damage size information, and this load management methodology provides an initial roadmap for reducing operations and maintenance costs for offshore wind farms while increasing turbine availability and overall profit.

  9. Degradations analysis and aging modeling for health assessment and prognostics of PEMFC

    International Nuclear Information System (INIS)

    Jouin, Marine; Gouriveau, Rafael; Hissel, Daniel; Péra, Marie-Cécile; Zerhouni, Noureddine

    2016-01-01

    Applying prognostics to Proton Exchange Membrane Fuel Cell (PEMFC) stacks is a good solution to help taking actions extending their lifetime. However, it requires a great understanding of the degradation mechanisms and failures occurring within the stack. This task is not simple when applied to a PEMFC due to the different levels (stack - cells - components), the different scales and the multiple causes that lead to degradation. To overcome this problem, this work proposes a methodology dedicated to the setting of a framework and a modeling of the aging for prognostics. This methodology is based on a deep literature review and degradation analyses of PEMFC stacks. This analysis allows defining a proper vocabulary dedicated to PEMFC's prognostics and health management and a clear limited framework to perform prognostics. Then the degradations review is used to select critical components within the stack, and to define their critical failure mechanisms thanks the proposal of new fault trees. The impact of these critical components and mechanisms on the power loss during aging is included to the model for prognostics. This model is finally validated on four datasets with different mission profiles both for health assessment and prognostics. - Highlights: • A proper framework to perform PHM, particularly prognostics, of PEMFC is proposed. • A degradation analysis is performed. • A completely new model of PEMFC degradation is proposed. • SOH estimation is performed with very high coefficients of determination.

  10. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2015-12-14

    Prognostics and health management is not a new concept. It has been used in relatively mature industries, such as aviation and electronics, to help improve operation and maintenance (O&M) practices. In the wind industry, prognostics and health management is relatively new. The level for both wind industry applications and research and development (R&D) has increased in recent years because of its potential for reducing O&M cost of wind power, especially for turbines installed offshore. The majority of wind industry application efforts has been focused on diagnosis based on various sensing and feature extraction techniques. For R&D, activities are being conducted in almost all areas of a typical prognostics and health management framework (i.e., sensing, data collection, feature extraction, diagnosis, prognosis, and maintenance scheduling). This presentation provides an overview of the current status of wind turbine prognostics and health management that focuses on drivetrain condition monitoring through vibration, oil debris, and oil condition analysis techniques. It also discusses turbine component health diagnosis through data mining and modeling based on supervisory control and data acquisition system data. Finally, it provides a brief survey of R&D activities for wind turbine prognostics and health management, along with future opportunities.

  11. An integrated framework for online diagnostic and prognostic health monitoring using a multistate deterioration process

    International Nuclear Information System (INIS)

    Moghaddass, Ramin; Zuo, Ming J.

    2014-01-01

    Efficient asset management is of paramount importance, particularly for systems with costly downtime and failure. As in energy and capital-intensive industries, the economic loss of downtime and failure is huge, the need for a low-cost and integrated health monitoring system has increased significantly over the years. Timely detection of faults and failures through an efficient prognostics and health management (PHM) framework can lead to appropriate maintenance actions to be scheduled proactively to avoid catastrophic failures and minimize the overall maintenance cost of the systems. This paper aims at practical challenges of online diagnostics and prognostics of mechanical systems under unobservable degradation. First, the elements of a multistate degradation structure are reviewed and then a model selection framework is introduced. Important dynamic performance measures are introduced, which can be used for online diagnostics and prognostics. The effectiveness of the result of this paper is demonstrated with a case study on the health monitoring of turbofan engines

  12. Smart Sensing System for the Prognostic Monitoring of Bone Health

    KAUST Repository

    Afsarimanesh, Nasrin; Zia, Asif; Mukhopadhyay, Subhas; Kruger, Marlena; Yu, Pak-Lam; Kosel, Jü rgen; Kovacs, Zoltan

    2016-01-01

    The objective of this paper is to report a novel non-invasive, real-time, and label-free smart assay technique for the prognostic detection of bone loss by electrochemical impedance spectroscopy (EIS). The proposed system incorporated an antibody-antigen-based sensor functionalization to induce selectivity for the C-terminal telopeptide type one collagen (CTx-I) molecules—a bone loss biomarker. Streptavidin agarose was immobilized on the sensing area of a silicon substrate-based planar sensor, patterned with gold interdigital electrodes, to capture the antibody-antigen complex. Calibration experiments were conducted with various known CTx-I concentrations in a buffer solution to obtain a reference curve that was used to quantify the concentration of an analyte in the unknown serum samples. Multivariate chemometric analyses were done to determine the performance viability of the developed system. The analyses suggested that a frequency of 710 Hz is the most discriminating regarding the system sensitivity. A detection limit of 0.147 ng/mL was achieved for the proposed sensor and the corresponding reference curve was linear in the range of 0.147 ng/mL to 2.669 ng/mL. Two sheep blood samples were tested by the developed technique and the results were validated using enzyme-linked immunosorbent assay (ELISA). The results from the proposed technique match those from the ELISA.

  13. Smart Sensing System for the Prognostic Monitoring of Bone Health

    KAUST Repository

    Afsarimanesh, Nasrin

    2016-06-24

    The objective of this paper is to report a novel non-invasive, real-time, and label-free smart assay technique for the prognostic detection of bone loss by electrochemical impedance spectroscopy (EIS). The proposed system incorporated an antibody-antigen-based sensor functionalization to induce selectivity for the C-terminal telopeptide type one collagen (CTx-I) molecules—a bone loss biomarker. Streptavidin agarose was immobilized on the sensing area of a silicon substrate-based planar sensor, patterned with gold interdigital electrodes, to capture the antibody-antigen complex. Calibration experiments were conducted with various known CTx-I concentrations in a buffer solution to obtain a reference curve that was used to quantify the concentration of an analyte in the unknown serum samples. Multivariate chemometric analyses were done to determine the performance viability of the developed system. The analyses suggested that a frequency of 710 Hz is the most discriminating regarding the system sensitivity. A detection limit of 0.147 ng/mL was achieved for the proposed sensor and the corresponding reference curve was linear in the range of 0.147 ng/mL to 2.669 ng/mL. Two sheep blood samples were tested by the developed technique and the results were validated using enzyme-linked immunosorbent assay (ELISA). The results from the proposed technique match those from the ELISA.

  14. Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals

    NARCIS (Netherlands)

    Steenstra, Ivan A.; Koopman, Fieke S.; Knol, Dirk L.; Kat, Eric; Bongers, Paulien M.; de Vet, Henrica C. W.; van Mechelen, Willem

    2005-01-01

    Information on prognostic factors for duration of sick leave due to low-back pain (LBP) is growing. In this prospective cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care

  15. Machinery health prognostics: A systematic review from data acquisition to RUL prediction

    Science.gov (United States)

    Lei, Yaguo; Li, Naipeng; Guo, Liang; Li, Ningbo; Yan, Tao; Lin, Jing

    2018-05-01

    Machinery prognostics is one of the major tasks in condition based maintenance (CBM), which aims to predict the remaining useful life (RUL) of machinery based on condition information. A machinery prognostic program generally consists of four technical processes, i.e., data acquisition, health indicator (HI) construction, health stage (HS) division, and RUL prediction. Over recent years, a significant amount of research work has been undertaken in each of the four processes. And much literature has made an excellent overview on the last process, i.e., RUL prediction. However, there has not been a systematic review that covers the four technical processes comprehensively. To fill this gap, this paper provides a review on machinery prognostics following its whole program, i.e., from data acquisition to RUL prediction. First, in data acquisition, several prognostic datasets widely used in academic literature are introduced systematically. Then, commonly used HI construction approaches and metrics are discussed. After that, the HS division process is summarized by introducing its major tasks and existing approaches. Afterwards, the advancements of RUL prediction are reviewed including the popular approaches and metrics. Finally, the paper provides discussions on current situation, upcoming challenges as well as possible future trends for researchers in this field.

  16. Prognostic Health Management for Avionics System Power Supplies

    National Research Council Canada - National Science Library

    Orsagh, Rolf; Brown, Douglas; Roemer, Michael; Dabney, Thomas; Hess, Andrew

    2005-01-01

    This paper presents an integrated approach to switching mode power supply health management that implements techniques from engineering disciplines including statistical reliability modeling, damage...

  17. Electronic Prognostics for Vehicle Health Management, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — All electronic systems are prone to wear-out and eventual failure and this has direct implications for Vehicle Health Management for NASA with its long space...

  18. Distributed leadership in health care

    DEFF Research Database (Denmark)

    Günzel-Jensen, Franziska; Jain, Ajay K.; Kjeldsen, Anne Mette

    2018-01-01

    Management and health care literature is increasingly preoccupied with leadership as a collective social process, and related leadership concepts such as distributed leadership have therefore recently gained momentum. This paper investigates how formal, i.e. transformational, transactional...... and empowering, leadership styles affect employees’ perceived agency in distributed leadership, and whether these associations are mediated by employees’ perceived organizational efficacy. Based on large-scale survey data from a study at one of Scandinavia’s largest public hospitals (N = 1,147), our results show...... that all leadership styles had a significant positive impact on employees’ perceived agency in distributed leadership. Further, organizational efficacy related negatively to employees’ perceived agency in distributed leadership; however a mediatory impact of this on the formal leadership styles...

  19. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure.

    Science.gov (United States)

    Allen, Larry A; Felker, G Michael; Mehra, Mandeep R; Chiong, Jun R; Dunlap, Stephanie H; Ghali, Jalal K; Lenihan, Daniel J; Oren, Ron M; Wagoner, Lynne E; Schwartz, Todd A; Adams, Kirkwood F

    2010-03-01

    Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association. Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes. The association between RDW and iron metabolism, inflammation, and neurohormonal activation was studied in a separate cohort of heart failure patients from the United Investigators to Evaluate Heart Failure (UNITE-HF) Biomarker registry. RDW was independently predictive of outcome (for each 1% increase in RDW, hazard ratio for mortality 1.06, 95% CI 1.01-1.12; hazard ratio for hospitalization or mortality 1.06; 95% CI 1.02-1.10) after adjustment for other covariates. Increasing RDW correlated with decreasing hemoglobin, increasing interleukin-6, and impaired iron mobilization. Our results confirm previous observations that RDW is a strong, independent predictor of adverse outcome in chronic heart failure and suggest elevated RDW may indicate inflammatory stress and impaired iron mobilization. These findings encourage further research into the relationship between heart failure and the hematologic system. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  20. A Survey of Health Management User Objectives Related to Diagnostic and Prognostic Metrics

    Science.gov (United States)

    Wheeler, Kevin R.; Kurtoglu, Tolga; Poll, Scott D.

    2010-01-01

    One of the most prominent technical challenges to effective deployment of health management systems is the vast difference in user objectives with respect to engineering development. In this paper, a detailed survey on the objectives of different users of health management systems is presented. These user objectives are then mapped to the metrics typically encountered in the development and testing of two main systems health management functions: diagnosis and prognosis. Using this mapping, the gaps between user goals and the metrics associated with diagnostics and prognostics are identified and presented with a collection of lessons learned from previous studies that include both industrial and military aerospace applications.

  1. Distributed computing for global health

    CERN Multimedia

    CERN. Geneva; Schwede, Torsten; Moore, Celia; Smith, Thomas E; Williams, Brian; Grey, François

    2005-01-01

    Distributed computing harnesses the power of thousands of computers within organisations or over the Internet. In order to tackle global health problems, several groups of researchers have begun to use this approach to exceed by far the computing power of a single lab. This event illustrates how companies, research institutes and the general public are contributing their computing power to these efforts, and what impact this may have on a range of world health issues. Grids for neglected diseases Vincent Breton, CNRS/EGEE This talk introduces the topic of distributed computing, explaining the similarities and differences between Grid computing, volunteer computing and supercomputing, and outlines the potential of Grid computing for tackling neglected diseases where there is little economic incentive for private R&D efforts. Recent results on malaria drug design using the Grid infrastructure of the EU-funded EGEE project, which is coordinated by CERN and involves 70 partners in Europe, the US and Russi...

  2. Prognostics and health management design for rotary machinery systems—Reviews, methodology and applications

    Science.gov (United States)

    Lee, Jay; Wu, Fangji; Zhao, Wenyu; Ghaffari, Masoud; Liao, Linxia; Siegel, David

    2014-01-01

    Much research has been conducted in prognostics and health management (PHM), an emerging field in mechanical engineering that is gaining interest from both academia and industry. Most of these efforts have been in the area of machinery PHM, resulting in the development of many algorithms for this particular application. The majority of these algorithms concentrate on applications involving common rotary machinery components, such as bearings and gears. Knowledge of this prior work is a necessity for any future research efforts to be conducted; however, there has not been a comprehensive overview that details previous and on-going efforts in PHM. In addition, a systematic method for developing and deploying a PHM system has yet to be established. Such a method would enable rapid customization and integration of PHM systems for diverse applications. To address these gaps, this paper provides a comprehensive review of the PHM field, followed by an introduction of a systematic PHM design methodology, 5S methodology, for converting data to prognostics information. This methodology includes procedures for identifying critical components, as well as tools for selecting the most appropriate algorithms for specific applications. Visualization tools are presented for displaying prognostics information in an appropriate fashion for quick and accurate decision making. Industrial case studies are included in this paper to show how this methodology can help in the design of an effective PHM system.

  3. Prognostic Impact of Health Care-Associated Meningitis in Adults with Intracranial Hemorrhage.

    Science.gov (United States)

    Habib, Onaizah B; Srihawan, Chanunya; Salazar, Lucrecia; Hasbun, Rodrigo

    2017-11-01

    Health care-associated meningitis and ventriculitis (HCAMV) occurs in adults with intracranial hemorrhage (ICH) and is associated with high rates of morbidity and mortality, but the prognostic impact of this infectious complication in a controlled matched study of ICH is unknown. We conducted a case-control study of adult patients with ICH and HCAMV at a large tertiary care hospital in Houston, Texas, from 2003 to 2016. Cases were defined as patients with ICH and HCAMV as documented by a positive cerebrospinal fluid culture. Controls were defined as patients with ICH without evidence of HCAMV. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of ≤4. This study included 120 patients with ICH; 40 patients also had HCAMV, whereas 80 patients had ICH with no evidence of HCAMV. Cases and controls were appropriately matched by age, Glasgow Coma Scale score, and Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Patients with ICH and meningitis had more comorbidities, higher rates of abnormal neurologic examination, hypoglycorrhachia, and elevated cerebrospinal fluid lactate levels (P < 0.05). Adverse clinical outcomes were greater in patients with HCAMV and ICH than in patients with ICH alone (83% vs. 30%; P < 0.001). On logistic regression analysis, independent risk factors associated with an adverse outcome were HCAMV and mechanical ventilation (P < 0.05). HCAMV has a significant prognostic impact in adults with ICH. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Prognostics and Health Management in Nuclear Power Plants: A Review of Technologies and Applications

    Energy Technology Data Exchange (ETDEWEB)

    Coble, Jamie B.; Ramuhalli, Pradeep; Bond, Leonard J.; Hines, Wes; Upadhyaya, Belle

    2012-07-17

    This report reviews the current state of the art of prognostics and health management (PHM) for nuclear power systems and related technology currently applied in field or under development in other technological application areas, as well as key research needs and technical gaps for increased use of PHM in nuclear power systems. The historical approach to monitoring and maintenance in nuclear power plants (NPPs), including the Maintenance Rule for active components and Aging Management Plans for passive components, are reviewed. An outline is given for the technical and economic challenges that make PHM attractive for both legacy plants through Light Water Reactor Sustainability (LWRS) and new plant designs. There is a general introduction to PHM systems for monitoring, fault detection and diagnostics, and prognostics in other, non-nuclear fields. The state of the art for health monitoring in nuclear power systems is reviewed. A discussion of related technologies that support the application of PHM systems in NPPs, including digital instrumentation and control systems, wired and wireless sensor technology, and PHM software architectures is provided. Appropriate codes and standards for PHM are discussed, along with a description of the ongoing work in developing additional necessary standards. Finally, an outline of key research needs and opportunities that must be addressed in order to support the application of PHM in legacy and new NPPs is presented.

  5. Prognostics and Health Management of Wind Turbines -- Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2017-04-28

    The global wind industry has seen tremendous growth during the past two decades. However, the industry is challenged by premature component failures, which lead to increased turbine downtime and subsequently, cost of energy for wind power. To mitigate the impacts from these failures, the wind industry has been exploring various areas for improvements ranging from product design, new materials or lubricants, to operation and maintenance (O&M) practices. Condition-based maintenance or prognostics and health management (PHM) has been explored as one enabling technology for improving O&M practices. This chapter provides a brief overview of wind turbine PHM with a focus on operational data mining and condition monitoring of drivetrains. Some future research and development opportunities in wind turbine PHM are also briefly discussed.

  6. Research on key technology of prognostic and health management for autonomous underwater vehicle

    Science.gov (United States)

    Zhou, Zhi

    2017-12-01

    Autonomous Underwater Vehicles (AUVs) are non-cable and autonomous motional underwater robotics. With a wide range of activities, it can reach thousands of kilometers. Because it has the advantages of wide range, good maneuverability, safety and intellectualization, it becomes an important tool for various underwater tasks. How to improve diagnosis accuracy of the AUVs electrical system faults, and how to repair AUVs by the information are the focus of navy in the world. In turn, ensuring safe and reliable operation of the system has very important significance to improve AUVs sailing performance. To solve these problems, in the paper the prognostic and health management(PHM) technology is researched and used to AUV, and the overall framework and key technology are proposed, such as data acquisition, feature extraction, fault diagnosis, failure prediction and so on.

  7. Prognostic Health Management System: Component Selection Based on Risk Criteria and Economic Benefit Assessment

    International Nuclear Information System (INIS)

    Pham, B.T.; Agarwal, V.; Lybeck, N.J.; Tawfik, M.S.

    2012-01-01

    Long-term operation (LTO), i.e., beyond 60 years, of the current fleet of nuclear power plants (NPPs) is an important element in the overall energy stability of the United States in coming decades. Problem Statement and Proposed Approach: - For LTO of NPPs, early and proactive diagnosis of degradation at systems, structures, and components (SSCs) level is required; - Periodic maintenance versus Proactive maintenance; - Prognostic Health Monitoring (PHM) can be used to better manage aging and degradation mechanisms, including emerging mechanisms; - Selection of components is crucial for implementing the PHM system; - Approach is to develop a quantitative framework that aids systematic identification of plant components that are selected for cost-effective PHM.

  8. Prognostic Health Monitoring System: Component Selection Based on Risk Criteria and Economic Benefit Assessment

    International Nuclear Information System (INIS)

    Pham, Binh T.; Agarwal, Vivek; Lybeck, Nancy J.; Tawfik, Magdy S.

    2012-01-01

    Prognostic health monitoring (PHM) is a proactive approach to monitor the ability of structures, systems, and components (SSCs) to withstand structural, thermal, and chemical loadings over the SSCs planned service lifespan. The current efforts to extend the operational license lifetime of the aging fleet of U.S. nuclear power plants from 40 to 60 years and beyond can benefit from a systematic application of PHM technology. Implementing a PHM system would strengthen the safety of nuclear power plants, reduce plant outage time, and reduce operation and maintenance costs. However, a nuclear power plant has thousands of SSCs, so implementing a PHM system that covers all SSCs requires careful planning and prioritization. This paper therefore focuses on a component selection that is based on the analysis of a component's failure probability, risk, and cost. Ultimately, the decision on component selection depends on the overall economical benefits arising from safety and operational considerations associated with implementing the PHM system. (author)

  9. Prognostics Health Management and Physics based failure Models for Electrolytic Capacitors

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper proposes first principles based modeling and prognostics approach for electrolytic capacitors. Electrolytic capacitors and MOSFETs are the two major...

  10. Experimental program for physics-of-failure modeling of electrolytic capacitors towards prognostics and health management

    International Nuclear Information System (INIS)

    Rana, Y.S.; Banerjee, Shantanab; Singh, Tej; Varde, P.V.

    2017-01-01

    Prognostics and Health Management (PHM) is a method used for predicting reliability of a component or system by assessing its current health and future operating conditions. A physics-of-failure (PoF)-based program on PHM for reliability prediction has been initiated at our institute. As part of the program, we aim at developing PoF-based models for degradation of electronic components and their experimental validation. In this direction, a database on existing PoF models for different electronic components has been prepared. We plan to experimentally determine the model constants and propose suitable methodology for PHM. Electrolytic capacitors are one of the most common passive components which find their applications in devices such as power supplies in aircrafts and printed circuit boards (PCBs) for regulation and protection of a nuclear reactor. Experimental studies have established that electrolytic capacitors degrade under electrical and thermal stress and tend to fail before their anticipated useful life at normal operating conditions. Equivalent series resistance (ESR) and capacitance (C) are the two main parameters used for monitoring health of such capacitors. In this paper, we present an experimental program for thermal and electrical overstress studies towards degradation models for electrolytic capacitors. (author)

  11. A self-cognizant dynamic system approach for prognostics and health management

    Science.gov (United States)

    Bai, Guangxing; Wang, Pingfeng; Hu, Chao

    2015-03-01

    Prognostics and health management (PHM) is an emerging engineering discipline that diagnoses and predicts how and when a system will degrade its performance and lose its partial or whole functionality. Due to the complexity and invisibility of rules and states of most dynamic systems, developing an effective approach to track evolving system states becomes a major challenge. This paper presents a new self-cognizant dynamic system (SCDS) approach that incorporates artificial intelligence into dynamic system modeling for PHM. A feed-forward neural network (FFNN) is selected to approximate a complex system response which is challenging task in general due to inaccessible system physics. The trained FFNN model is then embedded into a dual extended Kalman filter algorithm to track down system dynamics. A recursive computation technique used to update the FFNN model using online measurements is also derived. To validate the proposed SCDS approach, a battery dynamic system is considered as an experimental application. After modeling the battery system by a FFNN model and a state-space model, the state-of-charge (SoC) and state-of-health (SoH) are estimated by updating the FFNN model using the proposed approach. Experimental results suggest that the proposed approach improves the efficiency and accuracy for battery health management.

  12. Implementation of Remaining Useful Lifetime Transformer Models in the Fleet-Wide Prognostic and Health Management Suite

    International Nuclear Information System (INIS)

    Agarwal, Vivek; Lybeck, Nancy J.; Pham, Binh; Rusaw, Richard; Bickford, Randall

    2015-01-01

    Research and development efforts are required to address aging and reliability concerns of the existing fleet of nuclear power plants. As most plants continue to operate beyond the license life (i.e., towards 60 or 80 years), plant components are more likely to incur age-related degradation mechanisms. To assess and manage the health of aging plant assets across the nuclear industry, the Electric Power Research Institute has developed a web-based Fleet-Wide Prognostic and Health Management (FW-PHM) Suite for diagnosis and prognosis. FW-PHM is a set of web-based diagnostic and prognostic tools and databases, comprised of the Diagnostic Advisor, the Asset Fault Signature Database, the Remaining Useful Life Advisor, and the Remaining Useful Life Database, that serves as an integrated health monitoring architecture. The main focus of this paper is the implementation of prognostic models for generator step-up transformers in the FW-PHM Suite. One prognostic model discussed is based on the functional relationship between degree of polymerization, (the most commonly used metrics to assess the health of the winding insulation in a transformer) and furfural concentration in the insulating oil. The other model is based on thermal-induced degradation of the transformer insulation. By utilizing transformer loading information, established thermal models are used to estimate the hot spot temperature inside the transformer winding. Both models are implemented in the Remaining Useful Life Database of the FW-PHM Suite. The Remaining Useful Life Advisor utilizes the implemented prognostic models to estimate the remaining useful life of the paper winding insulation in the transformer based on actual oil testing and operational data.

  13. Is elevated Red cell distribution width a prognostic predictor in adult patients with community acquired Pneumonia?

    Science.gov (United States)

    2014-01-01

    Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb 30 mg/dl, systolic blood pressure 15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin 124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score. PMID:24597687

  14. Summary of Nuclear Power Plant Prognostics and Health Management Report: PNNL-21515

    Energy Technology Data Exchange (ETDEWEB)

    Coble, Jamie; Hines, Wesley; Upadhyaya; Belle [University of Tennessee, Knoxville (United States); Ramuhalli, Pradeep [Pacific Northwest National Laboratory, Richland (United States); Bond, Leonard [Iowa State University, Ames (United States)

    2014-08-15

    The recent changes in oil and gas production, as well as wider geo-political events are causing the economics for electricity generation to currently be in a state of some turbulence in the United States (USA). In spite of this, nuclear power continues to meet about a fifth of the electricity needs in the USA. Currently, three separate thrusts to ensure safe and economical nuclear power development to give energy security are being pursued in the USA: longer term operation for the legacy fleet, from 40.60 and possibly 60.80 years; four near-term new nuclear plants with a 60-year design life; and small modular reactors (SMR) design certification, which are expected to employ light water reactor technology, at least in the medium term. Within these activities, attention is turning to enhanced methods for plant component and structural health management. The state of the art in prognostic and health management systems for nuclear power plants was recently reviewed and presented in a report (PNNL-21515); this paper summarizes the key findings of that review.

  15. Active smoking and COPD phenotype: distribution and impact on prognostic factors

    Directory of Open Access Journals (Sweden)

    Riesco JA

    2017-07-01

    Full Text Available Juan Antonio Riesco,1,2 Bernardino Alcázar,3 Juan Antonio Trigueros,4 Anna Campuzano,5 Joselín Pérez,5 José Luis Lorenzo5 1Pulmonology Department, Hospital San Pedro de Alcántara, 2Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES, Cáceres, 3Pulmonology Department, Hospital La Loja, Granada, 4Centro de Salud de Menasalvas, Toledo, 5Grupo Ferrer Internacional, Barcelona, Spain Purpose: Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. Patients and methods: This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis, and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade, quality of life according to the COPD assessment test (CAT, and presence of comorbidities, according to phenotypic expression. Results: In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03. Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. Conclusion: Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease. Keywords: COPD, phenotype, smoking, prognostic factors, quality of life 

  16. Prognostics for Microgrid Components

    Science.gov (United States)

    Saxena, Abhinav

    2012-01-01

    Prognostics is the science of predicting future performance and potential failures based on targeted condition monitoring. Moving away from the traditional reliability centric view, prognostics aims at detecting and quantifying the time to impending failures. This advance warning provides the opportunity to take actions that can preserve uptime, reduce cost of damage, or extend the life of the component. The talk will focus on the concepts and basics of prognostics from the viewpoint of condition-based systems health management. Differences with other techniques used in systems health management and philosophies of prognostics used in other domains will be shown. Examples relevant to micro grid systems and subsystems will be used to illustrate various types of prediction scenarios and the resources it take to set up a desired prognostic system. Specifically, the implementation results for power storage and power semiconductor components will demonstrate specific solution approaches of prognostics. The role of constituent elements of prognostics, such as model, prediction algorithms, failure threshold, run-to-failure data, requirements and specifications, and post-prognostic reasoning will be explained. A discussion on performance evaluation and performance metrics will conclude the technical discussion followed by general comments on open research problems and challenges in prognostics.

  17. Multi-agent Prognostics Health and Usage Monitoring (Multi-PHUM), Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — A prognostic system needs to separate nominal component behavior from the faulty ones even in the cases when those behaviors are similar. Advanced pattern...

  18. Distributed Health Monitoring System for Reusable Liquid Rocket Engines

    Science.gov (United States)

    Lin, C. F.; Figueroa, F.; Politopoulos, T.; Oonk, S.

    2009-01-01

    The ability to correctly detect and identify any possible failure in the systems, subsystems, or sensors within a reusable liquid rocket engine is a major goal at NASA John C. Stennis Space Center (SSC). A health management (HM) system is required to provide an on-ground operation crew with an integrated awareness of the condition of every element of interest by determining anomalies, examining their causes, and making predictive statements. However, the complexity associated with relevant systems, and the large amount of data typically necessary for proper interpretation and analysis, presents difficulties in implementing complete failure detection, identification, and prognostics (FDI&P). As such, this paper presents a Distributed Health Monitoring System for Reusable Liquid Rocket Engines as a solution to these problems through the use of highly intelligent algorithms for real-time FDI&P, and efficient and embedded processing at multiple levels. The end result is the ability to successfully incorporate a comprehensive HM platform despite the complexity of the systems under consideration.

  19. Distinct distribution and prognostic significance of molecular subtypes of breast cancer in Chinese women: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Cai Qiuyin

    2011-07-01

    Full Text Available Abstract Background Molecular classification of breast cancer is an important prognostic factor. The distribution of molecular subtypes of breast cancer and their prognostic value has not been well documented in Asians. Methods A total of 2,791 breast cancer patients recruited for a population-based cohort study were evaluated for molecular subtypes of breast cancer by immunohistochemical assays. Data on clinicopathological characteristics were confirmed by centralized pathology review. The average follow-up of the patients was 53.4 months. Overall and disease-free survival by molecular subtypes of breast cancer were evaluated. Results The prevalence of the luminal A, luminal B, human epidermal growth factor receptor 2 (HER2, and triple-negative subtypes were 48.6%, 16.7%, 13.7%, and 12.9%, respectively. The luminal A subtype was more likely to be diagnosed in older women (P = 0.03 and had a stronger correlation with favorable clinicopathological factors (smaller tumor size, lower histologic grade, and earlier TNM stage than the triple-negative or HER2 subtypes. Women with triple-negative breast cancer had a higher frequency of family history of breast cancer than women with other subtypes (P = 0.048. The 5-year overall/disease-free survival percentages for the luminal A, luminal B, HER2, and triple-negative subtypes were 92.9%/88.6%, 88.6%/85.1%, 83.2%/79.1%, and 80.7%/76.0%, respectively. A similar pattern was observed in multivariate analyses. Immunotherapy was associated with improved overall and disease-free survival for luminal A breast cancer, but reduced disease-free survival (HR = 2.21, 95% CI, 1.09-4.48 for the HER2 subtype of breast cancer. Conclusions The triple-negative and HER2 subtypes were associated with poorer outcomes compared with the luminal A subtype among these Chinese women. The HER2 subtype was more prevalent in this Chinese population compared with Western populations, suggesting the importance of standardized HER2

  20. Local-Level Prognostics Health Management Systems Framework for Passive AdvSMR Components. Interim Report

    Energy Technology Data Exchange (ETDEWEB)

    Ramuhalli, Pradeep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Roy, Surajit [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hirt, Evelyn H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Pardini, Allan F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jones, Anthony M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Deibler, John E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States; Pitman, Stan G. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States; Tucker, Joseph C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States; Prowant, Matthew S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States; Suter, Jonathan D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States

    2014-09-12

    This report describes research results to date in support of the integration and demonstration of diagnostics technologies for prototypical AdvSMR passive components (to establish condition indices for monitoring) with model-based prognostics methods. The focus of the PHM methodology and algorithm development in this study is at the localized scale. Multiple localized measurements of material condition (using advanced nondestructive measurement methods), along with available measurements of the stressor environment, enhance the performance of localized diagnostics and prognostics of passive AdvSMR components and systems.

  1. Distributed data processing for public health surveillance

    Directory of Open Access Journals (Sweden)

    Yih Katherine

    2006-09-01

    Full Text Available Abstract Background Many systems for routine public health surveillance rely on centralized collection of potentially identifiable, individual, identifiable personal health information (PHI records. Although individual, identifiable patient records are essential for conditions for which there is mandated reporting, such as tuberculosis or sexually transmitted diseases, they are not routinely required for effective syndromic surveillance. Public concern about the routine collection of large quantities of PHI to support non-traditional public health functions may make alternative surveillance methods that do not rely on centralized identifiable PHI databases increasingly desirable. Methods The National Bioterrorism Syndromic Surveillance Demonstration Program (NDP is an example of one alternative model. All PHI in this system is initially processed within the secured infrastructure of the health care provider that collects and holds the data, using uniform software distributed and supported by the NDP. Only highly aggregated count data is transferred to the datacenter for statistical processing and display. Results Detailed, patient level information is readily available to the health care provider to elucidate signals observed in the aggregated data, or for ad hoc queries. We briefly describe the benefits and disadvantages associated with this distributed processing model for routine automated syndromic surveillance. Conclusion For well-defined surveillance requirements, the model can be successfully deployed with very low risk of inadvertent disclosure of PHI – a feature that may make participation in surveillance systems more feasible for organizations and more appealing to the individuals whose PHI they hold. It is possible to design and implement distributed systems to support non-routine public health needs if required.

  2. Application of the Sensor Selection Approach in Polymer Electrolyte Membrane Fuel Cell Prognostics and Health Management

    Directory of Open Access Journals (Sweden)

    Lei Mao

    2017-09-01

    Full Text Available In this paper, the sensor selection approach is investigated with the aim of using fewer sensors to provide reliable fuel cell diagnostic and prognostic results. The sensitivity of sensors is firstly calculated with a developed fuel cell model. With sensor sensitivities to different fuel cell failure modes, the available sensors can be ranked. A sensor selection algorithm is used in the analysis, which considers both sensor sensitivity to fuel cell performance and resistance to noise. The performance of the selected sensors in polymer electrolyte membrane (PEM fuel cell prognostics is also evaluated with an adaptive neuro-fuzzy inference system (ANFIS, and results show that the fuel cell voltage can be predicted with good quality using the selected sensors. Furthermore, a fuel cell test is performed to investigate the effectiveness of selected sensors in fuel cell fault diagnosis. From the results, different fuel cell states can be distinguished with good quality using the selected sensors.

  3. Neuroendocrine tumors of colon and rectum: validation of clinical and prognostic values of the World Health Organization 2010 grading classifications and European Neuroendocrine Tumor Society staging systems.

    Science.gov (United States)

    Shen, Chaoyong; Yin, Yuan; Chen, Huijiao; Tang, Sumin; Yin, Xiaonan; Zhou, Zongguang; Zhang, Bo; Chen, Zhixin

    2017-03-28

    This study evaluated and compared the clinical and prognostic values of the grading criteria used by the World Health Organization (WHO) and the European Neuroendocrine Tumors Society (ENETS). Moreover, this work assessed the current best prognostic model for colorectal neuroendocrine tumors (CRNETs). The 2010 WHO classifications and the ENETS systems can both stratify the patients into prognostic groups, although the 2010 WHO criteria is more applicable to CRNET patients. Along with tumor location, the 2010 WHO criteria are important independent prognostic parameters for CRNETs in both univariate and multivariate analyses through Cox regression (P<0.05). Data from 192 consecutive patients histopathologically diagnosed with CRNETs and had undergone surgical resection from January 2009 to May 2016 in a single center were retrospectively analyzed. Findings suggest that the WHO classifications are superior over the ENETS classification system in predicting the prognosis of CRNETs. Additionally, the WHO classifications can be widely used in clinical practice.

  4. Prognostic and health management for engineering systems: a review of the data-driven approach and algorithms

    Directory of Open Access Journals (Sweden)

    Thamo Sutharssan

    2015-07-01

    Full Text Available Prognostics and health management (PHM has become an important component of many engineering systems and products, where algorithms are used to detect anomalies, diagnose faults and predict remaining useful lifetime (RUL. PHM can provide many advantages to users and maintainers. Although primary goals are to ensure the safety, provide state of the health and estimate RUL of the components and systems, there are also financial benefits such as operational and maintenance cost reductions and extended lifetime. This study aims at reviewing the current status of algorithms and methods used to underpin different existing PHM approaches. The focus is on providing a structured and comprehensive classification of the existing state-of-the-art PHM approaches, data-driven approaches and algorithms.

  5. Context-Dependent Prognostics and Health Assessment: A Condition-Based Maintenance Approach That Supports Mission Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Allgood, G.O.; Kercel, S.W.

    1999-04-19

    In today's manufacturing environment, plants, systems, and equipment are being asked to perform at levels not thought possible a decade ago. The intent is to improve process operations and equipment reliability, availability, and maintainability without costly upgrades. Of course these gains must be achieved without impacting operational performance. Downsizing is also taking its toll on operations. Loss of personnel, particularly those who represent the corporate history, is depleting US industries of their valuable experiential base which has been relied on so heavily in the past. These realizations are causing companies to rethink their condition-based maintenance policies by moving away from reacting to equipment problems to taking a proactive approach by anticipating needs based on market and customer requirements. This paper describes a different approach to condition-based maintenance-context-dependent prognostics and health assessment. This diagnostic capability is developed around a context-dependent model that provides a capability to anticipate impending failures and determine machine performance over a protracted period of time. This prognostic capability links operational requirements to an economic performance model. In this context, a system may provide 100% operability with less than 100% functionality. This paradigm is used to facilitate optimal logistic supply and support.

  6. A Rest Time-Based Prognostic Framework for State of Health Estimation of Lithium-Ion Batteries with Regeneration Phenomena

    Directory of Open Access Journals (Sweden)

    Taichun Qin

    2016-11-01

    Full Text Available State of health (SOH prognostics is significant for safe and reliable usage of lithium-ion batteries. To accurately predict regeneration phenomena and improve long-term prediction performance of battery SOH, this paper proposes a rest time-based prognostic framework (RTPF in which the beginning time interval of two adjacent cycles is adopted to reflect the rest time. In this framework, SOH values of regeneration cycles, the number of cycles in regeneration regions and global degradation trends are extracted from raw SOH time series and predicted respectively, and then the three sets of prediction results are integrated to calculate the final overall SOH prediction values. Regeneration phenomena can be found by support vector machine and hyperplane shift (SVM-HS model by detecting long beginning time intervals. Gaussian process (GP model is utilized to predict the global degradation trend, and nonlinear models are utilized to predict the regeneration amplitude and the cycle number of each regeneration region. The proposed framework is validated through experimental data from the degradation tests of lithium-ion batteries. The results demonstrate that both the global degradation trend and the regeneration phenomena of the testing batteries can be well predicted. Moreover, compared with the published methods, more accurate SOH prediction results can be obtained under this framework.

  7. Differential evolution-based multi-objective optimization for the definition of a health indicator for fault diagnostics and prognostics

    Science.gov (United States)

    Baraldi, P.; Bonfanti, G.; Zio, E.

    2018-03-01

    The identification of the current degradation state of an industrial component and the prediction of its future evolution is a fundamental step for the development of condition-based and predictive maintenance approaches. The objective of the present work is to propose a general method for extracting a health indicator to measure the amount of component degradation from a set of signals measured during operation. The proposed method is based on the combined use of feature extraction techniques, such as Empirical Mode Decomposition and Auto-Associative Kernel Regression, and a multi-objective Binary Differential Evolution (BDE) algorithm for selecting the subset of features optimal for the definition of the health indicator. The objectives of the optimization are desired characteristics of the health indicator, such as monotonicity, trendability and prognosability. A case study is considered, concerning the prediction of the remaining useful life of turbofan engines. The obtained results confirm that the method is capable of extracting health indicators suitable for accurate prognostics.

  8. Health workforce in India: assessment of availability, production and distribution.

    Science.gov (United States)

    Hazarika, Indrajit

    2013-01-01

    India faces an acute shortage of health personnel. Together with inequalities in distribution of health workers, this shortfall impedes progress towards achievement of the Millennium Development Goals. The aim of this study was to assess health-workforce distribution, identify inequalities in health-worker provision and estimate the impact of this maldistribution on key health outcomes in India. Health-workforce availability and production were assessed by use of year-end data for 2009 obtained from the Indian Ministry of Statistics and Programme Implementation. Inequalities in the distribution of doctors, dentists, nurses and midwives were estimated by use of the Gini coefficient and the relation between health-worker density and selected health outcomes was assessed by linear regression. Inequalities in the availability of health workers exist in India. Certain states are experiencing an acute shortage of health personnel. Inequalities in the distribution of health workers are highest for doctors and dentists and have a significant effect on health outcomes. Although the production of health workers has expanded greatly in recent years, the problems of imbalances in their distribution persist. As India seeks to achieve universal health coverage by 2020, the realization of this goal remains challenged by the current lack of availability and inequitable distribution of appropriately trained, motivated and supported health workers.

  9. Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals

    NARCIS (Netherlands)

    Steenstra, I.A.; Koopman, F.S.; Knol, D.L.; de Kat, E.; Bongers, P.M.; de Vet, H.C.W.; van Mechelen, W.

    2005-01-01

    Background: Information on prognostic factors for duration of sick leave due to low-back pain (LBP) is growing. In this prospective cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational

  10. Trends in the distribution of South African health care expenditure

    African Journals Online (AJOL)

    1990-08-04

    Aug 4, 1990 ... This paper considers the distribution of health expenditure between the public ... An understanding of past health care expenditure patterns is a prerequisite to any .... of this total and local government for 8% in the same year.

  11. A probabilistic physics-of-failure model for prognostic health management of structures subject to pitting and corrosion-fatigue

    International Nuclear Information System (INIS)

    Chookah, M.; Nuhi, M.; Modarres, M.

    2011-01-01

    A combined probabilistic physics-of-failure-based model for pitting and corrosion-fatigue degradation mechanisms is proposed to estimate the reliability of structures and to perform prognosis and health management. A mechanistic superposition model for corrosion-fatigue mechanism was used as a benchmark model to propose the simple model. The proposed model describes the degradation of the structures as a function of physical and critical environmental stresses, such as amplitude and frequency of mechanical loads (for example caused by the internal piping pressure) and the concentration of corrosive chemical agents. The parameters of the proposed model are represented by the probability density functions and estimated through a Bayesian approach based on the data taken from the experiments performed as part of this research. For demonstrating applications, the proposed model provides prognostic information about the reliability of aging of structures and is helpful in developing inspection and replacement strategies. - Highlights: ► We model an inventory system under static–dynamic uncertainty strategy. ► The demand is stochastic and non-stationary. ► The optimal ordering policy is proven to be a base stock policy. ► A solution algorithm for finding an optimal solution is provided. ► Two heuristics developed produce high quality solutions and scale-up efficiently.

  12. Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study.

    Science.gov (United States)

    Nordeman, Lena; Gunnarsson, Ronny; Mannerkorpi, Kaisa

    2014-05-01

    To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care. A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression. A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability. The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years.

  13. A Survey of Artificial Intelligence for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Integrated Systems Health Management includes as key elements fault detection, fault diagnostics, and failure prognostics. Whereas fault detection and diagnostics...

  14. Health, personal responsibility, and distributive justice

    DEFF Research Database (Denmark)

    Andersen, Martin Marchman

    explains why we have justice-based reasons to reduce social inequality in health. In my second article I investigate and (partly) object to a suggestion put forward by Shlomi Segall, according to which we should exchange the notion of responsibility with a notion of Reasonable Avoidability in the luck...... responsibility is generally impossible. I argue, nonetheless, that this approach is plausible. In my fourth and final article I proceed under the assumption that responsibility is possible. I examine the relation between responsibility (for one’s own health condition) and cost-responsibility (for health care...

  15. Measuring inequalities in the distribution of the Fiji Health Workforce.

    Science.gov (United States)

    Wiseman, Virginia; Lagarde, Mylene; Batura, Neha; Lin, Sophia; Irava, Wayne; Roberts, Graham

    2017-06-30

    Despite the centrality of health personnel to the health of the population, the planning, production and management of human resources for health remains underdeveloped in many low- and middle-income countries (LMICs). In addition to the general shortage of health workers, there are significant inequalities in the distribution of health workers within LMICs. This is especially true for countries like Fiji, which face major challenges in distributing its health workforce across many inhabited islands. In this study, we describe and measure health worker distributional inequalities in Fiji, using data from the 2007 Population Census, and Ministry of Health records of crude death rates and health workforce personnel. We adopt methods from the economics literature including the Lorenz Curve/Gini Coefficient and Theil Index to measure the extent and drivers of inequality in the distribution of health workers at the sub-national level in Fiji for three categories of health workers: doctors, nurses, and all health workers (doctors, nurses, dentists and health support staff). Population size and crude death rates are used as proxies for health care needs. There are greater inequalities in the densities of health workers at the provincial level, compared to the divisional level in Fiji - six of the 15 provinces fall short of the recommended threshold of 2.3 health workers per 1,000 people. The estimated decile ratios, Gini co-efficient and Thiel index point to inequalities at the provincial level in Fiji, mainly with respect to the distribution of doctors; however these inequalities are relatively small. While populations with lower mortality tend to have a slightly greater share of health workers, the overall distribution of health workers on the basis of need is more equitable in Fiji than for many other LMICs. The overall shortage of health workers could be addressed by creating new cadres of health workers; employing increasing numbers of foreign doctors, including

  16. Distribution and Utilization of Health Facilities in Calabar Metropolis ...

    African Journals Online (AJOL)

    The level of accessibility increases with increasing utilization. Distance was a barrier to the utilization of health facilities due to the uneven distribution of health facilities and the inability of patients to overcome economic distance. Greater investment by government in the health sector would guarantee more equitable access ...

  17. Effect of Air Pollution on Menstrual Cycle Length-A Prognostic Factor of Women's Reproductive Health.

    Science.gov (United States)

    Merklinger-Gruchala, Anna; Jasienska, Grazyna; Kapiszewska, Maria

    2017-07-20

    Air pollution can influence women's reproductive health, specifically menstrual cycle characteristics, oocyte quality, and risk of miscarriage. The aim of the study was to assess whether air pollution can affect the length of the overall menstrual cycle and the length of its phases (follicular and luteal). Municipal ecological monitoring data was used to assess the air pollution exposure during the monitored menstrual cycle of each of 133 woman of reproductive age. Principal component analyses were used to group pollutants (PM 10 , SO₂, CO, and NO x ) to represent a source-related mixture. PM 10 and SO₂ assessed separately negatively affected the length of the luteal phase after standardization (b = -0.02; p = 0.03; b = -0.06; p = 0.02, respectively). Representing a fossil fuel combustion emission, they were also associated with luteal phase shortening (b = -0.32; p = 0.02). These pollutants did not affect the follicular phase length and overall cycle length, neither in single- nor in multi-pollutant models. CO and NO x assessed either separately or together as a traffic emission were not associated with overall cycle length or the length of cycle phases. Luteal phase shortening, a possible manifestation of luteal phase deficiency, can result from fossil fuel combustion. This suggests that air pollution may contribute to fertility problems in women.

  18. Health Canada unveils plan to distribute marijuana for medical use.

    Science.gov (United States)

    Thaczuk, Derek

    2003-08-01

    Under pressure from the courts, Health Canada reluctantly comes up with a distribution plan to provide dried cannabis and seeds to patients using medical marijuana. The plan has been greeted with considerable criticism

  19. Distributed Rocket Engine Testing Health Monitoring System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The on-ground and Distributed Rocket Engine Testing Health Monitoring System (DiRETHMS) provides a system architecture and software tools for performing diagnostics...

  20. Distributed Rocket Engine Testing Health Monitoring System, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Leveraging the Phase I achievements of the Distributed Rocket Engine Testing Health Monitoring System (DiRETHMS) including its software toolsets and system building...

  1. Component-Level Prognostics Health Management Framework for Passive Components - Advanced Reactor Technology Milestone: M2AT-15PN2301043

    Energy Technology Data Exchange (ETDEWEB)

    Ramuhalli, Pradeep; Roy, Surajit; Hirt, Evelyn H.; Prowant, Matthew S.; Pitman, Stan G.; Tucker, Joseph C.; Dib, Gerges; Pardini, Allan F.

    2015-06-19

    This report describes research results to date in support of the integration and demonstration of diagnostics technologies for prototypical advanced reactor passive components (to establish condition indices for monitoring) with model-based prognostics methods. Achieving this objective will necessitate addressing several of the research gaps and technical needs described in previous technical reports in this series.

  2. Health-related quality of life is a prognostic factor for survival in older patients after colorectal cancer diagnosis: A population-based study.

    Science.gov (United States)

    Fournier, Evelyne; Jooste, Valérie; Woronoff, Anne-Sophie; Quipourt, Valérie; Bouvier, Anne-Marie; Mercier, Mariette

    2016-01-01

    Studies carried out in the context of clinical trials have shown a relationship between survival and health-related quality of life in colorectal cancer patients. We assessed the prognostic value of health-related quality of life at diagnosis and of its longitudinal evolution on survival in older colorectal cancer patients. All patients aged ≥65 years, diagnosed with new colorectal cancer between 2003 and 2005 and registered in the Digestive Cancer Registry of Burgundy were eligible. Patients were asked to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at inclusion, three, six and twelve months after. Multivariate regression models were used to evaluate the prognostic value of health-related quality of life scores at diagnosis and their deterioration on relative survival. In multivariate analysis, a role functioning dimension lower than median was predictive of lower survival (hazard ratio=3.1, p=0.015). After three and six months of follow-up, patients with greater appetite loss were more likely to die, with hazard ratios of 4.7 (p=0.013) and 3.7 (p=0.002), respectively. Health-related quality of life assessments at diagnosis are independently associated with older colorectal cancer patients' survival. Its preservation should be a major management goal for older cancer patients. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  3. Blockchain distributed ledger technologies for biomedical and health care applications.

    Science.gov (United States)

    Kuo, Tsung-Ting; Kim, Hyeon-Eui; Ohno-Machado, Lucila

    2017-11-01

    To introduce blockchain technologies, including their benefits, pitfalls, and the latest applications, to the biomedical and health care domains. Biomedical and health care informatics researchers who would like to learn about blockchain technologies and their applications in the biomedical/health care domains. The covered topics include: (1) introduction to the famous Bitcoin crypto-currency and the underlying blockchain technology; (2) features of blockchain; (3) review of alternative blockchain technologies; (4) emerging nonfinancial distributed ledger technologies and applications; (5) benefits of blockchain for biomedical/health care applications when compared to traditional distributed databases; (6) overview of the latest biomedical/health care applications of blockchain technologies; and (7) discussion of the potential challenges and proposed solutions of adopting blockchain technologies in biomedical/health care domains. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  4. Risk distribution across multiple health insurance funds in rural Tanzania

    DEFF Research Database (Denmark)

    Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika

    2014-01-01

    cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health...... services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. METHODS: Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests...... were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. RESULTS: There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status...

  5. A Model-Based Prognostics Approach Applied to Pneumatic Valves

    Data.gov (United States)

    National Aeronautics and Space Administration — Within the area of systems health management, the task of prognostics centers on predicting when components will fail. Model-based prognostics exploits domain...

  6. A Model-based Prognostics Approach Applied to Pneumatic Valves

    Data.gov (United States)

    National Aeronautics and Space Administration — Within the area of systems health management, the task of prognostics centers on predicting when components will fail. Model-based prognostics exploits domain...

  7. Tweedie distributions for fitting semicontinuous health care utilization cost data

    Directory of Open Access Journals (Sweden)

    Christoph F. Kurz

    2017-12-01

    Full Text Available Abstract Background The statistical analysis of health care cost data is often problematic because these data are usually non-negative, right-skewed and have excess zeros for non-users. This prevents the use of linear models based on the Gaussian or Gamma distribution. A common way to counter this is the use of Two-part or Tobit models, which makes interpretation of the results more difficult. In this study, I explore a statistical distribution from the Tweedie family of distributions that can simultaneously model the probability of zero outcome, i.e. of being a non-user of health care utilization and continuous costs for users. Methods I assess the usefulness of the Tweedie model in a Monte Carlo simulation study that addresses two common situations of low and high correlation of the users and the non-users of health care utilization. Furthermore, I compare the Tweedie model with several other models using a real data set from the RAND health insurance experiment. Results I show that the Tweedie distribution fits cost data very well and provides better fit, especially when the number of non-users is low and the correlation between users and non-users is high. Conclusion The Tweedie distribution provides an interesting solution to many statistical problems in health economic analyses.

  8. On the measurement of the (multidimensional) inequality of health distributions

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    2013-01-01

    a standard mathematical structure. We single out two families of (absolute and relative) multidimensional health inequality indices, inspired by the classical normative approach to income inequality measurement. We also discuss how to extend the analysis to deal with the related problem of health deprivation......Health outcomes are often described according to two dimensions: quality of life and quantity of life. We analyze the measurement of inequality of health distributions referring to these two dimensions. Our analysis relies on a novel treatment of the quality-of-life dimension, which might not have...

  9. Using the β-binomial distribution to characterize forest health

    Science.gov (United States)

    S.J. Zarnoch; R.L. Anderson; R.M. Sheffield

    1995-01-01

    The β-binomial distribution is suggested as a model for describing and analyzing the dichotomous data obtained from programs monitoring the health of forests in the United States. Maximum likelihood estimation of the parameters is given as well as asymptotic likelihood ratio tests. The procedure is illustrated with data on dogwood anthracnose infection (caused...

  10. Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 3: A comparison between Italian and English mental health services and a survey of bipolar disorder.

    Science.gov (United States)

    Verdolini, Norma; Dean, Jonathon; Massucci, Giampaolo; Elisei, Sandro; Quartesan, Roberto; Zaman, Rashid; Agius, Mark

    2014-11-01

    Most of the prognostic factors of bipolar disorder, which determine disease course and outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic assessments. In previous parts of this research, we analysed various prognostic factors and focused on mixed states and rapid cycling subsets. We now compare our sample in England with a small sample from Italy to demonstrate the utility of focused prognostic questioning and of international comparison. We collected data from the clinical notes of 70 English bipolar and 8 Italian bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome. The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) English outpatients and 7 bipolar I (87.5%) and 1 bipolar II (12.5%) Italian outpatients. Differences between the groups are seen mainly in terms of age of onset, duration of both depressive and hypomanic episodes, presence of psychiatric family history, incidence of mixed state features and rapid cycling, presence of elated mood in response to past antidepressant treatment, and misuse of illicit drugs and alcohol. In order to promote improved mental health primary care, mental health systems in all countries should develop standardized epidemiological tools that are shared between countries. We recommend the use of a questionnaire that reminds clinicians of potentially prognostic information and suggest that this might identify important components of a potential standardized diagnostic and prognostic tool.

  11. Surface Prognostic Charts

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Surface Prognostic Charts are historical surface prognostic (forecast) charts created by the United States Weather Bureau. They include fronts, isobars, cloud, and...

  12. Using the {Beta}-binomial distribution to characterize forest health

    Energy Technology Data Exchange (ETDEWEB)

    Zarnoch, S. J. [USDA Forest Service, Southern Research Station, Athens, GA (United States); Anderson, R.L.; Sheffield, R. M. [USDA Forest Service, Southern Research Station, Asheville, NC (United States)

    1995-03-01

    Forest health monitoring programs often use base variables which are dichotomous (i e. alive/dead, damaged/undamaged) to describe the health of trees. Typical sampling designs usually consist of randomly or systematically chosen clusters of trees for observation.It was claimed that contagiousness of diseases for example may result in non-uniformity of affected trees, so that distribution of the proportions, rather than simply the mean proportion, becomes important. The use of the {Beta}-binomial model was suggested for such cases. Use of the {Beta}-binomial distribution model applied in forest health analyses, was described.. Data on dogwood anthracnose (caused by Discula destructiva), a disease of flowering dogwood (Cornus florida L.), was used to illustrate the utility of the model. The {Beta}-binomial model allowed the detection of different distributional patterns of dogwood anthracnose over time and space. Results led to further speculation regarding the cause of the patterns. Traditional proportion analyses like ANOVA would not have detected the trends found using the {Beta}-binomial model, until more distinct patterns had evolved at a later date. The model was said to be flexible and require no special weighting or transformations of data.Another advantage claimed was its ability to handle unequal sample sizes.

  13. An Approach to Prognostic Decision Making in the Aerospace Domain

    Data.gov (United States)

    National Aeronautics and Space Administration — The field of Prognostic Health Management (PHM) has been undergoing rapid growth in recent years, with development of increasingly sophisticated techniques for...

  14. Structural Health and Prognostics Management for Offshore Wind Plants; Final Report of Sandia R&D Activities.

    Energy Technology Data Exchange (ETDEWEB)

    Griffith, Daniel Todd [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Wind Energy Technologies Dept.

    2015-04-01

    This final report is a compilation of resear ch efforts - funded by the US Department of Energy Wind and Water Power Technolog ies Office over a four-year period from FY11 through FY14. The goals of this re search program were to develop and evaluate technical innovati ons with promise for maxi mizing revenues and reducing levelized cost of energy (LCOE) for offs hore wind plants - more specifically the goals of the Structural H ealth and Prognostics Management (SHPM) program were to reduce O&M costs and increase energy capture through use of SHPM-based technologies. A technology roadmap was deve loped at the start of the project to guide the research efforts. This roadmap identified and outlined six major research thrust areas each having five stages of ma turity. Research was conducted in each of these thrust areas, as documented throughout this report, although a major focus was on development of damage detection strategi es for the most frequent blade damage conditions and damage mitigation and life-exte nsion strategies via changes in turbine operations (smart loads management). Th e work summarized in this compilation report is the product of the work of many researchers. A summary of the major findings, status of the SHPM Technology Ro admap and recommendations for future work are also provided.

  15. The distributional effects of employer and individual health insurance mandates.

    Science.gov (United States)

    Holahan, J; Winterbottom, C; Zedlewski, S

    This paper assesses the impact of different kinds of employer and individual mandates on the cost to individuals, business, and government. We also examine the distribution of health care expenditures across individuals in different income groups, assuming that individuals ultimately bear the cost of employer payments through lower wages and the cost of government payments through tax contributions. A major conclusion is that net benefits to lower income individuals improve under all alternatives to the current system with relatively small increases in payments by individuals in any income group. Additionally, while employer mandates reduce individuals' direct payments, individual mandates can have lower costs to the government and better distributional outcomes. A 50% employer mandate also has many desirable features.

  16. Decision Criteria for Distributed Versus Non-Distributed Information Systems in the Health Care Environment

    Science.gov (United States)

    McGinnis, John W.

    1980-01-01

    The very same technological advances that support distributed systems have also dramatically increased the efficiency and capabilities of centralized systems making it more complex for health care managers to select the “right” system architecture to meet their particular needs. How this selection can be made with a reasonable degree of managerial comfort is the focus of this paper. The approach advocated is based on experience in developing the Tri-Service Medical Information System (TRIMIS) program. Along with this technical standards and configuration management procedures were developed that provided the necessary guidance to implement the selected architecture and to allow it to change in a controlled way over its life cycle.

  17. Prognostic Performance Metrics

    Data.gov (United States)

    National Aeronautics and Space Administration — This chapter presents several performance metrics for offline evaluation of prognostics algorithms. A brief overview of different methods employed for performance...

  18. A framework for quantifying net benefits of alternative prognostic models

    NARCIS (Netherlands)

    Rapsomaniki, E.; White, I.R.; Wood, A.M.; Thompson, S.G.; Feskens, E.J.M.; Kromhout, D.

    2012-01-01

    New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit)

  19. Prognostic methods in medicine

    NARCIS (Netherlands)

    Lucas, P. J.; Abu-Hanna, A.

    1999-01-01

    Prognosis--the prediction of the course and outcome of disease processes--plays an important role in patient management tasks like diagnosis and treatment planning. As a result, prognostic models form an integral part of a number of systems supporting these tasks. Furthermore, prognostic models

  20. Aircraft Anomaly Prognostics, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Ridgetop Group will leverage its proven Electromechanical Actuator (EMA) prognostics methodology to develop an advanced model-based actuator prognostic reasoner...

  1. Towards Prognostics for Electronics Components

    Science.gov (United States)

    Saha, Bhaskar; Celaya, Jose R.; Wysocki, Philip F.; Goebel, Kai F.

    2013-01-01

    Electronics components have an increasingly critical role in avionics systems and in the development of future aircraft systems. Prognostics of such components is becoming a very important research field as a result of the need to provide aircraft systems with system level health management information. This paper focuses on a prognostics application for electronics components within avionics systems, and in particular its application to an Isolated Gate Bipolar Transistor (IGBT). This application utilizes the remaining useful life prediction, accomplished by employing the particle filter framework, leveraging data from accelerated aging tests on IGBTs. These tests induced thermal-electrical overstresses by applying thermal cycling to the IGBT devices. In-situ state monitoring, including measurements of steady-state voltages and currents, electrical transients, and thermal transients are recorded and used as potential precursors of failure.

  2. Distributed leadership in health care teams: Constellation role distribution and leadership practices.

    Science.gov (United States)

    Chreim, Samia; MacNaughton, Kate

    2016-01-01

    Recent literature has been critical of research that adopts a narrow focus on single leaders and on leadership attributes and has called for attention to leadership that is distributed among individuals and to practices in which leaders engage. We conducted a study of health care teams where we attended to role distribution among leadership constellation members and to loose or tight coupling practices between leaders and the remainder of the team. This focus provides insights into how leadership can be practiced and structured to enhance team functioning. A qualitative, multicase study of four teams was conducted. Data collection involved 44 interviews with almost all the members of the teams and 18 team meeting observations. Thematic analysis was conducted by the two authors. Leadership constellations can give rise to leadership role overlaps and gaps that may create ambiguity within teams, ambiguity is diminished if the leaders can agree on which leader assumes ultimate authority in an area, the presence of more leaders does not necessarily entail more comprehensive fulfillment of team needs, and teams' needs for tight or loose leadership practices are influenced by contextual factors that we elaborate. (a) It is important to recognize areas of overlap and gaps in leadership roles and to provide clarity about role boundaries to avoid ambiguity. Role mapping exercises and open discussions should be considered. (b) Attempting to spread formal leadership responsibilities informally among individuals is not always a workable strategy for addressing team needs. (c) Organizations need to examine critically the allocation of resources to leadership activities.

  3. Structural Health and Prognostics Management for Offshore Wind Turbines: Sensitivity Analysis of Rotor Fault and Blade Damage with O&M Cost Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Myrent, Noah J. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Barrett, Natalie C. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Adams, Douglas E. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Griffith, Daniel Todd [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Wind Energy Technology Dept.

    2014-07-01

    Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling and simulation approach developed in prior work is used to identify how the underlying physics of the system are affected by the presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Sensitivity analyses were carried out for the detection strategies of rotor imbalance and shear web disbond developed in prior work by evaluating the robustness of key measurement parameters in the presence of varying wind speeds, horizontal shear, and turbulence. Detection strategies were refined for these fault mechanisms and probabilities of detection were calculated. For all three fault mechanisms, the probability of detection was 96% or higher for the optimized wind speed ranges of the laminar, 30% horizontal shear, and 60% horizontal shear wind profiles. The revised cost model provided insight into the estimated savings in operations and maintenance costs as they relate to the characteristics of the SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability

  4. The Distribution of Health Services in Iran Health Care System: A Case Study at East Azerbaijan

    Directory of Open Access Journals (Sweden)

    Hassan Almaspoor-khangah

    2016-10-01

    Full Text Available Background: It is necessary that various aspects of health information and statistics are identified and measured since health problems are getting more complex day by day. Objective: This study is aimed to investigate the distribution of health services in the health care system in Iran and the case of study is East Azerbaijan province. Methods: This research was a retrospective, descriptive, cross-sectional study. The statistical population included all health service providers in East Azerbaijan Province in the public, private, charity, military, social security, and NGO sectors. In this study, the data from all functional health sectors, including hospitals, health centers, and clinical, rehabilitation centers and all clinics and private offices were studied during 2014. The data relevant to performance were collected according to a pre-determined format (researcher- built checklist which was approved by five professionals and experts Health Services Management (content validity. Results: The study findings showed that the public sector by 45.28% accounted for the highest share of provided services and the private sector, social security, military institutions, charities and NGOs institutions by 25.47%, 18.92%, 4.37%, 3.3%, and 2.66% next rank in providing health services in East Azerbaijan province have been allocated. Conclusion: The results show that most of the health services in East Azerbaijan Province belongs to the public sector and the private sector has managed to develop its services in some parts surpassed the public sector. According to the study findings, Policies should be aimed to create balance and harmony in the provision of services among all service providers.

  5. Modeling for Battery Prognostics

    Science.gov (United States)

    Kulkarni, Chetan S.; Goebel, Kai; Khasin, Michael; Hogge, Edward; Quach, Patrick

    2017-01-01

    For any battery-powered vehicles (be it unmanned aerial vehicles, small passenger aircraft, or assets in exoplanetary operations) to operate at maximum efficiency and reliability, it is critical to monitor battery health as well performance and to predict end of discharge (EOD) and end of useful life (EOL). To fulfil these needs, it is important to capture the battery's inherent characteristics as well as operational knowledge in the form of models that can be used by monitoring, diagnostic, and prognostic algorithms. Several battery modeling methodologies have been developed in last few years as the understanding of underlying electrochemical mechanics has been advancing. The models can generally be classified as empirical models, electrochemical engineering models, multi-physics models, and molecular/atomist. Empirical models are based on fitting certain functions to past experimental data, without making use of any physicochemical principles. Electrical circuit equivalent models are an example of such empirical models. Electrochemical engineering models are typically continuum models that include electrochemical kinetics and transport phenomena. Each model has its advantages and disadvantages. The former type of model has the advantage of being computationally efficient, but has limited accuracy and robustness, due to the approximations used in developed model, and as a result of such approximations, cannot represent aging well. The latter type of model has the advantage of being very accurate, but is often computationally inefficient, having to solve complex sets of partial differential equations, and thus not suited well for online prognostic applications. In addition both multi-physics and atomist models are computationally expensive hence are even less suited to online application An electrochemistry-based model of Li-ion batteries has been developed, that captures crucial electrochemical processes, captures effects of aging, is computationally efficient

  6. Readability levels of health pamphlets distributed in hospitals and health centres in Athens, Greece.

    Science.gov (United States)

    Kondilis, B K; Akrivos, P D; Sardi, T A; Soteriades, E S; Falagas, M E

    2010-10-01

    Health literacy is important in the medical and social sciences due to its impact on behavioural and health outcomes. Nevertheless, little is known about it in Greece, including patients' level of understanding health brochures and pamphlets distributed in Greek hospitals and clinics. Observational study in the greater metropolitan area of Athens, Greece. Pamphlets and brochures written in the Greek language were collected from 17 hospitals and healthcare centres between the spring and autumn of 2006. Readability of pamphlets using the Flesch-Kincaid, Simple Measure of Gobbledygook (SMOG) and Fog methods was calculated based on a Greek readability software. Out of 70 pamphlets collected from 17 hospitals, 37 pamphlets met the criteria for the study. The average readability level of all scanned pamphlets was ninth to 10th grade, corresponding to a readability level of 'average'. A highly significant difference (PPamphlets from private hospitals were one grade more difficult than those from public hospitals. Approximately 43.7% of the Greek population aged ≥20 years would not be able to comprehend the available pamphlets, which were found to have an average readability level of ninth to 10th grade. Further research examining readability levels in the context of health literacy in Greece is warranted. This effort paves the way for additional research in the field of readability levels of health pamphlets in the Greek language, the sources of health information, and the level of understanding of key health messages by the population. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  7. Prognostics of Power MOSFET

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper demonstrates how to apply prognostics to power MOSFETs (metal oxide field effect transistor). The methodology uses thermal cycling to age devices and...

  8. Potential challenges facing distributed leadership in health care: evidence from the UK National Health Service.

    Science.gov (United States)

    Martin, Graeme; Beech, Nic; MacIntosh, Robert; Bushfield, Stacey

    2015-01-01

    The discourse of leaderism in health care has been a subject of much academic and practical debate. Recently, distributed leadership (DL) has been adopted as a key strand of policy in the UK National Health Service (NHS). However, there is some confusion over the meaning of DL and uncertainty over its application to clinical and non-clinical staff. This article examines the potential for DL in the NHS by drawing on qualitative data from three co-located health-care organisations that embraced DL as part of their organisational strategy. Recent theorising positions DL as a hybrid model combining focused and dispersed leadership; however, our data raise important challenges for policymakers and senior managers who are implementing such a leadership policy. We show that there are three distinct forms of disconnect and that these pose a significant problem for DL. However, we argue that instead of these disconnects posing a significant problem for the discourse of leaderism, they enable a fantasy of leadership that draws on and supports the discourse. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  9. Surgery in Brazilian Health Care: funding and physician distribution.

    Science.gov (United States)

    Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario

    2017-01-01

    to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a

  10. Impact of microbial count distributions on human health risk estimates

    DEFF Research Database (Denmark)

    Ribeiro Duarte, Ana Sofia; Nauta, Maarten

    2015-01-01

    Quantitative microbiological risk assessment (QMRA) is influenced by the choice of the probability distribution used to describe pathogen concentrations, as this may eventually have a large effect on the distribution of doses at exposure. When fitting a probability distribution to microbial...... enumeration data, several factors may have an impact on the accuracy of that fit. Analysis of the best statistical fits of different distributions alone does not provide a clear indication of the impact in terms of risk estimates. Thus, in this study we focus on the impact of fitting microbial distributions...... on risk estimates, at two different concentration scenarios and at a range of prevalence levels. By using five different parametric distributions, we investigate whether different characteristics of a good fit are crucial for an accurate risk estimate. Among the factors studied are the importance...

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

    Directory of Open Access Journals (Sweden)

    Chitra Mehta

    2016-01-01

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

  12. Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review.

    Science.gov (United States)

    Soukup, Viktor; Čapoun, Otakar; Cohen, Daniel; Hernández, Virginia; Babjuk, Marek; Burger, Max; Compérat, Eva; Gontero, Paolo; Lam, Thomas; MacLennan, Steven; Mostafid, A Hugh; Palou, Joan; van Rhijn, Bas W G; Rouprêt, Morgan; Shariat, Shahrokh F; Sylvester, Richard; Yuan, Yuhong; Zigeuner, Richard

    2017-11-01

    Tumour grade is an important prognostic indicator in non-muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications. To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO grading systems for NMIBC. A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive or metastatic disease. Secondary outcomes were disease recurrence, and overall and cancer-specific survival. For reproducibility, the primary outcome was interobserver variability between pathologists. Secondary outcome was intraobserver variability (repeatability) by the same pathologist. Of 3593 articles identified, 20 were included in the prognostic review; three were eligible for the reproducibility review. Increasing tumour grade in both classifications was associated with higher disease progression and recurrence rates. Progression rates in grade 1 patients were similar to those in low-grade patients; progression rates in grade 3 patients were higher than those in high-grade patients. Survival data were limited. Reproducibility of the 2004/2016 system was marginally better than that of the 1973 system. Two studies on repeatability showed conflicting results. Most studies had a moderate to high risk of bias. Current grading classifications in NMIBC are suboptimal. The 1973 system identifies more aggressive tumours. Intra- and interobserver variability was slightly less in the 2004/2016 classification. We could not confirm that the 2004/2016 classification outperforms the 1973 classification in prediction of recurrence and progression. This article

  13. Distributed Data Networks That Support Public Health Information Needs.

    Science.gov (United States)

    Tabano, David C; Cole, Elizabeth; Holve, Erin; Davidson, Arthur J

    Data networks, consisting of pooled electronic health data assets from health care providers serving different patient populations, promote data sharing, population and disease monitoring, and methods to assess interventions. Better understanding of data networks, and their capacity to support public health objectives, will help foster partnerships, expand resources, and grow learning health systems. We conducted semistructured interviews with 16 key informants across the United States, identified as network stakeholders based on their respective experience in advancing health information technology and network functionality. Key informants were asked about their experience with and infrastructure used to develop data networks, including each network's utility to identify and characterize populations, usage, and sustainability. Among 11 identified data networks representing hundreds of thousands of patients, key informants described aggregated health care clinical data contributing to population health measures. Key informant interview responses were thematically grouped to illustrate how networks support public health, including (1) infrastructure and information sharing; (2) population health measures; and (3) network sustainability. Collaboration between clinical data networks and public health entities presents an opportunity to leverage infrastructure investments to support public health. Data networks can provide resources to enhance population health information and infrastructure.

  14. Vertical equity of healthcare in Taiwan: health services were distributed according to need

    OpenAIRE

    Wang, Shiow-Ing; Yaung, Chih-Liang

    2013-01-01

    Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health ne...

  15. Prognostics in Battery Health Management

    Data.gov (United States)

    National Aeronautics and Space Administration — Batteries represent complex systems whose internal state vari- ables are either inaccessible to sensors or hard to measure un- der operational conditions. This work...

  16. Health Worker Focused Distributed Simulation for Improving Capability of Health Systems in Liberia.

    Science.gov (United States)

    Gale, Thomas C E; Chatterjee, Arunangsu; Mellor, Nicholas E; Allan, Richard J

    2016-04-01

    The main goal of this study was to produce an adaptable learning platform using virtual learning and distributed simulation, which can be used to train health care workers, across a wide geographical area, key safety messages regarding infection prevention control (IPC). A situationally responsive agile methodology, Scrum, was used to develop a distributed simulation module using short 1-week iterations and continuous synchronous plus asynchronous communication including end users and IPC experts. The module contained content related to standard IPC precautions (including handwashing techniques) and was structured into 3 distinct sections related to donning, doffing, and hazard perception training. Using Scrum methodology, we were able to link concepts applied to best practices in simulation-based medical education (deliberate practice, continuous feedback, self-assessment, and exposure to uncommon events), pedagogic principles related to adult learning (clear goals, contextual awareness, motivational features), and key learning outcomes regarding IPC, as a rapid response initiative to the Ebola outbreak in West Africa. Gamification approach has been used to map learning mechanics to enhance user engagement. The developed IPC module demonstrates how high-frequency, low-fidelity simulations can be rapidly designed using scrum-based agile methodology. Analytics incorporated into the tool can help demonstrate improved confidence and competence of health care workers who are treating patients within an Ebola virus disease outbreak region. These concepts could be used in a range of evolving disasters where rapid development and communication of key learning messages are required.

  17. Staff and bed distribution in public sector mental health services in ...

    African Journals Online (AJOL)

    Background. The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. Objective. To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province.

  18. Health Expenditure Growth: Looking beyond the Average through Decomposition of the Full Distribution

    NARCIS (Netherlands)

    C.A.M. de Meijer (Claudine); M.A. Koopmanschap (Marc); O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)

    2012-01-01

    textabstractExplanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures

  19. Prognostics 101: A tutorial for particle filter-based prognostics algorithm using Matlab

    International Nuclear Information System (INIS)

    An, Dawn; Choi, Joo-Ho; Kim, Nam Ho

    2013-01-01

    This paper presents a Matlab-based tutorial for model-based prognostics, which combines a physical model with observed data to identify model parameters, from which the remaining useful life (RUL) can be predicted. Among many model-based prognostics algorithms, the particle filter is used in this tutorial for parameter estimation of damage or a degradation model. The tutorial is presented using a Matlab script with 62 lines, including detailed explanations. As examples, a battery degradation model and a crack growth model are used to explain the updating process of model parameters, damage progression, and RUL prediction. In order to illustrate the results, the RUL at an arbitrary cycle are predicted in the form of distribution along with the median and 90% prediction interval. This tutorial will be helpful for the beginners in prognostics to understand and use the prognostics method, and we hope it provides a standard of particle filter based prognostics. -- Highlights: ► Matlab-based tutorial for model-based prognostics is presented. ► A battery degradation model and a crack growth model are used as examples. ► The RUL at an arbitrary cycle are predicted using the particle filter

  20. Prevalence and distribution of oral health knowledge according to ...

    African Journals Online (AJOL)

    Background: Having knowledge about health issues is necessary for making informed decisions related to practicing lifestyles conducive to good health. The aim of this study was to identify socio-demographic, behavioural and clinical covariates of knowledge related to the cause and prevention of oral diseases among ...

  1. Prognostics of Power MOSFET

    Science.gov (United States)

    Celaya, Jose Ramon; Saxena, Abhinav; Vashchenko, Vladislay; Saha, Sankalita; Goebel, Kai Frank

    2011-01-01

    This paper demonstrates how to apply prognostics to power MOSFETs (metal oxide field effect transistor). The methodology uses thermal cycling to age devices and Gaussian process regression to perform prognostics. The approach is validated with experiments on 100V power MOSFETs. The failure mechanism for the stress conditions is determined to be die-attachment degradation. Change in ON-state resistance is used as a precursor of failure due to its dependence on junction temperature. The experimental data is augmented with a finite element analysis simulation that is based on a two-transistor model. The simulation assists in the interpretation of the degradation phenomena and SOA (safe operation area) change.

  2. How social policy contributes to the distribution of population health: the case of gender health equity.

    Science.gov (United States)

    Beckfield, Jason; Morris, Katherine Ann; Bambra, Clare

    2018-02-01

    In this study we aimed to analyze gender health equity as a case of how social policy contributes to population health. We analyzed three sets of social-investment policies implemented in Europe and previously hypothesized to reduce gender inequity in labor market outcomes: childcare; active labor market programs; and long-term care. We use 12 indicators of social-investment policies from the OECD Social Expenditure Database, the OECD Family Database, and the Social Policy Indicators' Parental Leave Benefit Dataset. We draw outcome data from the 2015 Global Burden of Disease for years lived with disability and all-cause mortality among men and women ages 25-54 for 18 European nations over the 1995-2010 period. We estimate 12 linear regression models each for mortality and morbidity (i.e. years lived with disability), one per social-investment indicator. All models use country fixed-effects and cluster-robust standard errors. For years lived with disability, women benefit more from social investment for most indicators. The only exception is the percentage of young children in publicly funded childcare or schooling, which equally benefits men. For all-cause mortality, men benefit more or equally from social investment for most indicators, while women benefit more from government spending on direct job creation through civil employment. Social policy contributes to the distribution of population health. Social-investment advocates argue such policies in particular enhance economic gender equity. Our results show that these polices have ambiguous effects on gender health equity and even differential improvements among men for some outcomes.

  3. Prognostic value of admission plasma glucose in non-diabetic ...

    African Journals Online (AJOL)

    Prognostic value of admission plasma glucose in non-diabetic Nigerians with stroke. ... International Journal of Medicine and Health Development ... Outcome was measured using the Modified Rankin scale based on the last score of each ...

  4. A Model-based Avionic Prognostic Reasoner (MAPR)

    Data.gov (United States)

    National Aeronautics and Space Administration — The Model-based Avionic Prognostic Reasoner (MAPR) presented in this paper is an innovative solution for non-intrusively monitoring the state of health (SoH) and...

  5. A framework for quantifying net benefits of alternative prognostic models

    DEFF Research Database (Denmark)

    Rapsomaniki, Eleni; White, Ian R; Wood, Angela M

    2012-01-01

    New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit......) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk...... reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple...

  6. Prognostics for Ground Support Systems: Case Study on Pneumatic Valves

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics technologies determine the health (or damage) state of a component or sub- system, and make end of life (EOL) and remaining useful life (RUL)...

  7. Where Are the NGOs and Why? The Distribution of Health and Development NGOs in Bolivia

    OpenAIRE

    Galway, Lindsay P.; Corbett, Kitty K.; Zeng, Leilei

    2012-01-01

    Abstract Background The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution o...

  8. Spatial Distribution and Accessibility of Health Facilities in Akwa ...

    African Journals Online (AJOL)

    This paper therefore analyzed the spatial patterns of healthcare facilities in Akwa ... Data on six health indicator variables were obtained and analyzed to assess ... of healthcare facilities and thus hinders good access to high quality healthcare ...

  9. A framework for quantifying net benefits of alternative prognostic models

    OpenAIRE

    Rapsomaniki, E.; White, I.R.; Wood, A.M.; Thompson, S.G.; Ford, I.

    2012-01-01

    New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measure...

  10. Prognostic factors in oligodendrogliomas

    DEFF Research Database (Denmark)

    Westergaard, L; Gjerris, F; Klinken, L

    1997-01-01

    An outcome analysis was performed on 96 patients with pure cerebral oligodendrogliomas operated in the 30-year period 1962 to 1991. The most important predictive prognostic factors were youth and no neurological deficit, demonstrated as a median survival for the group younger than 20 years of 17...

  11. ['Judicialization' of public health policy for distribution of medicines].

    Science.gov (United States)

    Chieffi, Ana Luiza; Barata, Rita Barradas

    2009-08-01

    The supply of medicines in response to court orders or injunctions has become a common practice in the State of São Paulo, Brazil. This 'judicialization' of the health system clashes with basic principles of the Brazilian Unified National Health System (SUS), such as equal opportunity to access health services. The aim of this paper is to analyze the legal action used to obtain medicines through the São Paulo State Health Department, from two main angles: judicialization of public policies and breach of the equity principle. This is a descriptive study of legal action taken to obtain medicines through the São State Health Department, as listed in the Electronic Court Docket System for the year 2006. Most cases were filed through private attorneys; 47% of the patients had obtained their prescriptions through private care; and 73% of the cases involved patients from the three wealthiest areas in the city of São Paulo. The data demonstrate that such legal action violates key principles of the SUS such as equity, thereby privileging individuals with higher purchasing power and more access to information.

  12. Applications in bridge structure health monitoring using distributed fiber sensing

    Science.gov (United States)

    Feng, Yafei; Zheng, Huan; Ge, Huiliang

    2017-10-01

    In this paper, Brillouin Optical Time Domain Analysis (BOTDA) is proposed to solve the problem that the traditional point sensor is difficult to realize the comprehensive safety monitoring of bridges and so on. This technology not only breaks through the bottleneck of traditional monitoring point sensor, realize the distributed measurement of temperature and strain on a transmission path; can also be used for bridge and other structures of the damage identification, fracture positioning, settlement monitoring. The effectiveness and frontier of the technology are proved by comparing the test of the indoor model beam and the external field bridge, and the significance of the distributed optical fiber sensing technology to the monitoring of the important structure of the bridge is fully explained.

  13. Power distribution, the environment, and public health. A state-level analysis

    International Nuclear Information System (INIS)

    Boyce, James K.; Klemer, Andrew R.; Templet, Paul H.; Willis, Cleve E.

    1999-01-01

    This paper examines relationships among power distribution, the environment, and public health by means of a cross-sectional analysis of the 50 US states. A measure of inter-state variations in power distribution is derived from data on voter participation, tax fairness, Medicaid access, and educational attainment. We develop and estimate a recursive model linking the distribution of power to environmental policy, environmental stress, and public health. The results support the hypothesis that greater power inequality leads to weaker environmental policies, which in turn lead to greater environmental degradation and to adverse public health outcomes

  14. Power distribution, the environment, and public health. A state-level analysis

    Energy Technology Data Exchange (ETDEWEB)

    Boyce, James K. [Department of Economics, University of Massachusetts, Amherst, MA 01003 (United States); Klemer, Andrew R. [Department of Biology, University of Minnesota, Duluth, MN (United States); Templet, Paul H. [Institute of Environmental Studies, Louisiana State University, Baton Rouge, LA (United States); Willis, Cleve E. [Department of Resource Economics, University of Massachusetts, Amherst, MA 01003 (United States)

    1999-04-15

    This paper examines relationships among power distribution, the environment, and public health by means of a cross-sectional analysis of the 50 US states. A measure of inter-state variations in power distribution is derived from data on voter participation, tax fairness, Medicaid access, and educational attainment. We develop and estimate a recursive model linking the distribution of power to environmental policy, environmental stress, and public health. The results support the hypothesis that greater power inequality leads to weaker environmental policies, which in turn lead to greater environmental degradation and to adverse public health outcomes.

  15. Power distribution, the environment, and public health. A state-level analysis

    Energy Technology Data Exchange (ETDEWEB)

    Boyce, James K. [Department of Economics, University of Massachusetts, Amherst, MA 01003 (United States); Klemer, Andrew R. [Department of Biology, University of Minnesota, Duluth, MN (United States); Templet, Paul H. [Institute of Environmental Studies, Louisiana State University, Baton Rouge, LA (United States); Willis, Cleve E. [Department of Resource Economics, University of Massachusetts, Amherst, MA 01003 (United States)

    1999-04-15

    This paper examines relationships among power distribution, the environment, and public health by means of a cross-sectional analysis of the 50 US states. A measure of inter-state variations in power distribution is derived from data on voter participation, tax fairness, Medicaid access, and educational attainment. We develop and estimate a recursive model linking the distribution of power to environmental policy, environmental stress, and public health. The results support the hypothesis that greater power inequality leads to weaker environmental policies, which in turn lead to greater environmental degradation and to adverse public health outcomes

  16. A Mobile Robot Testbed for Prognostics-Enabled Autonomous Decision Making

    Data.gov (United States)

    National Aeronautics and Space Administration — The ability to utilize prognostic system health information in operational decision making, especially when fused with information about future operational,...

  17. A Systems Engineering Approach to Electro-Mechanical Actuator Diagnostic and Prognostic Development

    Data.gov (United States)

    National Aeronautics and Space Administration — The authors have formulated a Comprehensive Systems Engineering approach to Electro-Mechanical Actuator (EMA) Prognostics and Health Management (PHM) system...

  18. Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: insight from the National Health and Nutrition Examination Survey III (NHANES-III).

    Science.gov (United States)

    Doran, Bethany; Guo, Yu; Xu, Jinfeng; Weintraub, Howard; Mora, Samia; Maron, David J; Bangalore, Sripal

    2014-08-12

    National and international guidelines recommend fasting lipid panel measurement for risk stratification of patients for prevention of cardiovascular events. However, the prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol (LDL-C) is uncertain. Patients enrolled in the National Health and Nutrition Examination Survey III (NHANES-III), a nationally representative cross-sectional survey performed from 1988 to 1994, were stratified on the basis of fasting status (≥8 or fasting and nonfasting cohorts with similar baseline characteristics. The risk of outcomes as a function of LDL-C and fasting status was assessed with the use of receiver operating characteristic curves and bootstrapping methods. The interaction between fasting status and LDL-C was assessed with Cox proportional hazards modeling. Primary outcome was all-cause mortality. Secondary outcome was cardiovascular mortality. One-to-one matching based on propensity score yielded 4299 pairs of fasting and nonfasting individuals. For the primary outcome, fasting LDL-C yielded prognostic value similar to that for nonfasting LDL-C (C statistic=0.59 [95% confidence interval, 0.57-0.61] versus 0.58 [95% confidence interval, 0.56-0.60]; P=0.73), and LDL-C by fasting status interaction term in the Cox proportional hazards model was not significant (Pinteraction=0.11). Similar results were seen for the secondary outcome (fasting versus nonfasting C statistic=0.62 [95% confidence interval, 0.60-0.66] versus 0.62 [95% confidence interval, 0.60-0.66]; P=0.96; Pinteraction=0.34). Nonfasting LDL-C has prognostic value similar to that of fasting LDL-C. National and international agencies should consider reevaluating the recommendation that patients fast before obtaining a lipid panel. © 2014 American Heart Association, Inc.

  19. Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review.

    Science.gov (United States)

    Robinson, Maren N; Tansil, Kristin A; Elder, Randy W; Soler, Robin E; Labre, Magdala P; Mercer, Shawna L; Eroglu, Dogan; Baur, Cynthia; Lyon-Daniel, Katherine; Fridinger, Fred; Sokler, Lynn A; Green, Lawrence W; Miller, Therese; Dearing, James W; Evans, William D; Snyder, Leslie B; Kasisomayajula Viswanath, K; Beistle, Diane M; Chervin, Doryn D; Bernhardt, Jay M; Rimer, Barbara K

    2014-09-01

    Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products. Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns. Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics. Published by Elsevier Inc.

  20. State of the art and taxonomy of prognostics approaches, trends of prognostics applications and open issues towards maturity at different technology readiness levels

    Science.gov (United States)

    Javed, Kamran; Gouriveau, Rafael; Zerhouni, Noureddine

    2017-09-01

    Integrating prognostics to a real application requires a certain maturity level and for this reason there is a lack of success stories about development of a complete Prognostics and Health Management system. In fact, the maturity of prognostics is closely linked to data and domain specific entities like modeling. Basically, prognostics task aims at predicting the degradation of engineering assets. However, practically it is not possible to precisely predict the impending failure, which requires a thorough understanding to encounter different sources of uncertainty that affect prognostics. Therefore, different aspects crucial to the prognostics framework, i.e., from monitoring data to remaining useful life of equipment need to be addressed. To this aim, the paper contributes to state of the art and taxonomy of prognostics approaches and their application perspectives. In addition, factors for prognostics approach selection are identified, and new case studies from component-system level are discussed. Moreover, open challenges toward maturity of the prognostics under uncertainty are highlighted and scheme for an efficient prognostics approach is presented. Finally, the existing challenges for verification and validation of prognostics at different technology readiness levels are discussed with respect to open challenges.

  1. Health expenditure growth: looking beyond the average through decomposition of the full distribution.

    Science.gov (United States)

    de Meijer, Claudine; O'Donnell, Owen; Koopmanschap, Marc; van Doorslaer, Eddy

    2013-01-01

    Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. Where are the NGOs and why? The distribution of health and development NGOs in Bolivia.

    Science.gov (United States)

    Galway, Lindsay P; Corbett, Kitty K; Zeng, Leilei

    2012-11-23

    The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. The research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications

  3. MICRONUCLEI: A PROGNOSTIC TOOL

    OpenAIRE

    Ankit; Rinky; Manisha; Sonalika; Anand; Sanyog

    2014-01-01

    Squamous cell carcinoma is one the most common oral mucosal malignant tumor, diagnosis of oral squamous cell carcinoma rarely presents difficulty, it is the cancer staging and histo pathological grading that are more important for prognosis, micronuclei are good prognostic indicator. Micronuclei screening can be done easily by exfoliative cytology, one of the most valuable diagnostic method other than routine histopathology (H and E-stained sections) and immunohistochemist...

  4. Low-Cost, Distributed Environmental Monitors for Factory Worker Health

    Directory of Open Access Journals (Sweden)

    Geb W. Thomas

    2018-05-01

    Full Text Available An integrated network of environmental monitors was developed to continuously measure several airborne hazards in a manufacturing facility. The monitors integrated low-cost sensors to measure particulate matter, carbon monoxide, ozone and nitrogen dioxide, noise, temperature and humidity. The monitors were developed and tested in situ for three months in several overlapping deployments, before a full cohort of 40 was deployed in a heavy vehicle manufacturing facility for a year of data collection. The monitors collect data from each sensor and report them to a central database every 5 min. The work includes an experimental validation of the particle, gas and noise monitors. The R2 for the particle sensor ranges between 0.98 and 0.99 for particle mass densities up to 300 μg/m3. The R2 for the carbon monoxide sensor is 0.99 for concentrations up to 15 ppm. The R2 for the oxidizing gas sensor is 0.98 over the sensitive range from 20 to 180 ppb. The noise monitor is precise within 1% between 65 and 95 dBA. This work demonstrates the capability of distributed monitoring as a means to examine exposure variability in both space and time, building an important preliminary step towards a new approach for workplace hazard monitoring.

  5. Distributed Impact Detector System (DIDS) Health Monitoring System Evaluation

    Science.gov (United States)

    Prosser, William H.; Madaras, Eric I.

    2010-01-01

    Damage due to impacts from micrometeoroids and orbital debris is one of the most significant on-orbit hazards for spacecraft. Impacts to thermal protection systems must be detected and the damage evaluated to determine if repairs are needed to allow safe re-entry. To address this issue for the International Space Station Program, Langley Research Center and Johnson Space Center technologists have been working to develop and implement advanced methods for detecting impacts and resultant leaks. LaRC funded a Small Business Innovative Research contract to Invocon, Inc. to develop special wireless sensor systems that are compact, light weight, and have long battery lifetimes to enable applications to long duration space structures. These sensor systems are known as distributed impact detection systems (DIDS). In an assessment, the NASA Engineering and Safety Center procured two prototype DIDS sensor units to evaluate their capabilities in laboratory testing and field testing in an ISS Node 1 structural test article. This document contains the findings of the assessment.

  6. Vertical equity of healthcare in Taiwan: health services were distributed according to need

    Directory of Open Access Journals (Sweden)

    Wang Shiow-Ing

    2013-01-01

    Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

  7. Linking Health Concepts in the Assessment and Evaluation of Water Distribution Systems

    Science.gov (United States)

    Karney, Bryan W.; Filion, Yves R.

    2005-01-01

    The concept of health is not only a specific criterion for evaluation of water quality delivered by a distribution system but also a suitable paradigm for overall functioning of the hydraulic and structural components of the system. This article views health, despite its complexities, as the only criterion with suitable depth and breadth to allow…

  8. Accelerated Aging with Electrical Overstress and Prognostics for Power MOSFETs

    Science.gov (United States)

    Saha, Sankalita; Celaya, Jose Ramon; Vashchenko, Vladislav; Mahiuddin, Shompa; Goebel, Kai F.

    2011-01-01

    Power electronics play an increasingly important role in energy applications as part of their power converter circuits. Understanding the behavior of these devices, especially their failure modes as they age with nominal usage or sudden fault development is critical in ensuring efficiency. In this paper, a prognostics based health management of power MOSFETs undergoing accelerated aging through electrical overstress at the gate area is presented. Details of the accelerated aging methodology, modeling of the degradation process of the device and prognostics algorithm for prediction of the future state of health of the device are presented. Experiments with multiple devices demonstrate the performance of the model and the prognostics algorithm as well as the scope of application. Index Terms Power MOSFET, accelerated aging, prognostics

  9. Health risk assessment linked with purified biogas injection in a natural gas distribution system

    International Nuclear Information System (INIS)

    Leroux, Carole; Modelon, Hugues; Rousselle, Christophe; Zdanevitch, Isabelle; Evanno, Sebastien

    2009-06-01

    This document provides for the opinion of the French Agency for Environmental and Occupational Health and Safety (Afsset) expressed after the collective expertise carried out for the evaluation of the health risk linked with biogas injection in the natural gas distribution system. Following the recommendations issued by the Afsset, works have been started in order to collect the sludge-derived biogas and to analyse its composition. These data will be used to assess accidental risks (resulting from biogas valorisation, pipeline transport, industrial and domestic energy valorisation) as well as health risks for users (resulting from the injection in the natural gas distribution system)

  10. Prognostic factors of breast cancer

    International Nuclear Information System (INIS)

    Gonzalez Ortega, Jose Maria; Morales Wong, Mario Miguel; Lopez Cuevas, Zoraida; Diaz Valdez, Marilin

    2011-01-01

    The prognostic factors must to be differentiated of the predictive ones. A prognostic factor is any measurement used at moment of the surgery correlated with the free interval of disease or global survival in the absence of the systemic adjuvant treatment and as result is able to correlate with the natural history of the disease. In contrast, a predictive factor is any measurement associated with the response to a given treatment. Among the prognostic factors of the breast cancer are included the clinical, histological, biological, genetic and psychosocial factors. In present review of psychosocial prognostic factors has been demonstrated that the stress and the depression are negative prognostic factors in patients presenting with breast cancer. It is essential to remember that the assessment of just one prognostic parameter is a help but it is not useful to clinical and therapeutic management of the patient.(author)

  11. [Equity in health? Health inequalities, ethics, and theories of distributive justice].

    Science.gov (United States)

    Buyx, A M

    2010-01-01

    It is well-documented that the socio-economic status has an important influence on health. In all developed countries, health is closely correlated with income, education, and type of employment, as well as with several other social determinants. While data on this socio-economic health gradient have been available for decades, the moral questions surrounding social health inequalities have only recently been addressed within the field of public health ethics. The present article offers a brief overview of relevant data on social health inequalities and on some explanatory models from epidemiology, social medicine and related disciplines. The main part explores three influential normative accounts addressing the issue of health inequalities. Finally, an agenda for future work in the field of public health ethics and health inequalities is sketched, with particular attention to the German context.

  12. OmniPHR: A distributed architecture model to integrate personal health records.

    Science.gov (United States)

    Roehrs, Alex; da Costa, Cristiano André; da Rosa Righi, Rodrigo

    2017-07-01

    The advances in the Information and Communications Technology (ICT) brought many benefits to the healthcare area, specially to digital storage of patients' health records. However, it is still a challenge to have a unified viewpoint of patients' health history, because typically health data is scattered among different health organizations. Furthermore, there are several standards for these records, some of them open and others proprietary. Usually health records are stored in databases within health organizations and rarely have external access. This situation applies mainly to cases where patients' data are maintained by healthcare providers, known as EHRs (Electronic Health Records). In case of PHRs (Personal Health Records), in which patients by definition can manage their health records, they usually have no control over their data stored in healthcare providers' databases. Thereby, we envision two main challenges regarding PHR context: first, how patients could have a unified view of their scattered health records, and second, how healthcare providers can access up-to-date data regarding their patients, even though changes occurred elsewhere. For addressing these issues, this work proposes a model named OmniPHR, a distributed model to integrate PHRs, for patients and healthcare providers use. The scientific contribution is to propose an architecture model to support a distributed PHR, where patients can maintain their health history in an unified viewpoint, from any device anywhere. Likewise, for healthcare providers, the possibility of having their patients data interconnected among health organizations. The evaluation demonstrates the feasibility of the model in maintaining health records distributed in an architecture model that promotes a unified view of PHR with elasticity and scalability of the solution. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The Relation Between the Health Workforce distribution and Maternal and Child Health Inequalities

    NARCIS (Netherlands)

    M.A. Sousa (Angelica)

    2016-01-01

    markdownabstractWeak health systems with a shortage of qualified staff, and lack of equipment and medicines impede the delivery of quality health care that is required to prevent maternal and newborn deaths and the attainment of the health-related Millennium Development Goals (MDGs). Using the cases

  14. Prognostic factors for medulloblastoma

    International Nuclear Information System (INIS)

    Jenkin, Derek; Al Shabanah, Mohamed; Al Shail, Essam; Gray, Alan; Hassounah, Maher; Khafaga, Yasser; Kofide, Amani; Mustafa, Mahmoud; Schultz, Henrik

    2000-01-01

    Purpose: To evaluate prognostic factors for medulloblastoma. Methods and Materials: One hundred and seventy-three consecutive patients with medulloblastoma, treated at King Faisal Specialist Hospital (KFSH) from 1988-1997, were reviewed. Eighty-four percent were children less than 15 years old. From 1988-1994, treatment was at the discretion of the investigator. From 1994-1998, patients entered a single-arm best practice protocol in which, in staged patients, the surgical intent was total resection, standard radiation treatment was defined, and adjuvant chemotherapy was given to a 'high-risk' subset. Results: For 150 patients who completed surgical and radiation treatment, the 5-year survival rate was 58%, compared with 0% for 16 patients who were unable to start or complete radiation treatment. For staged patients, the 5-year survival was M0 + M1, 78% and M2 + M3, 21% (p 14 years and gross cystic/necrotic features in the primary tumor. The size of the primary tumor, the degree of hydrocephalus at diagnosis, the presence of residual tumor in the post-operative CT/MRI, and the functional status of the patient prior to radiation treatment were not significant factors. Conclusions: Stage M0 + M1 was the most powerful favorable prognostic factor. In Saudi Arabia more patients present with advanced disseminated disease, 41% M2 + M3, than in the West, and this impacts adversely on overall survival. Total resection and standard radiation treatment were not sensitive prognostic factors in a treatment environment in which 78% of patients underwent at least 90% tumor resection and 60% received standard radiation treatment. In order to improve the proportion of patients able to complete radiation treatment, consideration should be given to limiting resection when the attainment of total resection is likely to be morbid, and to delaying rather than omitting radiation treatment in the patient severely compromised postoperatively

  15. Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

    Science.gov (United States)

    Kanchanachitra, Churnrurtai; Lindelow, Magnus; Johnston, Timothy; Hanvoravongchai, Piya; Lorenzo, Fely Marilyn; Huong, Nguyen Lan; Wilopo, Siswanto Agus; dela Rosa, Jennifer Frances

    2011-02-26

    In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues. Copyright © 2011

  16. Equality in the distribution of health material and human resources in Guangxi: evidence from Southern China.

    Science.gov (United States)

    Sun, Jian

    2017-08-29

    The aim of this study was to assess the equality in the distribution of health material and human resources in Guangxi, and put forward proposal to improve the equality status of the health material and human resources. We used concentration index to evaluate the degree of income-related equality of health material and human resources. The concentration index values of the five resources ranged from -0.0847 to 0.1416 from 2011 to 2015. Health institution was concentrated among the poorer populations, while other four resources were concentrated among the richer populations. Overall, the equality status of health institutions, health care beds, health technical personnel, and certified nurses got better from 2011 to 2015. However, the equality status of practicing physicians has got worse since 2014.

  17. Implementing an overdose education and naloxone distribution program in a health system.

    Science.gov (United States)

    Devries, Jennifer; Rafie, Sally; Polston, Gregory

    To design and implement a health system-wide program increasing provision of take-home naloxone in patients at risk for opioid overdose, with the downstream aim of reducing fatalities. The program includes health care professional education and guidelines, development, and dissemination of patient education materials, electronic health record changes to promote naloxone prescriptions, and availability of naloxone in pharmacies. Academic health system, San Diego, California. University of California, San Diego Health (UCSDH), offers both inpatient and outpatient primary care and specialty services with 563 beds spanning 2 hospitals and 6 pharmacies. UCSDH is part of the University of California health system, and it serves as the county's safety net hospital. In January 2016, a multisite academic health system initiated a system-wide overdose education and naloxone distribution program to prevent opioid overdose and opioid overdose-related deaths. An interdisciplinary, interdepartmental team came together to develop and implement the program. To strengthen institutional support, naloxone prescribing guidelines were developed and approved for the health system. Education on naloxone for physicians, pharmacists, and nurses was provided through departmental trainings, bulletins, and e-mail notifications. Alerts in the electronic health record and preset naloxone orders facilitated co-prescribing of naloxone with opioid prescriptions. Electronic health record reports captured naloxone prescriptions ordered. Summary reports on the electronic health record measured naloxone reminder alerts and response rates. Since the start of the program, the health system has trained 252 physicians, pharmacists, and nurses in overdose education and take-home naloxone. There has been an increase in the number of prescriptions for naloxone from a baseline of 4.5 per month to an average of 46 per month during the 3 months following full implementation of the program including

  18. Prognostic factors in lupus nephritis

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Starklint, Henrik; Halberg, Poul

    2006-01-01

    To evaluate the prognostic significance of clinical and renal biopsy findings in an unselected cohort of patients with systemic lupus erythematosus (SLE) and nephritis.......To evaluate the prognostic significance of clinical and renal biopsy findings in an unselected cohort of patients with systemic lupus erythematosus (SLE) and nephritis....

  19. Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

    Science.gov (United States)

    Kaste, L M; Sadler, Z E; Hayes, K L; Narendran, S; Niessen, L C; Weintraub, J A

    1998-01-01

    The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

  20. Prognostic accuracy of electroencephalograms in preterm infants

    DEFF Research Database (Denmark)

    Fogtmann, Emilie Pi; Plomgaard, Anne Mette; Greisen, Gorm

    2017-01-01

    CONTEXT: Brain injury is common in preterm infants, and predictors of neurodevelopmental outcome are relevant. OBJECTIVE: To assess the prognostic test accuracy of the background activity of the EEG recorded as amplitude-integrated EEG (aEEG) or conventional EEG early in life in preterm infants...... for predicting neurodevelopmental outcome. DATA SOURCES: The Cochrane Library, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: We included observational studies that had obtained an aEEG or EEG within 7 days of life in preterm infants and reported...... neurodevelopmental outcomes 1 to 10 years later. DATA EXTRACTION: Two reviewers independently performed data extraction with regard to participants, prognostic testing, and outcomes. RESULTS: Thirteen observational studies with a total of 1181 infants were included. A metaanalysis was performed based on 3 studies...

  1. Where are the NGOs and why? The distribution of health and development NGOs in Bolivia

    Directory of Open Access Journals (Sweden)

    Galway Lindsay P

    2012-11-01

    Full Text Available Abstract Background The presence and influence of nongovernmental organizations (NGOs in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. Methods The research question is addressed using a geographic information system (GIS and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. Results This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. Conclusions The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty

  2. Benefit distribution of social health insurance: evidence from china's urban resident basic medical insurance.

    Science.gov (United States)

    Pan, Jay; Tian, Sen; Zhou, Qin; Han, Wei

    2016-09-01

    Equity is one of the essential objectives of the social health insurance. This article evaluates the benefit distribution of the China's Urban Residents' Basic Medical Insurance (URBMI), covering 300 million urban populations. Using the URBMI Household Survey data fielded between 2007 and 2011, we estimate the benefit distribution by the two-part model, and find that the URBMI beneficiaries from lower income groups benefited less than that of higher income groups. In other words, government subsidy that was supposed to promote the universal coverage of health care flew more to the rich. Our study provides new evidence on China's health insurance system reform, and it bears meaningful policy implication for other developing countries facing similar challenges on the way to universal coverage of health insurance. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  3. Lifecycle Prognostics Architecture for Selected High-Cost Active Components

    Energy Technology Data Exchange (ETDEWEB)

    N. Lybeck; B. Pham; M. Tawfik; J. B. Coble; R. M. Meyer; P. Ramuhalli; L. J. Bond

    2011-08-01

    There are an extensive body of knowledge and some commercial products available for calculating prognostics, remaining useful life, and damage index parameters. The application of these technologies within the nuclear power community is still in its infancy. Online monitoring and condition-based maintenance is seeing increasing acceptance and deployment, and these activities provide the technological bases for expanding to add predictive/prognostics capabilities. In looking to deploy prognostics there are three key aspects of systems that are presented and discussed: (1) component/system/structure selection, (2) prognostic algorithms, and (3) prognostics architectures. Criteria are presented for component selection: feasibility, failure probability, consequences of failure, and benefits of the prognostics and health management (PHM) system. The basis and methods commonly used for prognostics algorithms are reviewed and summarized. Criteria for evaluating PHM architectures are presented: open, modular architecture; platform independence; graphical user interface for system development and/or results viewing; web enabled tools; scalability; and standards compatibility. Thirteen software products were identified and discussed in the context of being potentially useful for deployment in a PHM program applied to systems in a nuclear power plant (NPP). These products were evaluated by using information available from company websites, product brochures, fact sheets, scholarly publications, and direct communication with vendors. The thirteen products were classified into four groups of software: (1) research tools, (2) PHM system development tools, (3) deployable architectures, and (4) peripheral tools. Eight software tools fell into the deployable architectures category. Of those eight, only two employ all six modules of a full PHM system. Five systems did not offer prognostic estimates, and one system employed the full health monitoring suite but lacked operations and

  4. Lifecycle Prognostics Architecture for Selected High-Cost Active Components

    International Nuclear Information System (INIS)

    Lybeck, N.; Pham, B.; Tawfik, M.; Coble, J.B.; Meyer, R.M.; Ramuhalli, P.; Bond, L.J.

    2011-01-01

    There are an extensive body of knowledge and some commercial products available for calculating prognostics, remaining useful life, and damage index parameters. The application of these technologies within the nuclear power community is still in its infancy. Online monitoring and condition-based maintenance is seeing increasing acceptance and deployment, and these activities provide the technological bases for expanding to add predictive/prognostics capabilities. In looking to deploy prognostics there are three key aspects of systems that are presented and discussed: (1) component/system/structure selection, (2) prognostic algorithms, and (3) prognostics architectures. Criteria are presented for component selection: feasibility, failure probability, consequences of failure, and benefits of the prognostics and health management (PHM) system. The basis and methods commonly used for prognostics algorithms are reviewed and summarized. Criteria for evaluating PHM architectures are presented: open, modular architecture; platform independence; graphical user interface for system development and/or results viewing; web enabled tools; scalability; and standards compatibility. Thirteen software products were identified and discussed in the context of being potentially useful for deployment in a PHM program applied to systems in a nuclear power plant (NPP). These products were evaluated by using information available from company websites, product brochures, fact sheets, scholarly publications, and direct communication with vendors. The thirteen products were classified into four groups of software: (1) research tools, (2) PHM system development tools, (3) deployable architectures, and (4) peripheral tools. Eight software tools fell into the deployable architectures category. Of those eight, only two employ all six modules of a full PHM system. Five systems did not offer prognostic estimates, and one system employed the full health monitoring suite but lacked operations and

  5. Prognostic accuracy of antenatal neonatology consultation.

    Science.gov (United States)

    Kukora, S; Gollehon, N; Weiner, G; Laventhal, N

    2017-01-01

    Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I=survivable, IIA=uncertain but likely survivable, II=uncertain, IIB=uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge). When possible, status at last follow-up was recorded for those discharged from the hospital. Prognostic accuracy was assessed using unweighted, multi-level likelihood ratios (LRs). The final cohort included 143 fetuses/infants distributed nearly evenly among the three diagnosis groups. Over half (64%) were assigned an uncertain prognosis, but most of these could be divided into 'likely survivable' or 'likely non-survivable' subgroups. Overall survival for the entire cohort was 62% (89/143). All but one of the fetuses assigned a non-survivable prognosis suffered fetal demise or died before hospital discharge. The neonatologist's antenatal prognosis accurately predicted the probability of survival by prognosis group (LR I=4.56, LR IIA=10.53, LR II=4.71, LR IIB=0.099, LR III=0.040). The LRs clearly differentiated between fetuses with high and low probability of survival. Eleven fetuses (7.7%) had misalignment between the predicted prognosis and outcome. Five died before discharge despite being given category I or IIA prognoses, whereas six infants with category IIB or III prognoses survived to discharge, though some of these were

  6. Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

    Science.gov (United States)

    Fragidis, Leonidas L; Chatzoglou, Prodromos D; Aggelidis, Vassilios P

    2016-11-14

    The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

  7. Financial Effect of a Drug Distribution Model Change on a Health System.

    Science.gov (United States)

    Turingan, Erin M; Mekoba, Bijan C; Eberwein, Samuel M; Roberts, Patricia A; Pappas, Ashley L; Cruz, Jennifer L; Amerine, Lindsey B

    2017-06-01

    Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer's change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.

  8. Distribution

    Science.gov (United States)

    John R. Jones

    1985-01-01

    Quaking aspen is the most widely distributed native North American tree species (Little 1971, Sargent 1890). It grows in a great diversity of regions, environments, and communities (Harshberger 1911). Only one deciduous tree species in the world, the closely related Eurasian aspen (Populus tremula), has a wider range (Weigle and Frothingham 1911)....

  9. Colorectal Cancer: Prognostic Values

    Directory of Open Access Journals (Sweden)

    Suzana Manxhuka-Kerliu

    2009-02-01

    Full Text Available After lung cancer colorectal cancer (Cc is ranked the second, as a cause of cancer-related death. The purpose of this study was to analyze the Cc cases in our material with respect to all prognostic values including histological type and grade, vascular invasion, perineural invasion, and tumor border features. There were investigated 149 cases of resection specimen with colorectal cancer, which were fixed in buffered neutral formalin and embedded in paraffin. Tissue sections (4(µm thick were cut and stained with H&E. Adenocarcinoma was the most frequent histological type found in 85,90% of cases, in 60,94% of males and 39,06% of females; squamous cell carcinoma in 7,38%, in 63,63% of males and 36,36% of females; mucinous carcinoma in 4,68%, in 57,15% of males and 42,85% of females; while adenosquamous carcinoma, undifferentiated carcinoma and carcinoma in situ in 0,71% of cases each. Dukes' classification was used in order to define the depth of invasion. Dukes B was found in 68,45% of cases, whereas in 31,54% of cases Dukes C was found. As far as histological grading is concerned, Cc was mostly with moderate differentiation (75,16% with neither vascular nor perineural invasion. Resection margins were in all cases free of tumor. Our data indicate that the pathologic features of the resection specimen constitute the most powerful predictors of postoperative outcome in Cc. Dukes' stage and degree of differentiation provide independent prognostic information in Cc. However, differentiation should be assessed by the worst pattern.

  10. The decentralisation-centralisation dilemma: recruitment and distribution of health workers in remote districts of Tanzania.

    Science.gov (United States)

    Munga, Michael A; Songstad, Nils Gunnar; Blystad, Astrid; Maestad, Ottar

    2009-04-30

    The implementation of decentralisation reforms in the health sector of Tanzania started in the 1980s. These reforms were intended to relinquish substantial powers and resources to districts to improve the development of the health sector. Little is known about the impact of decentralisation on recruitment and distribution of health workers at the district level. Reported difficulties in recruiting health workers to remote districts led the Government of Tanzania to partly re-instate central recruitment of health workers in 2006. The effects of this policy change are not yet documented. This study highlights the experiences and challenges associated with decentralisation and the partial re-centralisation in relation to the recruitment and distribution of health workers. An exploratory qualitative study was conducted among informants recruited from five underserved, remote districts of mainland Tanzania. Additional informants were recruited from the central government, the NGO sector, international organisations and academia. A comparison of decentralised and the reinstated centralised systems was carried out in order to draw lessons necessary for improving recruitment, distribution and retention of health workers. The study has shown that recruitment of health workers under a decentralised arrangement has not only been characterised by complex bureaucratic procedures, but by severe delays and sometimes failure to get the required health workers. The study also revealed that recruitment of highly skilled health workers under decentralised arrangements may be both very difficult and expensive. Decentralised recruitment was perceived to be more effective in improving retention of the lower cadre health workers within the districts. In contrast, the centralised arrangement was perceived to be more effective both in recruiting qualified staff and balancing their distribution across districts, but poor in ensuring the retention of employees. A combination of centralised

  11. How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

    Science.gov (United States)

    Nambisan, Satish; Nambisan, Priya

    2017-11-01

    Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals. © 2017 American Medical Association. All Rights Reserved.

  12. Diagnostic and Prognostic Models for Generator Step-Up Transformers

    Energy Technology Data Exchange (ETDEWEB)

    Vivek Agarwal; Nancy J. Lybeck; Binh T. Pham

    2014-09-01

    In 2014, the online monitoring (OLM) of active components project under the Light Water Reactor Sustainability program at Idaho National Laboratory (INL) focused on diagnostic and prognostic capabilities for generator step-up transformers. INL worked with subject matter experts from the Electric Power Research Institute (EPRI) to augment and revise the GSU fault signatures previously implemented in the Electric Power Research Institute’s (EPRI’s) Fleet-Wide Prognostic and Health Management (FW-PHM) Suite software. Two prognostic models were identified and implemented for GSUs in the FW-PHM Suite software. INL and EPRI demonstrated the use of prognostic capabilities for GSUs. The complete set of fault signatures developed for GSUs in the Asset Fault Signature Database of the FW-PHM Suite for GSUs is presented in this report. Two prognostic models are described for paper insulation: the Chendong model for degree of polymerization, and an IEEE model that uses a loading profile to calculates life consumption based on hot spot winding temperatures. Both models are life consumption models, which are examples of type II prognostic models. Use of the models in the FW-PHM Suite was successfully demonstrated at the 2014 August Utility Working Group Meeting, Idaho Falls, Idaho, to representatives from different utilities, EPRI, and the Halden Research Project.

  13. The Nigeria wealth distribution and health seeking behaviour: evidence from the 2012 national HIV/AIDS and reproductive health survey.

    Science.gov (United States)

    Fagbamigbe, Adeniyi F; Bamgboye, Elijah A; Yusuf, Bidemi O; Akinyemi, Joshua O; Issa, Bolakale K; Ngige, Evelyn; Amida, Perpetua; Bashorun, Adebobola; Abatta, Emmanuel

    2015-01-01

    Recently, Nigeria emerged as the largest economy in Africa and the 26th in the world. However, a pertinent question is how this new economic status has impacted on the wealth and health of her citizens. There is a dearth of empirical study on the wealth distribution in Nigeria which could be important in explaining the general disparities in their health seeking behavior. An adequate knowledge of Nigeria wealth distribution will no doubt inform policy makers in their decision making to improve the quality of life of Nigerians. This study is a retrospective analysis of the assets of household in Nigeria collected during the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus 2). We used the principal component analysis methods to construct wealth quintiles across households in Nigeria. At 5% significance level, we used ANOVA to determine differences in some health outcomes across the WQs and chi-square test to assess association between WQs and some reproductive health seeking behaviours. The wealth quintiles were found to be internally valid and coherent. However, there is a wide gap in the reproductive health seeking behavior of household members across the wealth quintiles with members of households in lower quintiles having lesser likelihood (33.0%) to receive antenatal care than among those in the highest quintiles (91.9%). While only 3% were currently using modern contraceptives in the lowest wealth quintile, it was 17.4% among the highest wealth quintile (p wealth quintiles showed a great disparity in the standard of living of Nigerian households across geo-political zones, states and rural-urban locations which had greatly influenced household health seeking behavior.

  14. Prognostic and predictive factors in colorectal cancer.

    Science.gov (United States)

    Bolocan, A; Ion, D; Ciocan, D N; Paduraru, D N

    2012-01-01

    Colorectal cancer (CRC) is an important public health problem; it is a leading cause of cancer mortality in the industrialized world, second to lung cancer: each year there are nearly one million new cases of CRC diagnosed worldwide and half a million deaths (1). This review aims to summarise the most important currently available markers for CRC that provide prognostic or predictive information. Amongst others, it covers serum markers such as CEA and CA19-9, markers expressed by tumour tissues, such as thymidylate synthase, and also the expression/loss of expression of certain oncogenes and tumour suppressor genes such as K-ras and p53. The prognostic value of genomic instability, angiogenesis and proliferative indices, such as the apoptotic index, are discussed. The advent of new therapies created the pathway for a personalized approach of the patient. This will take into consideration the complex genetic mechanisms involved in tumorigenesis, besides the classical clinical and pathological stagings. The growing number of therapeutic agents and known molecular targets in oncology lead to a compulsory study of the clinical use of biomarkers with role in improving response and survival, as well as in reducing toxicity and establishing economic stability. The potential predictive and prognostic biomarkers which have arisen from the study of the genetic basis of colorectal cancer and their therapeutical significance are discussed. RevistaChirurgia.

  15. Equality in Distribution of Human Resources: the Case of Iran's Ministry of Health and Medical Education.

    Science.gov (United States)

    Mobaraki, H; Hassani, A; Kashkalani, T; Khalilnejad, R; Chimeh, E Ehsani

    2013-01-01

    Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The fair allocation of human resources is one of the dimensions of equity, which was evaluated in this study. We evaluated the equity of human resources' distribution among Iran's medical science universities between 2005 and 2009 by inequality measures including Lorenze curve, Gini coefficient and Rabin hood indexes. In the distribution 60403 recruitment licenses among medical universities with 72456140 covered populations, Gini coefficient was 0.167 and Robin Hood Index 0.11. Calculations indicated Recruitment licenses are equitably distributed in MOH&ME of Iran. However a portion of recruitment licenses should redistributed for achieving perfect equal distribution among all public medical universities of Iran.

  16. Micro-level analysis of distributional changes in health care financing in Finland.

    Science.gov (United States)

    Klavus, J; Häkkinen, U

    1998-01-01

    In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

  17. Modelling the affordability and distributional implications of future health care financing options in South Africa.

    Science.gov (United States)

    McIntyre, Di; Ataguba, John E

    2012-03-01

    South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but

  18. Towards Prognostics for Electronics Components

    Data.gov (United States)

    National Aeronautics and Space Administration — Electronics components have an increasingly critical role in avionics systems and in the development of future aircraft systems. Prognostics of such components is...

  19. [Work and health inequalities: The unequal distribution of exposures at work in Germany and Europe].

    Science.gov (United States)

    Dragano, Nico; Wahrendorf, Morten; Müller, Kathrin; Lunau, Thorsten

    2016-02-01

    Health inequalities in the working population may partly be due to the unequal exposure to work-related risk factors among different occupational positions. Empirical data, however, exploring the distribution of exposures at work according to occupational position for Germany is missing. This paper summarizes existing literature on occupational inequalities and discusses the role of working conditions. In addition, using European survey data, we study how various exposures at work vary by occupational class. Analyses are based on the European Working Condition Survey, and we compare the German sample (n = 2096) with the sample from the EU-27 countries (n = 34,529). To measure occupational position we use occupational class (EGP-classes). First, we describe the prevalence of 16 different exposures at work by occupational class for men and women. Second, we estimate regression models, and thereby investigate if associations between occupational class and self-perceived health are related to an unequal distribution of exposures at work. For various exposures at work we found a higher prevalence among manual workers and lower-skilled employees for both physical and psychosocial conditions. With few exceptions only, this finding was true for men and women and consistent for Germany and Europe. Results indicate that the unequal distribution of health-adverse conditions at work contribute towards existing health inequalities among the working population.

  20. Prognostic biomarkers in osteoarthritis

    Science.gov (United States)

    Attur, Mukundan; Krasnokutsky-Samuels, Svetlana; Samuels, Jonathan; Abramson, Steven B.

    2013-01-01

    Purpose of review Identification of patients at risk for incident disease or disease progression in osteoarthritis remains challenging, as radiography is an insensitive reflection of molecular changes that presage cartilage and bone abnormalities. Thus there is a widely appreciated need for biochemical and imaging biomarkers. We describe recent developments with such biomarkers to identify osteoarthritis patients who are at risk for disease progression. Recent findings The biochemical markers currently under evaluation include anabolic, catabolic, and inflammatory molecules representing diverse biological pathways. A few promising cartilage and bone degradation and synthesis biomarkers are in various stages of development, awaiting further validation in larger populations. A number of studies have shown elevated expression levels of inflammatory biomarkers, both locally (synovial fluid) and systemically (serum and plasma). These chemical biomarkers are under evaluation in combination with imaging biomarkers to predict early onset and the burden of disease. Summary Prognostic biomarkers may be used in clinical knee osteoarthritis to identify subgroups in whom the disease progresses at different rates. This could facilitate our understanding of the pathogenesis and allow us to differentiate phenotypes within a heterogeneous knee osteoarthritis population. Ultimately, such findings may help facilitate the development of disease-modifying osteoarthritis drugs (DMOADs). PMID:23169101

  1. A self-scaling, distributed information architecture for public health, research, and clinical care.

    Science.gov (United States)

    McMurry, Andrew J; Gilbert, Clint A; Reis, Ben Y; Chueh, Henry C; Kohane, Isaac S; Mandl, Kenneth D

    2007-01-01

    This study sought to define a scalable architecture to support the National Health Information Network (NHIN). This architecture must concurrently support a wide range of public health, research, and clinical care activities. The architecture fulfils five desiderata: (1) adopt a distributed approach to data storage to protect privacy, (2) enable strong institutional autonomy to engender participation, (3) provide oversight and transparency to ensure patient trust, (4) allow variable levels of access according to investigator needs and institutional policies, (5) define a self-scaling architecture that encourages voluntary regional collaborations that coalesce to form a nationwide network. Our model has been validated by a large-scale, multi-institution study involving seven medical centers for cancer research. It is the basis of one of four open architectures developed under funding from the Office of the National Coordinator of Health Information Technology, fulfilling the biosurveillance use case defined by the American Health Information Community. The model supports broad applicability for regional and national clinical information exchanges. This model shows the feasibility of an architecture wherein the requirements of care providers, investigators, and public health authorities are served by a distributed model that grants autonomy, protects privacy, and promotes participation.

  2. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people.

    Science.gov (United States)

    Koudstaal, Stefan; Pujades-Rodriguez, Mar; Denaxas, Spiros; Gho, Johannes M I H; Shah, Anoop D; Yu, Ning; Patel, Riyaz S; Gale, Chris P; Hoes, Arno W; Cleland, John G; Asselbergs, Folkert W; Hemingway, Harry

    2017-09-01

    The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts. This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age- and sex-matched general population. In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients. NCT02551016. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

  3. Analysis of blood glucose distribution characteristics in a health examination population in Chengdu (2007–2015)

    OpenAIRE

    Huang, Wenxia; Xu, Wangdong; Zhu, Ping; Yang, Hanwei; Su, Linchong; Tang, Huairong; Liu, Yi

    2017-01-01

    Abstract With socioeconomic growth and cultural changes in China, the level of blood glucose may have changed in recent years. This study aims to detect the blood glucose distribution characteristics with a large size of health examination population. A total of 641,311 cases (360,259 males and 281,052 females) more than 18 years old during 2007 to 2015 were recruited from the Health Examination Center at West China hospital, Sichuan University. The percentage of cases with abnormal glucose l...

  4. Advanced air distribution: Improving health and comfort while reducing energy use

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor

    2015-01-01

    -quality indoor environments at the same time as low-energy consumption. Advanced air distribution, designed to supply clean air where, when, and as much as needed, makes it possible to efficiently achieve thermal comfort, control exposure to contaminants, provide high-quality air for breathing and minimizing......Indoor environment affects the health, comfort, and performance of building occupants. The energy used for heating, cooling, ventilating, and air conditioning of buildings is substantial. Ventilation based on total volume air distribution in spaces is not always an efficient way to provide high...... the risk of airborne cross-infection while reducing energy use. This study justifies the need for improving the present air distribution design in occupied spaces, and in general the need for a paradigm shift from the design of collective environments to the design of individually controlled environments...

  5. New Ways of Working in UK mental health services: developing distributed responsibility in community mental health teams?

    Science.gov (United States)

    Procter, Stephen; Harrison, Deborah; Pearson, Pauline; Dickinson, Claire; Lombardo, Chiara

    2016-01-01

    This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs.

  6. Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births.

    Science.gov (United States)

    Tatem, Andrew J; Campbell, James; Guerra-Arias, Maria; de Bernis, Luc; Moran, Allisyn; Matthews, Zoë

    2014-01-04

    The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed. This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies. These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery

  7. Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania.

    Science.gov (United States)

    Mtei, Gemini; Makawia, Suzan; Ally, Mariam; Kuwawenaruwa, August; Meheus, Filip; Borghi, Josephine

    2012-03-01

    Little is known about health system equity in Tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. This study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socio-economic groups. A system-wide analysis of benefits was undertaken, including benefits from all providers irrespective of ownership. The analysis used the household budget survey (HBS) from 2001, the most recent nationally representative survey data publicly available at the time, to analyse the distribution of health care payments through user fees, health insurance contributions [from the National Health Insurance Fund (NHIF) for the formal sector and the Community Health Fund (CHF), for the rural informal sector] and taxation. Due to lack of information on NHIF and CHF contributions in the HBS, a primary survey was administered to estimate CHF enrollment and contributions; assumptions were used to estimate NHIF contributions within the HBS. Data from the same household survey, administered to 2224 households in seven districts/councils, was used to analyse the distribution of health care benefits across socio-economic groups. The health financing system was mildly progressive overall, with income taxes and NHIF contributions being the most progressive financing sources. Out-of-pocket payments and contributions to the CHF were regressive. The health benefit distribution was fairly even but the poorest received a lower share of benefits relative to their share of need for health care. Public primary care facility use was pro-poor, whereas higher level and higher cost facility use was generally pro-rich. We conclude that health financing reforms can improve equity, so long as integration of health insurance schemes is promoted along with cross-subsidization and greater reliance on general taxation to finance health care for the poorest.

  8. Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at Work.

    Science.gov (United States)

    Wright, Adam; Bates, David W

    2010-01-01

    BACKGROUND: Many natural phenomena demonstrate power-law distributions, where very common items predominate. Problems, medications and lab results represent some of the most important data elements in medicine, but their overall distribution has not been reported. OBJECTIVE: Our objective is to determine whether problems, medications and lab results demonstrate a power law distribution. METHODS: Retrospective review of electronic medical record data for 100,000 randomly selected patients seen at least twice in 2006 and 2007 at the Brigham and Women's Hospital in Boston and its affiliated medical practices. RESULTS: All three data types exhibited a power law distribution. The 12.5% most frequently used problems account for 80% of all patient problems, the top 11.8% of medications account for 80% of all medication orders and the top 4.5% of lab result types account for all lab results. CONCLUSION: These three data elements exhibited power law distributions with a small number of common items representing a substantial proportion of all orders and observations, which has implications for electronic health record design.

  9. The potential for health risks from intrusion of contaminants into the distribution system from pressure transients.

    Science.gov (United States)

    LeChevallier, Mark W; Gullick, Richard W; Karim, Mohammad R; Friedman, Melinda; Funk, James E

    2003-03-01

    The potential for public health risks associated with intrusion of contaminants into water supply distribution systems resulting from transient low or negative pressures is assessed. It is shown that transient pressure events occur in distribution systems; that during these negative pressure events pipeline leaks provide a potential portal for entry of groundwater into treated drinking water; and that faecal indicators and culturable human viruses are present in the soil and water exterior to the distribution system. To date, all observed negative pressure events have been related to power outages or other pump shutdowns. Although there are insufficient data to indicate whether pressure transients are a substantial source of risk to water quality in the distribution system, mitigation techniques can be implemented, principally the maintenance of an effective disinfectant residual throughout the distribution system, leak control, redesign of air relief venting, and more rigorous application of existing engineering standards. Use of high-speed pressure data loggers and surge modelling may have some merit, but more research is needed.

  10. Enabling Patient Control of Personal Electronic Health Records Through Distributed Ledger Technology.

    Science.gov (United States)

    Cunningham, James; Ainsworth, John

    2017-01-01

    The rise of distributed ledger technology, initiated and exemplified by the Bitcoin blockchain, is having an increasing impact on information technology environments in which there is an emphasis on trust and security. Management of electronic health records, where both conformation to legislative regulations and maintenance of public trust are paramount, is an area where the impact of these new technologies may be particularly beneficial. We present a system that enables fine-grained personalized control of third-party access to patients' electronic health records, allowing individuals to specify when and how their records are accessed for research purposes. The use of the smart contract based Ethereum blockchain technology to implement this system allows it to operate in a verifiably secure, trustless, and openly auditable environment, features crucial to health information systems moving forward.

  11. Shoulder disorders in general practice : Prognostic indicators of outcome

    NARCIS (Netherlands)

    Van Der Windt, Daniëlle A W M; Koes, Bart W.; Boeke, A. Joan P; Devillé, Walter; De Jong, Bareld A.; Bouter, Lex M.

    Background. Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. Aim. To study the course of shoulder disorders in general practice and to determine prognostic indicators of

  12. A framework for quantifying net benefits of alternative prognostic models.

    Science.gov (United States)

    Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

    2012-01-30

    New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd.

  13. A framework for quantifying net benefits of alternative prognostic models‡

    Science.gov (United States)

    Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

    2012-01-01

    New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21905066

  14. Prognostics Applied to Electric Propulsion UAV

    Science.gov (United States)

    Goebel, Kai; Saha, Bhaskar

    2013-01-01

    Health management plays an important role in operations of UAV. If there is equipment malfunction on critical components, safe operation of the UAV might possibly be compromised. A technology with particular promise in this arena is equipment prognostics. This technology provides a state assessment of the health of components of interest and, if a degraded state has been found, it estimates how long it will take before the equipment will reach a failure threshold, conditional on assumptions about future operating conditions and future environmental conditions. This chapter explores the technical underpinnings of how to perform prognostics and shows an implementation on the propulsion of an electric UAV. A particle filter is shown as the method of choice in performing state assessment and predicting future degradation. The method is then applied to the batteries that provide power to the propeller motors. An accurate run-time battery life prediction algorithm is of critical importance to ensure the safe operation of the vehicle if one wants to maximize in-air time. Current reliability based techniques turn out to be insufficient to manage the use of such batteries where loads vary frequently in uncertain environments.

  15. A Prognostic Model to Predict Mortality among Non-Small-Cell Lung Cancer Patients in the U.S. Military Health System.

    Science.gov (United States)

    Lin, Jie; Carter, Corey A; McGlynn, Katherine A; Zahm, Shelia H; Nations, Joel A; Anderson, William F; Shriver, Craig D; Zhu, Kangmin

    2015-12-01

    Accurate prognosis assessment after non-small-cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System. We used the linked database from the Department of Defense's Central Cancer Registry and the Military Health System Data Repository. The data set was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management. The study subjects were 5054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease, and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The area under the receiver operating curves reached 0.841, 0.849, 0.848, and 0.838 during 1, 2, 3, and 5 years, respectively. This is the first NSCLC prognosis model for quick risk assessment within the Military Health System. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients, and researchers.

  16. Real-Time Prognostics of a Rotary Valve Actuator

    Science.gov (United States)

    Daigle, Matthew

    2015-01-01

    Valves are used in many domains and often have system-critical functions. As such, it is important to monitor the health of valves and their actuators and predict remaining useful life. In this work, we develop a model-based prognostics approach for a rotary valve actuator. Due to limited observability of the component with multiple failure modes, a lumped damage approach is proposed for estimation and prediction of damage progression. In order to support the goal of real-time prognostics, an approach to prediction is developed that does not require online simulation to compute remaining life, rather, a function mapping the damage state to remaining useful life is found offline so that predictions can be made quickly online with a single function evaluation. Simulation results demonstrate the overall methodology, validating the lumped damage approach and demonstrating real-time prognostics.

  17. Prognostic criteria of sensitivity to antibiotics of staphylococcus clinical strains

    Directory of Open Access Journals (Sweden)

    Gordiy Paliy

    2015-06-01

    Department of Microbiology, Virology and Immunology, Vinnytsya National Pirogov Memorial Medical University Ministry of Health of Ukraine   Abstract In the article, the new data of sensitivity to antibiotics in clinical strains of Staphylococci are presented. For the first time, analytic dependence of dynamic prognostic criteria of the change of sensitivity of S. aureus clinical strains, isolated from patients, was obtained by means of mathematical prediction. There were investigated prognosticated indexes of Staphylococcus strains’ sensitivity to beta-lactams (oxacillin, ceftriaxone, imipenem and meropenem, vancomycin and linezolid. The dynamic of sensitivity decreasing to oxacillin, ceftriaxone, carbapenems (imipenem, meropenem, vancomycin (92,5 % and high sensitivity to linezolid in clinical strains of S. aureus were found out. Key words: sensitivity, antibiotics, Staphylococcus, prognostic indexes.

  18. Spatial Distribution, Sources Apportionment and Health Risk of Metals in Topsoil in Beijing, China

    Directory of Open Access Journals (Sweden)

    Chunyuan Sun

    2016-07-01

    Full Text Available In order to acquire the pollution feature and regularities of distribution of metals in the topsoil within the sixth ring road in Beijing, a total of 46 soil samples were collected, and the concentrations of twelve elements (Nickel, Ni, Lithium, Li, Vanadium, V, Cobalt, Co, Barium, Ba, Strontium, Sr, Chrome, Cr, Molybdenum, Mo, Copper, Cu, Cadmium, Cd, Zinc, Zn, Lead, Pb were analyzed. Geostatistics and multivariate statistics were conducted to identify spatial distribution characteristics and sources. In addition, the health risk of the analyzed heavy metals to humans (adult was evaluated by an U.S. Environmental Protection Agency health risk assessment model. The results indicate that these metals have notable variation in spatial scale. The concentration of Cr was high in the west and low in the east, while that of Mo was high in the north and low in the south. High concentrations of Cu, Cd, Zn, and Pb were found in the central part of the city. The average enrichment degree of Cd is 5.94, reaching the standard of significant enrichment. The accumulation of Cr, Mo, Cu, Cd, Zn, and Pb is influenced by anthropogenic activity, including vehicle exhaustion, coal burning, and industrial processes. Health risk assessment shows that both non-carcinogenic and carcinogenic risks of selected heavy metals are within the safety standard and the rank of the carcinogenic risk of the four heavy metals is Cr > Co > Ni > Cd.

  19. Spatial Distribution, Sources Apportionment and Health Risk of Metals in Topsoil in Beijing, China.

    Science.gov (United States)

    Sun, Chunyuan; Zhao, Wenji; Zhang, Qianzhong; Yu, Xue; Zheng, Xiaoxia; Zhao, Jiayin; Lv, Ming

    2016-07-20

    In order to acquire the pollution feature and regularities of distribution of metals in the topsoil within the sixth ring road in Beijing, a total of 46 soil samples were collected, and the concentrations of twelve elements (Nickel, Ni, Lithium, Li, Vanadium, V, Cobalt, Co, Barium, Ba, Strontium, Sr, Chrome, Cr, Molybdenum, Mo, Copper, Cu, Cadmium, Cd, Zinc, Zn, Lead, Pb) were analyzed. Geostatistics and multivariate statistics were conducted to identify spatial distribution characteristics and sources. In addition, the health risk of the analyzed heavy metals to humans (adult) was evaluated by an U.S. Environmental Protection Agency health risk assessment model. The results indicate that these metals have notable variation in spatial scale. The concentration of Cr was high in the west and low in the east, while that of Mo was high in the north and low in the south. High concentrations of Cu, Cd, Zn, and Pb were found in the central part of the city. The average enrichment degree of Cd is 5.94, reaching the standard of significant enrichment. The accumulation of Cr, Mo, Cu, Cd, Zn, and Pb is influenced by anthropogenic activity, including vehicle exhaustion, coal burning, and industrial processes. Health risk assessment shows that both non-carcinogenic and carcinogenic risks of selected heavy metals are within the safety standard and the rank of the carcinogenic risk of the four heavy metals is Cr > Co > Ni > Cd.

  20. Distribution of metals and metalloids in dried seaweeds and health risk to population in southeastern China.

    Science.gov (United States)

    Chen, Qing; Pan, Xiao-Dong; Huang, Bai-Fen; Han, Jian-Long

    2018-02-23

    Concern about metals and metalloids, especially heavy metals in seaweeds has risen due to potential health risk. This study investigated the distribution of 10 metals and metalloids in 295 dried seaweeds (brown and red) and estimated the possible health risk via hazard index (HI). Elements in seaweeds can be sequenced in descending order by mean values: Al > Mn > As > Cu > Cr > Ni > Cd > Se > Pb > Hg. The levels of Cd, Cu, Mn and Ni in red seaweeds were significantly higher than those in brown seaweeds (P < 0.01). Correlation analysis showed contents of Ni-Cr (r = 0.59, P < 0.01) in seaweeds had moderate positive correlations. Seaweeds from different geographical origins had diverse element distribution. Risk assessment showed that HI at mean level was less than the threshold of 1. It indicates that for the general people there is low health risk to these elements by the intake of seaweeds. Furthermore, in terms of the confirmative toxicity of some metals, such as Cd, Pb and Hg, surveillance of metals in seaweeds should be performed continuously.

  1. HYGIENIC AND HEALTH QUALITY OF HOT BEVERAGES DISTRIBUTED BY VENDING MACHINES

    Directory of Open Access Journals (Sweden)

    L. Vallone

    2011-08-01

    Full Text Available The food and beverage vending had in the last 40 years a great development in Italy. From the hygienic and health point of view, the quality of the products distributed by Vending is essentially related to three factors: the quality of raw materials, the quality of tap water and the good working order together with the good cleanliness and hygienic status of equipments. In this work we wanted to test these features. We evaluated microbiological and fungal quality of raw materials (powders, of distributed hot beverages and the used equipments. Despite contamination levels shown by the results of this study, the temperature of the boiler is sufficient to make a significant reduction of bacterial and fungal loads. To obtain satisfactory results on the quality of delivered hot beverages is necessary to apply correct maintenance and cleaning/sanitation procedures of equipments, as well as an appropriate selection of suppliers.

  2. Investigating the Effect of Damage Progression Model Choice on Prognostics Performance

    Data.gov (United States)

    National Aeronautics and Space Administration — The success of model-based approaches to systems health management depends largely on the quality of the underly- ing models. In model-based prognostics, it is...

  3. A Modeling Framework for Prognostic Decision Making and its Application to UAV Mission Planning

    Data.gov (United States)

    National Aeronautics and Space Administration — The goal of prognostic decision making (PDM) is to utilize information on anticipated system health changes in selecting future actions. One of the key challenges in...

  4. Prognostic Fault Detection and Isolation for EMA and EPS Systems, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — In response to NASA SBIR topic X1.04, Ridgetop Group will extend and adapt RingDown: an innovative system for the non-invasive prognostic monitoring of the health of...

  5. Implementation of Prognostic Methodologies to Cryogenic Propellant Loading Test-bed

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics methodologies determine the health state of a system and predict the end of life and remaining useful life. This information enables operators to take...

  6. Enhancement of Physics-of-Failure Prognostic Models with System Level Features

    National Research Council Canada - National Science Library

    Kacprzynski, Gregory

    2002-01-01

    .... The novelty in the current prognostic tool development is that predictions are made through the fusion of stochastic physics-of-failure models, relevant system or component level health monitoring...

  7. A Testbed for Implementing Prognostic Methodologies on Cryogenic Propellant Loading Systems

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics technologies determine the health state of a system and predict its remaining useful life. With this information, operators are able to make...

  8. Structural health monitoring of cylindrical bodies under impulsive hydrodynamic loading by distributed FBG strain measurements

    International Nuclear Information System (INIS)

    Fanelli, Pierluigi; Ubertini, Stefano; Biscarini, Chiara; Jannelli, Elio; Ubertini, Filippo

    2017-01-01

    Various mechanical, ocean, aerospace and civil engineering problems involve solid bodies impacting the water surface and often result in complex coupled dynamics, characterized by impulsive loading conditions, high amplitude vibrations and large local deformations. Monitoring in such problems for purposes such as remaining fatigue life estimation and real time damage detection is a technical and scientific challenge of primary concern in this context. Open issues include the need for developing distributed sensing systems able to operate at very high acquisition frequencies, to be utilized to study rapidly varying strain fields, with high resolution and very low noise, while scientific challenges mostly relate to the definition of appropriate signal processing and modeling tools enabling the extraction of useful information from distributed sensing signals. Building on previous work by some of the authors, we propose an enhanced method for real time deformed shape reconstruction using distributed FBG strain measurements in curved bodies subjected to impulsive loading and we establish a new framework for applying this method for structural health monitoring purposes, as the main focus of the work. Experiments are carried out on a cylinder impacting the water at various speeds, proving improved performance in displacement reconstruction of the enhanced method compared to its previous version. A numerical study is then carried out considering the same physical problem with different delamination damages affecting the body. The potential for detecting, localizing and quantifying this damage using the reconstruction algorithm is thoroughly investigated. Overall, the results presented in the paper show the potential of distributed FBG strain measurements for real time structural health monitoring of curved bodies under impulsive hydrodynamic loading, defining damage sensitive features in terms of strain or displacement reconstruction errors at selected locations along

  9. [A prognostic model of a cholera epidemic].

    Science.gov (United States)

    Boev, B V; Bondarenko, V M; Prokop'eva, N V; San Román, R T; Raygoza-Anaya, M; García de Alba, R

    1994-01-01

    A new model for the prognostication of cholera epidemic on the territory of a large city is proposed. This model reflects the characteristic feature of contacting infection by sensitive individuals due to the preservation of Vibrio cholerae in their water habitat. The mathematical model of the epidemic quantitatively reflects the processes of the spread of infection by kinetic equations describing the interaction of the streams of infected persons, the causative agents and susceptible persons. The functions and parameters of the model are linked with the distribution of individuals according to the duration of the incubation period and infectious process, as well as the period of asymptomatic carrier state. The computer realization of the model by means of IBM PC/AT made it possible to study the cholera epidemic which took place in Mexico in 1833. The verified model of the cholera epidemic was used for the prognostication of the possible spread of this infection in Guadalajara, taking into account changes in the epidemiological situation and the size of the population, as well as improvements in sanitary and hygienic conditions, in the city.

  10. Spatial modelling of arsenic distribution and human health effects in Lake Victoria basin, Tanzania

    Science.gov (United States)

    Ijumulana, Julian; Mtalo, Felix; Bhattacharya, Prosun

    2016-04-01

    Increasing incidences of naturally occurring geogenic pollutants in drinking water sources and associated human health risks are the two major challenges requiring detailed knowledge to support decision making process at various levels. The presence, location and extent of environmental contamination is needed towards developing mitigation measures to achieve required standards. In this study we are developing a GIS-based model to detect and predict drinking water pollutants at the identified hotspots and monitor its variation in space. In addition, the mobility of pollutants within the affected region needs to be evaluated using topographic and hydrogeological data. Based on these geospatial data on contaminant distribution, spatial relationship of As and F contamination and reported human health effects such as dental caries, dental fluorosis, skeletal fluorosis and bone crippling, skin and other cancers etc. can be modeled for potential interventions for safe drinking water supplies.

  11. Mapping Power Law Distributions in Digital Health Social Networks: Methods, Interpretations, and Practical Implications.

    Science.gov (United States)

    van Mierlo, Trevor; Hyatt, Douglas; Ching, Andrew T

    2015-06-25

    Social networks are common in digital health. A new stream of research is beginning to investigate the mechanisms of digital health social networks (DHSNs), how they are structured, how they function, and how their growth can be nurtured and managed. DHSNs increase in value when additional content is added, and the structure of networks may resemble the characteristics of power laws. Power laws are contrary to traditional Gaussian averages in that they demonstrate correlated phenomena. The objective of this study is to investigate whether the distribution frequency in four DHSNs can be characterized as following a power law. A second objective is to describe the method used to determine the comparison. Data from four DHSNs—Alcohol Help Center (AHC), Depression Center (DC), Panic Center (PC), and Stop Smoking Center (SSC)—were compared to power law distributions. To assist future researchers and managers, the 5-step methodology used to analyze and compare datasets is described. All four DHSNs were found to have right-skewed distributions, indicating the data were not normally distributed. When power trend lines were added to each frequency distribution, R(2) values indicated that, to a very high degree, the variance in post frequencies can be explained by actor rank (AHC .962, DC .975, PC .969, SSC .95). Spearman correlations provided further indication of the strength and statistical significance of the relationship (AHC .987. DC .967, PC .983, SSC .993, Ppower distributions across multiple DHSNs, each addressing a unique condition. Results indicate that despite vast differences in theme, content, and length of existence, DHSNs follow properties of power laws. The structure of DHSNs is important as it gives insight to researchers and managers into the nature and mechanisms of network functionality. The 5-step process undertaken to compare actor contribution patterns can be replicated in networks that are managed by other organizations, and we conjecture that

  12. Follicular lymphoma international prognostic index

    NARCIS (Netherlands)

    Solal-Céligny, Philippe; Roy, Pascal; Colombat, Philippe; White, Josephine; Armitage, Jim O.; Arranz-Saez, Reyes; Au, Wing Y.; Bellei, Monica; Brice, Pauline; Caballero, Dolores; Coiffier, Bertrand; Conde-Garcia, Eulogio; Doyen, Chantal; Federico, Massimo; Fisher, Richard I.; Garcia-Conde, Javier F.; Guglielmi, Cesare; Hagenbeek, Anton; Haïoun, Corinne; LeBlanc, Michael; Lister, Andrew T.; Lopez-Guillermo, Armando; McLaughlin, Peter; Milpied, Noël; Morel, Pierre; Mounier, Nicolas; Proctor, Stephen J.; Rohatiner, Ama; Smith, Paul; Soubeyran, Pierre; Tilly, Hervé; Vitolo, Umberto; Zinzani, Pier-Luigi; Zucca, Emanuele; Montserrat, Emili

    2004-01-01

    The prognosis of follicular lymphomas (FL) is heterogeneous and numerous treatments may be proposed. A validated prognostic index (PI) would help in evaluating and choosing these treatments. Characteristics at diagnosis were collected from 4167 patients with FL diagnosed between 1985 and 1992.

  13. Prognostic stratification of ulcerated melanoma

    DEFF Research Database (Denmark)

    Bønnelykke-Behrndtz, Marie L; Schmidt, Henrik; Christensen, Ib J

    2014-01-01

    OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We...

  14. Modelling spatial distribution of snails transmitting parasitic worms with importance to human and animal health and analysis of distributional changes in relation to climate

    DEFF Research Database (Denmark)

    Pedersen, Ulrik Bo; Midzi, Nicholas; Mduluza, Takafira

    2014-01-01

    to naturalists but also of importance to human and animal health. The spatial distribution of freshwater snail intermediate hosts involved in the transmission of schistosomiasis, fascioliasis and paramphistomiasis (i.e. Bulinus globosus, Biomphalaria pfeifferi and Lymnaea natalensis) were modelled by the use...

  15. Cytogenetic prognostication within medulloblastoma subgroups.

    Science.gov (United States)

    Shih, David J H; Northcott, Paul A; Remke, Marc; Korshunov, Andrey; Ramaswamy, Vijay; Kool, Marcel; Luu, Betty; Yao, Yuan; Wang, Xin; Dubuc, Adrian M; Garzia, Livia; Peacock, John; Mack, Stephen C; Wu, Xiaochong; Rolider, Adi; Morrissy, A Sorana; Cavalli, Florence M G; Jones, David T W; Zitterbart, Karel; Faria, Claudia C; Schüller, Ulrich; Kren, Leos; Kumabe, Toshihiro; Tominaga, Teiji; Shin Ra, Young; Garami, Miklós; Hauser, Peter; Chan, Jennifer A; Robinson, Shenandoah; Bognár, László; Klekner, Almos; Saad, Ali G; Liau, Linda M; Albrecht, Steffen; Fontebasso, Adam; Cinalli, Giuseppe; De Antonellis, Pasqualino; Zollo, Massimo; Cooper, Michael K; Thompson, Reid C; Bailey, Simon; Lindsey, Janet C; Di Rocco, Concezio; Massimi, Luca; Michiels, Erna M C; Scherer, Stephen W; Phillips, Joanna J; Gupta, Nalin; Fan, Xing; Muraszko, Karin M; Vibhakar, Rajeev; Eberhart, Charles G; Fouladi, Maryam; Lach, Boleslaw; Jung, Shin; Wechsler-Reya, Robert J; Fèvre-Montange, Michelle; Jouvet, Anne; Jabado, Nada; Pollack, Ian F; Weiss, William A; Lee, Ji-Yeoun; Cho, Byung-Kyu; Kim, Seung-Ki; Wang, Kyu-Chang; Leonard, Jeffrey R; Rubin, Joshua B; de Torres, Carmen; Lavarino, Cinzia; Mora, Jaume; Cho, Yoon-Jae; Tabori, Uri; Olson, James M; Gajjar, Amar; Packer, Roger J; Rutkowski, Stefan; Pomeroy, Scott L; French, Pim J; Kloosterhof, Nanne K; Kros, Johan M; Van Meir, Erwin G; Clifford, Steven C; Bourdeaut, Franck; Delattre, Olivier; Doz, François F; Hawkins, Cynthia E; Malkin, David; Grajkowska, Wieslawa A; Perek-Polnik, Marta; Bouffet, Eric; Rutka, James T; Pfister, Stefan M; Taylor, Michael D

    2014-03-20

    Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, Group 3, and Group 4. Current medulloblastoma protocols stratify patients based on clinical features: patient age, metastatic stage, extent of resection, and histologic variant. Stark prognostic and genetic differences among the four subgroups suggest that subgroup-specific molecular biomarkers could improve patient prognostication. Molecular biomarkers were identified from a discovery set of 673 medulloblastomas from 43 cities around the world. Combined risk stratification models were designed based on clinical and cytogenetic biomarkers identified by multivariable Cox proportional hazards analyses. Identified biomarkers were tested using fluorescent in situ hybridization (FISH) on a nonoverlapping medulloblastoma tissue microarray (n = 453), with subsequent validation of the risk stratification models. Subgroup information improves the predictive accuracy of a multivariable survival model compared with clinical biomarkers alone. Most previously published cytogenetic biomarkers are only prognostic within a single medulloblastoma subgroup. Profiling six FISH biomarkers (GLI2, MYC, chromosome 11 [chr11], chr14, 17p, and 17q) on formalin-fixed paraffin-embedded tissues, we can reliably and reproducibly identify very low-risk and very high-risk patients within SHH, Group 3, and Group 4 medulloblastomas. Combining subgroup and cytogenetic biomarkers with established clinical biomarkers substantially improves patient prognostication, even in the context of heterogeneous clinical therapies. The prognostic significance of most molecular biomarkers is restricted to a specific subgroup. We have identified a small panel of cytogenetic biomarkers that reliably identifies very high-risk and very low-risk groups of patients, making it an excellent tool for selecting patients for therapy intensification and therapy de-escalation in future clinical trials.

  16. Stress Prediction for Distributed Structural Health Monitoring Using Existing Measurements and Pattern Recognition.

    Science.gov (United States)

    Lu, Wei; Teng, Jun; Zhou, Qiushi; Peng, Qiexin

    2018-02-01

    The stress in structural steel members is the most useful and directly measurable physical quantity to evaluate the structural safety in structural health monitoring, which is also an important index to evaluate the stress distribution and force condition of structures during structural construction and service phases. Thus, it is common to set stress as a measure in steel structural monitoring. Considering the economy and the importance of the structural members, there are only a limited number of sensors that can be placed, which means that it is impossible to obtain the stresses of all members directly using sensors. This study aims to develop a stress response prediction method for locations where there are insufficent sensors, using measurements from a limited number of sensors and pattern recognition. The detailed improved aspects are: (1) a distributed computing process is proposed, where the same pattern is recognized by several subsets of measurements; and (2) the pattern recognition using the subset of measurements is carried out by considering the optimal number of sensors and number of fusion patterns. The validity and feasibility of the proposed method are verified using two examples: the finite-element simulation of a single-layer shell-like steel structure, and the structural health monitoring of the space steel roof of Shenzhen Bay Stadium; for the latter, the anti-noise performance of this method is verified by the stress measurements from a real-world project.

  17. Development and Validation of a Lifecycle-based Prognostics Architecture with Test Bed Validation

    Energy Technology Data Exchange (ETDEWEB)

    Hines, J. Wesley [Univ. of Tennessee, Knoxville, TN (United States); Upadhyaya, Belle [Univ. of Tennessee, Knoxville, TN (United States); Sharp, Michael [Univ. of Tennessee, Knoxville, TN (United States); Ramuhalli, Pradeep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jeffries, Brien [Univ. of Tennessee, Knoxville, TN (United States); Nam, Alan [Univ. of Tennessee, Knoxville, TN (United States); Strong, Eric [Univ. of Tennessee, Knoxville, TN (United States); Tong, Matthew [Univ. of Tennessee, Knoxville, TN (United States); Welz, Zachary [Univ. of Tennessee, Knoxville, TN (United States); Barbieri, Federico [Univ. of Tennessee, Knoxville, TN (United States); Langford, Seth [Univ. of Tennessee, Knoxville, TN (United States); Meinweiser, Gregory [Univ. of Tennessee, Knoxville, TN (United States); Weeks, Matthew [Univ. of Tennessee, Knoxville, TN (United States)

    2014-11-06

    On-line monitoring and tracking of nuclear plant system and component degradation is being investigated as a method for improving the safety, reliability, and maintainability of aging nuclear power plants. Accurate prediction of the current degradation state of system components and structures is important for accurate estimates of their remaining useful life (RUL). The correct quantification and propagation of both the measurement uncertainty and model uncertainty is necessary for quantifying the uncertainty of the RUL prediction. This research project developed and validated methods to perform RUL estimation throughout the lifecycle of plant components. Prognostic methods should seamlessly operate from beginning of component life (BOL) to end of component life (EOL). We term this "Lifecycle Prognostics." When a component is put into use, the only information available may be past failure times of similar components used in similar conditions, and the predicted failure distribution can be estimated with reliability methods such as Weibull Analysis (Type I Prognostics). As the component operates, it begins to degrade and consume its available life. This life consumption may be a function of system stresses, and the failure distribution should be updated to account for the system operational stress levels (Type II Prognostics). When degradation becomes apparent, this information can be used to again improve the RUL estimate (Type III Prognostics). This research focused on developing prognostics algorithms for the three types of prognostics, developing uncertainty quantification methods for each of the algorithms, and, most importantly, developing a framework using Bayesian methods to transition between prognostic model types and update failure distribution estimates as new information becomes available. The developed methods were then validated on a range of accelerated degradation test beds. The ultimate goal of prognostics is to provide an accurate assessment for

  18. The Social Distribution of Health: Estimating Quality-Adjusted Life Expectancy in England.

    Science.gov (United States)

    Love-Koh, James; Asaria, Miqdad; Cookson, Richard; Griffin, Susan

    2015-07-01

    To model the social distribution of quality-adjusted life expectancy (QALE) in England by combining survey data on health-related quality of life with administrative data on mortality. Health Survey for England data sets for 2010, 2011, and 2012 were pooled (n = 35,062) and used to model health-related quality of life as a function of sex, age, and socioeconomic status (SES). Office for National Statistics mortality rates were used to construct life tables for age-sex-SES groups. These quality-of-life and length-of-life estimates were then combined to predict QALE as a function of these characteristics. Missing data were imputed, and Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was conducted to explore alternative regression models and measures of SES. Socioeconomic inequality in QALE at birth was estimated at 11.87 quality-adjusted life-years (QALYs), with a sex difference of 1 QALY. When the socioeconomic-sex subgroups are ranked by QALE, a differential of 10.97 QALYs is found between the most and least healthy quintile groups. This differential can be broken down into a life expectancy difference of 7.28 years and a quality-of-life adjustment of 3.69 years. The methods proposed in this article refine simple binary quality-adjustment measures such as the widely used disability-free life expectancy, providing a more accurate picture of overall health inequality in society than has hitherto been available. The predictions also lend themselves well to the task of evaluating the health inequality impact of interventions in the context of cost-effectiveness analysis. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

    Science.gov (United States)

    Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

    2017-07-11

    There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

  20. Distribution, sources and health risk assessment of mercury in kindergarten dust

    Science.gov (United States)

    Sun, Guangyi; Li, Zhonggen; Bi, Xiangyang; Chen, Yupeng; Lu, Shuangfang; Yuan, Xin

    2013-07-01

    Mercury (Hg) contamination in urban area is a hot issue in environmental research. In this study, the distribution, sources and health risk of Hg in dust from 69 kindergartens in Wuhan, China, were investigated. In comparison with most other cities, the concentrations of total mercury (THg) and methylmercury (MeHg) were significantly elevated, ranging from 0.15 to 10.59 mg kg-1 and from 0.64 to 3.88 μg kg-1, respectively. Among the five different urban areas, the educational area had the highest concentrations of THg and MeHg. The GIS mapping was used to identify the hot-spot areas and assess the potential pollution sources of Hg. The emissions of coal-power plants and coking plants were the main sources of THg in the dust, whereas the contributions of municipal solid waste (MSW) landfills and iron and steel smelting related industries were not significant. However, the emission of MSW landfills was considered to be an important source of MeHg in the studied area. The result of health risk assessment indicated that there was a high adverse health effect of the kindergarten dust in terms of Hg contamination on the children living in the educational area (Hazard index (HI) = 6.89).

  1. Distribution of Malaria Case in Simpenan Public Health Centre Sukabumi District in 2011

    Directory of Open Access Journals (Sweden)

    Hubullah Fuadzy

    2012-12-01

    Full Text Available The number of malaria in Simpenan public health centre area needs a quick step in the patients finding by malaria microscopic officers, both by Active Case Detection (ACD and Passive Case Detection (PCD. The objective of th is article is to determine the distribution of malaria cases at Simpenan public health centre in Sukabumi during 2011. Data collection was carried out by malaria officersfrom Simpenan public health centre by identifying malaria parasite with microscope to any gold miners who just got home and was having a highfever. Malaria cases during the year 2011 experienced an increasing trend (R2 = 0.0175 from January (8.86% to December (15.18%, 79 cases of malaria was found and the peak of cases happened in December. Malaria was notfound in the age group of 0-14 years, but cases ofmalaria were found in productive age group (15-44 years old = 83%, 45-59 years old = 14%, 2: 60 years old = 3%, and also to all people working as gold miners in malaria-endemic areas i.e. Aceh, Bangka, Jambi, Kalimantan, Medan, Papua, Riau, and Sumbawa. This indicated that malaria in Simpenan was predicted as import cases.

  2. Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa

    Directory of Open Access Journals (Sweden)

    Kiran Sukeri

    2014-11-01

    Full Text Available Background. The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service.  Objective. To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province. Method. In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only. Results. Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations.  Conclusion. Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system.

  3. Optimization of time distribution for studying the course modules on advanced training of health care administrators

    Directory of Open Access Journals (Sweden)

    Dorovskaya A.l.

    2015-06-01

    Full Text Available The research objective is rational (optimal time management in studying the course modules on Advanced Training of Health Care Administrators. Materials and methods. We conducted expert survey of 73 healthcare administrators from medical organizations of Saratov region. Branch-and-bound method was used for rescheduling the educational program. Results. Both direct and inverse problems have been solved. The direct one refers to time distribution for each module of the advanced Training of Healthcare Administrators course so that the total score is maximum and each module is marked not lower than "satisfactory". The inverse one resulted in achieving minimal time characteristics for varieties of average score. Conclusion. The offered approach allows to solve problems of managing time given for education.

  4. Distributed leadership - Strenghtening the condition for continious innovation in primary health organizations

    DEFF Research Database (Denmark)

    Günzel-Jensen, Franziska; Ulhøi, John Parm

    on distributed leadership as a means to influence resource availability, decision making and goal setting in an organizational setting. The overall RQ guiding this research is: how does DL need to be enacted to enable change and continuous innovation in healthcare. We first introduce a theory developing case...... study of four units within a Danish hospital with about 4500 employees. Our findings identify a mix of emergent and contextualized leadership which needs time to be enacted. Furthermore, we find that resource allocation, social capital accumulation, collaborative work culture, and legitimacy building......Public hospitals need to change and innovate to handle the challenges of increasing demands for more, faster, better and cheaper health provision. Practicing leadership does not occur in a sterile context but in a highly contextual and social setting. This in turn invites for focussing...

  5. Prognostic factors in Acanthamoeba keratitis.

    Science.gov (United States)

    Kaiserman, Igor; Bahar, Irit; McAllum, Penny; Srinivasan, Sathish; Elbaz, Uri; Slomovic, Allan R; Rootman, David S

    2012-06-01

    To assess the prognostic factors influencing visual prognosis and length of treatment after acanthamoeba keratitis (AK). Forty-two AK eyes of 41 patients treated between 1999 and 2006 were included. A diagnosis of AK was made on the basis of culture results with a corresponding clinical presentation. We calculated the prognostic effect of the various factors on final visual acuity and the length of treatment. Multivariate regression analysis was used to adjust for the simultaneous effects of the various prognostic factors. Mean follow-up was 19.7 ± 21.0 months. Sixty-four percent of cases had > 1 identified risk factor for AK, the most common risk factor being contact lens wear (92.9% of eyes). At presentation, median best spectacle corrected visual acuity (BCVA) was 20/200 (20/30 to Hand Motion [HM]) that improved after treatment to 20/50 (20/20 to Counting Fingers [CF]). Infection acquired by swimming or related to contact lenses had significantly better final BCVA (p = 0.03 and p = 0.007, respectively). Neuritis and pseudodendrites were also associated with better final BCVA (p = 0.04 and p = 0.05, respectively). Having had an epithelial defect on presentation and having been treated with topical steroid were associated with worse final best spectacle corrected visual acuity (BSCVA) (p = 0.0006 and p = 0.04). Multivariate regression analysis found a good initial visual acuity (p = 0.002), infections related to swimming (p = 0.01), the absence of an epithelial defect (p = 0.03), having been treated with chlorhexidine (p = 0.05), and not having receive steroids (p = 0.003) to significantly forecast a good final BCVA. We identified several prognostic factors that can help clinicians evaluate the expected visual damage of the AK infection and thus tailor treatment accordingly. Copyright © 2012 Canadian Ophthalmological Society. All rights reserved.

  6. Distributed Fiber Optic Sensor for On-Line Monitoring of Coal Gasifier Refractory Health

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Anbo [Center for Photonics Technology, Blacksburgh, VA (United States); Yu, Zhihao [Center for Photonics Technology, Blacksburgh, VA (United States)

    2015-11-30

    This report summarizes technical progress on the program “Distributed Fiber Optic Sensor for On-Line Monitoring of Coal Gasifier Refractory Health,” funded by the National Energy Technology Laboratory of the U.S. Department of Energy, and performed by the Center for Photonics Technology of the Bradley Department of Electrical and Computer Engineering at Virginia Tech. The scope of work entails analyses of traveling grating generation technologies in an optical fiber, as well as the interrogation of the gratings to infer a distributed temperature along the fiber, for the purpose of developing a real-time refractory health condition monitoring technology for coal gasifiers. During the project period, which is from 2011-2015, three different sensing principles were studied, including four-wave mixing (FWM), coherent optical time-domain reflectometer (C-OTDR) and Brillouin optical time-domain analysis (BOTDA). By comparing the three methods, the BOTDA was selected for further development into a complete bench-top sensing system for the proposed high-temperature sensing application. Based on the input from Eastman Chemical, the industrial collaborator on this project, a cylindrical furnace was designed and constructed to simulate typical gasifier refractory temperature conditions in the laboratory, and verify the sensor’s capability to fully monitor refractory conditions on the back-side at temperatures up to 1000°C. In the later stages of the project, the sensing system was tested in the simulated environment for its sensing performance and high-temperature survivability. Through theoretical analyses and experimental research on the different factors affecting the sensor performance, a sensor field deployment strategy was proposed for possible future sensor field implementations.

  7. Distribution of major health risks: findings from the Global Burden of Disease study.

    Directory of Open Access Journals (Sweden)

    Anthony Rodgers

    2004-10-01

    Full Text Available Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness.For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median.Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.

  8. Distributed and grid computing projects with research focus in human health.

    Science.gov (United States)

    Diomidous, Marianna; Zikos, Dimitrios

    2012-01-01

    Distributed systems and grid computing systems are used to connect several computers to obtain a higher level of performance, in order to solve a problem. During the last decade, projects use the World Wide Web to aggregate individuals' CPU power for research purposes. This paper presents the existing active large scale distributed and grid computing projects with research focus in human health. There have been found and presented 11 active projects with more than 2000 Processing Units (PUs) each. The research focus for most of them is molecular biology and, specifically on understanding or predicting protein structure through simulation, comparing proteins, genomic analysis for disease provoking genes and drug design. Though not in all cases explicitly stated, common target diseases include research to find cure against HIV, dengue, Duchene dystrophy, Parkinson's disease, various types of cancer and influenza. Other diseases include malaria, anthrax, Alzheimer's disease. The need for national initiatives and European Collaboration for larger scale projects is stressed, to raise the awareness of citizens to participate in order to create a culture of internet volunteering altruism.

  9. Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium

    Directory of Open Access Journals (Sweden)

    Lorenza Putignani

    2010-01-01

    Full Text Available Cryptosporidium spp. are coccidians, oocysts-forming apicomplexan protozoa, which complete their life cycle both in humans and animals, through zoonotic and anthroponotic transmission, causing cryptosporidiosis. The global burden of this disease is still underascertained, due to a conundrum transmission modality, only partially unveiled, and on a plethora of detection systems still inadequate or only partially applied for worldwide surveillance. In children, cryptosporidiosis encumber is even less recorded and often misidentified due to physiological reasons such as early-age unpaired immunological response. Furthermore, malnutrition in underdeveloped countries or clinical underestimation of protozoan etiology in developed countries contribute to the underestimation of the worldwide burden. Principal key indicators of the parasite distribution were associated to environmental (e.g., geographic and temporal clusters, etc. and host determinants of the infection (e.g., age, immunological status, travels, community behaviours. The distribution was geographically mapped to provide an updated picture of the global parasite ecosystems. The present paper aims to provide, by a critical analysis of existing literature, a link between observational epidemiological records and new insights on public health, and diagnostic and clinical impact of cryptosporidiosis.

  10. Wearable Sensor Localization Considering Mixed Distributed Sources in Health Monitoring Systems.

    Science.gov (United States)

    Wan, Liangtian; Han, Guangjie; Wang, Hao; Shu, Lei; Feng, Nanxing; Peng, Bao

    2016-03-12

    In health monitoring systems, the base station (BS) and the wearable sensors communicate with each other to construct a virtual multiple input and multiple output (VMIMO) system. In real applications, the signal that the BS received is a distributed source because of the scattering, reflection, diffraction and refraction in the propagation path. In this paper, a 2D direction-of-arrival (DOA) estimation algorithm for incoherently-distributed (ID) and coherently-distributed (CD) sources is proposed based on multiple VMIMO systems. ID and CD sources are separated through the second-order blind identification (SOBI) algorithm. The traditional estimating signal parameters via the rotational invariance technique (ESPRIT)-based algorithm is valid only for one-dimensional (1D) DOA estimation for the ID source. By constructing the signal subspace, two rotational invariant relationships are constructed. Then, we extend the ESPRIT to estimate 2D DOAs for ID sources. For DOA estimation of CD sources, two rational invariance relationships are constructed based on the application of generalized steering vectors (GSVs). Then, the ESPRIT-based algorithm is used for estimating the eigenvalues of two rational invariance matrices, which contain the angular parameters. The expressions of azimuth and elevation for ID and CD sources have closed forms, which means that the spectrum peak searching is avoided. Therefore, compared to the traditional 2D DOA estimation algorithms, the proposed algorithm imposes significantly low computational complexity. The intersecting point of two rays, which come from two different directions measured by two uniform rectangle arrays (URA), can be regarded as the location of the biosensor (wearable sensor). Three BSs adopting the smart antenna (SA) technique cooperate with each other to locate the wearable sensors using the angulation positioning method. Simulation results demonstrate the effectiveness of the proposed algorithm.

  11. A Physics-Based Modeling Framework for Prognostic Studies

    Science.gov (United States)

    Kulkarni, Chetan S.

    2014-01-01

    Prognostics and Health Management (PHM) methodologies have emerged as one of the key enablers for achieving efficient system level maintenance as part of a busy operations schedule, and lowering overall life cycle costs. PHM is also emerging as a high-priority issue in critical applications, where the focus is on conducting fundamental research in the field of integrated systems health management. The term diagnostics relates to the ability to detect and isolate faults or failures in a system. Prognostics on the other hand is the process of predicting health condition and remaining useful life based on current state, previous conditions and future operating conditions. PHM methods combine sensing, data collection, interpretation of environmental, operational, and performance related parameters to indicate systems health under its actual application conditions. The development of prognostics methodologies for the electronics field has become more important as more electrical systems are being used to replace traditional systems in several applications in the aeronautics, maritime, and automotive fields. The development of prognostics methods for electronics presents several challenges due to the great variety of components used in a system, a continuous development of new electronics technologies, and a general lack of understanding of how electronics fail. Similarly with electric unmanned aerial vehicles, electrichybrid cars, and commercial passenger aircraft, we are witnessing a drastic increase in the usage of batteries to power vehicles. However, for battery-powered vehicles to operate at maximum efficiency and reliability, it becomes crucial to both monitor battery health and performance and to predict end of discharge (EOD) and end of useful life (EOL) events. We develop an electrochemistry-based model of Li-ion batteries that capture the significant electrochemical processes, are computationally efficient, capture the effects of aging, and are of suitable

  12. Modelling spatial distribution of snails transmitting parasitic worms with importance to human and animal health and analysis of distributional changes in relation to climate

    Directory of Open Access Journals (Sweden)

    Ulrik B. Pedersen

    2014-05-01

    Full Text Available The environment, the on-going global climate change and the ecology of animal species determine the localisation of habitats and the geographical distribution of the various species in nature. The aim of this study was to explore the effects of such changes on snail species not only of interest to naturalists but also of importance to human and animal health. The spatial distribution of freshwater snail intermediate hosts involved in the transmission of schistosomiasis, fascioliasis and paramphistomiasis (i.e. Bulinus globosus, Biomphalaria pfeifferi and Lymnaea natalensis were modelled by the use of a maximum entropy algorithm (Maxent. Two snail observation datasets from Zimbabwe, from 1988 and 2012, were com- pared in terms of geospatial distribution and potential distributional change over this 24-year period investigated. Climate data, from the two years were identified and used in a species distribution modelling framework to produce maps of pre- dicted suitable snail habitats. Having both climate- and snail observation data spaced 24 years in time represent a unique opportunity to evaluate biological response of snails to changes in climate variables. The study shows that snail habitat suit- ability is highly variable in Zimbabwe with foci mainly in the central Highveld but also in areas to the South and West. It is further demonstrated that the spatial distribution of suitable habitats changes with variation in the climatic conditions, and that this parallels that of the predicted climate change.

  13. Health risk assessment of arsenic from blended water in distribution systems.

    Science.gov (United States)

    Zhang, Hui; Zhou, Xue; Wang, Kai; Wang, Wen D

    2017-12-06

    In a water distribution system with different sources, water blending occurs, causing specific variations of the arsenic level. This study was undertaken to investigate the concentration and cancer risk of arsenic in blended water in Xi'an city. A total of 672 tap water samples were collected from eight sampling points in the blending zones for arsenic determination. The risk was evaluated through oral ingestion and dermal absorption, separately for males and females, as well as with respect to seasons and blending zones. Although the arsenic concentrations always fulfilled the requirements of the World Health Organization (WHO) (≤10 μg L -1 ), the total cancer risk value was higher than the general guidance risk value of 1.00 × 10 -6 . In the blending zone of the Qujiang and No.3 WTPs (Z2), the total cancer risk value was over 1.00 × 10 -5 , indicating that public health would be affected to some extent. More than 99% of the total cancer risk was from oral ingestion, and dermal absorption had a little contribution. With higher exposure duration and lower body weight, women had a higher cancer risk. In addition, due to several influential factors, the total cancer risk in the four blending zones reached the maximum in different seasons. The sensitivity analysis by the tornado chart proved that body weight, arsenic concentration and ingestion rate significantly contributed to cancer risk. This study suggests the regular monitoring of water blending zones for improving risk management.

  14. Analysis of blood glucose distribution characteristics in a health examination population in Chengdu (2007-2015).

    Science.gov (United States)

    Huang, Wenxia; Xu, Wangdong; Zhu, Ping; Yang, Hanwei; Su, Linchong; Tang, Huairong; Liu, Yi

    2017-12-01

    With socioeconomic growth and cultural changes in China, the level of blood glucose may have changed in recent years. This study aims to detect the blood glucose distribution characteristics with a large size of health examination population.A total of 641,311 cases (360,259 males and 281,052 females) more than 18 years old during 2007 to 2015 were recruited from the Health Examination Center at West China hospital, Sichuan University.The percentage of cases with abnormal glucose level and the mean level of glucose were significantly increased since 2007 to 2015 overall. The percentage of cases with abnormal glucose level in males was significantly higher than that in females every year, and the percentage of cases with abnormal glucose level in aged population was higher than the young population. In addition, the mean level of glucose was higher in aged population with normal level of glucose than the young population with normal level of glucose, and the mean level of glucose was higher in males with normal level of glucose than the females with normal level of glucose.The population showed an increased level of blood glucose. Some preventive action may be adopted early and more attention can be paid to them.

  15. Pb Distribution in Groundwater and Its Impact to the Health of Indonesia’s Capital Citizen

    Science.gov (United States)

    Zulfaris, D. Y.; Prayogi, T. E.; Alam, B. Y. C. S.; Fadly, M.; Memed, M. W.; Daryanto, A.; Abdillah, F.; Nasution, E. M.; Sudianto, J. R.; Giarto, B.; Maliki, F.; Nuraeni, N.

    2017-03-01

    This study aims to measure the Pb distribution in Jakarta Capital Region’s groundwater and its recommendation based on the standards of The Health Minister Decree No. 492 / MENKES / PES / IV / 2010 about The Drinking Water Monitoring. The study also aims to analyze the impact of Pb intoxication in the human body. The study activity uses the field data that carried out by Geological Agency, Ministry of Energy and Mineral Resources, Indonesia from March to April 2015. The methods used in this study are direct observation and hydrogeological measurement to measure physics and chemistry parameters. The result showed that the Levels of heavy metals Pb (Lead) in the west - southwest of Jakarta Groundwater basin (Ciputat, Pamulang, Ciledug, Kebayoran, Pondok Cina, Pondok Jagung, and Serpong) are beyond the quality standards that has been suggested by the ministry of health. The government set the standard in 0.1 mg/L while these areas have the Pb content of up to 0.654 mg/L. In addition, Pb anomalies also occur in Muara Angke, Kamal Muara, and Kapuk Region of North Jakarta which has a very High level of Pb which is about 1.09 mg / Liter. Pb intoxication in humans can affect the reproductive system, mutagenicity, carcinogenicity, and have bad effects to the nervous system of infants and children.

  16. Spatial Distribution and Fuzzy Health Risk Assessment of Trace Elements in Surface Water from Honghu Lake.

    Science.gov (United States)

    Li, Fei; Qiu, Zhenzhen; Zhang, Jingdong; Liu, Chaoyang; Cai, Ying; Xiao, Minsi

    2017-09-04

    Previous studies revealed that Honghu Lake was polluted by trace elements due to anthropogenic activities. This study investigated the spatial distribution of trace elements in Honghu Lake, and identified the major pollutants and control areas based on the fuzzy health risk assessment at screening level. The mean total content of trace elements in surface water decreased in the order of Zn (18.04 μg/L) > Pb (3.42 μg/L) > Cu (3.09 μg/L) > Cr (1.63 μg/L) > As (0.99 μg/L) > Cd (0.14 μg/L), within limits of Drinking Water Guidelines. The results of fuzzy health risk assessment indicated that there was no obvious non-carcinogenic risk to human health, while carcinogenic risk was observed in descending order of As > Cr > Cd > Pb. As was regarded to have the highest carcinogenic risk among selected trace elements because it generally accounted for 64% of integrated carcinogenic risk. Potential carcinogenic risk of trace elements in each sampling site was approximately at medium risk level (10 -5 to 10 -4 ). The areas in the south (S4, S13, and S16) and northeast (S8, S18, and S19) of Honghu Lake were regarded as the risk priority control areas. However, the corresponding maximum memberships of integrated carcinogenic risk in S1, S3, S10-S13, S15, and S18 were of relatively low credibility (50-60%), and may mislead the decision-makers in identifying the risk priority areas. Results of fuzzy assessment presented the subordinate grade and corresponding reliability of risk, and provided more full-scale results for decision-makers, which made up for the deficiency of certainty assessment to a certain extent.

  17. Generic Software Architecture for Prognostics (GSAP) User Guide

    Science.gov (United States)

    Teubert, Christopher Allen; Daigle, Matthew John; Watkins, Jason; Sankararaman, Shankar; Goebel, Kai

    2016-01-01

    The Generic Software Architecture for Prognostics (GSAP) is a framework for applying prognostics. It makes applying prognostics easier by implementing many of the common elements across prognostic applications. The standard interface enables reuse of prognostic algorithms and models across systems using the GSAP framework.

  18. An Approach to Prognostic Decision Making in the Aerospace Domain

    Science.gov (United States)

    2012-09-01

    prediction of the Remaining Useful Life (RUL) and End of Life ( EOL ) as the goal of prognostics (Daigle & Goebel, 2010; Saxena et al., 2008). We believe...the drive). Either depletion of energy or com- plete component failure signify EOL . The goal of the PDM system is to reassess the original mission plan...either energy depletion or vehicle health deterioration resulted in EOL . PPG was allocated a limited number of utility function calls (UFC) to test

  19. Metrics for Evaluating Performance of Prognostic Techniques

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is an emerging concept in condition basedmaintenance(CBM)ofcriticalsystems.Alongwith developing the fundamentals of being able to confidently predict...

  20. Simulating Degradation Data for Prognostic Algorithm Development

    Data.gov (United States)

    National Aeronautics and Space Administration — PHM08 Challenge Dataset is now publicly available at the NASA Prognostics Respository + Download INTRODUCTION - WHY SIMULATE DEGRADATION DATA? Of various challenges...

  1. Distribution and health risk assessment to heavy metals near smelting and mining areas of Hezhang, China.

    Science.gov (United States)

    Briki, Meryem; Zhu, Yi; Gao, Yang; Shao, Mengmeng; Ding, Huaijian; Ji, Hongbing

    2017-08-19

    Mining and smelting areas in Hezhang have generated a large amount of heavy metals into the environment. For that cause, an evaluative study on human exposure to heavy metals including Co, Ni, Cu, Zn, Cr, As, Cd, Pb, Sb, Bi, Be, and Hg in hair and urine was conducted for their concentrations and correlations. Daily exposure and non-carcinogenic and carcinogenic risk were estimated. Sixty-eight scalp hair and 66 urine samples were taken from participants of different ages (6-17, 18-40, 41-60, and ≥ 65 years) living in the vicinity of an agricultural soil near mine and smelting areas. The results compared to the earlier studies showed an elevated concentration of Pb, Be, Bi, Co, Cr, Ni, Sb, and Zn in hair and urine. These heavy metals were more elevated in mining than in smelting. Considering gender differences, females were likely to be more affected than male. By investigating age differences in this area, high heavy metal concentrations in male's hair and urine existed in age of 18-40 and ≥ 66, respectively. However, females did not present homogeneous age distribution. Hair and urine showed a different distribution of heavy metals in different age and gender. In some cases, significant correlation was found between heavy metals in hair and urine (P > 0.05 and P > 0.01) in mining area. The estimated average daily intake of heavy metals in vegetables showed a great contribution compared to the soil and water. Non-carcinogenic and carcinogenic risk values of total pathways in mining and smelting areas were higher than 1 and exceeded the acceptable levels. Thus, the obtained data might be useful for further studies. They can serve as a basis of comparison and assessing the effect of simultaneous exposure from heavy metals in mining and smelting areas, and potential health risks from exposure to heavy metals in vegetables need more consideration.

  2. Accelerated Aging in Electrolytic Capacitors for Prognostics

    Science.gov (United States)

    Celaya, Jose R.; Kulkarni, Chetan; Saha, Sankalita; Biswas, Gautam; Goebel, Kai Frank

    2012-01-01

    The focus of this work is the analysis of different degradation phenomena based on thermal overstress and electrical overstress accelerated aging systems and the use of accelerated aging techniques for prognostics algorithm development. Results on thermal overstress and electrical overstress experiments are presented. In addition, preliminary results toward the development of physics-based degradation models are presented focusing on the electrolyte evaporation failure mechanism. An empirical degradation model based on percentage capacitance loss under electrical overstress is presented and used in: (i) a Bayesian-based implementation of model-based prognostics using a discrete Kalman filter for health state estimation, and (ii) a dynamic system representation of the degradation model for forecasting and remaining useful life (RUL) estimation. A leave-one-out validation methodology is used to assess the validity of the methodology under the small sample size constrain. The results observed on the RUL estimation are consistent through the validation tests comparing relative accuracy and prediction error. It has been observed that the inaccuracy of the model to represent the change in degradation behavior observed at the end of the test data is consistent throughout the validation tests, indicating the need of a more detailed degradation model or the use of an algorithm that could estimate model parameters on-line. Based on the observed degradation process under different stress intensity with rest periods, the need for more sophisticated degradation models is further supported. The current degradation model does not represent the capacitance recovery over rest periods following an accelerated aging stress period.

  3. [Prognostic scores for pulmonary embolism].

    Science.gov (United States)

    Junod, Alain

    2016-03-23

    Nine prognostic scores for pulmonary embolism (PE), based on retrospective and prospective studies, published between 2000 and 2014, have been analyzed and compared. Most of them aim at identifying PE cases with a low risk to validate their ambulatory care. Important differences in the considered outcomes: global mortality, PE-specific mortality, other complications, sizes of low risk groups, exist between these scores. The most popular score appears to be the PESI and its simplified version. Few good quality studies have tested the applicability of these scores to PE outpatient care, although this approach tends to already generalize in the medical practice.

  4. Bayesian distributed lag interaction models to identify perinatal windows of vulnerability in children's health.

    Science.gov (United States)

    Wilson, Ander; Chiu, Yueh-Hsiu Mathilda; Hsu, Hsiao-Hsien Leon; Wright, Robert O; Wright, Rosalind J; Coull, Brent A

    2017-07-01

    Epidemiological research supports an association between maternal exposure to air pollution during pregnancy and adverse children's health outcomes. Advances in exposure assessment and statistics allow for estimation of both critical windows of vulnerability and exposure effect heterogeneity. Simultaneous estimation of windows of vulnerability and effect heterogeneity can be accomplished by fitting a distributed lag model (DLM) stratified by subgroup. However, this can provide an incomplete picture of how effects vary across subgroups because it does not allow for subgroups to have the same window but different within-window effects or to have different windows but the same within-window effect. Because the timing of some developmental processes are common across subpopulations of infants while for others the timing differs across subgroups, both scenarios are important to consider when evaluating health risks of prenatal exposures. We propose a new approach that partitions the DLM into a constrained functional predictor that estimates windows of vulnerability and a scalar effect representing the within-window effect directly. The proposed method allows for heterogeneity in only the window, only the within-window effect, or both. In a simulation study we show that a model assuming a shared component across groups results in lower bias and mean squared error for the estimated windows and effects when that component is in fact constant across groups. We apply the proposed method to estimate windows of vulnerability in the association between prenatal exposures to fine particulate matter and each of birth weight and asthma incidence, and estimate how these associations vary by sex and maternal obesity status in a Boston-area prospective pre-birth cohort study. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Congener specific distribution and health risk assessment of polychlorinated biphenyls in urban soils

    Directory of Open Access Journals (Sweden)

    Bhupander Kumar

    2012-10-01

    Full Text Available Polychlorinated biphenyls (PCBs were primarily used in transformers and capacitors, lubricants, flame retardants, plasticizers, paint, carbonless papers, etc. These are capable of long-range atmospheric transport and have been designated as persistent organic pollutants by the Stockholm Convention. Due to their characteristic properties, PCBs are found worldwide in all environmental matrices (including human and biota. Soils are usually considered to be the source as well as sink for environmental pollutants, with cumulative effects of long-range atmospheric transport and local sources. Around the world, comparatively higher concentrations of PCBs have been reported in urban soils than suburban or rural soils. Higher amount of PCBs in urban soils may cause toxicological health risks to urban residents through ingestion, inhalation and skin contact. This paper presents the PCB distribution in soils from Delhi, India, and exposure risk estimates for human health through soil ingestion. The concentration of ΣPCBs ranged between 1.08-100.67 ng g–1 (mean 21.16 ng g–1±5.24 ng g–1, which was much lower than the Canadian soil quality guideline value of 1.3 mg/kg or 1300 ng g–1. Human health risk estimates through the soil ingestion pathway were made in terms of lifetime average daily dose (LADD, incremental lifetime cancer risks and non-carcinogenic hazard quotient (HQ. The LADD for Delhi adults and children was 3.02x10–8 mg kg–1 d–1 and 1.57x10–7 mg kg–1 d–1, respectively, which corresponds to toxic equivalent quotients (TEQ intake of 0.105 pg TEQ kg–1 d–1 (0.735 pg TEQ kg–1 week–1 and 0.543 pg TEQ kg–1 d–1 (3.801 pg TEQ kg–1 week–1, respectively. The estimated LADD for Delhi residents was lower than the acceptable

  6. Improving the Distribution of Rural Health Houses Using Elicitation and GIS in Khuzestan Province (the Southwest of Iran).

    Science.gov (United States)

    Mohammadi, Ali; Valinejadi, Ali; Sakipour, Sara; Hemmat, Morteza; Zarei, Javad; Askari Majdabadi, Hesamedin

    2017-08-27

    Rural health houses constitute a major provider of some primary health services in the villages of Iran. Given the challenges of providing health services in rural areas, health houses should be established based on the criteria of health network systems (HNSs). The value of these criteria and their precedence over others have not yet been thoroughly investigated. The present study was conducted to propose a model for improving the distribution of rural health houses in HNSs. The present applied study was conducted in Khuzestan province in the southwest of Iran in 2014-2016. First, the descriptive and spatial data required were collected and entered into ArcGIS after modifications, and the Geodatabase was then created. Based on the criteria of the HNS and according to experts' opinions, the main criteria and the sub-criteria for an optimal site selection were determined. To determine the criteria's coefficient of importance (ie, their weight), the main criteria and the sub-criteria were compared in pairs according to experts' opinions. The results of the pairwise comparisons were entered into Expert Choice and the weight of the main criteria and the sub-criteria were determined using the analytic hierarchy process (AHP). The application layers were then formed in geographic information system (GIS). A model was ultimately proposed in the GIS for the optimal distribution of rural health houses by overlaying the weighting layers and the other layers related to villages and rural health houses. Based on the experts' opinions, six criteria were determined as the main criteria for an optimal site selection for rural health houses, including welfare infrastructures, population, dispersion, accessibility, corresponding routes, distance to the rural health center and the absence of natural barriers to accessibility. Of the main criteria proposed, the highest weight was given to "population" (0.506). The priorities suggested in the proposed model for establishing rural

  7. Analysis of the distributional impact of out-of-pocket health payments: evidence from a public health insurance program for the poor in Mexico.

    Science.gov (United States)

    Garcia-Diaz, Rocio; Sosa-Rubi, Sandra G; Sosa-Rub, Sandra G

    2011-07-01

    Many governments have health programs focused on improving health among the poor and these have an impact on out-of-pocket health payments made by individuals. Therefore, one of the objectives of these programs is to reach the poorest and reduce their out-of-pocket expenditure. In this paper we propose the distributional poverty impact approach to measure the poverty impact of out-of-pocket health payments of different health financing policies. This approach is comparable to the impoverishment methodology proposed by Wagstaff and van Doorslaer (2003) that compares poverty indices before and after out-of-pocket health payments. In order to escape the specification of a particular poverty index, we use the marginal dominance approach that uses non-intersecting curves and can rank poverty reducing health financing policies. We present an empirical application of the out-of-pocket health payments for an innovative social financing policy implemented in Mexico named Seguro Popular. The paper finds evidence that Seguro Popular program has a better distributional poverty impact when families face illness when compared to other poverty reducing policies. The empirical dominance approach uses data from Mexico in 2006 and considers international poverty standards of $2 per person per day. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Grain Size Distribution and Health Risk Assessment of Metals in Outdoor Dust in Chengdu, Southwestern China.

    Science.gov (United States)

    Chen, Mengqin; Pi, Lu; Luo, Yan; Geng, Meng; Hu, Wenli; Li, Zhi; Su, Shijun; Gan, Zhiwei; Ding, Sanglan

    2016-04-01

    A total of 27 outdoor dust samples from roads, parks, and high spots were collected and analyzed to investigate the contamination of 11 metals (Cr, Mn, Co, Ni, Cu, Zn, As, Sr, Cd, Sb, and Pb) in Chengdu, China. The results showed that the samples from the high spots exhibited the highest heavy metal level compared with those from the roads and the parks, except for Ni, Cu, and Pb. The dust was classified into five grain size fractions. The mean loads of each grain size fraction of 11 determined metals displayed similar distribution, and the contribution of median size (63-125, 125-250, 250-500 μm) fractions accounted for more than 70% of overall heavy metal loads. The health risk posed by the determined metals to human via dust ingestion, dermal contact, and inhalation was investigated. Oral and respiratory bioaccessible parts of the metals in dust were extracted using simulated stomach solution and composite lung serum. The mean bioaccessibilities of 11 investigated metals in the gastric solution were much higher than those in the composite lung serum, especially Zn, Cd, and Pb. Ingestion was the most important exposure pathway with percentage greater than 70% for both children and adults. Risk evaluation results illustrated that children in Chengdu might suffer noncarcinogenic risk when exposed to outdoor dust. Given that the cancer risk values of Pb and Cr larger than 1 × 10(-4), potential carcinogenic risk might occur for Chengdu residents through outdoor dust intake.

  9. Hemoglobin E in Northeast India: A review on its origin, distribution, migration and health implication

    Directory of Open Access Journals (Sweden)

    Sikdar Mithun

    2016-09-01

    Full Text Available A systematic review of the studies on hemoglobin E in Northeast India has been carried out to understand the magnitude of research undertaken on this aspect during the last seven decades. Owing to the high prevalence of hemoglobin E in this part of India different authors have studied this hemoglobin from different perspectives and found conflicting results. However a systematic review of such studies is lacking from a holistic point of view. Most of the epidemiological, in vitro as well as in vivo studies show signatures of selection with this hemoglobin locus. However, how this polymorphism is maintained at different rates at different geographical region is still a matter of contention. This review will fill the gap from all perspectives starting from the frequency distribution of hemoglobin E and its spread in different parts of Northeast India, its relationship with malaria hypothesis, the population migration, population affinity and most importantly the health implication arising out of it. A probable origin of hemoglobin E among an Austroasiatic population of Northeast India has been postulated with the help of advance molecular anthropological knowledge like the deep rooted markers of mt DNA and Y-chromosome haplotypes.

  10. A study on the distribution of scatter ray in chest radiography of a health examination bus

    International Nuclear Information System (INIS)

    Cho, Ji Hwan; Jin, Seong Jin; Min, Byeong In

    2017-01-01

    The purpose of this study was to evaluate the distribution of spatial scatter ray on the chest radiographs of patients on health examination bus. In this paper, we propose a method for minimize unnecessary exposure by measuring the scattered dose after exposure the actual subject and comparing the body mass index (BMI) with the tube current amount mAs. The results of this study showed that the mean BMI of the subjects was 23.31±3.12. The mean mAs value was 2.92±1.19, which males was higher than females. The mean value of the scatter ray at position 1 in the radiography room was 771.81±151.15 μ/hr. The mean value of the scatter rays at the position 2 outside the entrance of the radiography room was measured as 53.86±25.66 μ/hr. As the BMI and mAs was increase the spatial scatter dose was increased at position 1 and position 2 in the photographing room. In order to minimize the exposure dose of scatter ray, radiation workers should shoot the radiation as low as possible within the range that does not impair the quality of the image. It will be necessary to make efforts to not wait for a waiting person near the entrance door of the photographing room

  11. Privacy protection in HealthGrid: distributing encryption management over the VO.

    Science.gov (United States)

    Torres, Erik; de Alfonso, Carlos; Blanquer, Ignacio; Hernández, Vicente

    2006-01-01

    Grid technologies have proven to be very successful in tackling challenging problems in which data access and processing is a bottleneck. Notwithstanding the benefits that Grid technologies could have in Health applications, privacy leakages of current DataGrid technologies due to the sharing of data in VOs and the use of remote resources, compromise its widespreading. Privacy control for Grid technology has become a key requirement for the adoption of Grids in the Healthcare sector. Encrypted storage of confidential data effectively reduces the risk of disclosure. A self-enforcing scheme for encrypted data storage can be achieved by combining Grid security systems with distributed key management and classical cryptography techniques. Virtual Organizations, as the main unit of user management in Grid, can provide a way to organize key sharing, access control lists and secure encryption management. This paper provides programming models and discusses the value, costs and behavior of such a system implemented on top of one of the latest Grid middlewares. This work is partially funded by the Spanish Ministry of Science and Technology in the frame of the project Investigación y Desarrollo de Servicios GRID: Aplicación a Modelos Cliente-Servidor, Colaborativos y de Alta Productividad, with reference TIC2003-01318.

  12. Towards the use of radon distribution in schools as a health indicator

    International Nuclear Information System (INIS)

    Milu, C.; Gheorghe, R.; Dumitrescu, A.

    2006-01-01

    A pilot study concerning indoor radon and gamma dose measurements in school and kindergarten was performed in Bucharest metropolitan area, within a bilateral cooperation between the Institute of Public Health, Bucharest, Romania, and Joszef Stefan Institute, Ljubliana, Slovenia. One hundred schools and kindergartens were included in this study. Because the geological structure of Bucharest subsoil is the same for whole selected aria (a loess platform), the school selection criteria were the age of buildings and the type of building materials. Indoor radon concentrations were measured with nuclear track detectors one month, during the winter. The data have presented a lognormal distribution in the range of (43:477). An arithmetic mean of 146 Bq/m 3 and a geometric mean of 128.18 Bq/m 3 were obtained. Concomitant with indoor radon measurements, gamma dose rate measurement carried out, using thermoluminescence dosimeters. The results ranged from 65.51 to 127.45 n Sv/hour, with a mean of 91.1141(SD12.22) n Sv/mouth and a geometric mean of 90.31 n Sv/hour. The obtained results merely show a preliminary picture of indoor radon and gamma levels in schools and kindergarten from Bucharest and as such a good base for a national monitoring program. (authors)

  13. A study on the distribution of scatter ray in chest radiography of a health examination bus

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Ji Hwan [Dept. of Health Care Clinic, Inje University Busan Paik Hospital, Busan (Korea, Republic of); Jin, Seong Jin [Gammaknife center, Inje University Haeundae Paik Hospital, Busan (Korea, Republic of); Min, Byeong In [Dept. of of Nuclear Applied Engineering, Inje University, Incheon (Korea, Republic of)

    2017-09-15

    The purpose of this study was to evaluate the distribution of spatial scatter ray on the chest radiographs of patients on health examination bus. In this paper, we propose a method for minimize unnecessary exposure by measuring the scattered dose after exposure the actual subject and comparing the body mass index (BMI) with the tube current amount mAs. The results of this study showed that the mean BMI of the subjects was 23.31±3.12. The mean mAs value was 2.92±1.19, which males was higher than females. The mean value of the scatter ray at position 1 in the radiography room was 771.81±151.15 μ/hr. The mean value of the scatter rays at the position 2 outside the entrance of the radiography room was measured as 53.86±25.66 μ/hr. As the BMI and mAs was increase the spatial scatter dose was increased at position 1 and position 2 in the photographing room. In order to minimize the exposure dose of scatter ray, radiation workers should shoot the radiation as low as possible within the range that does not impair the quality of the image. It will be necessary to make efforts to not wait for a waiting person near the entrance door of the photographing room.

  14. Testing an empirically derived mental health training model featuring small groups, distributed practice and patient discussion.

    Science.gov (United States)

    Murrihy, Rachael C; Byrne, Mitchell K; Gonsalvez, Craig J

    2009-02-01

    Internationally, family doctors seeking to enhance their skills in evidence-based mental health treatment are attending brief training workshops, despite clear evidence in the literature that short-term, massed formats are not likely to improve skills in this complex area. Reviews of the educational literature suggest that an optimal model of training would incorporate distributed practice techniques; repeated practice over a lengthy time period, small-group interactive learning, mentoring relationships, skills-based training and an ongoing discussion of actual patients. This study investigates the potential role of group-based training incorporating multiple aspects of good pedagogy for training doctors in basic competencies in brief cognitive behaviour therapy (BCBT). Six groups of family doctors (n = 32) completed eight 2-hour sessions of BCBT group training over a 6-month period. A baseline control design was utilised with pre- and post-training measures of doctors' BCBT skills, knowledge and engagement in BCBT treatment. Family doctors' knowledge, skills in and actual use of BCBT with patients improved significantly over the course of training compared with the control period. This research demonstrates preliminary support for the efficacy of an empirically derived group training model for family doctors. Brief CBT group-based training could prove to be an effective and viable model for future doctor training.

  15. Prognostic

    Directory of Open Access Journals (Sweden)

    Kamel Abd Elaziz Mohamed

    2014-10-01

    Conclusion: Our study suggests that lactate clearance could be used as a useful biomarker which is inexpensive and a reliable predictor of patient outcome in critically ill patients admitted to ICU with severe community-acquired pneumonia.

  16. Geographic distribution of need and access to health care in rural population: an ecological study in Iran

    Directory of Open Access Journals (Sweden)

    Najafi Behzad

    2011-09-01

    Full Text Available Abstract Introduction Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009. Methods Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP, crude birth rate (CBR and crude mortality rate (CMR in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR. Results There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared. Conclusion Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

  17. Prognostic radiographic aspects of spondylolisthesis

    International Nuclear Information System (INIS)

    Saraste, H.; Brostroem, L.A.; Aparisi, T.

    1984-01-01

    A series of 202 patients (133 men, 69 women) with lumbar spondylolysis were examined radiographically on two occasions, first at the time of diagnosis and later at a follow-up, after an observation period of 20 years or more. The films frompatients in groups without and with moderate and severe olisthesis were evaluated with respect to variables describing lumbosacral lordosis, wedging of the spondylolytic vertebra, lengths of the transverse processes and iliolumbar ligaments, disk height, progression of slipping, and influence on measured olisthesis of lumbar spine flexion and extension at the radiographic examination. The evaluation was made with special attention to possible signs which could be predictive for the prognosis of vertebral slipping. Progression of slipping did not differ between patients diagnosed as adults or adolescents. Reduction of disk height was correlated to the degree of slipping present at the initial examination and to the progression of olisthesis. Flexion and extension of the lumbar spine did not modify the degree of olisthesis. Data concerning the lengths of the transverse processes and the iliolumbar ligaments, and lumbar lordosis, cannot be used for prognostic purposes. The lumbar index reflecting the degree of wedge deformity of the spondylolytic vertebra was shown to be the only variable of prognostic value for the development of vertebral slipping. (orig.)

  18. Prognostic radiographic aspects of spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Saraste, H; Brostroem, L A; Aparisi, T

    1984-01-01

    A series of 202 patients (133 men, 69 women) with lumbar spondylolysis were examined radiographically on two occasions, first at the time of diagnosis and later at a follow-up, after an observation period of 20 years or more. The films from patients in groups without and with moderate and severe olisthesis were evaluated with respect to variables describing lumbosacral lordosis, wedging of the spondylolytic vertebra, lengths of the transverse processes and iliolumbar ligaments, disk height, progression of slipping, and influence on measured olisthesis of lumbar spine flexion and extension at the radiographic examination. The evaluation was made with special attention to possible signs which could be predictive for the prognosis of vertebral slipping. Progression of slipping did not differ between patients diagnosed as adults or adolescents. Reduction of disk height was correlated to the degree of slipping present at the initial examination and to the progression of olisthesis. Flexion and extension of the lumbar spine did not modify the degree of olisthesis. Data concerning the lengths of the transverse processes and the iliolumbar ligaments, and lumbar lordosis, cannot be used for prognostic purposes. The lumbar index reflecting the degree of wedge deformity of the spondylolytic vertebra was shown to be the only variable of prognostic value for the development of vertebral slipping.

  19. Prognostic factors in Fournier gangrene.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Córdoba, Luis; Devesa, Jose Manuel

    2012-01-01

    Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in antibiotic and surgical treatment. This is a retrospective study of all the patients diagnosed and surgically treated for Fournier gangrene at General University Hospital Ramon y Cajal between 1988 and 2008. Possible prognostic factors that could have any influence on the evolution of Fournier gangrene were analyzed. Seventy patients were analyzed, 62 males (88.6%) and 8 females (11.4%) with a mean age of 57.9 ± 13.5 years. Most frequent clinical manifestations were perineal pain (82.9%) and fever (60%). Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. Medical complications rate was 27.1% and mortality one 22.9%. Ethylism, coexistence of neoplasms, presence of skin necrosis, myonecrosis, abdominal wall affection, number of debrided areas, reoperations, concentration of creatinine in serum>1.4 mg/dL, and hemoglobin <10 g/dL, and platelet count <150 × 10(9)/L in whole blood are associated with higher mortality rates. Identification of prognostic factors may help to determine high-risk patients in order to establish an optimal treatment, according to severity of the infection and general status. Copyright © 2012. Published by Elsevier B.V.

  20. Concordance for prognostic models with competing risks

    DEFF Research Database (Denmark)

    Wolbers, Marcel; Blanche, Paul; Koller, Michael T

    2014-01-01

    The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate i...

  1. Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards.

    Science.gov (United States)

    Saunders, P J; Middleton, J D; Rudge, G

    2017-09-01

    The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  2. Diagnostic Reasoning using Prognostic Information for Unmanned Aerial Systems

    Science.gov (United States)

    Schumann, Johann; Roychoudhury, Indranil; Kulkarni, Chetan

    2015-01-01

    With increasing popularity of unmanned aircraft, continuous monitoring of their systems, software, and health status is becoming more and more important to ensure safe, correct, and efficient operation and fulfillment of missions. The paper presents integration of prognosis models and prognostic information with the R2U2 (REALIZABLE, RESPONSIVE, and UNOBTRUSIVE Unit) monitoring and diagnosis framework. This integration makes available statistically reliable health information predictions of the future at a much earlier time to enable autonomous decision making. The prognostic information can be used in the R2U2 model to improve diagnostic accuracy and enable decisions to be made at the present time to deal with events in the future. This will be an advancement over the current state of the art, where temporal logic observers can only do such valuation at the end of the time interval. Usefulness and effectiveness of this integrated diagnostics and prognostics framework was demonstrated using simulation experiments with the NASA Dragon Eye electric unmanned aircraft.

  3. A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis.

    Science.gov (United States)

    Rovers, John P; Mages, Michelle D

    2017-09-25

    The social determinants of health include the health systems under which people live and utilize health services. One social determinant, for which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications. This is critical for settings with poor access to health care. Rural and remote Australia is one example of a setting where the pharmacy profession, schools of pharmacy, and regulatory agencies require pharmacists to assure medication access. Studies of drug distribution systems in such settings are uncommon. This study describes a model for a drug distribution system in an Aboriginal Health Service in remote Australia. The results may be useful for policy setting, pharmacy system design, health professions education, benchmarking, or quality assurance efforts for health system managers in similarly remote locations. The results also suggest that pharmacists can promote access to medications as a social determinant of health. The primary objective of this study was to propose a model for a drug procurement, storage, and distribution system in a remote region of Australia. The secondary objective was to learn the opinions and experiences of healthcare workers under the model. Qualitative research methods were used. Semi-structured interviews were performed with a convenience sample of 11 individuals employed by an Aboriginal health service. Transcripts were analyzed using Event Structure Analysis (ESA) to develop the model. Transcripts were also analyzed to determine the opinions and experiences of health care workers. The model was comprised of 24 unique steps with seven distinct components: choosing a supplier; creating a list of preferred medications; budgeting and ordering; supply and shipping; receipt and storage in the clinic; prescribing process; dispensing and patient counseling. Interviewees described opportunities for quality improvement in choosing suppliers, legal issues and

  4. Structural health monitoring of an existing PC box girder bridge with distributed HCFRP sensors in a destructive test

    Science.gov (United States)

    Yang, Caiqian; Wu, Zhishen; Zhang, Yufeng

    2008-06-01

    The application of hybrid carbon fiber reinforced polymer (HCFRP) sensors was addressed to monitor the structural health of an existing prestressed concrete (PC) box girder bridge in a destructive test. The novel HCFRP sensors were fabricated with three types of carbon tows in order to realize distributed and broad-based sensing, which is characterized by long-gauge length and low cost. The HCFRP sensors were bonded on the bottom and side surfaces of the existing bridge to monitor its structural health. The gauge lengths of the sensors bonded on the bottom and side surfaces were 1.5 m and 1.0 m, respectively. The HCFRP sensors were distributed on the bridge for two purposes. One was to detect damage and monitor the structural health of the bridge, such as the initiation and propagation of new cracks, strain distribution and yielding of steel reinforcements. The other purpose was to monitor the propagation of existing cracks. The good relationship between the change in electrical resistance and load indicates that the HCFRP sensors can provide actual infrastructures with a distributed damage detection and structural health monitoring system. Corrections were made to this article on 13 May 2008. The corrected electronic version is identical to the print version.

  5. Structural health monitoring of an existing PC box girder bridge with distributed HCFRP sensors in a destructive test

    International Nuclear Information System (INIS)

    Yang Caiqian; Wu Zhishen; Zhang Yufeng

    2008-01-01

    The application of hybrid carbon fiber reinforced polymer (HCFRP) sensors was addressed to monitor the structural health of an existing prestressed concrete (PC) box girder bridge in a destructive test. The novel HCFRP sensors were fabricated with three types of carbon tows in order to realize distributed and broad-based sensing, which is characterized by long-gauge length and low cost. The HCFRP sensors were bonded on the bottom and side surfaces of the existing bridge to monitor its structural health. The gauge lengths of the sensors bonded on the bottom and side surfaces were 1.5 m and 1.0 m, respectively. The HCFRP sensors were distributed on the bridge for two purposes. One was to detect damage and monitor the structural health of the bridge, such as the initiation and propagation of new cracks, strain distribution and yielding of steel reinforcements. The other purpose was to monitor the propagation of existing cracks. The good relationship between the change in electrical resistance and load indicates that the HCFRP sensors can provide actual infrastructures with a distributed damage detection and structural health monitoring system. Corrections were made to this article on 13 May 2008. The corrected electronic version is identical to the print version

  6. Distribution of Effort-Reward Imbalance in Denmark and Its Prospective Association With a Decline in Self-Rated Health

    NARCIS (Netherlands)

    Rugulies, Reiner; Aust, Birgit; Siegrist, Johannes; von dem Knesebeck, Olaf; Bultmann, Ute; Bjorner, Jakob B.; Burr, Hermann

    Objective: To analyze the distribution of effort-reward imbalance (ERI) and to investigate its impact on self-rated health in a representative sample of the Danish workforce. Methods: We studied 4977 employees who responded to a questionnaire in 2000, of which 3470 responded to a follow-up survey in

  7. Exploiting geo-distributed clouds for a e-health monitoring system with minimum service delay and privacy preservation.

    Science.gov (United States)

    Shen, Qinghua; Liang, Xiaohui; Shen, Xuemin; Lin, Xiaodong; Luo, Henry Y

    2014-03-01

    In this paper, we propose an e-health monitoring system with minimum service delay and privacy preservation by exploiting geo-distributed clouds. In the system, the resource allocation scheme enables the distributed cloud servers to cooperatively assign the servers to the requested users under the load balance condition. Thus, the service delay for users is minimized. In addition, a traffic-shaping algorithm is proposed. The traffic-shaping algorithm converts the user health data traffic to the nonhealth data traffic such that the capability of traffic analysis attacks is largely reduced. Through the numerical analysis, we show the efficiency of the proposed traffic-shaping algorithm in terms of service delay and privacy preservation. Furthermore, through the simulations, we demonstrate that the proposed resource allocation scheme significantly reduces the service delay compared to two other alternatives using jointly the short queue and distributed control law.

  8. Physics-of-Failure Approach to Prognostics

    Science.gov (United States)

    Kulkarni, Chetan S.

    2017-01-01

    As more and more electric vehicles emerge in our daily operation progressively, a very critical challenge lies in accurate prediction of the electrical components present in the system. In case of electric vehicles, computing remaining battery charge is safety-critical. In order to tackle and solve the prediction problem, it is essential to have awareness of the current state and health of the system, especially since it is necessary to perform condition-based predictions. To be able to predict the future state of the system, it is also required to possess knowledge of the current and future operations of the vehicle. In this presentation our approach to develop a system level health monitoring safety indicator for different electronic components is presented which runs estimation and prediction algorithms to determine state-of-charge and estimate remaining useful life of respective components. Given models of the current and future system behavior, the general approach of model-based prognostics can be employed as a solution to the prediction problem and further for decision making.

  9. Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

    OpenAIRE

    Chivu, CM; Reidpath, DD

    2010-01-01

    This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright @ 2010 Chivu and Reidpath BACKGROUND: Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign...

  10. A Novel UAV Electric Propulsion Testbed for Diagnostics and Prognostics

    Science.gov (United States)

    Gorospe, George E., Jr.; Kulkarni, Chetan S.

    2017-01-01

    This paper presents a novel hardware-in-the-loop (HIL) testbed for systems level diagnostics and prognostics of an electric propulsion system used in UAVs (unmanned aerial vehicle). Referencing the all electric, Edge 540T aircraft used in science and research by NASA Langley Flight Research Center, the HIL testbed includes an identical propulsion system, consisting of motors, speed controllers and batteries. Isolated under a controlled laboratory environment, the propulsion system has been instrumented for advanced diagnostics and prognostics. To produce flight like loading on the system a slave motor is coupled to the motor under test (MUT) and provides variable mechanical resistance, and the capability of introducing nondestructive mechanical wear-like frictional loads on the system. This testbed enables the verification of mathematical models of each component of the propulsion system, the repeatable generation of flight-like loads on the system for fault analysis, test-to-failure scenarios, and the development of advanced system level diagnostics and prognostics methods. The capabilities of the testbed are extended through the integration of a LabVIEW-based client for the Live Virtual Constructive Distributed Environment (LVCDC) Gateway which enables both the publishing of generated data for remotely located observers and prognosers and the synchronization the testbed propulsion system with vehicles in the air. The developed HIL testbed gives researchers easy access to a scientifically relevant portion of the aircraft without the overhead and dangers encountered during actual flight.

  11. IDH Mutations: Genotype-Phenotype Correlation and Prognostic Impact

    Directory of Open Access Journals (Sweden)

    Xiao-Wei Wang

    2014-01-01

    Full Text Available IDH1/2 mutation is the most frequent genomic alteration found in gliomas, affecting 40% of these tumors and is one of the earliest alterations occurring in gliomagenesis. We investigated a series of 1305 gliomas and showed that IDH mutation is almost constant in 1p19q codeleted tumors. We found that the distribution of IDH1R132H, IDH1nonR132H, and IDH2 mutations differed between astrocytic, mixed, and oligodendroglial tumors, with an overrepresentation of IDH2 mutations in oligodendroglial phenotype and an overrepresentation of IDH1nonR132H in astrocytic tumors. We stratified grade II and grade III gliomas according to the codeletion of 1p19q and IDH mutation to define three distinct prognostic subgroups: 1p19q and IDH mutated, IDH mutated—which contains mostly TP53 mutated tumors, and none of these alterations. We confirmed that IDH mutation with a hazard ratio = 0.358 is an independent prognostic factor of good outcome. These data refine current knowledge on IDH mutation prognostic impact and genotype-phenotype associations.

  12. Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

    Directory of Open Access Journals (Sweden)

    Reidpath Daniel D

    2010-08-01

    Full Text Available Abstract Background Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV, the relationship between area deprivation and exposure was examined. Methods Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. Results It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01. This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications.

  13. Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England.

    Science.gov (United States)

    Chivu, Corina M; Reidpath, Daniel D

    2010-08-10

    Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV), the relationship between area deprivation and exposure was examined. Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to) available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01). This effect was independent of the school size, the type of school, and the geographic region. The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications.

  14. Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling.

    Science.gov (United States)

    Hsiu Chen, Chen; Wen, Fur-Hsing; Hou, Ming-Mo; Hsieh, Chia-Hsun; Chou, Wen-Chi; Chen, Jen-Shi; Chang, Wen-Cheng; Tang, Siew Tzuh

    2017-09-01

    Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients' last 6 months and estimated the time spent in each state. Prognostic awareness was categorized into four states: (a) unknown and not wanting to know, state 1; (b) unknown but wanting to know, state 2; (c) inaccurate awareness, state 3; and (d) accurate awareness, state 4. Transitional probabilities were examined by multistate Markov modeling. Initially, 59.5% of patients had accurate prognostic awareness, whereas the probabilities of being in states 1-3 were 8.1%, 17.4%, and 15.0%, respectively. Patients' prognostic awareness generally remained unchanged (probabilities of remaining in the same state: 45.5%-92.9%). If prognostic awareness changed, it tended to shift toward higher prognostic-awareness states (probabilities of shifting to state 4 were 23.2%-36.6% for patients initially in states 1-3, followed by probabilities of shifting to state 3 for those in states 1 and 2 [9.8%-10.1%]). Patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in states 1-4, respectively, in their last 6 months. Terminally ill cancer patients' prognostic awareness generally remained unchanged, with a tendency to become more aware of their prognosis. Health care professionals should facilitate patients' transitions toward accurate prognostic awareness in a timely manner to promote preference-based EOL decisions. Terminally ill Taiwanese cancer patients' prognostic awareness generally remained stable, with a tendency toward developing

  15. Survey on current practices for neurological prognostication after cardiac arrest.

    Science.gov (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro

    2015-05-01

    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Estrogenic activity, chemical levels and health risk assessment of municipal distribution point water from Pretoria and Cape Town, South Africa.

    Science.gov (United States)

    Van Zijl, Magdalena Catherina; Aneck-Hahn, Natalie Hildegard; Swart, Pieter; Hayward, Stefan; Genthe, Bettina; De Jager, Christiaan

    2017-11-01

    Endocrine disrupting chemicals (EDCs) are ubiquitous in the environment and have been detected in drinking water from various countries. Although various water treatment processes can remove EDCs, chemicals can also migrate from pipes that transport water and contaminate drinking water. This study investigated the estrogenic activity in drinking water from various distribution points in Pretoria (City of Tshwane) (n = 40) and Cape Town (n = 40), South Africa, using the recombinant yeast estrogen screen (YES) and the T47D-KBluc reporter gene assay. The samples were collected seasonally over four sampling periods. The samples were also analysed for bisphenol A (BPA), nonylphenol (NP), di(2-ethylhexyl) adipate (DEHA), dibutyl phthalate (DBP), di(2-ethylhexyl) phthalate (DEHP), diisononylphthalate (DINP), 17β-estradiol (E 2 ), estrone (E 1 ) and ethynylestradiol (EE 2 ) using ultra-performance liquid chromatography-tandem mass spectrophotometry (UPLC-MS/MS). This was followed by a scenario based health risk assessment to assess the carcinogenic and toxic human health risks associated with the consumption of distribution point water. None of the water extracts from the distribution points were above the detection limit in the YES bioassay, but the EEq values ranged from 0.002 to 0.114 ng/L using the T47D-KBluc bioassay. BPA, DEHA, DBP, DEHP, DINP E 1 , E 2, and EE 2 were detected in distribution point water samples. NP was below the detection limit for all the samples. The estrogenic activity and levels of target chemicals were comparable to the levels found in other countries. Overall the health risk assessment revealed acceptable health and carcinogenic risks associated with the consumption of distribution point water. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Accounting for parameter uncertainty in the definition of parametric distributions used to describe individual patient variation in health economic models

    Directory of Open Access Journals (Sweden)

    Koen Degeling

    2017-12-01

    Full Text Available Abstract Background Parametric distributions based on individual patient data can be used to represent both stochastic and parameter uncertainty. Although general guidance is available on how parameter uncertainty should be accounted for in probabilistic sensitivity analysis, there is no comprehensive guidance on reflecting parameter uncertainty in the (correlated parameters of distributions used to represent stochastic uncertainty in patient-level models. This study aims to provide this guidance by proposing appropriate methods and illustrating the impact of this uncertainty on modeling outcomes. Methods Two approaches, 1 using non-parametric bootstrapping and 2 using multivariate Normal distributions, were applied in a simulation and case study. The approaches were compared based on point-estimates and distributions of time-to-event and health economic outcomes. To assess sample size impact on the uncertainty in these outcomes, sample size was varied in the simulation study and subgroup analyses were performed for the case-study. Results Accounting for parameter uncertainty in distributions that reflect stochastic uncertainty substantially increased the uncertainty surrounding health economic outcomes, illustrated by larger confidence ellipses surrounding the cost-effectiveness point-estimates and different cost-effectiveness acceptability curves. Although both approaches performed similar for larger sample sizes (i.e. n = 500, the second approach was more sensitive to extreme values for small sample sizes (i.e. n = 25, yielding infeasible modeling outcomes. Conclusions Modelers should be aware that parameter uncertainty in distributions used to describe stochastic uncertainty needs to be reflected in probabilistic sensitivity analysis, as it could substantially impact the total amount of uncertainty surrounding health economic outcomes. If feasible, the bootstrap approach is recommended to account for this uncertainty.

  18. Accounting for parameter uncertainty in the definition of parametric distributions used to describe individual patient variation in health economic models.

    Science.gov (United States)

    Degeling, Koen; IJzerman, Maarten J; Koopman, Miriam; Koffijberg, Hendrik

    2017-12-15

    Parametric distributions based on individual patient data can be used to represent both stochastic and parameter uncertainty. Although general guidance is available on how parameter uncertainty should be accounted for in probabilistic sensitivity analysis, there is no comprehensive guidance on reflecting parameter uncertainty in the (correlated) parameters of distributions used to represent stochastic uncertainty in patient-level models. This study aims to provide this guidance by proposing appropriate methods and illustrating the impact of this uncertainty on modeling outcomes. Two approaches, 1) using non-parametric bootstrapping and 2) using multivariate Normal distributions, were applied in a simulation and case study. The approaches were compared based on point-estimates and distributions of time-to-event and health economic outcomes. To assess sample size impact on the uncertainty in these outcomes, sample size was varied in the simulation study and subgroup analyses were performed for the case-study. Accounting for parameter uncertainty in distributions that reflect stochastic uncertainty substantially increased the uncertainty surrounding health economic outcomes, illustrated by larger confidence ellipses surrounding the cost-effectiveness point-estimates and different cost-effectiveness acceptability curves. Although both approaches performed similar for larger sample sizes (i.e. n = 500), the second approach was more sensitive to extreme values for small sample sizes (i.e. n = 25), yielding infeasible modeling outcomes. Modelers should be aware that parameter uncertainty in distributions used to describe stochastic uncertainty needs to be reflected in probabilistic sensitivity analysis, as it could substantially impact the total amount of uncertainty surrounding health economic outcomes. If feasible, the bootstrap approach is recommended to account for this uncertainty.

  19. Intracellular pH distribution as a cell health indicator in Saccharomyces cerevisiae

    DEFF Research Database (Denmark)

    Aabo, Thomas; Glückstad, Jesper; Siegumfeldt, Henrik

    2011-01-01

    .d.(pHint)) to describe the internal pH distributions. The cellular pH distributional response to external stress such as heat has not previously been determined. In this study, the intracellular pH (pHi) and the s.d.(pHint) of Saccharomyces cerevisiae cells exposed to supralethal temperatures were measured using...

  20. Relationship between Trust, Distributed Leadership and Job Performance in Health Care Context

    DEFF Research Database (Denmark)

    Jain, Ajay K.; Günzel-Jensen, Franziska

    2014-01-01

    satisfaction mediates the relationship between vertical trust and distributed leadership, and further distributed leadership had a positive impact on job performance. Furthermore, the results also showed that job satisfaction had a positively significant impact on distributed leadership and employees......´ performance. Moreover, distributed leadership has affected employees´ performance positively and it carries the impact of job satisfaction on performance. Implications: The study showed that trust and job satisfaction are important triggers of DL. Furthermore, results are also interesting because literature......Purpose: This study aims at investigating the effect of vertical trust on distributed leadership and performance as mediated by job satisfaction, and further to see the role of DL in carrying out the effect of satisfaction on employees´ performance. Design: Grounded in literature on organizational...

  1. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients

    International Nuclear Information System (INIS)

    Lagerwaard, Frank J.; Levendag, Peter C.; Nowak, Peter J.C.M.; Eijkenboom, Wilhelmina M.H.; Hanssens, Patrick E.J.; Schmitz, Paul I.M.

    1999-01-01

    Purpose: Prognostic factors in 1292 patients with brain metastases, treated in a single institution were identified in order to determine subgroups of patients suitable for selection in future trials. Materials and Methods: From January 1981 through December 1990, 1292 patients with CT-diagnosed brain metastases were referred to the Department of Radiation Oncology, Daniel den Hoed Cancer Center, Rotterdam. The majority of patients were treated with whole brain radiotherapy (84%), the remainder were treated with steroids only or surgery and radiotherapy. Information on potential prognostic factors (age, sex, performance status, number and distribution of brain metastases, site of primary tumor, histology, interval between primary tumor and brain metastases, systemic tumor activity, serum lactate dehydrogenase, response to steroid treatment, and treatment modality) was collected. Univariate and multivariate analyses were performed to determine significant prognostic factors. Results were compared with literature findings using a review of prognostic factors in 18 published reports. Results: Overall median survival was 3.4 months, with 6-month, 1-year, and 2-year survival percentages of 36%, 12%, and 4% respectively. Survival was statistically significantly different between treatment modalities, with median survival of 1.3 months in patients treated with steroids only, 3.6 months in patients treated with radiotherapy, and 8.9 months in patients treated with neurosurgery followed by radiotherapy (p < 0.0001). Multivariate analysis confirmed literature findings of the major prognostic value of treatment modality on survival of patients with brain metastases. Performance status, response to steroid treatment, systemic tumor activity, and serum lactate dehydrogenase were independent prognostic factors with the strongest impact on survival, second only to treatment modality. Site of primary tumor, age, and number of brain metastases were also identified as prognostic

  2. A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification

    DEFF Research Database (Denmark)

    Gang, Anne O.; Pedersen, Michael; d'Amore, Francesco

    2015-01-01

    The introduction of rituximab and generally improved health among elderly patients have increased the survival of patients with diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) from 1992 is based on pre-rituximab data from clinical trials including several lymphoma ...... dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients 1 extranodal lesion, however excluding stage....... subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal...... lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate...

  3. Metrics for Evaluating Performance of Prognostics Techniques

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is an emerging concept in condition based maintenance (CBM) of critical systems. Along with developing the fundamentals of being able to confidently...

  4. Evaluating Algorithm Performance Metrics Tailored for Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics has taken center stage in Condition Based Maintenance (CBM) where it is desired to estimate Remaining Useful Life (RUL) of a system so that remedial...

  5. Model-based Prognostics under Limited Sensing

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is crucial to providing reliable condition-based maintenance decisions. To obtain accurate predictions of component life, a variety of sensors are often...

  6. Prognostic Factors for Refractory Status Epilepticus

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2013-03-01

    Full Text Available Researchers at the Mayo Clinic, Rochester, MN studied the outcome and identified prognostic factors for refractory status epilepticus (RSE in 54 adult patients, median age 52 years [range 18-93].

  7. Examining levels, distribution and correlates of health insurance coverage in Kenya.

    Science.gov (United States)

    Kazungu, Jacob S; Barasa, Edwine W

    2017-09-01

    To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. We analysed secondary data from the Kenya Demographic and Health Survey (KDHS) conducted in 2009 and 2014. We examined the level of health insurance coverage overall, and by type, using an asset index to categorise households into five socio-economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being the poorest. The high-low ratio (Q5/Q1 ratio), concentration curve and concentration index (CIX) were employed to assess inequalities in health insurance coverage, and logistic regression to examine correlates of health insurance coverage. Overall health insurance coverage increased from 8.17% to 19.59% between 2009 and 2014. There was high inequality in overall health insurance coverage, even though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95% CI 0.52-0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45-0.52). Individuals that were older, employed in the formal sector; married, exposed to media; and male, belonged to a small household, had a chronic disease and belonged to rich households, had increased odds of health insurance coverage. Health insurance coverage in Kenya remains low and is characterised by significant inequality. In a context where over 80% of the population is in the informal sector, and close to 50% live below the national poverty line, achieving high and equitable coverage levels with contributory and voluntary health insurance mechanism is problematic. Kenya should consider a universal, tax-funded mechanism that ensures revenues are equitably and efficiently collected, and everyone (including the poor and those in the informal sector) is covered. © 2017 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

  8. Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon.

    Science.gov (United States)

    Robyn, Paul Jacob; Shroff, Zubin; Zang, Omer Ramses; Kingue, Samuel; Djienouassi, Sebastien; Kouontchou, Christian; Sorgho, Gaston

    2015-03-01

    Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, Pimpact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policy-makers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

  9. Uncertainty Management for Diagnostics and Prognostics of Batteries using Bayesian Techniques

    Science.gov (United States)

    Saha, Bhaskar; Goebel, kai

    2007-01-01

    Uncertainty management has always been the key hurdle faced by diagnostics and prognostics algorithms. A Bayesian treatment of this problem provides an elegant and theoretically sound approach to the modern Condition- Based Maintenance (CBM)/Prognostic Health Management (PHM) paradigm. The application of the Bayesian techniques to regression and classification in the form of Relevance Vector Machine (RVM), and to state estimation as in Particle Filters (PF), provides a powerful tool to integrate the diagnosis and prognosis of battery health. The RVM, which is a Bayesian treatment of the Support Vector Machine (SVM), is used for model identification, while the PF framework uses the learnt model, statistical estimates of noise and anticipated operational conditions to provide estimates of remaining useful life (RUL) in the form of a probability density function (PDF). This type of prognostics generates a significant value addition to the management of any operation involving electrical systems.

  10. Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective?

    Science.gov (United States)

    Li, Dan; Zhou, Zhongliang; Si, Yafei; Xu, Yongjian; Shen, Chi; Wang, Yiyang; Wang, Xiao

    2018-02-27

    The inequality of health human resource is a worldwide problem, and solving it also is one of the major goals of China's recent health system reform. Yet there is a huge disparity among cities in mainland China. The aim of this study is to analyze the distribution inequality of the health human resource in 322 prefecture-level cities of mainland China in 2014, and to reveal the facets and causes of the inequalities. The data for this study were acquired from the provincial and municipal Health Statistics Yearbook (2014) and Statistical Yearbook (2014), the municipal National Economic Bulletin (2014), and the official websites of municipal governments, involving 322 prefecture-level cities. Meanwhile, Concentration Index was used to measure the magnitude of the unequal distribution of health human resource. A decomposition analysis was employed to quantify the contribution of each determinant to the total inequality. The overall concentration index of doctors and nurses in mainland China in 2014 was 0.1038 (95% CI = 0.0208, 0.1865) and 0.0785 (95% CI =0.0018, 0.1561). Decomposition of the concentration index revealed that economic status was the primary contributor (58.5% and 57%) to the inequality of doctors and nurses, followed by the Southwest China (19.1% and 18.6%), urbanization level (- 13.1% and - 12.8%), and revenue (8.0% and 7.8%). Party secretaries with Master degree (7.0%, 6.8%), mayors who were 60 years old or above (6.3%, 6.1%) also were proved to be a major contributor to the inequality of health human resource. There was inequality of health human resource distribution which was pro-rich in mainland China in 2014. Economic status of the cities accounted for most of the existing inequality, followed by the Southwest China, urbanization level, revenue, party secretaries with Master degree, and mayors who were 60 years old or above in respective importance. Besides, the party secretaries and mayors also had certain influence on the allocation

  11. Possible health effects of liquefied petroleum gas on workers at filling and distribution stations of Gaza governorates.

    Science.gov (United States)

    Sirdah, M M; Al Laham, N A; El Madhoun, R A

    2013-03-01

    Liquefied petroleum gas (LPG) is widely used in the Gaza Strip for domestic purposes, in agriculture and industry and, illegally, in cars. This study aimed to identify possible health effects on workers exposed to LPG in Gaza governorates. Data were collected by a questionnaire interview, and haematological and biochemical analyses of venous blood samples were made from 30 workers at filling and distribution stations and 30 apparently healthy controls. Statistically significant differences were found in all self-reported health-related complaints among LPG workers versus controls. LPG workers had significantly higher values of red blood cell counts, haemoglobin, haematocrit mean corpuscular haemoglobin and platelet counts. They also had significantly higher values of kidney function tests (urea, creatinine and uric acid) and liver function enzyme activities (aspartate aminotransferase and alanine aminotransferase). LPG workers at Gaza Strip petroleum stations are at higher risk for health-related symptoms and clinical abnormalities.

  12. Specialty pharmacies and other restricted drug distribution systems: financial and safety considerations for patients and health-system pharmacists.

    Science.gov (United States)

    Kirschenbaum, Bonnie E

    2009-12-15

    To discuss the role of restricted drug distribution systems in the implementation of risk evaluation and mitigation strategies (REMS), health-system pharmacists' concerns associated with the use of specialty pharmacies and other restricted drug distribution systems, reimbursement policies for high-cost specialty drugs, supply chain models for traditional and specialty drugs, and emerging trends in the management of and reimbursement for specialty pharmaceuticals. Restricted drug distribution systems established by pharmaceutical manufacturers, specialty pharmacies, or other specialty suppliers may be a component of REMS, which are required by the Food and Drug Administration for the management of known or potential serious risks from certain drugs. Concerns of health-system pharmacists using specialty suppliers include access to pharmaceuticals, operational challenges, product integrity, financial implications, continuity of care, and patient safety. An ambulatory care patient taking a specialty drug product from home to a hospital outpatient clinic or inpatient setting for administration, a practice known as "brown bagging," raises concerns about product integrity and institutional liability. An institution's finances, tolerance for liability, and ability to skillfully manage the processes involved often determine its choice between an approach that prohibits brown bagging but is costly and one that permits the practice under certain conditions and is less costly. The recent shift from a traditional supply chain model to a specialty pharmacy supply chain model for high-cost pharmaceuticals has the potential to increase pharmaceutical costs for health systems. A dialogue is needed between health-system pharmacists and group purchasing organizations to address the latter's role in mitigating the financial implications of this change and to help clarify the safety issues. Some health plans have shifted part of the cost of expensive drugs to patients by establishing a

  13. Distribution of physical therapists working on public and private establishments in different levels of complexity of health care in Brazil.

    Science.gov (United States)

    Costa, Larissa R; Costa, José L R; Oishi, Jorge; Driusso, Patricia

    2012-01-01

    The Brazilian Health System is organized on a regional and hierarchical form with three levels of complexity of health care. The Primary Care represents the first element of a continuing health care process, complemented by specialized actions. However, the centrality of the specialized care is still a problem in Brazil, especially in the private sector. Studies on the distribution of professionals in the health system allowing the formulation of appropriate policies are needed. To investigate the distribution of physical therapists in the levels of complexity of health care and between public and private establishments, according to data from the National Register of Health Service Providers (NRHSP). A descriptive cross-sectional study was performed considering NRHSP-national bank data collected in March 2010 and demographic census 2010 data. Data were analyzed through descriptive statistics techniques. We identified 53,181 registries of physical therapists, 60% linked to the private sector. Only 13% of all entries were linked to primary care. The predominance in specialized care occurred in the public sector (65%) and private sector (100%). The specialized establishments of private sector linked to the southeast region (16,043) were the main sites of physical therapists. Only the public sector in the south had a majority in the Primary Care. When considering the sizes of the cities, there is focus on specialist care in bigger cities. This study identified the concentration of physical therapists in the specialized care, mostly in metropolis and big cities and in the private sector, with restricted to participation in the primary care.

  14. Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

    Directory of Open Access Journals (Sweden)

    Paul Jacob Robyn

    2015-03-01

    Full Text Available Background Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. Methods To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Results Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, P< 0.001 and improved health facility infrastructure (aOR= 3.54, 95% CI: 2.73-4.58 respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR= 5.60, 95% CI: 4.12-7.61, P< 0.001; nurse aides aOR= 4.29, 95% CI: 3.11-5.93, P< 0.001. On the other hand, improved health facility infrastructure (aOR= 3.56, 95% CI: 2.75-4.60, P< 0.001, was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Conclusion Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on

  15. [Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)].

    Science.gov (United States)

    Benach, Joan; Julià, Mireia; Tarafa, Gemma; Mir, Jordi; Molinero, Emilia; Vives, Alejandra

    2015-01-01

    To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale. A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender. The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health. Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Measuring the Distributional Impact of Public Health Spending on Poverty in Nigeria

    Directory of Open Access Journals (Sweden)

    Olawale Ibrahim Olateju

    2009-05-01

    Full Text Available Most African health systems are replicas of what was inherited from the colonial era and are therefore unevenly weighted toward privileged elites and Urban centers. Improved health status leads to increased productivity, educational performance, higher life expectancy, savings and investments, and decreased debts and expenditure on health care. Ultimately this would lead to greater equity, economic return, and social and political stability. The health impacts of climate change can occur through a number of direct and indirect causal pathways, and the severity is in part determined by the adaptive capacity of the population. Those groups particularly at risk include poorer countries and communities, those geographically vulnerable to extreme weather events, and those highly dependent on agriculture for their livelihood.The paper examines the impact of public health expenditure, and poverty among the general populace. The trend of the country human development index and public expenditure on health were analyzed using correlation coefficient and regression analysis and simple descriptive analysis. The findings reveal that the variations in the human development index could be traced to the budget estimates

  17. Embedded and Distributed Machine Learning for Prognostics Monitoring

    Data.gov (United States)

    National Aeronautics and Space Administration — Scheduled maintenance is inefficient and costly with no ability to take into account actual hardware degradation. The goal of this project is to develop a generic...

  18. Secure and scalable deduplication of horizontally partitioned health data for privacy-preserving distributed statistical computation.

    Science.gov (United States)

    Yigzaw, Kassaye Yitbarek; Michalas, Antonis; Bellika, Johan Gustav

    2017-01-03

    Techniques have been developed to compute statistics on distributed datasets without revealing private information except the statistical results. However, duplicate records in a distributed dataset may lead to incorrect statistical results. Therefore, to increase the accuracy of the statistical analysis of a distributed dataset, secure deduplication is an important preprocessing step. We designed a secure protocol for the deduplication of horizontally partitioned datasets with deterministic record linkage algorithms. We provided a formal security analysis of the protocol in the presence of semi-honest adversaries. The protocol was implemented and deployed across three microbiology laboratories located in Norway, and we ran experiments on the datasets in which the number of records for each laboratory varied. Experiments were also performed on simulated microbiology datasets and data custodians connected through a local area network. The security analysis demonstrated that the protocol protects the privacy of individuals and data custodians under a semi-honest adversarial model. More precisely, the protocol remains secure with the collusion of up to N - 2 corrupt data custodians. The total runtime for the protocol scales linearly with the addition of data custodians and records. One million simulated records distributed across 20 data custodians were deduplicated within 45 s. The experimental results showed that the protocol is more efficient and scalable than previous protocols for the same problem. The proposed deduplication protocol is efficient and scalable for practical uses while protecting the privacy of patients and data custodians.

  19. Distribution and determinants of health and work status in a comprehensive population of injury patients

    NARCIS (Netherlands)

    Meerding, Willem Jan; Looman, Caspar W. N.; Essink-Bot, Marie-Louise; Toet, Hidde; Mulder, Saakje; van Beeck, Ed F.

    2004-01-01

    BACKGROUND: Insight into the distribution and determinants of both short- and long-term disability can be used to prioritize the development of prevention policies and to improve trauma care. We report on a large follow-up study in a comprehensive population of injury patients. METHODS: We fielded a

  20. Anopheles plumbeus (Diptera: Culicidae) in Germany: updated geographic distribution and public health impact of a nuisance and vector mosquito.

    Science.gov (United States)

    Heym, Eva C; Kampen, Helge; Fahle, Marcus; Hohenbrink, Tobias L; Schäfer, Mandy; Scheuch, Dorothee E; Walther, Doreen

    2017-01-01

    The aim of this study was to map the current spatial distribution of Anopheles plumbeus in Germany, a potential vector of malaria parasites and West Nile virus. Reports of mass occurrence and nuisance connected with artificial breeding site usage by this species were analysed. Distribution data were collected from 2011 to 2014 mainly through trapping and submissions of adult mosquito specimens to a citizen science project. In the framework of the latter, additional information was gathered on recent nuisance incidents caused by An. plumbeus, including a longitudinal analysis of mosquito occurrence and the impact of management measures at a nuisance site in south-western Germany. Based on the most comprehensive set of collection data obtained during the last decades, An. plumbeus is shown to be widely distributed over Germany. The data also indicate a continuing extension of the breeding site repertoire of the species from natural to artificial habitats that facilitate mass development. Increasing incidents of persistent nuisance suggest that this mosquito species is rarely diagnosed correctly and managed adequately. As An. plumbeus is both a serious nuisance pest and a potential vector species, awareness of this species and the public health problems linked to it should be raised among pest managers and public health personnel. © 2016 John Wiley & Sons Ltd.

  1. An Optimization Method for Condition Based Maintenance of Aircraft Fleet Considering Prognostics Uncertainty

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    Qiang Feng

    2014-01-01

    Full Text Available An optimization method for condition based maintenance (CBM of aircraft fleet considering prognostics uncertainty is proposed. The CBM and dispatch process of aircraft fleet is analyzed first, and the alternative strategy sets for single aircraft are given. Then, the optimization problem of fleet CBM with lower maintenance cost and dispatch risk is translated to the combinatorial optimization problem of single aircraft strategy. Remain useful life (RUL distribution of the key line replaceable Module (LRM has been transformed into the failure probability of the aircraft and the fleet health status matrix is established. And the calculation method of the costs and risks for mission based on health status matrix and maintenance matrix is given. Further, an optimization method for fleet dispatch and CBM under acceptable risk is proposed based on an improved genetic algorithm. Finally, a fleet of 10 aircrafts is studied to verify the proposed method. The results shows that it could realize optimization and control of the aircraft fleet oriented to mission success.

  2. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

    Science.gov (United States)

    Scholten-Peeters, Gwendolijne G M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

    2003-07-01

    We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However, there is some inconsistency in the literature and there have been no systematic attempts to analyze the level of evidence for prognostic factors in whiplash recovery. Studies were selected for inclusion following a comprehensive search of MEDLINE, EMBASE, CINAHL, the database of the Dutch Institute of Allied Health Professions up until April 2002 and hand searches of the reference lists of retrieved articles. Studies were selected if the objective was to assess prognostic factors associated with recovery; the design was a prospective cohort study; the study population included at least an identifiable subgroup of patients suffering from a whiplash injury; and the paper was a full report published in English, German, French or Dutch. The methodological quality was independently assessed by two reviewers. A study was considered to be of 'high quality' if it satisfied at least 50% of the maximum available quality score. Two independent reviewers extracted data and the association between prognostic factors and functional recovery was calculated in terms of risk estimates. Fifty papers reporting on twenty-nine cohorts were included in the review. Twelve cohorts were considered to be of 'high quality'. Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed. Strong evidence was found for high initial pain intensity being an adverse prognostic factor. There was strong evidence that for older age, female gender, high acute psychological response, angular deformity of the neck, rear-end collision, and compensation not being associated with an adverse prognosis. Several physical (e

  3. Prognostic effect of estrogen receptor status across age in primary breast cancer

    DEFF Research Database (Denmark)

    Bentzon, N.; During, M.; Rasmussen, B.B.

    2008-01-01

    prognostic factor over all age groups. This effect was limited to the first 5 years after diagnosis, RR: 2.08 (95% CI: 1.95-2.22, p ER negative tumors, RR of death: 0.89 (95% CI: 0.79-1.00, p = 0.049). Results were......Estrogen receptor (ER) status is considered as an important prognostic factor as well as a predictive factor for endocrine responsiveness in breast cancer. We analyzed the distribution of ER status across age and estimated variations in the prognostic impact of ER status related to patients' age...... and time since diagnosis. Overall, 26,944 patients with primary breast cancer diagnosed from 1989 to 2004 were included. The proportion of ER positive tumors increased over age from 51 to 82%. In multivariate analysis of overall survival, ER positive status was found to be a significantly positive...

  4. Education policies and health inequalities: evidence from changes in the distribution of Body Mass Index in France, 1981-2003.

    Science.gov (United States)

    Etile, Fabrice

    2014-03-01

    This paper contributes to the debate over the effectiveness of education policies in reducing overall health inequalities as compared to public health actions directed at the less-educated. Recentered Influence Function (RIF) regressions are used to decompose the contribution of education to the changing distribution of Body Mass Index (BMI) in France, between 1981 and 2003, into a composition effect (the shift in population education due to a massive educational expansion), and a structure effect (a changing educational gradient in BMI). Educational expansion has reduced overall BMI inequality by 3.4% for women and 2.3% for men. However, the structure effect on its own has produced a 10.9% increase in overall inequality for women, due to a steeper education gradient starting from the second quartile of the distribution. This structure effect on overall inequality is also large (7.6%) for men, albeit insignificant as it remains concentrated in the last decile. Educational expansion policies can thus reduce overall BMI inequalities; but attention must still be paid to the BMI gradient in education even for policies addressing overall rather than socioeconomic health inequalities. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. [The incidence and distribution of accidents with biological fluids among health personnel and the general population].

    Science.gov (United States)

    Imaz Iglesia, I; Gómez López, L I; Fernández Martínez, J A; Mareca Doñate, R; Sangrador Arenas, L A

    1996-01-01

    To assess the informative usefulness of the Registry, to calculate the incidence rates of accident with biological fluids among health care workers and in the community, to know about the postaccident rate of seroconversion to HIV and to identify risk groups. A descriptive study of the HIV records file of the Registry of Accidental Contacts to Biological Fluids in the Clinic Hospital of Zaragoza was conducted, between January 1987 and September 1993. The registry includes the reports of health care workers and the general population of Health Area III in Aragón (Spain), except for the Calatayud's Hospital. Incidence rates, rate ratios and their 95% confidence intervals were calculated. A total number of 595 accidents were reported, in none of them and HIV infection occurred subsequently. The incidence rate in health care workers was of 1.7 reports per 100 workers per year, while in the community it was of 8.1 per 100,000 people. The housekeeping staff was the group with a higher incidence (rate = 6.7; 95% IC: 3-14.8) and the type of accident more frequently described was needlestick injury. The incidence of reported accidents has increased in the community and in health care workers, which may be due to the increase in the reporting. In health care workers, the incidence in 1993 was within the range reported from other countries. The perception of risk is universal after accidents with unknown biological fluids. The correct disposal of material with biological contamination should be the more important preventive action.

  6. Personality pathology in a forensic setting : prevalence, assessment, and prognostic value for treatment

    NARCIS (Netherlands)

    Spaans, M.A.

    2016-01-01

    Research on the prevalence, diagnostic and prognostic value for treatment of personality pathology – i.e., both personality disorders and problematic personality characteristics – was carried out within a mainly Dutch forensic mental health setting. Issues such as (dis)simulation and unintentional

  7. Prognostic DNA Methylation Markers for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Siri H. Strand

    2014-09-01

    Full Text Available Prostate cancer (PC is the most commonly diagnosed neoplasm and the third most common cause of cancer-related death amongst men in the Western world. PC is a clinically highly heterogeneous disease, and distinction between aggressive and indolent disease is a major challenge for the management of PC. Currently, no biomarkers or prognostic tools are able to accurately predict tumor progression at the time of diagnosis. Thus, improved biomarkers for PC prognosis are urgently needed. This review focuses on the prognostic potential of DNA methylation biomarkers for PC. Epigenetic changes are hallmarks of PC and associated with malignant initiation as well as tumor progression. Moreover, DNA methylation is the most frequently studied epigenetic alteration in PC, and the prognostic potential of DNA methylation markers for PC has been demonstrated in multiple studies. The most promising methylation marker candidates identified so far include PITX2, C1orf114 (CCDC181 and the GABRE~miR-452~miR-224 locus, in addition to the three-gene signature AOX1/C1orf114/HAPLN3. Several other biomarker candidates have also been investigated, but with less stringent clinical validation and/or conflicting evidence regarding their possible prognostic value available at this time. Here, we review the current evidence for the prognostic potential of DNA methylation markers in PC.

  8. Prognostic significance of serum bilirubin in stroke

    International Nuclear Information System (INIS)

    Arslan, A.; Ismail, M.; Khan, F.; Khan, A.; Khattak, M.B.; Anwar, M.J.

    2011-01-01

    Background: Oxidative injury is an important cause of the neurologic lesion in stroke. Serum bilirubin is considered a natural antioxidant that may affect the prognosis of stroke. The purpose of this study was to evaluate the prognostic significance of bilirubin in stroke patients. Methods: A prospective cross-sectional study was conducted in Medical Units of Khyber Teaching Hospital, Peshawar. Inpatients admitted with acute attack of stroke were included in this study. Data regarding serum bilirubin and concurrent cerebrovascular risk factors were collected. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to analyse stroke's severity and functional outcomes, respectively. Results: Hypertension, diabetes mellitus and heart diseases were the most common risk factors. Patients were divided into 3 groups on the basis of serum bilirubin, i.e., =0.6 mg/dl (Group-1), 0.7-0.9 mg/dl (Group-2), and =1.0 mg/dl (Group-3). The mean pre-hospitalisation NIHSS score for Groups 1, 2 and 3 was 5.62, 11.66 and 25.33, respectively; and post-hospitalisation score was 0.875, 3.76 and 16.26, respectively. The pre-hospitalisation mRS score was 4 for Group-1, 4.52 for Group-2 and 4.93 for Group-3; while post-hospitalisation Mrs Score was 1.50, 2.38 and 4.26, respectively. Average serum bilirubin level was significantly higher in patients with poor outcomes as compared with good outcomes (p<0.01). Conclusions: This study suggests that higher serum bilirubin levels were associated with increased stroke severity, longer hospitalisation and poor prognosis. (author)

  9. The effect of state of health on organ distribution and excretion of systemic plutonium in the Mayak workers

    International Nuclear Information System (INIS)

    Suslova, K.G.; Khokhryakov, V.F.; Tokarskaya, Z.B.; Nifatov, A.P.; Sokolova, A.B.; Kudryavtzeva, T.I.; Miller, S.C.; Krahenbuhl, M.P.

    2003-01-01

    The extrapulmonary distribution of plutonium in 20 organs (excluding the respiratory tract) was studied in workers who chronically inhaled plutonium at the radiochemical plants of the Mayak Production Association (Ozyorsk, Russia). The data were obtained by radiochemical analysis of soft tissue and bones samples collected at autopsy of 591 workers. The systemic plutonium distribution was determined in healthy individuals as well as in those with health impairment, specifically for those with liver diseases. Twenty-five years after the beginning of inhalation, systemic fractions in the liver and skeleton of individuals who were healthy at the time of death approximate the ratio 45%:45% proposed in the International Commission on Radiological Protection (ICRP) Publication 30. Pathological process in the liver, accompanied by fatty dystrophy of hepatocytes, increased plutonium clearance from the liver. There was a considerable shift of the plutonium from the liver to the skeleton in individuals who died from liver disease. The average fractions of systemic plutonium in the liver and skeleton of those individuals were 14% and 78% respectively, which did not correspond to ICRP models, indicating a significant effect of disease conditions. Plutonium that was not redistributed was excreted. The urinary excretion rate of plutonium also correlated with state of health. The observed excretion as a fraction of systemic content was 1.64 x 10 -5 d -1 for individuals of good health and 2.34 x 10 -5 d -1 for individuals with various chronic diseases. The current models do not account for the influence of different pathological processes in the body on plutonium distribution and retention in systemic organs. This could have significant consequences for dosimetry calculations and risk estimations. (author)

  10. Morphological prognostic factors in breast cancer. Hospital Conrado Benitez, 1998-2002

    International Nuclear Information System (INIS)

    Prieto, M.; Rodriguez, I.; Ropero, R; Suarez, C.; Hernandez, R.

    2009-01-01

    Breast cancer is a major health problem in women. In Cuba, the adjusted incidence rate to world population in 2004 indicates that it is the leading cause in females, with a figure of 30.3. Establish the most important prognostic factors has been the subject of several studies with the purposes of stratifying patients according to risk groups and treatment schedules. The overall objective was to determine the influence on survival at 5 years of morphological prognostic factors, determined by histological techniques. (Author)

  11. Well-being, health, and productivity improvement after an employee well-being intervention in large retail distribution centers.

    Science.gov (United States)

    Rajaratnam, Augustine S; Sears, Lindsay E; Shi, Yuyan; Coberley, Carter R; Pope, James E

    2014-12-01

    To evaluate changes in well-being, biometric, and productivity indicators after a well-being intervention. Biometric and self-reported outcomes were assessed among 677 retail distribution center employees before and after a 6-month well-being intervention. Despite lower well-being at baseline compared to an independent random sample of workers, program participants' well-being, productivity, body mass index, systolic blood pressure, and total cholesterol improved significantly after the intervention, whereas the decline in diastolic blood pressure was not significant. Moreover, participants' specific transition across well-being segments over the intervention period demonstrated more improvement than decline. There is evidence that programs designed to improve well-being within a workforce can be used to significantly and positively impact employee health and productivity, which should result in reduced health care costs, improved employee productivity, and increased overall profitability.

  12. The Digital Distribution of Public Health News Surrounding the Human Papillomavirus Vaccination: A Longitudinal Infodemiology Study.

    Science.gov (United States)

    Mahoney, L Meghan; Tang, Tang; Ji, Kai; Ulrich-Schad, Jessica

    2015-01-01

    New media changes the dissemination of public health information and misinformation. During a guest appearance on the Today Show, US Representative Michele Bachmann claimed that human papillomavirus (HPV) vaccines could cause "mental retardation". The purpose of this study is to explore how new media influences the type of public health information users access, as well as the impact to these platforms after a major controversy. Specifically, this study aims to examine the similarities and differences in the dissemination of news articles related to the HPV vaccination between Google News and Twitter, as well as how the content of news changed after Michele Bachmann's controversial comment. This study used a purposive sampling to draw the first 100 news articles that appeared on Google News and the first 100 articles that appeared on Twitter from August 1-October 31, 2011. Article tone, source, topics, concerns, references, publication date, and interactive features were coded. The intercoder reliability had a total agreement of .90. Results indicate that 44.0% of the articles (88/200) about the HPV vaccination had a positive tone, 32.5% (65/200) maintained a neutral tone, while 23.5% (47/200) presented a negative tone. Protection against diseases 82.0% (164/200), vaccine eligibility for females 75.5% (151/200), and side effects 59.0% (118/200) were the top three topics covered by these articles. Google News and Twitter articles significantly differed in article tone, source, topics, concerns covered, types of sources referenced in the article, and uses of interactive features. Most notably, topic focus changed from public health information towards political conversation after Bachmann's comment. Before the comment, the HPV vaccine news talked more often about vaccine dosing (Ppolitics (P=.01) and talked more about HPV vaccine eligibility for males (P=.01). This longitudinal infodemiology study suggests that new media influences public health communication

  13. Concentration distribution and potential health risk of heavy metals in Mactra veneriformis from Bohai Bay, China

    International Nuclear Information System (INIS)

    Li, Yuhu; Liu, Hui; Zhou, Hailong; Ma, Wandong; Han, Qian; Diao, Xiaoping; Xue, Qinzhao

    2015-01-01

    Highlights: • Mn was dominant in the heavy metals, followed by Zn, and Pb was the lowest. • THQs of Co were the highest at three sections and the others were less than 1. • Heavy metal concentration in clam was affected by pollution sources, and itself. • Consumer should be aware of their health risks associated with the consuming clam. - Abstract: To investigate the pollution level and evaluate the potential health risks of heavy metals, the concentrations of chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), cadmium (Cd), antimony (Sb), and lead (Pb) were determined by inductively coupled plasma-mass spectrometry (ICP-MS) in 198 clams (Mactra veneriformis) collected from 11 sites of the Bohai Bay. The results showed that heavy metal concentrations in the clams were different at different sites (p < 0.05). Mn was dominant with a percentage of 22.08–77.03% in heavy metals, followed by Zn with 12.66–57.11%, and the concentration of Pb was the lowest with 0.45–1.04%. The potential health risk to consumers was evaluated by the target hazard quotient (THQ) and the maximum daily consumption rate (CR max ). The results indicated that the THQs of Co were the highest with the values of 1.125, 1.665, and 1.144 at three sections; the values of other individual metals were <1, which indicated that consumption of clams from the study areas caused health risks due to Co. Moreover, the CR max values also indicated the potential health risk caused by Co in clams consumed in this area. Pearson correlation analysis and principal component analysis (PCA) indicated that there were significantly positive or negative correlations between the heavy metals (p < 0.05), and the studied metals were divided into four groups. The results indicated that the concentrations of heavy metals in clams were affected not only by pollution sources but also by the characteristics of clams that could absorb

  14. Biological Prognostic Markers in Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Vladimíra Vroblová

    2009-01-01

    Full Text Available Chronic lymphocytic leukemia (CLL is the most frequent leukemic disease of adults in the Western world. It is remarkable by an extraordinary heterogeneity of clinical course with overall survival ranging from several months to more than 15 years. Classical staging sytems by Rai and Binet, while readily available and useful for initial assessment of prognosis, are not able to determine individual patient’s ongoing clinical course of CLL at the time of diagnosis, especially in early stages. Therefore, newer biological prognostic parameters are currently being clinically evaluated. Mutational status of variable region of immunoglobulin heavy chain genes (IgVH, cytogenetic aberrations, and both intracellular ZAP- 70 and surface CD38 expression are recognized as parameters with established prognostic value. Molecules regulating the process of angiogenesis are also considered as promising markers. The purpose of this review is to summarize in detail the specific role of these prognostic factors in chronic lymphocytic leukemia.

  15. Space-time distribution of the ALS incident cases by onset type in the Health District of Ferrara, Italy.

    Science.gov (United States)

    Govoni, V; Della Coletta, E; Cesnik, E; Casetta, I; Tugnoli, V; Granieri, E

    2015-04-01

    An ecological study in the resident population of the Health District (HD) of Ferrara, Italy, has been carried out to establish the distribution in space and time of the amyotrophic lateral sclerosis (ALS) incident cases according to the disease onset type and gender in the period 1964-2009. The hypothesis of a uniform distribution was assumed. The incident cases of spinal onset ALS and bulbar onset ALS were evenly distributed in space and time in both men and women. The spinal onset ALS incident cases distribution according to gender was significantly different from the expected in the extra-urban population (20 observed cases in men 95% Poisson confidence interval 12.22-30.89, expected cases in men 12.19; six observed cases in women 95% Poisson confidence interval 2.20-13.06, expected cases in women 13.81), whereas no difference was found in the urban population. The spinal onset ALS incidence was higher in men than in women in the extra-urban population (difference between the rates = 1.53, 95% CI associated with the difference 0.52-2.54), whereas no difference between sexes was found in the urban population. The uneven distribution according to gender of the spinal onset ALS incident cases only in the extra-urban population suggests the involvement of a gender related environmental risk factor associated with the extra-urban environment. Despite some limits of the spatial analysis in the study of rare diseases, the results appear consistent with the literature data. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Intelligent Prognostic Framework for Degradation Assessment and Remaining Useful Life Estimation of Photovoltaic Module

    Directory of Open Access Journals (Sweden)

    Nabil Laayouj

    2016-12-01

    Full Text Available All industrial systems and machines are subjected to degradation processes, which can be related to the operating conditions. This degradation can cause unwanted stops at any time and major maintenance work sometimes. The accurate prediction of the remaining useful life (RUL is an important challenge in condition-based maintenance. Prognostic activity allows estimating the RUL before failure occurs and triggering actions to mitigate faults in time when needed. In this study, a new smart prognostic method for photovoltaic module health degradation was developed based on two approaches to achieve more accurate predictions: online diagnosis and data-driven prognosis. This framework of forecasting integrates the strengths of real-time monitoring in the first approach and relevant vector machine in the second. The results show that the proposed method is plausible due to its good prediction of RUL and can be effectively applied to many systems for monitoring and prognostics.

  17. Health implications of PAH release from coated cast iron drinking water distribution systems in The Netherlands.

    Science.gov (United States)

    Blokker, E J Mirjam; van de Ven, Bianca M; de Jongh, Cindy M; Slaats, P G G Nellie

    2013-05-01

    Coal tar and bitumen have been historically used to coat the insides of cast iron drinking water mains. Polycyclic aromatic hydrocarbons (PAHs) may leach from these coatings into the drinking water and form a potential health risk for humans. We estimated the potential human cancer risk from PAHs in coated cast iron water mains. In a Dutch nationwide study, we collected drinking water samples at 120 locations over a period of 17 days under various operational conditions, such as undisturbed operation, during flushing of pipes, and after a mains repair, and analyzed these samples for PAHs. We then estimated the health risk associated with an exposure scenario over a lifetime. During flushing, PAH levels frequently exceeded drinking water quality standards; after flushing, these levels dropped rapidly. After the repair of cast iron water mains, PAH levels exceeded the drinking water standards for up to 40 days in some locations. The estimated margin of exposure for PAH exposure through drinking water was > 10,000 for all 120 measurement locations, which suggests that PAH exposure through drinking water is of low concern for consumer health. However, factors that differ among water systems, such as the use of chlorination for disinfection, may influence PAH levels in other locations.

  18. Distribution of ideal cardiovascular health by educational levels from 1978 to 2006

    DEFF Research Database (Denmark)

    Olsen, Gitte S; Holm, Ann-Sofie S; Jørgensen, Torben

    2014-01-01

    BACKGROUND: The focus on improvements in ideal cardiovascular health is a relatively new approach and to our knowledge nobody has published the trend in regard to educational difference. DESIGN: Time trend analysis from six cross-sectional studies in 1978-2006 from the south-western part of the c......BACKGROUND: The focus on improvements in ideal cardiovascular health is a relatively new approach and to our knowledge nobody has published the trend in regard to educational difference. DESIGN: Time trend analysis from six cross-sectional studies in 1978-2006 from the south-western part...... index adjusted for age and stratified according to sex and educational level as length of vocational training. RESULTS: The proportion of women with ideal cardiovascular health increased from 2% in 1978 to 13......, the educational difference was less pronounced probably because very few men reached an ideal cardiovascular risk profile. This stresses the importance for preventive efforts targeting low educated groups, and men in particular....

  19. Nottingham Prognostic Index in Triple-Negative Breast Cancer: a reliable prognostic tool?

    International Nuclear Information System (INIS)

    Albergaria, André; Ricardo, Sara; Milanezi, Fernanda; Carneiro, Vítor; Amendoeira, Isabel; Vieira, Daniella; Cameselle-Teijeiro, Jorge; Schmitt, Fernando

    2011-01-01

    A breast cancer prognostic tool should ideally be applicable to all types of invasive breast lesions. A number of studies have shown histopathological grade to be an independent prognostic factor in breast cancer, adding prognostic power to nodal stage and tumour size. The Nottingham Prognostic Index has been shown to accurately predict patient outcome in stratified groups with a follow-up period of 15 years after primary diagnosis of breast cancer. Clinically, breast tumours that lack the expression of Oestrogen Receptor, Progesterone Receptor and Human Epidermal growth factor Receptor 2 (HER2) are identified as presenting a 'triple-negative' phenotype or as triple-negative breast cancers. These poor outcome tumours represent an easily recognisable prognostic group of breast cancer with aggressive behaviour that currently lack the benefit of available systemic therapy. There are conflicting results on the prevalence of lymph node metastasis at the time of diagnosis in triple-negative breast cancer patients but it is currently accepted that triple-negative breast cancer does not metastasize to axillary nodes and bones as frequently as the non-triple-negative carcinomas, favouring instead, a preferentially haematogenous spread. Hypothetically, this particular tumour dissemination pattern would impair the reliability of using Nottingham Prognostic Index as a tool for triple-negative breast cancer prognostication. The present study tested the effectiveness of the Nottingham Prognostic Index in stratifying breast cancer patients of different subtypes with special emphasis in a triple-negative breast cancer patient subset versus non- triple-negative breast cancer. We demonstrated that besides the fact that TNBC disseminate to axillary lymph nodes as frequently as luminal or HER2 tumours, we also showed that TNBC are larger in size compared with other subtypes and almost all grade 3. Additionally, survival curves demonstrated that these prognostic factors are

  20. PROGNOSTIC SIGNIFICANCE OF CD56 EXPRESSION IN ACUTE LEUKEMIAS

    Directory of Open Access Journals (Sweden)

    B. M. Ahmed

    2014-12-01

    Conclusions. CD56 antigenic expression in AML cases represents an adverse prognostic factor. It should be regularly investigated in cases of AML for better prognostic stratification and assessment. KEY WORDS: CD56; leukemia, myeloid; prognosis

  1. Prognostics-Enabled Power Supply for ADAPT Testbed, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Ridgetop's role is to develop electronic prognostics for sensing power systems in support of NASA/Ames ADAPT testbed. The prognostic enabled power systems from...

  2. Tropospheric Ozone Assessment Report: Present-day ozone distribution and trends relevant to human health

    Directory of Open Access Journals (Sweden)

    Zoë L. Fleming

    2018-02-01

    Full Text Available This study quantifies the present-day global and regional distributions (2010–2014 and trends (2000–2014 for five ozone metrics relevant for short-term and long-term human exposure. These metrics, calculated by the Tropospheric Ozone Assessment Report, are: 4th highest daily maximum 8-hour ozone (4MDA8; number of days with MDA8 > 70 ppb (NDGT70, SOMO35 (annual Sum of Ozone Means Over 35 ppb and two seasonally averaged metrics (3MMDA1; AVGMDA8. These metrics were explored at ozone monitoring sites worldwide, which were classified as urban or non-urban based on population and nighttime lights data. Present-day distributions of 4MDA8 and NDGT70, determined predominantly by peak values, are similar with highest levels in western North America, southern Europe and East Asia. For the other three metrics, distributions are similar with North–South gradients more prominent across Europe and Japan. Between 2000 and 2014, significant negative trends in 4MDA8 and NDGT70 occur at most US and some European sites. In contrast, significant positive trends are found at many sites in South Korea and Hong Kong, with mixed trends across Japan. The other three metrics have similar, negative trends for many non-urban North American and some European and Japanese sites, and positive trends across much of East Asia. Globally, metrics at many sites exhibit non-significant trends. At 59% of all sites there is a common direction and significance in the trend across all five metrics, whilst 4MDA8 and NDGT70 have a common trend at ~80% of all sites. Sensitivity analysis shows AVGMDA8 trends differ with averaging period (warm season or annual. Trends are unchanged at many sites when a 1995–2014 period is used; although fewer sites exhibit non-significant trends. Over the longer period 1970–2014, most Japanese sites exhibit positive 4MDA8/SOMO35 trends. Insufficient data exist to characterize ozone trends for the rest of Asia and other world regions.

  3. Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia.

    Science.gov (United States)

    Sedlmayr, Richard; Fink, Günther; Miller, John M; Earle, Duncan; Steketee, Richard W

    2013-03-18

    Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts. This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets (ITNs) conducted in partnership with a Zambian agribusiness, and its cost-effectiveness from the perspective of the National Malaria Control Programme (NMCP). The study was designed as a cluster-randomized controlled trial. A list of 81,597 cotton farmers was obtained from Dunavant, a contract farming company in Zambia's cotton sector, in December 2010. 39,963 (49%) were randomly selected to obtain one ITN each. Follow-up interviews were conducted with 438 farmers in the treatment and 458 farmers in the control group in June and July 2011. Treatment and control households were compared with respect to bed net ownership, bed net usage, self-reported fever, and self-reported confirmed malaria. Cost data was collected throughout the programme. The distribution effectively reached target beneficiaries, with approximately 95% of households in the treatment group reporting that they had received an ITN through the programme. The average increase in the fraction of household members sleeping under an ITN the night prior to the interview was 14.6 percentage points (p-value US$ per ITN to Zambia's NMCP. The results illustrate that existing private sector networks can efficiently control malaria in remote rural regions. The intra-household allocation of ITNs distributed through this channel was comparable to that of ITNs received from other sources, and the health impact remained substantial.

  4. Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010).

    Science.gov (United States)

    del Canto, M; García-Martínez, L; Fernández-Villa, T; Molina, A J; Campanario, F; García-Sanz, M; López-Abente, G; Honrado, E; Martín-Sánchez, V

    2015-01-01

    Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Factors that explain how policy makers distribute resources to mental health services.

    Science.gov (United States)

    Corrigan, Patrick W; Watson, Amy C

    2003-04-01

    Advocates hope to influence the resource allocation decisions of legislators and other policy makers to capture more resources for mental health programs. Findings from social psychological research suggest factors that, if pursued, may improve advocacy efforts. In particular, allocation decisions are affected by policy makers' perceptions of the scarcity of resources, effectiveness of specific programs, needs of people who have problems that are served by these programs, and extent of personal responsibility for these problems. These perceptions are further influenced by political ideology. Conservatives are motivated by a tendency to punish persons who are perceived as having personal responsibility for their problems by withholding resources, whereas liberals are likely to avoid tough allocation decisions. Moreover, these perceptions are affected by political accountability, that is, whether politicians perceive that their constituents will closely monitor their decisions. Just as the quality of clinical interventions improves when informed by basic research on human behavior, the efforts of mental health advocates will be advanced when they understand the psychological forces that affect policy makers' decisions about resources.

  6. Prognostic significance of macrophage invasion in hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Atanasov, Georgi; Hau, Hans-Michael; Dietel, Corinna; Benzing, Christian; Krenzien, Felix; Brandl, Andreas; Wiltberger, Georg; Matia, Ivan; Prager, Isabel; Schierle, Katrin; Robson, Simon C.; Reutzel-Selke, Anja; Pratschke, Johann; Schmelzle, Moritz; Jonas, Sven

    2015-01-01

    Tumor-associated macrophages (TAMs) promote tumor progression and have an effect on survival in human cancer. However, little is known regarding their influence on tumor progression and prognosis in human hilar cholangiocarcinoma. We analyzed surgically resected tumor specimens of hilar cholangiocarcinoma (n = 47) for distribution and localization of TAMs, as defined by expression of CD68. Abundance of TAMs was correlated with clinicopathologic characteristics, tumor recurrence and patients’ survival. Statistical analysis was performed using SPSS software. Patients with high density of TAMs in tumor invasive front (TIF) showed significantly higher local and overall tumor recurrence (both ρ < 0.05). Furthermore, high density of TAMs was associated with decreased overall (one-year 83.6 % vs. 75.1 %; three-year 61.3 % vs. 42.4 %; both ρ < 0.05) and recurrence-free survival (one-year 93.9 % vs. 57.4 %; three-year 59.8 % vs. 26.2 %; both ρ < 0.05). TAMs in TIF and tumor recurrence, were confirmed as the only independent prognostic variables in the multivariate survival analysis (all ρ < 0.05). Overall survival and recurrence free survival of patients with hilar cholangiocarcinoma significantly improved in patients with low levels of TAMs in the area of TIF, when compared to those with a high density of TAMs. These observations suggest their utilization as valuable prognostic markers in routine histopathologic evaluation, and might indicate future therapeutic approaches by targeting TAMs

  7. Evaluating biomarkers for prognostic enrichment of clinical trials.

    Science.gov (United States)

    Kerr, Kathleen F; Roth, Jeremy; Zhu, Kehao; Thiessen-Philbrook, Heather; Meisner, Allison; Wilson, Francis Perry; Coca, Steven; Parikh, Chirag R

    2017-12-01

    A potential use of biomarkers is to assist in prognostic enrichment of clinical trials, where only patients at relatively higher risk for an outcome of interest are eligible for the trial. We investigated methods for evaluating biomarkers for prognostic enrichment. We identified five key considerations when considering a biomarker and a screening threshold for prognostic enrichment: (1) clinical trial sample size, (2) calendar time to enroll the trial, (3) total patient screening costs and the total per-patient trial costs, (4) generalizability of trial results, and (5) ethical evaluation of trial eligibility criteria. Items (1)-(3) are amenable to quantitative analysis. We developed the Biomarker Prognostic Enrichment Tool for evaluating biomarkers for prognostic enrichment at varying levels of screening stringency. We demonstrate that both modestly prognostic and strongly prognostic biomarkers can improve trial metrics using Biomarker Prognostic Enrichment Tool. Biomarker Prognostic Enrichment Tool is available as a webtool at http://prognosticenrichment.com and as a package for the R statistical computing platform. In some clinical settings, even biomarkers with modest prognostic performance can be useful for prognostic enrichment. In addition to the quantitative analysis provided by Biomarker Prognostic Enrichment Tool, investigators must consider the generalizability of trial results and evaluate the ethics of trial eligibility criteria.

  8. Biogas production and distribution. Operators' health and safety. Extended abstract

    International Nuclear Information System (INIS)

    Gardeur-Algros, E.; Chesnot, T.; Charissou, A.M.; Paris, T.; Bronner, C.

    2013-06-01

    Production and recovery of biogas from different substrates of agricultural, urban and industrial issues are at the heart of sustainable development for the production of renewable energy, reducing greenhouse gases and waste treatment. In 2011, in France, about 200 biogas plants were operational. Moreover, about 300 ISDND (nonhazardous waste storage or landfill sites) also produce biogas, about 90 that of them valorize it. Because of regulatory contexts and favorable measures to bolster the economy, the number of sites is growing and anaerobic pathways are diversifying in terms of substrate / treated waste, anaerobic digestion processes and ways of valorization. So it seems appropriate to focus on the health and safety of workers potentially exposed to various hazards during operations of monitoring, maintenance or malfunction of facilities. First, through a literature search and a query of experts, data such as substrate, digestate and biogas composition, information feedback on reported incidents / accidents or accidents at work and illnesses of operators have been sought. Then, critical points concerning the health and safety of operators in these sectors were identified by implementing some steps of HACCP (Hazard Analysis - Critical Control Points). Five sectors (agricultural methanization in farms and in centralized plants - methanization of urban sewage sludge - methanization of household garbage - industrial methanization in sectors like food industry, stationery and chemistry - biogas production from landfill sites) have been studied and led to dedicated syntheses. They summarize the collected information and present an operating diagram indicating the different stages of biogas production and recovery. On this diagram, critical points are identified, assessed according to their importance and are associated with phases of maintenance operation, or malfunction. The results are intended to educate the actors to potential risks and attention they need to

  9. Effectiveness of accelerated radiotherapy for patients with inoperable non-small cell lung cancer (NSCLC) and borderline prognostic factors without distant metastasis: a retrospective review

    International Nuclear Information System (INIS)

    Nguyen, Linh N.; Komaki, Ritsuko; Allen, Pamela; Schea, Randi A.; Milas, Luka

    1999-01-01

    Purpose: The standard treatment for patients with unresectable or medically inoperable non-small cell lung cancer (NSCLC) and good prognostic factors (e.g., weight loss [WL] ≤5% and Karnofsky performance status [KPS] ≥70) is induction chemotherapy followed by definitive radiotherapy to the primary site at 1.8-2.0 Gy per fraction with a total dose of 60-63 Gy to the target volume. Patients with poor prognostic factors usually receive radiotherapy alone, but the fractionation schedule and total dose have not been standardized. To attempt to optimize irradiation doses and schedule, we compared the effectiveness of accelerated radiotherapy (ACRT) alone to 45 Gy at 3 Gy per fraction with standard radiation therapy (STRT) of 60-66 Gy at 2 Gy per fraction in regard to tumor response, local control, distant metastasis, toxicity, and survival. Methods and Materials: Fifty-five patients treated with radiation for NSCLC at The University of Texas M. D. Anderson Cancer Center between 1990 and 1994 were identified. All 55 patients had node-positive, and no distant metastasis (N+, M0) of NSCLC. Two cohorts were identified. One cohort (26 patients) had borderline poor prognostic factors (KPS less than 70 but higher than 50, and/or WL of more than 5%) and was treated with radiotherapy alone to 45 Gy over 3 weeks at 3 Gy/fraction (ACRT). The second cohort (29 patients) had significantly better prognostic factors (KPS ≥70 and WL ≤5%) and was treated to 60-66 Gy over 6 to 6((1)/(2)) weeks at 2 Gy per fraction (STRT) during the same period. Results: In the first cohort treated by ACRT, the distribution of patients by AJCC stage was IIB 8%, IIIA 19%, and IIIB 73%. Sixty-two percent had KPS 5%. The maximum response rate as determined by chest X-ray was 60% among 45 of 55 patients who were evaluable for response: combined complete responses (20%) and partial responses (40%). Overall survival in these patients was 13% at 2 and 5 years, with a locoregional control rate of 42% and a

  10. Occupational health experience in the production and distribution of radionuclides used in medicine

    International Nuclear Information System (INIS)

    Gaburo, J.C.; Sanches, M.P.; Gian, M.A.A.

    1994-01-01

    A brief description of the main operations performed in the Radioisotope Production Facility at IPEN-CNEN/SP is presented. This facility is provided with hot cells which must be periodically replaced due to deterioration by reagent processing and hard treatment to which they are submitted. When the lifetime of these hot cells are at their limit, leaking of airborne materials arises bringing forth incorporation by workers. As a safe control, a series of procedures have been implemented in a program of internal monitoring by urine sampling and external monitoring by film badge. From this program it became possible to evaluate the radiation dose received by workers. The results obtained within the last 10 years where analyzed against the lifetime of the hot cells and studies were made to verify possible explicit or implicit relations between doses and the natural stress of these hot cells. In the distribution of the effective dose equivalent among 304 workers submitted for individual monitoring of internal exposure by urine samples, some significant exposures higher than 4.5 mSv. The sum of effective doses and doses from external exposures can lead to levels close to regulatory limits. The internal effective dose equivalent is small when compared with whole body external dose equivalent, however it is not negligible

  11. Estimation of customer lifetime value of a health insurance with interest rates obeying uniform distribution

    Science.gov (United States)

    Widyawan, A.; Pasaribu, U. S.; Henintyas, Permana, D.

    2015-12-01

    Nowadays some firms, including insurer firms, think that customer-centric services are better than product-centric ones in terms of marketing. Insurance firms will try to attract as many new customer as possible while maintaining existing customer. This causes the Customer Lifetime Value (CLV) becomes a very important thing. CLV are able to put customer into different segments and calculate the present value of a firm's relationship with its customer. Insurance customer will depend on the last service he or she can get. So if the service is bad now, then customer will not renew his contract though the service is very good at an erlier time. Because of this situation one suitable mathematical model for modeling customer's relationships and calculating their lifetime value is Markov Chain. In addition, the advantages of using Markov Chain Modeling is its high degree of flexibility. In 2000, Pfeifer and Carraway states that Markov Chain Modeling can be used for customer retention situation. In this situation, Markov Chain Modeling requires only two states, which are present customer and former ones. This paper calculates customer lifetime value in an insurance firm with two distinctive interest rates; the constant interest rate and uniform distribution of interest rates. The result shows that loyal customer and the customer who increase their contract value have the highest CLV.

  12. Prognostic factors for neckpain in general practice.

    NARCIS (Netherlands)

    Hoving, J.L.; Vet, H.C.W. de; Twisk, J.W.R.; Devillé, W.L.J.M.; Windt, D. van der; Koes, B.W.; Bouter, L.M.

    2004-01-01

    Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age,

  13. EVALUATION OF THE PROGNOSTIC VALUE OF THE ...

    African Journals Online (AJOL)

    Objectives To evaluate the role and prognostic value of the expression of epidermal growth factor receptors (EGFR) in serum and urine for the detection of human bladder cancer. Patients and Methods The study comprised 30 patients with newly diagnosed transitional cell carcinoma of the bladder and 10 normal volunteers ...

  14. Systematic review of renal carcinoma prognostic factors.

    Science.gov (United States)

    Lorente, D; Trilla, E; Meseguer, A; Planas, J; Placer, J; Celma, A; Salvador, C; Regis, L; Morote, J

    2017-05-01

    The natural history of renal cell carcinoma is heterogeneous. Some scenarios can be found in terms of clinical presentation, clinical evolution or type of recurrence (local/metastatic). The aim of this publication is to analyze the most important prognostic factors published in the literature. A literature review ob published papers was performed using the Pubmed, from first Motzer's classification published in 1999 to 2015, according to PRISMA declaration. Search was done using the following keywords: kidney neoplasm, kidney cancer, renal cell carcinoma, prognostic factors, mortality, survival and disease progression. Papers were classified according to level of evidence, the number of patients included and the type of study performed. The evolution in the knowledge of molecular pathways related to renal oncogenesis and the new targeted therapies has left to remain obsolete the old prognostic models. It's necessary to perform a continuous review to actualize nomograms and to adapt them to the new scenarios. Is necessary to perform a proper external validation of existing prognostic factors using prospective and multicentric studies to add them into the daily urologist clinical practice. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Prognostic factors in Guillain-Barre syndrome

    Directory of Open Access Journals (Sweden)

    Semra Mungan

    2014-12-01

    Full Text Available Objective: Guillain–Barre syndrome (GBS is an immune-mediated disorder of peripheral nerves resulting as acute inflammatory demyelinating polyradiculoneuropathy. GBS has a heterogeneous clinical course and laboratory findings. Acute onset and progressive course, and is usually associated with a good prognosis but some forms have a poor prognosis. Factors that can affect the prognosis of GBS have been investigated in several studies. Assessment of poor prognostic factors of GBS plays a vital role in the management and monitorization of patients. Methods: In this retrospective study of patients admitted to the acute phase of GBS removing clinical and laboratory profiles and was planned to investigate the prognostic factors. Results: Totally 23 patients (Female/male: 16/7 were recruited. Mean age was 47 (range: 17-70 years. Statistically significant poor prognostic factors were advanced age (p=0.042, erythrocyte sedimentation rate (p=0.027 and serum albumin level (p=0.007. Conclusion: Advanced age, increased ESR and decreased albumin levels were found as poor prognostic factors in GBS.

  16. Aggressive fibromatosis - impact of prognostic variables on ...

    African Journals Online (AJOL)

    Objective. To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation. Materials and methods. Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed ...

  17. Gastric lymphomas in Turkey. Analysis of prognostic factors with special emphasis on flow cytometric DNA content.

    Science.gov (United States)

    Aydin, Z D; Barista, I; Canpinar, H; Sungur, A; Tekuzman, G

    2000-07-01

    In contrast to DNA ploidy, to the authors' knowledge the prognostic significance of S-phase fraction (SPF) in gastric lymphomas has not been determined. In the current study, the prognostic significance of various parameters including SPF and DNA aneuploidy were analyzed and some distinct epidemiologic and biologic features of gastric lymphomas in Turkey were found. A series of 78 gastric lymphoma patients followed at Hacettepe University is reported. DNA flow cytometry was performed for 34 patients. The influence of various parameters on survival was investigated with the log rank test. The Cox proportional hazards model was fitted to identify independent prognostic factors. The median age of the patients was 50 years. There was no correlation between patient age and tumor grade. DNA content analysis revealed 4 of the 34 cases to be aneuploid with DNA index values < 1.0. The mean SPF was 33.5%. In the univariate analysis, surgical resection of the tumor, modified Ann Arbor stage, performance status, response to first-line chemotherapy, lactate dehydrogenase (LDH) level, and SPF were important prognostic factors for disease free survival (DFS). The same parameters, excluding LDH level, were important for determining overall survival (OS). In the multivariate analysis, surgical resection of the tumor, disease stage, performance status, and age were found to be important prognostic factors for OS. To the authors' knowledge the current study is the first to demonstrate the prognostic significance of SPF in gastric lymphomas. The distinguishing features of Turkish gastric lymphoma patients are 1) DNA indices of aneuploid cases that all are < 1.0, which is a unique feature; 2) a lower percentage of aneuploid cases; 3) a higher SPF; 4) a younger age distribution; and 5) lack of an age-grade correlation. The authors conclude that gastric lymphomas in Turkey have distinct biologic and epidemiologic characteristics. Copyright 2000 American Cancer Society.

  18. [Buying and distribution of drugs: perceptions of officers of a network of primary health care in the interior of the state of Sao Paulo].

    Science.gov (United States)

    Juliani, C M

    1995-12-01

    The study present analyse the process to buy and distribution of medicaments for the Basic Unit of Health in municipal district of state São Paulo. To achieve some general considerations about the National Politic of Medicaments in Brazil, to emphasize feature relative the its structuration in the Unique System of Health.

  19. Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey.

    Science.gov (United States)

    Ghimire, Mamata; Ayer, Rakesh; Kondo, Masahide

    2018-02-14

    Nepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal. Data were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE. Based on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure. This study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far

  20. Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

    International Nuclear Information System (INIS)

    Priola, Adriano Massimiliano; Priola, Sandro Massimo; Gned, Dario; Ducco, Lorena; Veltri, Andrea; Giraudo, Maria Teresa; Fornari, Alessandro; Ferrero, Bruno

    2016-01-01

    To evaluate the usefulness of diffusion-weighted magnetic resonance for distinguishing thymomas according to WHO and Masaoka-Koga classifications and in predicting disease-free survival (DFS) by using the apparent diffusion coefficient (ADC). Forty-one patients were grouped based on WHO (low-risk vs. high-risk) and Masaoka-Koga (early vs. advanced) classifications. For prognosis, seven patients with recurrence at follow-up were grouped separately from healthy subjects. Differences on ADC levels between groups were tested using Student-t testing. Logistic regression models and areas under the ROC curve (AUROC) were estimated. Mean ADC values were different between groups of WHO (low-risk = 1.58 ± 0.20 x 10 -3 mm 2 /sec; high-risk = 1.21 ± 0.23 x 10 -3 mm 2 /sec; p < 0.0001) and Masaoka-Koga (early = 1.43 ± 0.26 x 10 -3 mm 2 /sec; advanced = 1.31 ± 0.31 x 10 -3 mm 2 /sec; p = 0.016) classifications. Mean ADC of type-B3 (1.05 ± 0.17 x 10 -3 mm 2 /sec) was lower than type-B2 (1.32 ± 0.20 x 10 -3 mm 2 /sec; p = 0.023). AUROC in discriminating groups was 0.864 for WHO classification (cut-point = 1.309 x 10 -3 mm 2 /sec; accuracy = 78.1 %) and 0.730 for Masaoka-Koga classification (cut-point = 1.243 x 10 -3 mm 2 /sec; accuracy = 73.2 %). Logistic regression models and two-way ANOVA were significant for WHO classification (odds ratio[OR] = 0.93, p = 0.007; p < 0.001), but not for Masaoka-Koga classification (OR = 0.98, p = 0.31; p = 0.38). ADC levels were significantly associated with DFS recurrence rate being higher for patients with ADC ≤ 1.299 x 10 -3 mm 2 /sec (p = 0.001; AUROC, 0.834; accuracy = 78.0 %). ADC helps to differentiate high-risk from low-risk thymomas and discriminates the more aggressive type-B3. Primary tumour ADC is a prognostic indicator of recurrence. (orig.)

  1. Spatial distribution mapping of drinking water fluoride levels in Karnataka, India: fluoride-related health effects.

    Science.gov (United States)

    Chowdhury, Chitta R; Shahnawaz, Khijmatgar; Kumari, Divya; Chowdhury, Avidyuti; Bedi, Raman; Lynch, Edward; Harding, Stewart; Grootveld, Martin

    2016-11-01

    (1) To estimate the concentrations of fluoride in drinking water throughout different zones and districts of the state of Karnataka. (2) To investigate the variation of fluoride concentration in drinking water from different sources, and its relationships to daily temperature and rainfall status in the regional districts. (3) To develop an updated fluoride concentration intensity map of the state of Karnataka, and to evaluate these data in the context of fluoride-related health effects such as fluorosis and their prevalence. Aqueous standard solutions of 10, 100 and 1,000 ppm fluoride (F - ) were prepared with analytical grade Na + /F - and a buffer; TISAB II was incorporated in both calibration standard and analysis solutions in order to remove the potentially interfering effects of trace metal ions. This analysis was performed using an ion-selective electrode (ISE), and mean determination readings for n = 5 samples collected at each Karnataka water source were recorded. The F - concentration in drinking water in Karnataka state was found to vary substantially, with the highest mean values recorded being in the north-eastern zone (1.61 ppm), and the lowest in the south-western one (only 0.41 ppm). Analysis of variance (ANOVA) demonstrated that there were very highly significant 'between-zone' and 'between-districts-within-zones' sources of variation (p water source F - levels within this state. The southern part of Karnataka has low levels of F - in its drinking water, and may require fluoridation treatment in order to mitigate for dental caries and further ailments related to fluoride deficiency. However, districts within the north-eastern region have contrastingly high levels of fluoride, an observation which has been linked to dental and skeletal fluorosis. This highlights a major requirement for interventional actions in order to ensure maintenance of the recommended range of fluoride concentrations (0.8-1.5 ppm) in Karnataka's drinking water

  2. The association of drinking water treatment and distribution network disturbances with Health Call Centre contacts for gastrointestinal illness symptoms.

    Science.gov (United States)

    Malm, Annika; Axelsson, Gösta; Barregard, Lars; Ljungqvist, Jakob; Forsberg, Bertil; Bergstedt, Olof; Pettersson, Thomas J R

    2013-09-01

    There are relatively few studies on the association between disturbances in drinking water services and symptoms of gastrointestinal (GI) illness. Health Call Centres data concerning GI illness may be a useful source of information. This study investigates if there is an increased frequency of contacts with the Health Call Centre (HCC) concerning gastrointestinal symptoms at times when there is a risk of impaired water quality due to disturbances at water works or the distribution network. The study was conducted in Gothenburg, a Swedish city with 0.5 million inhabitants with a surface water source of drinking water and two water works. All HCC contacts due to GI symptoms (diarrhoea, vomiting or abdominal pain) were recorded for a three-year period, including also sex, age, and geocoded location of residence. The number of contacts with the HCC in the affected geographical areas were recorded during eight periods of disturbances in the water works (e.g. short stops of chlorine dosing), six periods of large disturbances in the distribution network (e.g. pumping station failure or pipe breaks with major consequences), and 818 pipe break and leak repairs over a three-year period. For each period of disturbance the observed number of calls was compared with the number of calls during a control period without disturbances in the same geographical area. In total about 55, 000 calls to the HCC due to GI symptoms were recorded over the three-year period, 35 per 1000 inhabitants and year, but much higher (>200) for children water works or in the distribution network. Our results indicate that GI symptoms due to disturbances in water works or the distribution network are rare. The number of serious failures was, however limited, and further studies are needed to be able to assess the risk of GI illness in such cases. The technique of using geocoded HCC data together with geocoded records of disturbances in the drinking water network was feasible. Copyright © 2013 Elsevier

  3. The Biochemical Prognostic Factors of Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Myung Won Lee

    2014-06-01

    Full Text Available BackgroundPatients with subclinical hypothyroidism (SHT are common in clinical practice. However, the clinical significance of SHT, including prognosis, has not been established. Further clarifying SHT will be critical in devising a management plan and treatment guidelines for SHT patients. Thus, the aim of this study was to investigate the prognostic factors of SHT.MethodsWe reviewed the medical records of Korean patients who visited the endocrinology outpatient clinic of Severance Hospital from January 2008 to September 2012. Newly-diagnosed patients with SHT were selected and reviewed retrospectively. We compared two groups: the SHT maintenance group and the spontaneous improvement group.ResultsThe SHT maintenance group and the spontaneous improvement group had initial thyroid-stimulating hormone (TSH levels that were significantly different (P=0.035. In subanalysis for subjects with TSH levels between 5 to 10 µIU/mL, the spontaneous improvement group showed significantly lower antithyroid peroxidase antibody (anti-TPO-Ab titer than the SHT maintenance group (P=0.039. Regarding lipid profiles, only triglyceride level, unlike total cholesterol and low density lipoprotein cholesterol, was related to TSH level, which is correlated with the severity of SHT. Diffuse thyroiditis on ultrasonography only contributed to the severity of SHT, not to the prognosis. High sensitivity C-reactive protein and urine iodine excretion, generally regarded as possible prognostic factors, did not show any significant relation with the prognosis and severity of SHT.ConclusionOnly initial TSH level was a definite prognostic factor of SHT. TPO-Ab titer was also a helpful prognostic factor for SHT in cases with mildly elevated TSH. Other than TSH and TPO-Ab, we were unable to validate biochemical prognostic factors in this retrospective study for Korean SHT patients.

  4. The globally distributed genus Alexandrium: multifaceted roles in marine ecosystems and impacts on human health.

    Science.gov (United States)

    Anderson, Donald M; Alpermann, Tilman J; Cembella, Allan D; Collos, Yves; Masseret, Estelle; Montresor, Marina

    2012-02-01

    The dinoflagellate genus Alexandrium is one of the major harmful algal bloom (HAB) genera with respect to the diversity, magnitude and consequences of blooms. The ability of Alexandrium to colonize multiple habitats and to persist over large regions through time is testimony to the adaptability and resilience of this group of species. Three different families of toxins, as well as an as yet incompletely characterized suite of allelochemicals are produced among Alexandrium species. Nutritional strategies are equally diverse, including the ability to utilize a range of inorganic and organic nutrient sources, and feeding by ingestion of other organisms. Many Alexandrium species have complex life histories that include sexuality and often, but not always, cyst formation, which is characteristic of a meroplanktonic life strategy and offers considerable ecological advantages. Due to the public health and ecosystem impacts of Alexandrium blooms, the genus has been extensively studied, and there exists a broad knowledge base that ranges from taxonomy and phylogeny through genomics and toxin biosynthesis to bloom dynamics and modeling. Here we present a review of the genus Alexandrium, focusing on the major toxic and otherwise harmful species.

  5. Human Health Risk Assessment Simulations in a Distributed Environment for Shuttle Launch

    Science.gov (United States)

    Thirumalainambi, Rajkumar; Bardina, Jorge

    2004-01-01

    During the launch of a rocket under prevailing weather conditions, commanders at Cape Canaveral Air Force station evaluate the possibility of whether wind blown toxic emissions might reach civilian and military personnel in the near by area. In our model, we focused mainly on Hydrogen chloride (HCL), Nitrogen oxides (NOx) and Nitric acid (HNO3), which are non-carcinogenic chemicals as per United States Environmental Protection Agency (USEPA) classification. We have used the hazard quotient model to estimate the number of people at risk. It is based on the number of people with exposure above a reference exposure level that is unlikely to cause adverse health effects. The risk to the exposed population is calculated by multiplying the individual risk and the number in exposed population. The risk values are compared against the acceptable risk values and GO or NO-go situation is decided based on risk values for the Shuttle launch. The entire model is simulated over the web and different scenaria can be generated which allows management to choose an optimum decision.

  6. Iodine in the environment: its distribution and relationship to human health

    International Nuclear Information System (INIS)

    Fuge, R.

    1987-01-01

    Many workers have attempted to link the incidence of I deficiency problems to geology and the levels of I in water supplies. However, much of the data used in the studies involved are unreliable or inadequate. In the light of recent data it is apparent that the role of drinking water as a source of dietary I has been greatly over estimated as levels in surface waters rarely exceed 3 μg/l, with subsurface sources somewhat higher. There is much conflicting evidence on the role of geology in I deficiency problems. The parent material strongly influences the type of soil formed and its ability to trap I. Additionally some rocks, particularly organic-rich sediments could add significant quantities of I to the soil. A more recent problem regarding iodine's influence on human health is that of radioactive I released during nuclear bomb attacks and nuclear power station accidents. This problem, which has been highlighted by the accidents at 3-mile Island and Chernobyl, mainly concerns the fate of 131 I which has a high specific activity and rapidly enters the food chain. In central continental areas where I is low any radioactive I released in this way would become a major source for plants and animals

  7. [Distribution Characteristics of Heavy Metals in Environmental Samples Around Electroplating Factories and the Health Risk Assessment].

    Science.gov (United States)

    Guo, Peng-ran; Lei, Yong-qian; Zhou, Qiao-li; Wang, Chang; Pan, Jia-chuan

    2015-09-01

    This study aimed to investigate the pollution degree and human health risk of heavy metals in soil and air samples around electroplating factories. Soil, air and waste gas samples were collected to measure 8 heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) in two electroplating factories, located in Baiyun district of Guangzhou city. Geoaccumulation index and USEPA Risk Assessment Guidance for Superfund (RAGS) were respectively carried out. Results showed that concentrations of Hg and Pb in waste gas and Cr in air samples were higher than limits of the corresponding quality standards, and concentrations of Cd, Hg and Zn in soil samples reached the moderate pollution level. The HQ and HI of exposure by heavy metals in air and soil samples were both lower than 1, indicating that there was no non-carcinogen risk. CRAs and CRCr in soil samples were beyond the maximum acceptable level of carcinogen risk (10(-4)), and the contribution rate of CRCr to TCR was over 81%. CRCr, CRNi and TCR in air samples were in range of 10(-6) - 10(-4), indicating there was possibly carcinogen risk but was acceptable risk. CR values for children were higher than adults in soils, but were higher for adults in air samples. Correlation analysis revealed that concentrations of heavy metals in soils were significantly correlated with these in waste gas samples, and PCA data showed pollution sources of Cd, Hg and Zn in soils were different from other metals.

  8. Prognostic and survival analysis of presbyopia: The healthy twin study

    Science.gov (United States)

    Lira, Adiyani; Sung, Joohon

    2015-12-01

    Presbyopia, a vision condition in which the eye loses its flexibility to focus on near objects, is part of ageing process which mostly perceptible in the early or mid 40s. It is well known that age is its major risk factor, while sex, alcohol, poor nutrition, ocular and systemic diseases are known as common risk factors. However, many other variables might influence the prognosis. Therefore in this paper we developed a prognostic model to estimate survival from presbyopia. 1645 participants which part of the Healthy Twin Study, a prospective cohort study that has recruited Korean adult twins and their family members based on a nation-wide registry at public health agencies since 2005, were collected and analyzed by univariate analysis as well as Cox proportional hazard model to reveal the prognostic factors for presbyopia while survival curves were calculated by Kaplan-Meier method. Besides age, sex, diabetes, and myopia; the proposed model shows that education level (especially engineering program) also contribute to the occurrence of presbyopia as well. Generally, at 47 years old, the chance of getting presbyopia becomes higher with the survival probability is less than 50%. Furthermore, our study shows that by stratifying the survival curve, MZ has shorter survival with average onset time about 45.8 compare to DZ and siblings with 47.5 years old. By providing factors that have more effects and mainly associate with presbyopia, we expect that we could help to design an intervention to control or delay its onset time.

  9. Real-time appraisal of the spatially distributed heat related health risk and energy demand of cities

    Science.gov (United States)

    Keramitsoglou, Iphigenia; Kiranoudis, Chris T.; Sismanidis, Panagiotis

    2016-08-01

    The Urban Heat Island (UHI) is an adverse environmental effect of urbanization that increases the energy demand of cities, impacts the human health, and intensifies and prolongs heatwave events. To facilitate the study of UHIs the Institute for Astronomy, Astrophysics, Space Applications and Remote Sensing of the National Observatory of Athens (IAASARS/NOA) has developed an operational real-time system that exploits remote sensing image data from Meteosat Second Generation - Spinning Enhanced Visible and Infrared Imager (MSG-SEVIRI) and generates high spatiotemporal land surface temperature (LST) and 2 m air temperature (TA) time series. These datasets form the basis for the generation of higher value products and services related to energy demand and heat-related health issues. These products are the heatwave hazard (HZ); the HUMIDEX (i.e. an index that describes the temperature felt by an individual exposed to heat and humidity); and the cooling degrees (CD; i.e. a measure that reflects the energy needed to cool a building). The spatiotemporal characteristics of HZ, HUMIDEX and CD are unique (1 km/5 min) and enable the appraisal of the spatially distributed heat related health risk and energy demand of cities. In this paper, the real time generation of the high spatiotemporal HZ, HUMIDEX and CD products is discussed. In addition, a case study corresponding to Athens' September 2015 heatwave is presented so as to demonstrate their capabilities. The overall aim of the system is to provide high quality data to several different end users, such as health responders, and energy suppliers. The urban thermal monitoring web service is available at http://snf-652558.vm.okeanos.grnet.gr/treasure/portal/info.html.

  10. Conceptualizing prognostic awareness in advanced cancer: a systematic review.

    Science.gov (United States)

    Applebaum, Allison J; Kolva, Elissa A; Kulikowski, Julia R; Jacobs, Jordana D; DeRosa, Antonio; Lichtenthal, Wendy G; Olden, Megan E; Rosenfeld, Barry; Breitbart, William

    2014-09-01

    This systematic review synthesizes the complex literature on prognostic awareness in cancer. A total of 37 studies examining cancer patients' understanding of their prognosis were included. Prognostic awareness definitions and assessment methods were inconsistent across studies. A surprisingly high percentage of patients (up to 75%) were unaware of their poor prognosis, and in several studies, even their cancer diagnosis (up to 96%), particularly in studies conducted outside of North America. This review highlights surprisingly low rates of prognostic awareness in patients with advanced cancer as well as discrepancies in prognostic awareness assessment, suggesting the need for empirically validated measures of prognostic awareness. © The Author(s) 2013.

  11. Chemistry, distribution, and metabolism of tomato carotenoids and their impact on human health.

    Science.gov (United States)

    Khachik, Frederick; Carvalho, Lorena; Bernstein, Paul S; Muir, Garth J; Zhao, Da-You; Katz, Nikita B

    2002-11-01

    Recent epidemiological studies have suggested that the consumption of tomatoes and tomato-based food products reduce the risk of prostate cancer in humans. This protective effect has been attributed to carotenoids, which are one of the major classes of phytochemicals in this fruit. The most abundant carotenoid in tomato is lycopene, followed by phytoene, phytofluene, zeta-carotene, gamma-carotene, beta-carotene, neurosporene, and lutein. The distribution of lycopene and related carotenoids in tomatoes and tomato-based food products has been determined by extraction and high-performance liquid chromatography-UV/Visible photodiode array detection. Detailed qualitative and quantitative analysis of human serum, milk, and organs, particularly prostate, have revealed the presence of all the aforementioned carotenoids in biologically significant concentrations. Two oxidative metabolites of lycopene, 2,6-cyclolycopene-1,5-diols A and B, which are only present in tomatoes in extremely low concentrations, have been isolated and identified in human serum, milk, organs (liver, lung, breast, liver, prostate, colon) and skin. Carotenoids may also play an important role in the prevention of age-related macular degeneration, cataracts, and other blinding disorders. Among 25 dietary carotenoids and nine metabolites routinely found in human serum, mainly (3R,3'R,6'R)-lutein, (3R,3'R)-zeaxanthin, lycopene, and their metabolites were detected in ocular tissues. In this review we identified and quantified the complete spectrum of carotenoids from pooled human retinal pigment epithelium, ciliary body, iris, lens, and in the uveal tract and in other tissues of the human eye to gain a better insight into the metabolic pathways of ocular carotenoids. Although (3R,3'R,6'R)-lutein, (3R,3'R)-zeaxanthin, and their metabolites constitute the major carotenoids in human ocular tissues, lycopene and a wide range of dietary carotenoids have been detected in high concentrations in ciliary body and

  12. Pilot study to reduce emissions, improve health, and offset BC emissions through the distribution of improved cook stoves in Nepal

    Science.gov (United States)

    Banmali Pradhan, B.; Panday, A. K.; Surapipith, V.

    2013-12-01

    In most developing countries, wood and other biomass fuels are still the primary source of energy for the majority of the people, particularly the poor. It is estimated that cook stoves account for approximately 20% of global black carbon emissions. In Nepal 87% of energy is supplied from traditional biomass and 75% of households still depend on biomass as a cooking fuel. The substitution of traditional cook stoves with improved cook stoves provides an important way to reduce black carbon emissions. In 2013 the International Centre for Integrated Mountain Development (ICIMOD) has commenced a pilot study that both examines ways to effectively disseminate improved cookstoves across remote rural mountain regions, and also quantifies the resulting changes in emissions, air quality and health. The selected study area is in Bajrabarahi Village in Makawanpur district, to the southwest of Kathmandu. The study area consists of around 1600 households, which are divided into control groups and groups where the cook stove intervention is taking place. The study complements the ';Clean Cooking energy solution for all by 2017' announced by the Government of Nepal recently, and will provide insights to the government on ways to effectively reduce black carbon emissions from cook stoves. To make the study robust and sustainable, local women's group and a local medical institution are involved in the project right from the conceptualization stage. The study region has been chosen in part because the medical school Patan Academy of Health Sciences (PAHS) has already started a long term health assessment in the region, and has built up considerable local contacts. The local women's group is working on the modality of cook stove distribution through micro credit programmes in the village. We will distribute the best available manufactured, fan-assisted cook stoves that are expected to reduce BC emissions the most. Health assessments, emissions estimates, as well as measurements of

  13. FDA: polyurethane condom carries "extremely misleading" label. Federal agency allows distribution for public health's sake.

    Science.gov (United States)

    1995-02-01

    The labeling of the Avanti polyurethane condom selling in 10 Western states makes misleading claims about protection from pregnancy and sexually transmitted diseases (STDs) according to officials at the US Food and Drug Administration (FDA). Avanti is sold in a foil package printed with the claim that it is effective against pregnancy, HIV, and STDs. However, polyurethane condoms have not undergone clinical efficacy testing for contraception or STDs, according to officials. The manufacturer of the condom refuted this allegation, stating that latex condoms have the same claims on them. In early 1995 the FDA met with the manufacturer and other companies developing plastic condoms, and concluded that these condoms could not make such claims, nor any claims about slippage and breakage rates. Despite warnings in 1993 to the manufacturer of Avanti about labeling restrictions, the company printed pregnancy and STD efficacy claims on the boxes and individual packages. The FDA later worked out a compromise with the firm in which only the boxes had to be reprinted with the generic label. The FDA had to weigh the risk of the public health cost of delaying sale of the condom, which is the first impermeable condom proven safe for people with latex allergies. In 1991 the FDA was defining standards for clinical testing and labeling of polyurethane condoms under congressional mandate, but the manufacturer of Avanti began mass production based on a preliminary approval determining that the condom was equivalent to latex condoms already on the market. 7000 Avanti condoms were subsequently tested in five countries, but these user tests did not compare Avanti to latex condoms and did not test for pregnancy and STD protection. Test results submitted to the FDA by the company indicated that, although Avanti is more than 1/3 less elastic than latex condoms, it did not break more frequently in an in-use study involving 187 couples.

  14. Global Ozone Distribution relevant to Human Health: Metrics and present day levels from the Tropospheric Ozone Assessment Report (TOAR)

    Science.gov (United States)

    Fleming, Z. L.; Doherty, R. M.; von Schneidemesser, E.; Cooper, O. R.; Malley, C.; Colette, A.; Xu, X.; Pinto, J. P.; Simpson, D.; Schultz, M. G.; Hamad, S.; Moola, R.; Solberg, S.; Feng, Z.

    2017-12-01

    Using stations from the TOAR surface ozone database, this study quantifies present-day global and regional distributions of five ozone metrics relevant for both short-term and long-term human exposure. These metrics were explored at ozone monitoring sites globally, and re-classified for this project as urban or non-urban using population densities and night-time lights. National surface ozone limit values are usually related to an annual number of exceedances of daily maximum 8-hour running mean (MDA8), with many countries not even having any ozone limit values. A discussion and comparison of exceedances in the different ozone metrics, their locations and the seasonality of exceedances provides clues as to the regions that potentially have more serious ozone health implications. Present day ozone levels (2010-2014) have been compared globally and show definite geographical differences (see Figure showing the annual 4th highest MDA8 for present day ozone for all non-urban stations). Higher ozone levels are seen in western compared to eastern US, and between southern and northern Europe, and generally higher levels in east Asia. The metrics reflective of peak concentrations show highest values in western North America, southern Europe and East Asia. A number of the metrics show similar distributions of North-South gradients, most prominent across Europe and Japan. The interquartile range of the regional ozone metrics was largest in East Asia, higher for urban stations in Asia but higher for non-urban stations in Europe and North America. With over 3000 monitoring stations included in this analysis and despite the higher densities of monitoring stations in Europe, north America and East Asia, this study provides the most comprehensive global picture to date of surface ozone levels in terms of health-relevant metrics.

  15. Accelerated Aging System for Prognostics of Power Semiconductor Devices

    Science.gov (United States)

    Celaya, Jose R.; Vashchenko, Vladislav; Wysocki, Philip; Saha, Sankalita

    2010-01-01

    Prognostics is an engineering discipline that focuses on estimation of the health state of a component and the prediction of its remaining useful life (RUL) before failure. Health state estimation is based on actual conditions and it is fundamental for the prediction of RUL under anticipated future usage. Failure of electronic devices is of great concern as future aircraft will see an increase of electronics to drive and control safety-critical equipment throughout the aircraft. Therefore, development of prognostics solutions for electronics is of key importance. This paper presents an accelerated aging system for gate-controlled power transistors. This system allows for the understanding of the effects of failure mechanisms, and the identification of leading indicators of failure which are essential in the development of physics-based degradation models and RUL prediction. In particular, this system isolates electrical overstress from thermal overstress. Also, this system allows for a precise control of internal temperatures, enabling the exploration of intrinsic failure mechanisms not related to the device packaging. By controlling the temperature within safe operation levels of the device, accelerated aging is induced by electrical overstress only, avoiding the generation of thermal cycles. The temperature is controlled by active thermal-electric units. Several electrical and thermal signals are measured in-situ and recorded for further analysis in the identification of leading indicators of failures. This system, therefore, provides a unique capability in the exploration of different failure mechanisms and the identification of precursors of failure that can be used to provide a health management solution for electronic devices.

  16. A copula-based sampling method for data-driven prognostics

    International Nuclear Information System (INIS)

    Xi, Zhimin; Jing, Rong; Wang, Pingfeng; Hu, Chao

    2014-01-01

    This paper develops a Copula-based sampling method for data-driven prognostics. The method essentially consists of an offline training process and an online prediction process: (i) the offline training process builds a statistical relationship between the failure time and the time realizations at specified degradation levels on the basis of off-line training data sets; and (ii) the online prediction process identifies probable failure times for online testing units based on the statistical model constructed in the offline process and the online testing data. Our contributions in this paper are three-fold, namely the definition of a generic health index system to quantify the health degradation of an engineering system, the construction of a Copula-based statistical model to learn the statistical relationship between the failure time and the time realizations at specified degradation levels, and the development of a simulation-based approach for the prediction of remaining useful life (RUL). Two engineering case studies, namely the electric cooling fan health prognostics and the 2008 IEEE PHM challenge problem, are employed to demonstrate the effectiveness of the proposed methodology. - Highlights: • We develop a novel mechanism for data-driven prognostics. • A generic health index system quantifies health degradation of engineering systems. • Off-line training model is constructed based on the Bayesian Copula model. • Remaining useful life is predicted from a simulation-based approach

  17. Total Mercury in Squalid Callista Megapitaria squalida from the SW Gulf of California, Mexico: Tissue Distribution and Human Health Risk.

    Science.gov (United States)

    Romo-Piñera, Abril K; Escobar-Sánchez, Ofelia; Ruelas-Inzunza, Jorge; Frías-Espericueta, Martín G

    2018-03-01

    We evaluated the total Hg concentration in different tissues of squalid callista Megapitaria squalida in order to measure Hg distribution in tissue and to estimate human health risk. Samples were obtained by free diving in the SW Gulf of California, Mexico. Concentrations are given on a wet weight basis. A total of 89 squalid callista specimens were obtained, presenting an average Hg concentration of 0.07 ± 0.04 µg g -1 . There were no significant differences (p > 0.05) in Hg concentration between tissues (visceral mass = 0.09 ± 0.08 µg g -1 ; mantle = 0.06 ± 0.07 µg g -1 ; muscle = 0.06 ± 0.04 µg g -1 ). The low Hg values found in squalid callista and its low risk quotient (HQ = 0.03) suggest that the consumption of squalid callista does not represent a human health risk. However, HQ calculated using MeHg was > 1, it which could indicate a potential risk related to consumption of clams.

  18. Emission, distribution and health effects of ultrafine particles by road traffic; Emissies, verspreiding en gezondheidseffecten van ultrafijnstof door wegverkeer

    Energy Technology Data Exchange (ETDEWEB)

    Keuken, M.; Wilmink, I.; Tromp, P.; De Kluizenaar, Y.

    2009-02-15

    Epidemiological studies show that living in the vicinity of busy traffic routes is detrimental to health. This study quantifies the issue of ultrafine particles (UFPs). The results can be used to support technological and mobility policies for reducing exposure to UFPs. The study was conducted in three work packages: (1) WP1: emissions, distribution and health effects of UFPs by road traffic and curbing options; (2) WP2: exposure and toxicology of UFPs near the source; (3) WP3: shaping, testing and dissemination of a thorough TNO vision on the UFP theme. [Dutch] Epidemiologisch onderzoek wijst uit dat wonen nabij drukke verkeerswegen schadelijk is voor de gezondheid. In deze studie wordt het probleem van ultrafijne (UF) deeltjes gekwantificeerd en op basis daarvan kan het technologie- en mobiliteitsbeleid voor vermindering van de blootstelling aan UF worden ondersteund. Het UF-onderzoek (UFO) is uitgevoerd in drie werkpakketten: (1) WP1: emissies, verspreiding en gezondheidseffecten van UF door het wegverkeer en de mogelijkheden die te beperken; (2) WP2: blootstelling en toxicologie van UF nabij de bron; (3) WP3: vormen, toetsen en uitdragen van een gedegen TNO visie op het thema UF.

  19. Pollution level, phase distribution and health risk of polycyclic aromatic hydrocarbons in indoor air at public places of Hangzhou, China

    International Nuclear Information System (INIS)

    Lu Hao; Zhu Lizhong; Chen Shuguang

    2008-01-01

    PAHs pollution survey in air of public places was conducted in Hangzhou, China. The most serious PAHs pollution was observed in indoor air of shopping centers and the slightest was in train stations. The molecular weight of chrysene (MW 228) appeared to be the dividing line for the PAHs with a larger or smaller distribution in the vapor or particulate phase. Concentrations of 15 PAHs on PM 2.5 accounted for 71.3% of total particulate PAHs, and followed by PM 2.5-10 fraction (17.6%) and >PM 10 fraction (11.1%). In shopping centers and supermarkets, emission of 2-4 rings PAHs occurred from indoor sources, whereas 5-6 rings PAHs predominantly originated from transport of outdoor air. In temples, PAHs in indoor air mainly originated from incense burning. Health risks associated with the inhalation of PAHs were assessed, and naphthalene made the greatest contribution (62.4%) to the total health risks. - Concentrations of PAHs in the air of selected public places in Hangzhou correspond to 10 -3 life-time lung cancer risk

  20. Hierarchical Distributed-Lag Models: Exploring Varying Geographic Scale and Magnitude in Associations Between the Built Environment and Health.

    Science.gov (United States)

    Baek, Jonggyu; Sanchez-Vaznaugh, Emma V; Sánchez, Brisa N

    2016-03-15

    It is well known that associations between features of the built environment and health depend on the geographic scale used to construct environmental attributes. In the built environment literature, it has long been argued that geographic scales may vary across study locations. However, this hypothesized variation has not been systematically examined due to a lack of available statistical methods. We propose a hierarchical distributed-lag model (HDLM) for estimating the underlying overall shape of food environment-health associations as a function of distance from locations of interest. This method enables indirect assessment of relevant geographic scales and captures area-level heterogeneity in the magnitudes of associations, along with relevant distances within areas. The proposed model was used to systematically examine area-level variation in the association between availability of convenience stores around schools and children's weights. For this case study, body mass index (weight kg)/height (m)2) z scores (BMIz) for 7th grade children collected via California's 2001-2009 FitnessGram testing program were linked to a commercial database that contained locations of food outlets statewide. Findings suggested that convenience store availability may influence BMIz only in some places and at varying distances from schools. Future research should examine localized environmental or policy differences that may explain the heterogeneity in convenience store-BMIz associations. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Follow-up of blood glucose distribution characteristics in a health examination population in Chengdu from 2010 to 2016.

    Science.gov (United States)

    Wang, Yuting; Xu, Wangdong; Zhang, Qiongying; Bao, Ting; Yang, Hanwei; Huang, Wenxia; Tang, Huairong

    2018-02-01

    The worldwide prevalence and incidence of diabetes and obesity are increasing in pandemic proportions. Thus, regular health examination is an important way for early detection of diabetes and glucose intolerance. The present study aims to detect the blood glucose distribution characteristics of the participants in the Health Examination Center at West China Hospital, Sichuan University from 2010 to 2016.A prospective cohort included 9168 Chinese participants, aged 18 years or more, who had available information on fasting blood glucose concentrations at the start of the study (2010). Examination surveys were conducted every year from 2010 to 2016. Cases having serum level of fasting blood glucose between 2.2 and 6.1 mmol/L were considered as normality, while serum level of fasting blood glucose level of glucose was gradually reduced both in males and females from 2010 to 2016, by which the percentage of males having normal level of glucose was significantly lower than that in females. Moreover, the mean level of glucose was significantly increased from 2010 to 2016 both in males and females overall, and the mean level of glucose was higher in males compared with that in females every year. Furthermore, we showed that the level of glucose was gradually increased year by year in each age group, and the level of glucose was higher in aged cases compared with the young population.The study population in the current study showed higher levels of glucose with ages increasing, and males indicated higher expression of glucose than that in females. Some preventive action may be adopted early and more attention can be paid to this health-examination population.

  2. The Distribution and Health Risk Assessment of Metals in Soils in the Vicinity of Industrial Sites in Dongguan, China

    Directory of Open Access Journals (Sweden)

    Chao Liu

    2016-08-01

    Full Text Available Exponential industrialization and rapid urbanization have resulted in contamination of soil by metals from anthropogenic sources in Dongguan, China. The aims of this research were to determine the concentration and distribution of various metals (arsenic (As, cadmium (Cd, chromium (Cr, copper (Cu, mercury (Hg, nickel (Ni, lead (Pb and zinc (Zn in soils and identify their potential health risks for local residents. A total of 106 soil samples were collected from the vicinity of industrial sites in Dongguan. Two types of samples were collected from each site: topsoil (0–20 cm, TS and shallow soil (20–50 cm, SS. Results showed that the soils were contaminated by metals and pollution was mainly focused on TS. The geoaccumulation index (Igeo and pollution indexes (PI implied that there was a slight increase in the concentrations of Cd, Cu, Hg, Ni, and Pb, but the metal pollution caused by industrial activities was less severe, and elements of As and Cr exhibited non-pollution level. The risk assessment results suggested that there was a potential health risk associated with As and Cr exposure for residents because the carcinogenic risks of As and Cr via corresponding exposure pathways exceeded the safety limit of 10−6 (the acceptable level of carcinogenic risk for humans. Furthermore, oral ingestion and inhalation of soil particles are the main exposure pathways for As and Cr to enter the human body. This study may provide basic information of metal pollution control and human health protection in the vicinity of industrial regions.

  3. Breast MR imaging: correlation of high resolution dynamic MR findings with prognostic factors

    International Nuclear Information System (INIS)

    Lee, Shin Ho; Cho, Nariya; Chung, Hye Kyung; Kim, Seung Ja; Cho, Kyung Soo; Moon, Woo Kyung; Cho, Joo Hee

    2005-01-01

    We wanted to correlate the kinetic and morphologic MR findings of invasive breast cancer with the classical and molecular prognostic factors. Eighty-seven patients with invasive ductal carcinoma NOS underwent dynamic MR imaging at 1.5 T, and with using the T1-weighted 3D FLASH technique. The morphologic findings (shape, margin, internal enhancement of the mass or the enhancement distribution and the internal enhancement of any non-mass lesion) and the kinetic findings (the initial phase and the delayed phase of the time-signal. Intensity curve) were interpreted using a ACR BI-RADS-MRI lexicon. We correlate MR findings with histopathologic prognostic factors (tumor size, lymph node status and tumor grade) and the immunohistochemically detected biomarkers (ER, PR, ρ 53, c-erbB-2, EGFR and Ki-67). Univariate and multivariate statistical analyses were than performed. Among the MR findings, a spiculated margin, rim enhancement and washout were significantly correlated with the prognostic factors. A spiculated margin was independently associated with the established predictors of a good prognosis (a lower histologic and nuclear grade, positive ER and PR) and rim enhancement was associated with a poor prognosis (a higher histologic and nuclear grade, negative ER and PR). Wash out was a independent predictor of Ki-67 activity. Some of the findings of high resolution dynamic MR imaging were associated with the prognostic factors, and these findings may predict the prognosis of breast cancer

  4. Elements of a unified prognostic model for secondary air contamination by resuspension

    International Nuclear Information System (INIS)

    Besnus, F.; Garger, E.; Gordeev, S.; Hollaender, W.; Kashparov, V.; Martinez-Serrano, J.; Mironov, V.; Nicholson, K.; Tschiersch, J.; Vintersved, I.

    1996-01-01

    Based on results of several joint experimental campaigns and an extensive literature survey, a prognostic model was constructed capable of predicting airborne activity concentrations and size distributions as well as soil surface activity concentrations as a function of time and meteorological conditions. Example scenario calculations show that agricultural practices are of lesser importance to secondary air contamination than dust storms immediately after primary deposition and forest fires

  5. Bayesian Framework Approach for Prognostic Studies in Electrolytic Capacitor under Thermal Overstress Conditions

    Science.gov (United States)

    2012-09-01

    make end of life ( EOL ) and remaining useful life (RUL) estimations. Model-based prognostics approaches perform these tasks with the help of first...in parameters Degradation Modeling Parameter estimation Prediction Thermal / Electrical Stress Experimental Data State Space model RUL EOL ...distribution at given single time point kP , and use this for multi-step predictions to EOL . There are several methods which exits for selecting the sigma

  6. Accurate bearing remaining useful life prediction based on Weibull distribution and artificial neural network

    Science.gov (United States)

    Ben Ali, Jaouher; Chebel-Morello, Brigitte; Saidi, Lotfi; Malinowski, Simon; Fnaiech, Farhat

    2015-05-01

    Accurate remaining useful life (RUL) prediction of critical assets is an important challenge in condition based maintenance to improve reliability and decrease machine's breakdown and maintenance's cost. Bearing is one of the most important components in industries which need to be monitored and the user should predict its RUL. The challenge of this study is to propose an original feature able to evaluate the health state of bearings and to estimate their RUL by Prognostics and Health Management (PHM) techniques. In this paper, the proposed method is based on the data-driven prognostic approach. The combination of Simplified Fuzzy Adaptive Resonance Theory Map (SFAM) neural network and Weibull distribution (WD) is explored. WD is used just in the training phase to fit measurement and to avoid areas of fluctuation in the time domain. SFAM training process is based on fitted measurements at present and previous inspection time points as input. However, the SFAM testing process is based on real measurements at present and previous inspections. Thanks to the fuzzy learning process, SFAM has an important ability and a good performance to learn nonlinear time series. As output, seven classes are defined; healthy bearing and six states for bearing degradation. In order to find the optimal RUL prediction, a smoothing phase is proposed in this paper. Experimental results show that the proposed method can reliably predict the RUL of rolling element bearings (REBs) based on vibration signals. The proposed prediction approach can be applied to prognostic other various mechanical assets.

  7. [Prognostic factors of early breast cancer].

    Science.gov (United States)

    Almagro, Elena; González, Cynthia S; Espinosa, Enrique

    2016-02-19

    Decision about the administration of adjuvant therapy for early breast cancer depends on the evaluation of prognostic factors. Lymph node status, tumor size and grade of differentiation are classical variables in this regard, and can be complemented by hormonal receptor status and HER2 expression. These factors can be combined into prognostic indexes to better estimate the risk of relapse or death. Other factors are less important. Gene profiles have emerged in recent years to identify low-risk patients who can forgo adjuvant chemotherapy. A number of profiles are available and can be used in selected cases. In the future, gene profiling will be used to select patients for treatment with new targeted therapies. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Diagnostic and prognostic epigenetic biomarkers in cancer.

    Science.gov (United States)

    Costa-Pinheiro, Pedro; Montezuma, Diana; Henrique, Rui; Jerónimo, Carmen

    2015-01-01

    Growing cancer incidence and mortality worldwide demands development of accurate biomarkers to perfect detection, diagnosis, prognostication and monitoring. Urologic (prostate, bladder, kidney), lung, breast and colorectal cancers are the most common and despite major advances in their characterization, this has seldom translated into biomarkers amenable for clinical practice. Epigenetic alterations are innovative cancer biomarkers owing to stability, frequency, reversibility and accessibility in body fluids, entailing great potential of assay development to assist in patient management. Several studies identified putative epigenetic cancer biomarkers, some of which have been commercialized. However, large multicenter validation studies are required to foster translation to the clinics. Herein we review the most promising epigenetic detection, diagnostic, prognostic and predictive biomarkers for the most common cancers.

  9. Prognostic Gene Expression Profiles in Breast Cancer

    DEFF Research Database (Denmark)

    Sørensen, Kristina Pilekær

    Each year approximately 4,800 Danish women are diagnosed with breast cancer. Several clinical and pathological factors are used as prognostic and predictive markers to categorize the patients into groups of high or low risk. Around 90% of all patients are allocated to the high risk group...... clinical courses, and they may be useful as novel prognostic biomarkers in breast cancer. The aim of the present project was to predict the development of metastasis in lymph node negative breast cancer patients by RNA profiling. We collected and analyzed 82 primary breast tumors from patients who...... and the time of event. Previous findings have shown that high expression of the lncRNA HOTAIR is correlated with poor survival in breast cancer. We validated this finding by demonstrating that high HOTAIR expression in our primary tumors was significantly associated with worse prognosis independent...

  10. Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

    Directory of Open Access Journals (Sweden)

    Jack Kit-Chung Ng

    2016-10-01

    Full Text Available Background/Aims: Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD patients remain unknown. Methods: We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. Results: Amongst the 193 patients, 134 (69.4% met the criteria of being frail. Frailty Score significantly correlated with Charlson's comorbidity score (r = 0.40, p Conclusions: Frailty is prevalent among Chinese PD patients. Frail PD patients have a high risk of requiring hospitalization and their hospital stay tends to be prolonged. Early identification may allow timely intervention to prevent adverse health outcomes in this group of patients.

  11. Genetic prognostic markers in colorectal cancer.

    OpenAIRE

    Houlston, R S; Tomlinson, I P

    1997-01-01

    The contribution of molecular genetics to colorectal cancer has been restricted largely to relatively rare inherited tumours and to the detection of germline mutations predisposing to these cancers. However, much is now also known about somatic events leading to colorectal cancer. A number of studies has been undertaken examining possible relations between genetic features and prognostic indices. While many of these studies are small and inconclusive, it is clear that a number of different pa...

  12. Machinery prognostics and prognosis oriented maintenance management

    CERN Document Server

    Yan, Jihong

    2014-01-01

    This book gives a complete presentatin of the basic essentials of machinery prognostics and prognosis oriented maintenance management, and takes a look at the cutting-edge discipline of intelligent failure prognosis technologies for condition-based maintenance.  Latest research results and application methods are introduced for signal processing, reliability moelling, deterioration evaluation, residual life prediction and maintenance-optimization as well as applications of these methods.

  13. No prognostic value added by vitamin D pathway SNPs to current prognostic system for melanoma survival.

    Directory of Open Access Journals (Sweden)

    Li Luo

    Full Text Available The prognostic improvement attributed to genetic markers over current prognostic system has not been well studied for melanoma. The goal of this study is to evaluate the added prognostic value of Vitamin D Pathway (VitD SNPs to currently known clinical and demographic factors such as age, sex, Breslow thickness, mitosis and ulceration (CDF. We utilized two large independent well-characterized melanoma studies: the Genes, Environment, and Melanoma (GEM and MD Anderson studies, and performed variable selection of VitD pathway SNPs and CDF using Random Survival Forest (RSF method in addition to Cox proportional hazards models. The Harrell's C-index was used to compare the performance of model predictability. The population-based GEM study enrolled 3,578 incident cases of cutaneous melanoma (CM, and the hospital-based MD Anderson study consisted of 1,804 CM patients. Including both VitD SNPs and CDF yielded C-index of 0.85, which provided slight but not significant improvement by CDF alone (C-index = 0.83 in the GEM study. Similar results were observed in the independent MD Anderson study (C-index = 0.84 and 0.83, respectively. The Cox model identified no significant associations after adjusting for multiplicity. Our results do not support clinically significant prognostic improvements attributable to VitD pathway SNPs over current prognostic system for melanoma survival.

  14. PROGNOSTIC FACTORS OF SURVIVAL IN RENAL CANCER

    Directory of Open Access Journals (Sweden)

    A. V. Seriogin

    2014-08-01

    Full Text Available The purpose of the study was to reveal the independent anatomic, histological, and clinical factors of cancer-specific survival in patients with renal-cell carcinoma (RCC. For this, the authors retrospectively analyzed their experience with radical surgical treatments in 73 RCC patients operated on at the Department of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, from January 1, 1999 to December 31, 2004; their outcomes have become known by the present time. There was a statistically significant correlation of cancer-specific survival with its parameters, such as pathological stage of a tumor, its maximum pathological size, differentiation grade, involvement of regional lymph nodes, venous tumor thrombosis, level of thrombocytosis, and degree of the clinical symptoms of the disease. Multivariate analysis of survival in RCC in relation to the prognostic factors could reveal odd ratios for the limit values of significant prognostic factors. The statistically significant prognostic values established in the present study, as well as the molecular factors the implication of which is being now investigated can become in future an effective addition to the TNM staging system to define indications for certain treatments and to predict survival in RCC  

  15. PROGNOSTIC FACTORS OF SURVIVAL IN RENAL CANCER

    Directory of Open Access Journals (Sweden)

    A. V. Seriogin

    2009-01-01

    Full Text Available The purpose of the study was to reveal the independent anatomic, histological, and clinical factors of cancer-specific survival in patients with renal-cell carcinoma (RCC. For this, the authors retrospectively analyzed their experience with radical surgical treatments in 73 RCC patients operated on at the Department of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, from January 1, 1999 to December 31, 2004; their outcomes have become known by the present time. There was a statistically significant correlation of cancer-specific survival with its parameters, such as pathological stage of a tumor, its maximum pathological size, differentiation grade, involvement of regional lymph nodes, venous tumor thrombosis, level of thrombocytosis, and degree of the clinical symptoms of the disease. Multivariate analysis of survival in RCC in relation to the prognostic factors could reveal odd ratios for the limit values of significant prognostic factors. The statistically significant prognostic values established in the present study, as well as the molecular factors the implication of which is being now investigated can become in future an effective addition to the TNM staging system to define indications for certain treatments and to predict survival in RCC  

  16. Prognostic factors for recurrences in neck pain patients up to 1 year after chiropractic care.

    Science.gov (United States)

    Langenfeld, Anke; Humphreys, B Kim; Swanenburg, Jaap; Peterson, Cynthia K

    2015-09-01

    Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode. Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere. Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as "recurrent." Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age. The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention in Swiss chiropractic patients presenting from varied onsets is low. This study found preliminary findings that older age and a previous episode of neck may be useful predictors of neck pain recurrence within 1 year. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  17. Design, Development, and Testing of a UAV Hardware-in-the-Loop Testbed for Aviation and Airspace Prognostics Research

    Science.gov (United States)

    Kulkarni, Chetan; Teubert, Chris; Gorospe, George; Burgett, Drew; Quach, Cuong C.; Hogge, Edward

    2016-01-01

    The airspace is becoming more and more complicated, and will continue to do so in the future with the integration of Unmanned Aerial Vehicles (UAVs), autonomy, spacecraft, other forms of aviation technology into the airspace. The new technology and complexity increases the importance and difficulty of safety assurance. Additionally, testing new technologies on complex aviation systems & systems of systems can be very difficult, expensive, and sometimes unsafe in real life scenarios. Prognostic methodology provides an estimate of the health and risks of a component, vehicle, or airspace and knowledge of how that will change over time. That measure is especially useful in safety determination, mission planning, and maintenance scheduling. The developed testbed will be used to validate prediction algorithms for the real-time safety monitoring of the National Airspace System (NAS) and the prediction of unsafe events. The framework injects flight related anomalies related to ground systems, routing, airport congestion, etc. to test and verify algorithms for NAS safety. In our research work, we develop a live, distributed, hardware-in-the-loop testbed for aviation and airspace prognostics along with exploring further research possibilities to verify and validate future algorithms for NAS safety. The testbed integrates virtual aircraft using the X-Plane simulator and X-PlaneConnect toolbox, UAVs using onboard sensors and cellular communications, and hardware in the loop components. In addition, the testbed includes an additional research framework to support and simplify future research activities. It enables safe, accurate, and inexpensive experimentation and research into airspace and vehicle prognosis that would not have been possible otherwise. This paper describes the design, development, and testing of this system. Software reliability, safety and latency are some of the critical design considerations in development of the testbed. Integration of HITL elements in

  18. Anicteric hepatoxicity: a potential health risk of occupational exposures in Nigerian petroleum oil refining and distribution industry.

    Science.gov (United States)

    Ezejiofor, Tobias I Ndubuisi; Ezejiofor, Anthonet N; Orisakwe, Orish E; Nwigwe, Hariet C; Osuala, Ferdinand Ou; Iwuala, Moses Oe

    2014-01-22

    Literature abounds linking one's job to certain unpalatable health outcomes. Since exposures to hazardous conditions in industrial environments often results in sundry health effects among workers, we embarked on this study to investigate the hepatic health effects of occupational activities in the petroleum refining and distribution industry. Biochemical markers of liver functions were assayed in plasma, using Reflotron dry chemistry spectrophotometric system. The study was conducted on randomly selected workers of Port Harcourt Refining Company (PHRC) and Pipelines and Petroleum Product Marketing Company (PPMC) both in Alesa-Eleme near Port Harcourt, Nigeria, as well as non-oil work civil servants serving as control subjects. Results showed that, bilirubin ranged 0.3-1.6 mg/dl with a mean of 0.66±0.20mg/dl among the oil workers as against 0.5-1.00mg/dl with a mean of 0.58±0.13mg/dl in non-oil workers, Alkaline phosphatase ranged 50.00-296.00u/l (mean: 126.21±39.49u/l) in oil workers as against 40.20-111u/l (mean: 66.83±18.54u/l) for non-oil workers, Aspartic transaminases (AST) ranged 5.80-140.20u/l (mean: 21.81±11.49u/l) in oil workers against 18.00-44.00u/l (mean: 26.89±6.99u/l) for non-oil workers, while Alanine transaminases (ALT) ranged 4.90-86.00u/l (mean: 22.14±11.28u/l) in oil workers as against 10.00-86.60u/l (mean: 22.30±10.22u/l) for the non-oil workers. A close study of the results revealed that although the mean values for all the studied parameters were still within the parametric reference ranges, however, relative to the referents, there were significant increases (Pdifferentiation data showed that though the mean values for the parameters were higher in males than females, the increases were not significant in most cases (P>0.05), whereas data for age and exposure period classifications revealed that irrespective of the age of the worker, the effects are likely to start after the first five years, manifesting fully after the first decade

  19. Fatigue as prognostic risk marker of mental sickness absence in white collar employees.

    Science.gov (United States)

    Roelen, C A M; Heymans, M W; van Rhenen, W; Groothoff, J W; Twisk, J W R; Bültmann, U

    2014-06-01

    To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced concentration, reduced motivation, and reduced physical activity. SA was medically certified by an occupational physician in the 3rd or 4th SA week with diagnostic codes according to the 10th version of the International Classification of Diseases. Medically certified SA was retrieved at the individual level from an occupational health register after 1-year follow-up. CIS scores were investigated as prognostic risk markers predicting medically certified SA and particularly SA certified as mental SA. 614 employees (N = 378 men and N = 236 women) had complete data and were eligible for analysis; 63 (10 %) had medically certified SA of whom 39 (6 %) had mental SA. Fatigue severity and total CIS scores were associated with medically certified SA in men, but poorly discriminated between men with and without medically certified SA. Fatigue severity, reduced concentration, reduced motivation, and total CIS scores were also associated with mental SA in men. CIS and its reduced concentration scale were valid prognostic risk markers of mental SA. CONCLUSION Fatigue was a prognostic risk marker of mental SA in white collar men. The CIS should be further validated as a screening tool for the risk of mental SA in white collar working populations.

  20. Relationship between Regional Body Fat Distribution and Diabetes Mellitus: 2008 to 2010 Korean National Health and Nutrition Examination Surveys

    Directory of Open Access Journals (Sweden)

    Soo In Choi

    2017-01-01

    Full Text Available BackgroundThe aim of this study was to investigate the association between regional body fat distribution, especially leg fat mass, and the prevalence of diabetes mellitus (DM in adult populations.MethodsA total of 3,181 men and 3,827 postmenopausal women aged 50 years or older were analyzed based on Korea National Health and Nutrition Examination Surveys (2008 to 2010. Body compositions including muscle mass and regional fat mass were measured using dual-energy X-ray absorptiometry.ResultsThe odds ratios (ORs for DM was higher with increasing truncal fat mass and arm fat mass, while it was lower with increasing leg fat mass. In a partial correlation analysis adjusted for age, leg fat mass was negatively associated with glycosylated hemoglobin in both sexes and fasting glucose in women. Leg fat mass was positively correlated with appendicular skeletal muscle mass and homeostasis model assessment of β cell. In addition, after adjusting for confounding factors, the OR for DM decreased gradually with increasing leg fat mass quartiles in both genders. When we subdivided the participants into four groups based on the median values of leg fat mass and leg muscle mass, higher leg fat mass significantly lowered the risk of DM even though they have smaller leg muscle mass in both genders (P<0.001.ConclusionThe relationship between fat mass and the prevalence of DM is different according to regional body fat distribution. Higher leg fat mass was associated with a lower risk of DM in Korean populations. Maintaining leg fat mass may be important in preventing impaired glucose tolerance.

  1. Clinicopathological analysis of prognostic factors in colorectal carcinoma

    Directory of Open Access Journals (Sweden)

    Aura Jurescu

    2016-12-01

    Full Text Available BACKGROUND Prediction of prognosis is vital for therapy options in patients with colorectal carcinoma (CRC. We aimed to identify some prognostic factors that could ensure a more adequate prediction of CRC patients’ outcome. MATERIALS AND METHODS We performed a study on a group of 253 CRC patients in the County Hospital ofTimișoara. The following variable parameters: age, gender, histological type, depth of tumor invasion (pT, histological grade (G, lymph node metastasis (LNM, lympho-vascular invasion (LVI were analyzed using Fisher’s exact test. RESULTS The incidence of CRC increased with age. Gender distribution was evidenced as follows: 159 (63% were male patients and 94 (37% were female patients. 234 (92% cases were conventional adenocarcinomas (ADK nM, 19 (8% were mucinous adenocarcinomas (ADK M. 1% of cases were pT1 stage, 9% pT2, 58% pT3 and 32% pT4 stage. 5% of the tumors were G1, 95% G2, G3, G4. In pT1&pT2 stages only 4% presented LVI, while in pT3&pT4 LVI was significantly higher, 42% of the examined cases. Only two cases from pT1&pT2 tumors showed LNM vs. 55% (127 cases of pT3&pT4 stages. CONCLUSIONS Tumor stage remains the most important prognostic predictor of clinical outcome for these patients. Pathologic assessment of various clinicopathological factors plays n essential role in patient management. Graphical abstract: Infiltrative aspects of colorectal carcinoma REFERENCES 1. Corman ML. Carcinoma of the Colon. In: Corman ML, editors. Colon and Rectal Surgery. 5-th edition. Philadelphia: Lippincott Williams nad Wilkins. 2005. p. 767-920. 2. Bresalier R. Malignant neoplasms of the large intestine. In: Feldman M, Friedman LS, Sleisenger MH (Editors. Gastrointestinal and Liver Disease (Pathology, Diagnosis, Management. Philadelphia, London,New York: Saunders. 2002. p. 2215-2263. 3. Schneider N, Langner C. Prognostic stratification of colorectal cancer patients: current perspectives. Cancer Management and Research. 2014;6:291- 300.

  2. Presence and use of legislative guidelines for the distribution of decentralized decision making authority in the jimma zone health system, southwest ethiopia.

    Science.gov (United States)

    Woldie, Mirkuzie; Jirra, Challi; Azene, Girma

    2011-08-01

    Decentralization ultimately involves the execution of most health care activities at lower levels of the health system. However, when poorly implemented, decentralization can create confusion about roles and responsibilities. Therefore, the objective of this study was to assess the presence and use of legislative guidelines depicting the distribution of decentralized authority for decision making in the Jimma Zone health system, Southwest Ethiopia. A cross sectional study employing both qualitative and quantitative methods was undertaken from 16(th) January to 15(th) March 2007 in Jimma Zone. Health managers at relevant departments of the Federal Ministry of Health, Oromia Regional Health Bureau (RHB), Jimma Zonal Health Department, 13 Woreda Health Offices of Jimma Zone and the health centers and health posts in these districts were included in the study. Data was collected using interview guides and self administered structured questionnaires prepared for each level of the health system. Tape-recorded qualitative data was transcribed and analyzed using thematic framework approach while SPSS for windows version 12.0.1 was used to analyze the quantitative data obtained. According to the regional guidelines, ensuring achievement of regional health service targets is the responsibility of the RHB. This was clear to 97 (97.9%) of the health managers included in this study. However, almost equivalent proportion of the respondents, 95 (95.9%) agreed that the FMOH should be responsible for this. Similarly, 71 (73.9%) of the health managers knew that approval of health budgets and efforts for local resource generation is the responsibility of the Woreda Administrative Council while the remaining 27.1% were uncertain or disagreed about this regional direction. Such confusions were observed in almost every functional area. Moreover, legislative guidelines were not available in most of the district health offices and health facilities. Legislative guidelines depicting the

  3. Tracing source, distribution and health risk of potentially harmful elements (PHEs) in street dust of Durgapur, India.

    Science.gov (United States)

    Gope, Manash; Masto, Reginald Ebhin; George, Joshy; Balachandran, Srinivasan

    2018-06-15

    Street dust samples from Durgapur, the steel city of eastern India, were collected from five different land use patterns, i.e., national highways, urban residential area, sensitive area, industrial area and busy traffic zone during summer, monsoon, and winter to analyze the pollution characteristics, chemical fractionation, source apportionment and health risk of heavy metals (HMs). The samples were fractionated into ≤ 53 µm and analyzed for potentially harmful elements (PHEs) viz. Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn. Summer season indicated higher concentrations of PHEs when compared to the other two seasons. Mean enrichment factor (EF), geo-accumulation index (Igeo), and contamination factor (CF) were high for Cd followed by Pb during all the three season in Durgapur. Chemical fractionation was executed in order to obtain distribution patterns of PHEs and to evaluate their bioavailable fractions in street dust samples. Mn was found to be highly bioavailable and bioavailability of the PHEs were in the order of Mn > Zn > Pb > Ni > Cd > Cu > Fe > Cr. Principal Component Analysis (PCA), cluster analysis, correlation analysis indicated the main sources of PHEs could be industrial, especially coal powered thermal plant, iron and steel industries and cement industries and vehicular. Multivariate analysis of variance (MANOVA) indicated that sites, seasons and their interaction were significantly affected by different PHEs as a whole. The health risk was calculated with total metal as well as mobile fraction of PHEs, which indicated that the actual non-carcinogenic risk due to bioavailable PHEs was less (HI < 1) when compared to total concentrations of PHEs. Carcinogenic risk was observed for total Cr in street dust (Child: 4.6E-06; Adult: 3.6E-06). Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Isocyanic acid in a global chemistry transport model: Tropospheric distribution, budget, and identification of regions with potential health impacts

    Science.gov (United States)

    Young, Paul. J.; Emmons, Louisa K.; Roberts, James M.; Lamarque, Jean-FrançOis; Wiedinmyer, Christine; Veres, Patrick; Vandenboer, Trevor C.

    2012-05-01

    This study uses a global chemical transport model to estimate the distribution of isocyanic acid (HNCO). HNCO is toxic, and concentrations exceeding 1 ppbv have been suggested to have negative health effects. Based on fire studies, HNCO emissions were scaled to those of hydrogen cyanide (30%), resulting in yearly total emissions of 1.5 Tg for 2008, from both anthropogenic and biomass burning sources. Loss processes included heterogeneous uptake (pH dependent), dry deposition (like formic acid), and reaction with the OH radical (k = 1 × 10-15 molecule-1 cm3 s-1). Annual mean surface HNCO concentrations were highest over parts of China (maximum of 470 pptv), but episodic fire emissions gave much higher levels, exceeding 4 ppbv in tropical Africa and the Amazon, and exceeding 10 ppbv in Southeast Asia and Siberia. This suggests that large biomass burning events could result in deleterious health effects for populations in these regions. For the tropospheric budget, using the model-calculated pH the HNCO lifetime was 37 days, with the split between dry deposition and heterogeneous loss being 95%:5%. Fixing the heterogeneous loss rate at pH = 7 meant that this process dominated, accounting for ˜70% of the total loss, giving a lifetime of 6 days, and resulting in upper tropospheric concentrations that were essentially zero. However, changing the pH does not notably impact the high concentrations found in biomass burning regions. More observational data is needed to evaluate the model, as well as a better representation of the likely underestimated biofuel emissions, which could mean more populations exposed to elevated HNCO concentrations.

  5. Phthalate esters in main source water and drinking water of Zhejiang Province (China): Distribution and health risks.

    Science.gov (United States)

    Wang, Xiaofeng; Lou, Xiaoming; Zhang, Nianhua; Ding, Gangqiang; Chen, Zhijian; Xu, Peiwei; Wu, Lizhi; Cai, Jianmin; Han, Jianlong; Qiu, Xueting

    2015-10-01

    To evaluate the distributions and health risks of phthalate esters in the main source water and corresponding drinking water of Zhejiang Province, the concentrations of 16 phthalate esters in water samples from 19 sites were measured from samples taken in the dry season and wet season. The concentration of the total phthalate ester congeners in source water ranged from 1.07 μg/L to 7.12 μg/L in the wet season, from 0.01 μg/L to 1.58 μg/L in the dry season, from 1.18 μg/L to 15.28 μg/L from drinking water in the wet season, and from 0.16 μg/L to 1.86 μg/L from drinking water in the dry season. Of the 16 phthalate esters, dimethyl phthalate, dibutyl phthalate, di-(2-ethyl-hexyl) phthalate, di-iso-butyl phthalate, bis-2-n-butoxyethyl phthalate, and dicyclohexyl phthalate were present in the samples analyzed, dominated by di-iso-butyl phthalate and di-(2-ethyl-hexyl) phthalate. The concentrations of phthalate esters in the wet season were all relatively higher than those in the dry season, and the drinking water had higher concentrations of phthalate esters than source water. The phthalate ester congeners studied pose little health risk to nearby citizens. Environ Toxicol Chem 2015;34:2205-2212. © 2015 SETAC. © 2015 SETAC.

  6. Physics Based Electrolytic Capacitor Degradation Models for Prognostic Studies under Thermal Overstress

    Science.gov (United States)

    Kulkarni, Chetan S.; Celaya, Jose R.; Goebel, Kai; Biswas, Gautam

    2012-01-01

    Electrolytic capacitors are used in several applications ranging from power supplies on safety critical avionics equipment to power drivers for electro-mechanical actuators. This makes them good candidates for prognostics and health management research. Prognostics provides a way to assess remaining useful life of components or systems based on their current state of health and their anticipated future use and operational conditions. Past experiences show that capacitors tend to degrade and fail faster under high electrical and thermal stress conditions that they are often subjected to during operations. In this work, we study the effects of accelerated aging due to thermal stress on different sets of capacitors under different conditions. Our focus is on deriving first principles degradation models for thermal stress conditions. Data collected from simultaneous experiments are used to validate the desired models. Our overall goal is to derive accurate models of capacitor degradation, and use them to predict performance changes in DC-DC converters.

  7. The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds.

    Science.gov (United States)

    Viergever, Roderik F; Hendriks, Thom C C

    2016-02-18

    Little is known about who the main public and philanthropic funders of health research are globally, what they fund and how they decide what gets funded. This study aims to identify the 10 largest public and philanthropic health research funding organizations in the world, to report on what they fund, and on how they distribute their funds. The world's key health research funding organizations were identified through a search strategy aimed at identifying different types of funding organizations. Organizations were ranked by their reported total annual health research expenditures. For the 10 largest funding organizations, data were collected on (1) funding amounts allocated towards 20 health areas, and (2) schemes employed for distributing funding (intramural/extramural, project/'people'/organizational and targeted/untargeted funding). Data collection consisted of a review of reports and websites and interviews with representatives of funding organizations. Data collection was challenging; data were often not reported or reported using different classification systems. Overall, 55 key health research funding organizations were identified. The 10 largest funding organizations together funded research for $37.1 billion, constituting 40% of all public and philanthropic health research spending globally. The largest funder was the United States National Institutes of Health ($26.1 billion), followed by the European Commission ($3.7 billion), and the United Kingdom Medical Research Council ($1.3 billion). The largest philanthropic funder was the Wellcome Trust ($909.1 million), the largest funder of health research through official development assistance was USAID ($186.4 million), and the largest multilateral funder was the World Health Organization ($135.0 million). Funding distribution mechanisms and funding patterns varied substantially between the 10 largest funders. There is a need for increased transparency about who the main funders of health research are

  8. Distributed health data networks: a practical and preferred approach to multi-institutional evaluations of comparative effectiveness, safety, and quality of care.

    Science.gov (United States)

    Brown, Jeffrey S; Holmes, John H; Shah, Kiran; Hall, Ken; Lazarus, Ross; Platt, Richard

    2010-06-01

    Comparative effectiveness research, medical product safety evaluation, and quality measurement will require the ability to use electronic health data held by multiple organizations. There is no consensus about whether to create regional or national combined (eg, "all payer") databases for these purposes, or distributed data networks that leave most Protected Health Information and proprietary data in the possession of the original data holders. Demonstrate functions of a distributed research network that supports research needs and also address data holders concerns about participation. Key design functions included strong local control of data uses and a centralized web-based querying interface. We implemented a pilot distributed research network and evaluated the design considerations, utility for research, and the acceptability to data holders of methods for menu-driven querying. We developed and tested a central, web-based interface with supporting network software. Specific functions assessed include query formation and distribution, query execution and review, and aggregation of results. This pilot successfully evaluated temporal trends in medication use and diagnoses at 5 separate sites, demonstrating some of the possibilities of using a distributed research network. The pilot demonstrated the potential utility of the design, which addressed the major concerns of both users and data holders. No serious obstacles were identified that would prevent development of a fully functional, scalable network. Distributed networks are capable of addressing nearly all anticipated uses of routinely collected electronic healthcare data. Distributed networks would obviate the need for centralized databases, thus avoiding numerous obstacles.

  9. Evaluating Prognostics Performance for Algorithms Incorporating Uncertainty Estimates

    Data.gov (United States)

    National Aeronautics and Space Administration — Uncertainty Representation and Management (URM) are an integral part of the prognostic system development.1As capabilities of prediction algorithms evolve, research...

  10. A Survey of Metrics for Performance Evaluation of Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics is an emerging concept in condition basedmaintenance(CBM)ofcriticalsystems.Alongwith developing the fundamentals of being able to confidently predict...

  11. Do the key prognostic factors for non-specific neck pain have moderation effects? - A study protocol.

    Science.gov (United States)

    Balasundaram, Arun Prasad; Robinson, Hilde Stendal; Vøllestad, Nina Køpke

    2018-05-01

    Neck pain is one of the common musculoskeletal conditions prevalent in the general population in Norway. Patients with neck pain, seek treatment from different health professionals such as general practitioners, physiotherapists, chiropractors and alternative medicine practitioners. The interventions for neck pain are typically provided in a primary care or specialised healthcare setting depending on the general practitioners' referral patterns. Clinicians are interested to know the various prognostic factors that can explain the recovery from neck pain. In order to know this, studies have explored and reported on a range of prognostic factors that contribute to the outcomes in patients with neck pain. This information is currently available only for neck pain following whiplash injury that has a traumatic origin. There is limited information on the role of prognostic factors specifically for non-specific neck pain without a traumatic episode. Moreover, there is a lack of data on whether there are interactions (moderation effects) between the prognostic factors. Therefore, we propose a hypothesis to elucidate whether the same set of prognostic factors found in neck pain associated with whiplash injuries are also identified in patients with neck pain without trauma. Additionally, we hypothesize that the association between a prognostic factor and the outcome variable (s) would be dependent on the third variable, thereby confirming the moderation effects. Clinicians could make informed decisions in the clinical management of neck pain with the knowledge of prognostic factors that explain the outcomes. It could also be used for the development of new interventions or for modifying the existing ones. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Treatment outcome of thymic epithelial tumor: prognostic factors and optimal postoperative radiation therapy

    International Nuclear Information System (INIS)

    Oh, Dong Ryul; Ahn, Yong Chan; Kim, Kwan Min; Kim, Jhin Gook; Shim, Young Mog; Han, Jung Ho

    2005-01-01

    This study was conducted to analyze treatment outcome and prognostic significance of World Health Organization (WHO)-defined thymic epithelial tumor (TET) subtype and to assess optimal radiation target volume in patients receiving surgery and adjuvant radiation therapy with TET. The record of 160 patients with TET, who received surgical resection at the Samsung medical Center, from December 1994 to June 2004, were reviewed. 99 patients were treated with postoperative radiation therapy (PORT). PORT was recommended when patients had more than one findings among suspicious incomplete resection or positive resection margin or Masaoka stage II ∼ IV or WHO tumor type B2 ∼ C. PORT performed to primary tumor bed only with a mean dose of 54 Gy. The prognostic factor and pattern of failure were analyzed retrospectively. The overall survival rate at 5 years was 87.3%. Age (more than 60 years 77.8%, less than 60 years 91.1%; ρ = 0.03), Masaoka stage (I 92.2%, II 95.4%, III 82.1%, IV 67.5%; ρ = 0.001), WHO tumor type (A-B1 96.0%, B2-C 82.3%; ρ = 0.001), Extent of resection (R0 resection 92.3%, R1 or 2 resection 72.6%; ρ = 0.001) were the prognostic factors according to univariate analysis. But WHO tumor type was the only significant prognostic factor according to multivariate analysis. Recurrence was observed in 5 patients of 71 Masoka stage I-III patients who received grossly complete tumor removal (R0, R1 resection ) and PORT to primary tumor bed. Mediastinal recurrence was observed in only one patients. There were no recurrence within irradiation field. WHO tumor type was the important prognostic factor to predict survival of patients with TET. This study suggest that PORT to only primary tumor bed was optimal. To avoid pleura-or pericardium-based recurrence, further study of effective chemotherapy should be investigated

  13. Comparison of Two Probabilistic Fatigue Damage Assessment Approaches Using Prognostic Performance Metrics

    Directory of Open Access Journals (Sweden)

    Xuefei Guan

    2011-01-01

    Full Text Available In this paper, two probabilistic prognosis updating schemes are compared. One is based on the classical Bayesian approach and the other is based on newly developed maximum relative entropy (MRE approach. The algorithm performance of the two models is evaluated using a set of recently developed prognostics-based metrics. Various uncertainties from measurements, modeling, and parameter estimations are integrated into the prognosis framework as random input variables for fatigue damage of materials. Measures of response variables are then used to update the statistical distributions of random variables and the prognosis results are updated using posterior distributions. Markov Chain Monte Carlo (MCMC technique is employed to provide the posterior samples for model updating in the framework. Experimental data are used to demonstrate the operation of the proposed probabilistic prognosis methodology. A set of prognostics-based metrics are employed to quantitatively evaluate the prognosis performance and compare the proposed entropy method with the classical Bayesian updating algorithm. In particular, model accuracy, precision, robustness and convergence are rigorously evaluated in addition to the qualitative visual comparison. Following this, potential development and improvement for the prognostics-based metrics are discussed in detail.

  14. Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

    Directory of Open Access Journals (Sweden)

    Avinash Agarwal

    2016-09-01

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

  15. Functional decline in nursing home residents: A prognostic study.

    Directory of Open Access Journals (Sweden)

    Javier Jerez-Roig

    Full Text Available To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults.A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013-2015, conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil. Functional capacity was assessed by the items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring', 'toileting' and 'walking', through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods.The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8-82.7%, 65.1% (CI 95%: 58.9-70.5%, 53.5% (CI 95%: 47.2-59.5% and 44.0% (CI 95%: 37.7-50.2% at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001, continence decline (HR = 1.85; p = 0.002 and incidence of hospitalizations (HR = 1.62; p = 0.020, adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight.The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.

  16. Cross-National Validation of Prognostic Models Predicting Sickness Absence and the Added Value of Work Environment Variables

    NARCIS (Netherlands)

    Roelen, Corne A. M.; Stapelfeldt, Christina M.; Heymans, Martijn W.; van Rhenen, Willem; Labriola, Merete; Nielsen, Claus V.; Bultmann, Ute; Jensen, Chris

    Purpose To validate Dutch prognostic models including age, self-rated health and prior sickness absence (SA) for ability to predict high SA in Danish eldercare. The added value of work environment variables to the models' risk discrimination was also investigated. Methods 2,562 municipal eldercare

  17. Cross-National Validation of Prognostic Models Predicting Sickness Absence and the Added Value of Work Environment Variables

    NARCIS (Netherlands)

    Roelen, C.A.M.; Stapelfeldt, C.M.; Heijmans, M.W.; van Rhenen, W.; Labriola, M.; Nielsen, C.V.; Bultmann, U.; Jensen, C.

    2015-01-01

    Purpose To validate Dutch prognostic models including age, self-rated health and prior sickness absence (SA) for ability to predict high SA in Danish eldercare. The added value of work environment variables to the models’ risk discrimination was also investigated. Methods 2,562 municipal eldercare

  18. Individual participant data meta-analysis of prognostic factor studies: state of the art?

    Directory of Open Access Journals (Sweden)

    Abo-Zaid Ghada

    2012-04-01

    Full Text Available Abstract Background Prognostic factors are associated with the risk of a subsequent outcome in people with a given disease or health condition. Meta-analysis using individual participant data (IPD, where the raw data are synthesised from multiple studies, has been championed as the gold-standard for synthesising prognostic factor studies. We assessed the feasibility and conduct of this approach. Methods A systematic review to identify published IPD meta-analyses of prognostic factors studies, followed by detailed assessment of a random sample of 20 articles published from 2006. Six of these 20 articles were from the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in traumatic brain injury collaboration, for which additional information was also used from simultaneously published companion papers. Results Forty-eight published IPD meta-analyses of prognostic factors were identified up to March 2009. Only three were published before 2000 but thereafter a median of four articles exist per year, with traumatic brain injury the most active research field. Availability of IPD offered many advantages, such as checking modelling assumptions; analysing variables on their continuous scale with the possibility of assessing for non-linear relationships; and obtaining results adjusted for other variables. However, researchers also faced many challenges, such as large cost and time required to obtain and clean IPD; unavailable IPD for some studies; different sets of prognostic factors in each study; and variability in study methods of measurement. The IMPACT initiative is a leading example, and had generally strong design, methodological and statistical standards. Elsewhere, standards are not always as high and improvements in the conduct of IPD meta-analyses of prognostic factor studies are often needed; in particular, continuous variables are often categorised without reason; publication bias and availability bias are rarely

  19. The geographical distribution and habitats of three liver fluke intermediate hosts in South - Africa and the health implications involved

    Directory of Open Access Journals (Sweden)

    K. N. de Kock

    2008-09-01

    persons and authorities were totally unsuccessful. In view of statistics available for elsewhere in the world, it would be unwise to assume that no problems exist in this regard in South Africa. The number of people suffering from fasciolosis was already estimated at 2.4 million in 61 countries in 1995 and another 180 million at risk of becoming infected, with the highest prevalence’s reported from Bolivia, China, Ecuador, Egypt, France, Iran, Peru and Portugal. The results of recent serological assays for the detection of fasciolosis in cattle herds in selected areas in South Africa indicated positive cases from localities that closely correspond to the geographical distribution of the three Lymnaea species in this country. According to reports in the literature, the high prevalence of fasciolosis in livestock in the highlands of Ethiopia couldhave serious health implications for people in the area because they have to use the same water resources. In many rural areas in South Africa local populations also have no other options than to share natural water resources with their livestock. In most instances these water bodies harbour at least one of the Lymnaea species which can maintain the life cycle of fasciola. Under such conditions residents could daily be exposed to the risk of becoming infected. It is a matter of concern that epidemiological research with regard to human fasciolosis is such aneglected subject in South Africa. In our opinion epidemiological surveys should be conducted to determine the prevalence of human fasciolosis in specific areas which could be selected on the basis of using the geographical distribution of the three Linnaean species as guidelines. Efforts should also be made to conduct surveys to update the geographical distribution of the snail intermediate hosts and awareness programmes should be launched in rural areas at risk.

  20. [Ovarian carcinoma: new prognostic and therapeutic viewpoints].

    Science.gov (United States)

    Goldhirsch, A; Joss, R; Greiner, R; Brunner, K W

    1980-11-01

    Some recently developed concepts concerning the management of ovarian cancer are discussed. Cytoreductive surgery to debulk the tumor to a minimum, even in those cases which were considered inoperable in the past, improves the chances for cure. Adjuvant radiotherapy or combination chemotherapy with new drugs have proved highly effective in inducing complete remission and potential cures in these patients. The definition and better understanding of prognostic criteria play a primary role in the selection of treatment. In designing the strategy for adequate treatment, the following points are of major importance: (1) exact definition of tumor spread as determined by accurate surgical staging; (2) histologic and cytologic grading; and (3) evaluation of response.

  1. Prognostic indicators in alcoholic cirrhotic men

    DEFF Research Database (Denmark)

    Gluud, C; Henriksen, Jens Henrik Sahl; Nielsen, G

    1988-01-01

    as wedged minus free hepatic vein pressure, and median pressure was 14 mm Hg (range = 3 to 26 mm Hg). Fourteen of 31 patients (45%) had esophageal varices at upper gastrointestinal endoscopy (the size being considered large in nine patients). During follow-up (median = 31 months; range = 2 to 51 months), 12...... patients (21%) developed variceal hemorrhage. Applying Cox's regression analysis, information about previous variceal bleeding (p = 0.0046), large varices at endoscopy (p = 0.012), hepatic vein pressure gradient (p = 0.0056) and indocyanine green clearance (p = 0.038) all contained significant prognostic...

  2. Prognostic effect of estrogen receptor status across age in primary breast cancer

    DEFF Research Database (Denmark)

    Bentzon, Niels; Düring, Maria; Rasmussen, Birgitte Bruun

    2008-01-01

    Estrogen receptor (ER) status is considered as an important prognostic factor as well as a predictive factor for endocrine responsiveness in breast cancer. We analyzed the distribution of ER status across age and estimated variations in the prognostic impact of ER status related to patients' age...... unchanged in patients who did not receive adjuvant systemic therapy (n = 6,272). Thus, positive ER status does not confer a negative impact on survival in young women as has been previously reported. The inferior prognosis for ER negative patients during the first 5 years after diagnosis changes...... into a slightly superior residual prognosis compared to ER positive patients independent of use of adjuvant systemic therapy. This may have an impact on future designing of guidelines for adjuvant endocrine therapy beyond 5 years....

  3. A hybrid Multi Agent System architecture for distributed supervision of chronic patients in the eHealth setting

    NARCIS (Netherlands)

    Blanson Henkemans, O.A.; Bonacina, S.; Cappiello, N.; Mast, C.A.P.G. van der; Neerincx, M.A.; Pinciroli, F.

    2007-01-01

    eHealth, the use of Information and Communication Technology (ICT) in the health sector, enhances today's health care environment. In particular, the use of Multi Agent System (MAS) technology, an aspect of ICT, can further contribute to the improvement of health care. Exceptional integration of

  4. Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

    Science.gov (United States)

    Santos, Itamar S; Bittencourt, Márcio S; Oliveira, Ilka R S; Souza, Angelita G; Meireles, Danilo P; Rundek, Tatjana; Foppa, Murilo; Bezerra, Daniel C; Freire, Cláudia M V; Roelke, Leonard H; Carrilho, Sayonara; Benseñor, Isabela M; Lotufo, Paulo A

    2014-11-01

    Carotid intima-media thickness (IMT) is a noninvasive measurement of early atherosclerosis. Most IMT studies have involved populations with low rates of racial blending. The aim of the present article is to describe IMT value distributions and analyze the influence of sex and race on IMT values in a large Brazilian sample, a setting with a high rate of racial admixture. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort of 15,105 adult (aged 35-74 years) civil servants in six Brazilian cities. Baseline assessment included IMT measurements in both common carotid arteries. Race was self-reported. We studied the association between sex and race with IMT values using multiple linear regression models. We conducted analyses in all and low-risk individuals, defined as those without classical cardiovascular risk factors. We analyzed complete IMT data from 10,405 ELSA-Brasil participants. We present nomograms by age for all and low-risk individuals, stratified by sex and race. We found that men had significantly higher maximal IMT values compared with women (β = 0.058; P < 0.001). This association remained for low-risk individuals (β = 0.027; P = 0.001). In addition, Brown and White individuals had lower maximal IMT values compared with Black individuals for all (β = -0.034 and β = -0.054, respectively; P < 0.001) and low-risk individuals (β = -0.027; P = 0.013 and β = -0.035; P < 0.001, respectively). We found significantly higher IMT values in men. We found significantly higher IMT values in Black individuals than White and Brown individuals. These results persisted when analyses were restricted to low-risk individuals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Distribution, genetic and cardiovascular determinants of FVIII:c - Data from the population-based Gutenberg Health Study.

    Science.gov (United States)

    Hermanns, M Iris; Grossmann, Vera; Spronk, Henri M H; Schulz, Andreas; Jünger, Claus; Laubert-Reh, Dagmar; Mazur, Johanna; Gori, Tommaso; Zeller, Tanja; Pfeiffer, Norbert; Beutel, Manfred; Blankenberg, Stefan; Münzel, Thomas; Lackner, Karl J; Ten Cate-Hoek, Arina J; Ten Cate, Hugo; Wild, Philipp S

    2015-01-01

    Elevated levels of c are associated with risk for both venous and arterial thromboembolism. However, no population-based study on the sex-specific distribution and reference ranges of plasma c and its cardiovascular determinants is available. c was analyzed in a randomly selected sample of 2533 males and 2440 females from the Gutenberg Health Study in Germany. Multivariable regression analyses for c were performed under adjustment for genetic determinants, cardiovascular risk factors and cardiovascular disease. Females (126.6% (95% CI: 125.2/128)) showed higher c levels than males (121.2% (119.8/122.7)). c levels increased with age in both sexes (ß per decade: 5.67% (4.22/7.13) male, 6.15% (4.72/7.57) female; p<0.001). Sex-specific reference limits and categories indicating the grade of deviation from the reference were calculated, and nomograms for c were created. c was approximately 25% higher in individuals with non-O blood type. Adjusted for sex and age, ABO-blood group accounted for 18.3% of c variation. In multivariable analysis, c was notably positively associated with diabetes mellitus, obesity, hypertension and dyslipidemia and negatively with current smoking. In a fully adjusted multivariable model, the strongest associations observed were of elevated c with diabetes and peripheral artery disease in both sexes and with obesity in males. Effects of SNPs in the vWF, STAB2 and SCARA5 gene were stronger in females than in males. The use of nomograms for valuation of c might be useful to identify high-risk cohorts for thromboembolism. Additionally, the prospective evaluation of c as a risk predictor becomes feasible. Copyright © 2015. Published by Elsevier Ireland Ltd.

  6. Distribution of heavy metals in muscles and internal organs of Korean cephalopods and crustaceans: risk assessment for human health.

    Science.gov (United States)

    Mok, Jong Soo; Kwon, Ji Young; Son, Kwang Tae; Choi, Woo Seok; Shim, Kil Bo; Lee, Tae Seek; Kim, Ji Hoe

    2014-12-01

    Samples of seven species of cephalopods and crustaceans were collected from major fish markets on the Korean coast and analyzed for mercury (Hg) using a direct Hg analyzer and for the metals cadmium (Cd), lead (Pb), chromium, silver, nickel, copper, and zinc using inductively coupled plasma mass spectrometry. The distributions of heavy metals in muscles, internal organs, and whole tissues were determined, and a risk assessment was conducted to provide information concerning consumer safety. The heavy metals accumulated to higher levels (P octopus (relatively large cephalopods), red snow crab, and snow crab exceeded the European Union limits. The estimated dietary intake of Cd, Pb, and Hg for each part of all species accounted for 1.73 to 130.57%, 0.03 to 0.39%, and 0.93 to 1.67%, respectively, of the provisional tolerable daily intake adopted by the Joint Food and Agriculture Organization and World Health Organization Expert Committee on Food Additives; the highest values were found in internal organs. The hazard index (HI) is recognized as a reasonable parameter for assessing the risk of heavy metal consumption associated with contaminated food. Because of the high HI (>1.0) of the internal organs of cephalopods and the maximum HI for whole tissue of 0.424, consumers eating internal organs or whole tissues of cephalopods could be at risk of high heavy metal exposure. Therefore, the internal organs of relatively large cephalopods and crabs (except blue crab) are unfit for consumption. However, consumption of flesh after removing internal organs is a suitable approach for decreasing exposure to harmful metals.

  7. Should culture affect practice? A comparison of prognostic discussions in consultations with immigrant versus native-born cancer patients.

    Science.gov (United States)

    Butow, Phyllis N; Sze, Ming; Eisenbruch, Maurice; Bell, Melaine L; Aldridge, Lynley J; Abdo, Sarah; Tanious, Michelle; Dong, Skye; Iedema, Rick; Vardy, Janette; Hui, Rina; Boyle, Francis; Liauw, Winston; Goldstein, David

    2013-08-01

    Poor prognosis is difficult to impart, particularly across a cultural divide. This study compared prognostic communication with immigrants (with and without interpreters) versus native-born patients in audio-taped oncology consultations. Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Fifty percent of doctor and 59% of patient prognostic speech units were not interpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few prognostic facts, and oncologist characteristics no prognostic facts, disclosed. Oncologists were significantly less likely to convey hope to immigrants (p=0.0004), and more likely to use medical jargon (p=0.009) than with Australian-born patients. Incurable disease status and a limited life span were commonly acknowledged, generally with no timeframe provided. Physical issues were discussed more commonly than emotional aspects. While culture did not appear to influence doctor speech, interpreters filtered or blocked much prognostic communication. Initiatives to empower all patients to attain needed information, optimise communication when an interpreter is present and train cancer health professionals in culturally appropriate care, are urgently required. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Prognostic molecular markers in early breast cancer

    International Nuclear Information System (INIS)

    Esteva, Francisco J; Hortobagyi, Gabriel N

    2004-01-01

    A multitude of molecules involved in breast cancer biology have been studied as potential prognostic markers. In the present review we discuss the role of established molecular markers, as well as potential applications of emerging new technologies. Those molecules used routinely to make treatment decisions in patients with early-stage breast cancer include markers of proliferation (e.g. Ki-67), hormone receptors, and the human epidermal growth factor receptor 2. Tumor markers shown to have prognostic value but not used routinely include cyclin D 1 and cyclin E, urokinase-like plasminogen activator/plasminogen activator inhibitor, and cathepsin D. The level of evidence for other molecular markers is lower, in part because most studies were retrospective and not adequately powered, making their findings unsuitable for choosing treatments for individual patients. Gene microarrays have been successfuly used to classify breast cancers into subtypes with specific gene expression profiles and to evaluate prognosis. RT-PCR has also been used to evaluate expression of multiple genes in archival tissue. Proteomics technologies are in development

  9. Prognostic factors in invasive bladder cancer

    International Nuclear Information System (INIS)

    Maulard-Durdux, C.; Housset, M.

    1998-01-01

    In France, invasive bladder cancer is the more frequent urologic malignancy after prostate carcinoma. Treatment of bladder cancer is radical cystectomy. New therapeutic approaches such as chemo-radiation combination for a conservative procedure, neo-adjuvant or adjuvant chemotherapy are still developing. In this way, a rigorous selection of patients is needed. This selection is based on prognostic criteria that could be divided into four groups: the volume of the tumor including the tumor infiltration depth, the nodal status, the presence or not of hydronephrosis and the residual tumor mass after trans-urethral resection; the histologic aspects of the tumor including histologic grading, the presence or not of an epidermoid metaplasia, of in situ carcinoma or of thrombi; the expression of tumor markers tissue polypeptide antigen, bladder tumor antigen; the biologic aspects of the tumor as ploidy, cytogenetic abnormalities, expression of Ki67, expression of oncogenes or tumor suppressor genes, expression of tumor antigens or growth factor receptors. This paper reviews the prognostic value of the various parameters. (authors)

  10. Prognostic Disclosure and its Influence on Cancer Patients

    Directory of Open Access Journals (Sweden)

    Chen-Hsiu Chen

    2014-09-01

    Conclusions: In order to close the gap between patients’ preferences for prognostic disclosure and actual receipt of prognostic information, healthcare professionals should develop interventions to overcome the physicians’ difficulty in revealing prognosis, thus facilitating cancer patients’ awareness of prognosis and providing high quality end-of-life care.

  11. Applicability of RFID in the prognostics of logistic systems

    NARCIS (Netherlands)

    Lopez De La Cruz, A.M.; Veeke, H.P.M.; Lodewijks, G.

    2007-01-01

    The objective of this paper is to investigate the applicability of RFID in prognostic logistics. Starting from a general introduction of prognostic logistics, the system structure, and technical requirements are discussed. Based on this discussion the issues and concerns regarding the applicability

  12. Early prognostication markers in cardiac arrest patients treated with hypothermia.

    Science.gov (United States)

    Karapetkova, M; Koenig, M A; Jia, X

    2016-03-01

    Established prognostication markers, such as clinical findings, electroencephalography (EEG) and biochemical markers, used by clinicians to predict neurological outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain. MEDLINE and Embase were searched for evidence on the current standards for neurological outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers and multimodal approaches for prognostication are included and reviewed. Whilst the prognostic accuracy of various tests after TH has been questioned, pupillary light reflexes and somatosensory evoked potentials are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 h after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as magnetic resonance imaging and computed tomography, can identify functional and structural brain injury but are not readily available at the patient's bedside because of limited availability and high costs. A multimodal algorithm composed of neurological examination, EEG-based quantitative testing and somatosensory evoked potentials, in conjunction with newer magnetic resonance imaging sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed more than 72 h after CA. © 2015 EAN.

  13. Some interesting prognostic factors related to cutaneous malignant melanoma

    International Nuclear Information System (INIS)

    Figueroa, Alejandro Yuri Joan; Diaz Anaya, Amnia; Montero Leon, Jorge Felipe; Jimenez Mendes, Lourdes

    2009-01-01

    The aim of present research was to determine the independent prognostic value and the 3 and 5 years survival of more significant clinicopathological prognostic factors and in each stage, according to pathological staging system of tumor-nodule-metastasis (TNM) in patients with cutaneous malignant melanoma (CMM)

  14. Treatments and other prognostic factors in the management of the open abdomen: A systematic review.

    Science.gov (United States)

    Cristaudo, Adam T; Jennings, Scott B; Hitos, Kerry; Gunnarsson, Ronny; DeCosta, Alan

    2017-02-01

    The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Despite this, challenges remain with it associated with a high incidence of complications and poor outcomes. The objective of this article is to perform a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify prognostic factors in OA patients in regard to definitive fascial closure (DFC), mortality and intra-abdominal complications. An electronic database search was conducted involving Medline, Excerpta Medica, Central Register of Controlled Trials, Cumulative Index to Nursing, and Allied Health Literature and Clinicaltrials.gov. All studies that described prognostic factors in regard to the above outcomes in OA patients were eligible for inclusion. Data collected were synthesized by each outcome of interest and assessed for methodological quality. Thirty-one studies were included in the final synthesis. Enteral nutrition, organ dysfunction, local and systemic infection, number of reexplorations, worsening Injury Severity Score, and the development of a fistula appeared to significantly delay DFC. Age and Adult Physiology And Chronic Health Evaluation version II score were predictors for in-hospital mortality. Failed DFC, large bowel resection and >5 to 10 L of intravenous fluids in 5 to 10 and >10 L of intravenous fluids in management of OA patients will avoid prolonged treatment and facilitate early DFC. Future research should focus on the development of a prognostic model. Systematic review, level III.

  15. Utility of Hippocrates' prognostic aphorism to predict death in the modern era: prospective cohort study.

    Science.gov (United States)

    St John, Philip D; Montgomery, Patrick R

    2014-12-15

    To determine if one of Hippocrates' aphorisms, identifying good cognition and good appetite as two prognostic factors, predicts death in community living older adults in the modern era. Secondary analysis of an existing population based cohort study. Manitoba Study of Health and Aging. 1751 community living adults aged more than 65 enrolled in the Manitoba Study of Health and Aging in 1991 and followed over five years. Time to death. We recreated the hippocratic prognosticator using an item that measures appetite drawn from the Center for Epidemiologic Studies-depression subscale, and the mini-mental state examination, with a score of >25 being considered as normal. People with normal cognition and appetite were compared with those with either poor cognition or poor appetite. We constructed Cox regression models, adjusted for age, sex, education, and functional status. The prognostic aphorism predicted death, with an unadjusted hazard ratio of 2.37 (95% confidence interval 1.93 to 2.88) and a hazard ratio of 1.71 (1.37 to 2.12) adjusted for age, sex, and education. Both poor appetite and poor cognition predicted death. The sensitivity and specificity were not, however, sufficient for the measure to be used alone. An aphorism devised by Hippocrates millennia ago can predict death in the modern era. © St John et al 2014.

  16. Utility of Hippocrates’ prognostic aphorism to predict death in the modern era: prospective cohort study

    Science.gov (United States)

    Montgomery, Patrick R

    2014-01-01

    Objective To determine if one of Hippocrates’ aphorisms, identifying good cognition and good appetite as two prognostic factors, predicts death in community living older adults in the modern era. Design Secondary analysis of an existing population based cohort study. Setting Manitoba Study of Health and Aging. Participants 1751 community living adults aged more than 65 enrolled in the Manitoba Study of Health and Aging in 1991 and followed over five years. Main outcome measure Time to death. Methods We recreated the hippocratic prognosticator using an item that measures appetite drawn from the Center for Epidemiologic Studies-depression subscale, and the mini-mental state examination, with a score of >25 being considered as normal. People with normal cognition and appetite were compared with those with either poor cognition or poor appetite. We constructed Cox regression models, adjusted for age, sex, education, and functional status. Results The prognostic aphorism predicted death, with an unadjusted hazard ratio of 2.37 (95% confidence interval 1.93 to 2.88) and a hazard ratio of 1.71 (1.37 to 2.12) adjusted for age, sex, and education. Both poor appetite and poor cognition predicted death. The sensitivity and specificity were not, however, sufficient for the measure to be used alone. Conclusion An aphorism devised by Hippocrates millennia ago can predict death in the modern era. PMID:25512328

  17. Performance of four ischemic stroke prognostic scores in a Brazilian population.

    Science.gov (United States)

    Kuster, Gustavo W; Dutra, Lívia A; Brasil, Israel P; Pacheco, Evelyn P; Arruda, Márcio J C; Volcov, Cristiane; Domingues, Renan B

    2016-02-01

    Ischemic stroke (IS) prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL), and Totaled Health Risks in Vascular Events (THRIVE) were compared. Two hundred six patients with a mean ± SD age of 67.58 ± 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.

  18. Performance of four ischemic stroke prognostic scores in a Brazilian population

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2016-02-01

    Full Text Available ABSTRACT Objective Ischemic stroke (IS prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. Method We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS, Stroke Prognostication Using Age and NIHSS (SPAN-100, Acute Stroke Registry and Analysis of Lausanne (ASTRAL, and Totaled Health Risks in Vascular Events (THRIVE were compared. Results Two hundred six patients with a mean ± SD age of 67.58 ± 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. Conclusion THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.

  19. Assessment of corticosteroid-induced alkaline phosphatase as a prognostic indicator in canine lymphoma.

    Science.gov (United States)

    Wiedemann, A L; Charney, S C; Barger, A M; Schaeffer, D J; Kitchell, B E

    2005-04-01

    To examine the incidence of elevated corticosteroid-induced alkaline phosphatase (sALP) in dogs with lymphoma and to determine if sALP is a reliable prognostic indicator in canine lymphoma. The medical records of 62 canine lymphoma patients treated with a combination chemotherapy protocol from 1994 to 2003 at the University of Illinois Veterinary Teaching Hospital were examined. Variables assessed with respect to response rate and remission duration included age, bodyweight, sex, breed, World Health Organization stage (I to V), substage (a or b), pretreatment administration of corticosteroid, and serum levels of alkaline phosphatase, sALP and alanine aminotransferase. sALP was not statistically significant with respect to response rate or duration of remission, nor was preinduction glucocorticoid administration. Stage was significant with respect to achieving remission. It was found that sALP is not a useful prognostic indicator for response rate and remission duration in dogs with lymphoma.

  20. Mucins as diagnostic and prognostic biomarkers in a fish-parasite model: transcriptional and functional analysis.

    Directory of Open Access Journals (Sweden)

    Jaume Pérez-Sánchez

    Full Text Available Mucins are O-glycosylated glycoproteins present on the apex of all wet-surfaced epithelia with a well-defined expression pattern, which is disrupted in response to a wide range of injuries or challenges. The aim of this study was to identify mucin gene sequences of gilthead sea bream (GSB, to determine its pattern of distribution in fish tissues and to analyse their transcriptional regulation by dietary and pathogenic factors. Exhaustive search of fish mucins was done in GSB after de novo assembly of next-generation sequencing data hosted in the IATS transcriptome database (www.nutrigroup-iats.org/seabreamdb. Six sequences, three categorized as putative membrane-bound mucins and three putative secreted-gel forming mucins, were identified. The transcriptional tissue screening revealed that Muc18 was the predominant mucin in skin, gills and stomach of GSB. In contrast, Muc19 was mostly found in the oesophagus and Muc13 was along the entire intestinal tract, although the posterior intestine exhibited a differential pattern with a high expression of an isoform that does not share a clear orthologous in mammals. This mucin was annotated as intestinal mucin (I-Muc. Its RNA expression was highly regulated by the nutritional background, whereas the other mucins, including Muc2 and Muc2-like, were expressed more constitutively and did not respond to high replacement of fish oil (FO by vegetable oils (VO in plant protein-based diets. After challenge with the intestinal parasite Enteromyxum leei, the expression of a number of mucins was decreased mainly in the posterior intestine of infected fish. But, interestingly, the highest down-regulation was observed for the I-Muc. Overall, the magnitude of the changes reflected the intensity and progression of the infection, making mucins and I-Muc, in particular, reliable markers of prognostic and diagnostic value of fish intestinal health.

  1. From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

    Science.gov (United States)

    Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

    2016-01-01

    Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

  2. Poverty in the midst of plenty: unmet needs and distribution of health care resources in South Korea.

    Directory of Open Access Journals (Sweden)

    Jongho Heo

    Full Text Available BACKGROUND: The unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them. METHODS AND FINDINGS: The current study conducted multilevel logistic regression analysis to assess the effects of individual- and contextual-level predictors in meeting individual health care needs in South Korea. We sampled 7,200 individuals over the age of 19 in the Fourth Korea National Health and Nutrition Examination Survey in 2009. Included in the regression model were individual predictors such as demographic variables, socio-economic status, and self-rated health; the density of beds and physicians in public and private sectors within different regions were used as contextual-level predictors. This study showed the inverse association between unmet needs and regional resources in private sectors after controlling for the effects of individual-level predictors. CONCLUSION: Our findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, particularly where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme. Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea.

  3. Prognostic factors of follicular thyroid carcinoma.

    Science.gov (United States)

    Ríos, Antonio; Rodríguez, José M; Ferri, Belén; Martínez-Barba, Enrique; Torregrosa, Núria M; Parrilla, Pascual

    2015-01-01

    Most prognostic studies in differentiated carcinoma have included a high number of papillary carcinomas and few follicular carcinomas, and not all of their conclusions therefore apply to the latter. To analyze the prognostic factors of follicular thyroid carcinoma. Patients with histological diagnosis of follicular carcinoma who had undergone potentially curative surgery, had no disseminated disease at diagnosis, and had been followed up for at least 5 years. Tumor recurrence was defined as: 1) tumor lesions with cytological analysis suggesting malignancy and/or 2) patients with total thyroidectomy with thyroglobulin levels >2 ng/mL. Clinical, therapeutic, and histological parameters were analyzed to assess prognostic factors. Recurrence was found in 25 (38%) of the 66 study patients during a follow-up period of 99 ± 38 months. Most patients with recurrence (n=20) had increased Tg levels without anatomical location, and were initially treated with radioactive I131. In the remaining 5 cases, surgical excision of the lesion was performed, and three patients required surgery during the follow-up period. Two patients died due to the disease (3%), and two other patients (3%) currently have distant metastases. Mean disease-free interval was 154 ± 14 months, and rates of disease-free patients at 5, 10, 15, and 20 years were 71, 58, 58, and 58% respectively. Clinical factors influencing recurrence included 1) age (p=0.0035); 2) sex (p=0.0114); and 3) cervical pain (p=0.0026). Histological/surgical factors associated with recurrence included 1) infiltration into neighboring structures (p=0.0000); 2) type of carcinoma (p=0.0000); 3) size (p=0.0162); 4) vascular invasion (p=0.0085); and 5) adenopathies (p=0.046). In the multivariate study, cervical pain (p=0.018) and extrathyroid invasion (p=0.045) continued to be significant factors. In follicular carcinoma, rates of disease-free patients are 71% at 5 years and 58% at 10 years, and the main predictive factors are presence

  4. How evidence-based workforce planning in Australia is informing policy development in the retention and distribution of the health workforce.

    Science.gov (United States)

    Crettenden, Ian F; McCarty, Maureen V; Fenech, Bethany J; Heywood, Troy; Taitz, Michelle C; Tudman, Sam

    2014-02-03

    Australia's health workforce is facing significant challenges now and into the future. Health Workforce Australia (HWA) was established by the Council of Australian Governments as the national agency to progress health workforce reform to address the challenges of providing a skilled, innovative and flexible health workforce in Australia. HWA developed Australia's first major, long-term national workforce projections for doctors, nurses and midwives over a planning horizon to 2025 (called Health Workforce 2025; HW 2025), which provided a national platform for developing policies to help ensure Australia's health workforce meets the community's needs. A review of existing workforce planning methodologies, in concert with the project brief and an examination of data availability, identified that the best fit-for-purpose workforce planning methodology was the stock and flow model for estimating workforce supply and the utilisation method for estimating workforce demand. Scenario modelling was conducted to explore the implications of possible alternative futures, and to demonstrate the sensitivity of the model to various input parameters. Extensive consultation was conducted to test the methodology, data and assumptions used, and also influenced the scenarios selected for modelling. Additionally, a number of other key principles were adopted in developing HW 2025 to ensure the workforce projections were robust and able to be applied nationally. The findings from HW 2025 highlighted that a 'business as usual' approach to Australia's health workforce is not sustainable over the next 10 years, with a need for co-ordinated, long-term reforms by government, professions and the higher education and training sector for a sustainable and affordable health workforce. The main policy levers identified to achieve change were innovation and reform, immigration, training capacity and efficiency and workforce distribution. While HW 2025 has provided a national platform for health

  5. Prognostic value of the Glasgow Prognostic Score for glioblastoma multiforme patients treated with radiotherapy and temozolomide.

    Science.gov (United States)

    Topkan, Erkan; Selek, Ugur; Ozdemir, Yurday; Yildirim, Berna A; Guler, Ozan C; Ciner, Fuat; Mertsoylu, Huseyin; Tufan, Kadir

    2018-04-25

    To evaluate the prognostic value of the Glasgow Prognostic Score (GPS), the combination of C-reactive protein (CRP) and albumin, in glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (GPS). Data of newly diagnosed GBM patients treated with partial brain RT and concurrent and adjuvant TMZ were retrospectively analyzed. The patients were grouped into three according to the GPS criteria: GPS-0: CRP L and albumin > 35 g/L; GPS-1: CRP L and albumin L or CRP > 10 mg/L and albumin > 35 g/L; and GPS-2: CRP > 10 mg/L and albumin L. Primary end-point was the association between the GPS groups and the overall survival (OS) outcomes. A total of 142 patients were analyzed (median age: 58 years, 66.2% male). There were 64 (45.1%), 40 (28.2%), and 38 (26.7%) patients in GPS-0, GPS-1, and GPS-2 groups, respectively. At median 15.7 months follow-up, the respective median and 5-year OS rates for the whole cohort were 16.2 months (95% CI 12.7-19.7) and 9.5%. In multivariate analyses GPS grouping emerged independently associated with the median OS (P GPS grouping and the RTOG RPA classification were found to be strongly correlated in prognostic stratification of GBM patients (correlation coefficient: 0.42; P GPS appeared to be useful in prognostic stratification of GBM patients into three groups with significantly different survival durations resembling the RTOG RPA classification.

  6. Sensitivity of adaptive enrichment trial designs to accrual rates, time to outcome measurement, and prognostic variables

    Directory of Open Access Journals (Sweden)

    Tianchen Qian

    2017-12-01

    Full Text Available Adaptive enrichment designs involve rules for restricting enrollment to a subset of the population during the course of an ongoing trial. This can be used to target those who benefit from the experimental treatment. Trial characteristics such as the accrual rate and the prognostic value of baseline variables are typically unknown when a trial is being planned; these values are typically assumed based on information available before the trial starts. Because of the added complexity in adaptive enrichment designs compared to standard designs, it may be of special concern how sensitive the trial performance is to deviations from assumptions. Through simulation studies, we evaluate the sensitivity of Type I error, power, expected sample size, and trial duration to different design characteristics. Our simulation distributions mimic features of data from the Alzheimer's Disease Neuroimaging Initiative cohort study, and involve two subpopulations based on a genetic marker. We investigate the impact of the following design characteristics: the accrual rate, the time from enrollment to measurement of a short-term outcome and the primary outcome, and the prognostic value of baseline variables and short-term outcomes. To leverage prognostic information in baseline variables and short-term outcomes, we use a semiparametric, locally efficient estimator, and investigate its strengths and limitations compared to standard estimators. We apply information-based monitoring, and evaluate how accurately information can be estimated in an ongoing trial.

  7. 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.

  8. Sudden Sensorineural Hearing Loss; Prognostic Factors

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    Arjun Dass

    2015-09-01

    Full Text Available Introduction: Sudden sensorineural hearing loss (SSNHL is a frightening and frustrating symptom for the patient as well as the physician. Prognosis is affected by multiple factors including duration of hearing loss, presence of associated vertigo and tinnitus, and co-morbidities such as hypertension and diabetes.   Materials and Methods: Forty subjects presenting to our department with features of sudden hearing loss were included in the study. Detailed otological history and examination, serial audiometric findings and course of disease were studied.   Results: Subjects presenting late (in older age, having associated vertigo, hypertension and diabetes had a significantly lower rate of recovery.   Conclusion:  Only 60–65% of patients experiencing SSNHL recover within a period of 1 month; this rate is further affected by presence of multiple prognostic indicators.

  9. Prognostic factors and treatment of endometrial carcinoma

    International Nuclear Information System (INIS)

    Aalders, J.G.

    1982-01-01

    The aim of the present study was to gain more insight into the natural history of endometrial carcinoma, to evaluate prognostic factors and to assess the various treatment methods and the results. Using the data of the Norwegian Radium Hospital, where treatment of gynecological cancer is centralized to a great extent, a large series of patients with long term follow-up, covering all clinical stages and recurrences of endometrial carcinoma, could be evaluated. This resulted in five articles. These articles, together with a study from the University Hospital in Groningen are presented and discussed, and recommendations for treatment are given. The relevant treatments assessed are postoperative external irradiation, preoperative uterine radium packing, preoperative low dose external irradiation and radiotherapy alone. (Auth.)

  10. Prognostic factors in childhood intracranial neoplasms

    International Nuclear Information System (INIS)

    Ampil, F.L.

    1987-01-01

    Thirty-six cases of primary intracranial neoplasm in children (over 1 year but under 13 years of age) seen at the university medical center between 1951 and 1982 were reviewed because of concern as to the results and after-effects of applied therapy. The overall 5-year actuarial survival rate was 17 %. Several factors of possible prognostic relevance, such as patient's age, intracranial location of the tumor, application or nonapplication of therapy, single or multiple modes of therapy, and extent of surgery, were analyzed. Completeness of surgical removal of the tumor proved to be the only statistically significant factor that correlated with survival. There was only one recorded case of severe learning disability and abnormal neuropsychologic development among the 12 living patients. The influence of patient's age (and technical factors) at the time of irradiation in correlation with the child's subsequent posttreatment functional performance, as reported in the literature, is reviewed. (author)

  11. Prognostic significance of Glasgow prognostic score in patients undergoing esophagectomy for esophageal squamous cell carcinoma.

    Science.gov (United States)

    Feng, Ji-Feng; Zhao, Qiang; Chen, Qi-Xun

    2014-01-01

    Recent studies have revealed that Glasgow prognostic score (GPS), an inflammation-based prognostic score, is inversely related to prognosis in a variety of cancers; high levels of GPS is associated with poor prognosis. However, few studies regarding GPS in esophageal cancer (EC) are available. The aim of this study was to determine whether the GPS is useful for predicting cancer-specific survival (CSS) of patients for esophageal squamous cell carcinoma (ESCC). The GPS was calculated on the basis of admission data as follows: Patients with elevated C-reactive protein (CRP) level (>10 mg/L) and hypoalbuminemia (L) were assigned to GPS2. Patients with one or no abnormal value were assigned to GPS1 or GPS0, respectively. Our study showed that GPS was associated with tumor size, depth of invasion, and nodal metastasis (PGPS0, GPS1, and GPS2 were 60.8%, 34.7% and 10.7%, respectively (PGPS was a significant predictor of CSS. GPS1-2 had a hazard ratio (HR) of 2.399 [95% confidence interval (CI): 1.805-3.190] for 1-year CSS (PGPS is associated with tumor progression. GPS can be considered as an independent prognostic factor in patients who underwent esophagectomy for ESCC.

  12. Nasopharyngeal Carcinomas: Prognostic Factors and Treatment Features

    International Nuclear Information System (INIS)

    ARIBAS, B.K.; DEMIR, P.; UNLU, D.N.; YOLOGLU, Z.; CETINDAG, F.; OZDOGAN, Z.; DIZMAN, A.

    2008-01-01

    Purpose: We retrospectively evaluated the clinical, radiological and pathological features determining the prognosis of patients with nasopharyngeal carcinoma in Ankara Oncology Hospital, Turkey. Material and Methods: Two hundred and fifty-nine patients, 74 women and 185 males with nasopharyngeal carcinoma were treated between 1993 and 2008. All imaging data including CT and MRI were reevaluated according to the criteria which determine parapharyngeal, oropharyngeal, nasal, skull-base (bone)/sinus, infra temporal fossa, orbit, intracranial involvements and lymph node metastasis by our radiologists. The patients were re staged using the AJCC 2002 classification with these new radiological findings and clinical data base. We evaluated prognostic factors using univariate Kaplan- Meier and multivariate Cox regression analyses. Gender, age (40-year cut-off), histology, T- and N-stage, tumor size, regional involvement, radiotherapy and/or chemotherapy and response to therapy were studied as variables. Results: Five-year disease-free and overall survival rates were 45±4% and 72±3%, respectively. We found that age, gender, WHO type, radiotherapy and/or chemotherapy, N-stage and response to therapy were significant prognostic factors on disease-free survival and overall survival. In the chemo-radiotherapy group, we did not detect any survival difference between patients given four or fewer chemotherapy courses. Conclusions: Radiotherapy improved survival but chemotherapy, in the neoadjuvant and adjuvant setting, had no added effect to radiotherapy. N-stage and response to treatment were the most important independent predictors on survival. Age, gender, type, therapy and bone/sinus involvement were among the predictive factors on multivariate analysis, as well.

  13. A Policy Review on The Distribution of Health Operational Aid Funds in Achieving Maternal and Child Health Program (MDGs 4, 5 in Three Districts/Cities of East Java Province

    Directory of Open Access Journals (Sweden)

    Niniek Lely Pratiwi

    2015-06-01

    Full Text Available Background: Health Policy Regulation Number 494/Menkes/SK/IV/2010 on the distribution of BOK funds to local government is one of the government’s responsibility for the development of public health in improving health promotion and prevention efforts in order to accelerate the achievement of MDGs in Health. The purpose of the study is to provide policy recommendations regarding to BOK in achieving the goals of maternal and child health programs. Methods: Secondary data review of the district health profile in 2009-2011 and analysis on the primary data collected from focus group discussion (FGD with invited technical implementor from district health office and health centers as well as some of the staffs of the local government that handle BOK. Results: The decline in maternal and infant mortality rates are still slow and cases of malnutrition increased from the three profile data review Sampang, Gresik and Sidoarjo. Local governments pay little commitment in developing priority strategies of maternal and child health programs in the form of a local action and innovation plan. BOK preventive promotive activities are lacking of monitoring and accountability controls, especially in health centers located far from the district center. Financial accountability is less precise to the programs and targetes, having seen the data of maternal and child health outcomes KN1-KN4 coverage which rose in 2010, but then fell back in 2011. Conclusion: Evaluation and monitoring are needed on the utilization of BOK funds, supervising the activities by the district/city health office, as well as by local community leaders. Prioritise monitoring the health centers in the area with high MMR and IMR. Suggestion: Needed routine and periodic mentoring and coaching in the form of technical assistance related to the utilization of BOK.

  14. ‘At-risk’ places: inequities in the distribution of environmental stressors and prescription rates of mental health medications in Glasgow, Scotland

    Science.gov (United States)

    Maantay, Juliana; Maroko, Andrew

    2015-11-01

    Using geospatial analytical methods, this study examines the association between one aspect of the built environment, namely, the concentration of vacant and derelict land (VDL), and the prevalence of mental health disorders (using the proxy variable of mental health medication prescription rates) in Glasgow, Scotland. This study builds on our previous research, which demonstrated the spatial correspondence between the locations of VDL in Glasgow and several physical health outcomes. Numerous studies of other locales have found similar correspondence between different elements of the built environment and various health outcomes. This is the first study of its kind to look at the spatial concentration of vacant and derelict land in relation to mental health, socio-economic indicators, environmental justice, and health inequities. The findings of this study demonstrate an inequity with respect to the distribution of vacant and derelict land, as confirmed by Pearson correlations between VDL density and deprivation (r = .521, p depression, or psychosis and the density of vacant and derelict land while adjusting for socio-demographic characteristics. This indicates that areas with higher VDL densities tend to exhibit higher rates of mental health issues. Based on these findings, strategies for constructive re-use of VDL are proposed.

  15. Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

    OpenAIRE

    Sreeramareddy Chandrashekhar T; Ramakrishnareddy N; Harsha Kumar HN; Sathian Brijesh; Arokiasamy John T

    2011-01-01

    Abstract Background Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use. Methods A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to ...

  16. Modified Acoustic Emission for Prognostic Health Monitoring, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Prime Photonics proposes to team with Dr. Duke of Virginia Tech to develop a multi-mode, enhanced piezoelectric acoustic emission sensing system to couple large...

  17. Prognostic Health Management of DoD Assets

    Science.gov (United States)

    2015-06-01

    2011;528(22):6708-14. [9] Andreykiv O, Skalsky V, Serhiyenko O, Rudavskyy D. Acoustic emission estimation of crack formation in aluminium alloys ...Measurement and interpretation of fatigue crack growth in 7075 aluminum alloy using acoustic emission monitoring. Journal of testing and evaluation...Gokhale A. Quantification of damage evolution in a 7075 aluminum alloy using an acoustic emission technique. Materials Science and Engineering: A

  18. Vehicle Remote Health Monitoring and Prognostic Maintenance System

    Directory of Open Access Journals (Sweden)

    Uferah Shafi

    2018-01-01

    Full Text Available In many industries inclusive of automotive vehicle industry, predictive maintenance has become more important. It is hard to diagnose failure in advance in the vehicle industry because of the limited availability of sensors and some of the designing exertions. However with the great development in automotive industry, it looks feasible today to analyze sensor’s data along with machine learning techniques for failure prediction. In this article, an approach is presented for fault prediction of four main subsystems of vehicle, fuel system, ignition system, exhaust system, and cooling system. Sensor is collected when vehicle is on the move, both in faulty condition (when any failure in specific system has occurred and in normal condition. The data is transmitted to the server which analyzes the data. Interesting patterns are learned using four classifiers, Decision Tree, Support Vector Machine, K Nearest Neighbor, and Random Forest. These patterns are later used to detect future failures in other vehicles which show the similar behavior. The approach is produced with the end goal of expanding vehicle up-time and was demonstrated on 70 vehicles of Toyota Corolla type. Accuracy comparison of all classifiers is performed on the basis of Receiver Operating Characteristics (ROC curves.

  19. Aging Methodologies and Prognostic Health Management for Electrolytic Capacitors

    Data.gov (United States)

    National Aeronautics and Space Administration — Understanding the ageing mechanisms of electronic components critical avionics systems such as the GPS and INAV are of critical importance. Electrolytic capacitors...

  20. Prognostics Methods for Battery Health Monitoring Using a Bayesian Framework

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    National Aeronautics and Space Administration — This paper explores how the remaining useful life (RUL) can be assessed for complex systems whose internal state variables are either inaccessible to sensors or hard...

  1. Prognostic Techniques for Capacitor Degradation and Health Monitoring

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    National Aeronautics and Space Administration — This paper discusses our initial efforts in constructing physics of failure models for electrolytic capacitors subjected to electrical stressors in DC-DC power...

  2. Prognostic indices for brain metastases – usefulness and challenges

    Directory of Open Access Journals (Sweden)

    Nieder Carsten

    2009-03-01

    Full Text Available Abstract Background This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed. Methods Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA. Results So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA, all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool. Conclusion This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.

  3. Accounting for parameter uncertainty in the definition of parametric distributions used to describe individual patient variation in health economic models

    NARCIS (Netherlands)

    Degeling, Koen; Ijzerman, Maarten J.; Koopman, Miriam; Koffijberg, Hendrik

    2017-01-01

    Background: Parametric distributions based on individual patient data can be used to represent both stochastic and parameter uncertainty. Although general guidance is available on how parameter uncertainty should be accounted for in probabilistic sensitivity analysis, there is no comprehensive

  4. Accounting for parameter uncertainty in the definition of parametric distributions used to describe individual patient variation in health economic models

    NARCIS (Netherlands)

    Degeling, Koen; IJzerman, Maarten J; Koopman, Miriam; Koffijberg, Hendrik

    2017-01-01

    Background Parametric distributions based on individual patient data can be used to represent both stochastic and parameter uncertainty. Although general guidance is available on how parameter uncertainty should be accounted for in probabilistic sensitivity analysis, there is no comprehensive

  5. Infrastructure and distributed learning methodology for privacy-preserving multi-centric rapid learning health care: euroCAT

    Directory of Open Access Journals (Sweden)

    Timo M. Deist

    2017-06-01

    The euroCAT infrastructure has been successfully implemented in five radiation clinics across three countries. SVM models can be learned on data distributed over all five clinics. Furthermore, the infrastructure provides a general framework to execute learning algorithms on distributed data. The ongoing expansion of the euroCAT network will facilitate machine learning in radiation oncology. The resulting access to larger datasets with sufficient variation will pave the way for generalizable prediction models and personalized medicine.

  6. Accounting for parameter uncertainty in the definition of parametric distributions used to describe individual patient variation in health economic models

    OpenAIRE

    Degeling, Koen; IJzerman, Maarten J.; Koopman, Miriam; Koffijberg, Hendrik

    2017-01-01

    Background Parametric distributions based on individual patient data can be used to represent both stochastic and parameter uncertainty. Although general guidance is available on how parameter uncertainty should be accounted for in probabilistic sensitivity analysis, there is no comprehensive guidance on reflecting parameter uncertainty in the (correlated) parameters of distributions used to represent stochastic uncertainty in patient-level models. This study aims to provide this guidance by ...

  7. TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

    Directory of Open Access Journals (Sweden)

    Babucea Ana-Gabriela

    2017-02-01

    Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

  8. Very High Frequency Monitoring System for Engine Gearbox and Generator Health Management (Postprint)

    National Research Council Canada - National Science Library

    Watson, Matthew J; Byington, Carl S; Behbahani, Alireza

    2007-01-01

    .... These gas turbine engine vibration monitoring technologies will address existing operation and maintenance goals for current military system and prognostics health management algorithms for advanced engines...

  9. Comparison of two prognostic models for acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Abd-ElRahim Ibrahim Youssef

    2016-10-01

    Conclusion: (1 There is an agreement to great extent in risk stratification of APE patients by PESI and ESC prognostic models, where mortality rate is increased among high risk classes of both models, (2 ESC prognostic model is more accurate than PESI model in mortality prediction of APE patients especially in the high risk class, (3 echocardiographic evidence of RVD and elevated plasma BNP can help to identify APE patients at increased risk of adverse short-term outcome and (4 integration of RVD assessment by echocardiography and BNP to clinical findings improves the prognostic value of ESC model.

  10. Molecular Pathology: Predictive, Prognostic, and Diagnostic Markers in Uterine Tumors.

    Science.gov (United States)

    Ritterhouse, Lauren L; Howitt, Brooke E

    2016-09-01

    This article focuses on the diagnostic, prognostic, and predictive molecular biomarkers in uterine malignancies, in the context of morphologic diagnoses. The histologic classification of endometrial carcinomas is reviewed first, followed by the description and molecular classification of endometrial epithelial malignancies in the context of histologic classification. Taken together, the molecular and histologic classifications help clinicians to approach troublesome areas encountered in clinical practice and evaluate the utility of molecular alterations in the diagnosis and subclassification of endometrial carcinomas. Putative prognostic markers are reviewed. The use of molecular alterations and surrogate immunohistochemistry as prognostic and predictive markers is also discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study.

    Science.gov (United States)

    Gnanapragasam, V J; Bratt, O; Muir, K; Lee, L S; Huang, H H; Stattin, P; Lophatananon, A

    2018-02-28

    The purpose of this study is to validate a new five-tiered prognostic classification system to better discriminate cancer-specific mortality in men diagnosed with primary non-metastatic prostate cancer. We applied a recently described five-strata model, the Cambridge Prognostic Groups (CPGs 1-5), in two international cohorts and tested prognostic performance against the current standard three-strata classification of low-, intermediate- or high-risk disease. Diagnostic clinico-pathological data for men obtained from the Prostate Cancer data Base Sweden (PCBaSe) and the Singapore Health Study were used. The main outcome measure was prostate cancer mortality (PCM) stratified by age group and treatment modality. The PCBaSe cohort included 72,337 men, of whom 7162 died of prostate cancer. The CPG model successfully classified men with different risks of PCM with competing risk regression confirming significant intergroup distinction (p study of nearly 75,000 men confirms that the CPG five-tiered prognostic model has superior discrimination compared to the three-tiered model in predicting prostate cancer death across different age and treatment groups. Crucially, it identifies distinct sub-groups of men within the old intermediate-risk and high-risk criteria who have very different prognostic outcomes. We therefore propose adoption of the CPG model as a simple-to-use but more accurate prognostic stratification tool to help guide management for men with newly diagnosed prostate cancer.

  12. Updating and prospective validation of a prognostic model for high sickness absence.

    Science.gov (United States)

    Roelen, C A M; Heymans, M W; Twisk, J W R; van Rhenen, W; Pallesen, S; Bjorvatn, B; Moen, B E; Magerøy, N

    2015-01-01

    To further develop and validate a Dutch prognostic model for high sickness absence (SA). Three-wave longitudinal cohort study of 2,059 Norwegian nurses. The Dutch prognostic model was used to predict high SA among Norwegian nurses at wave 2. Subsequently, the model was updated by adding person-related (age, gender, marital status, children at home, and coping strategies), health-related (BMI, physical activity, smoking, and caffeine and alcohol intake), and work-related (job satisfaction, job demands, decision latitude, social support at work, and both work-to-family and family-to-work spillover) variables. The updated model was then prospectively validated for predictions at wave 3. 1,557 (77 %) nurses had complete data at wave 2 and 1,342 (65 %) at wave 3. The risk of high SA was under-estimated by the Dutch model, but discrimination between high-risk and low-risk nurses was fair after re-calibration to the Norwegian data. Gender, marital status, BMI, physical activity, smoking, alcohol intake, job satisfaction, job demands, decision latitude, support at the workplace, and work-to-family spillover were identified as potential predictors of high SA. However, these predictors did not improve the model's discriminative ability, which remained fair at wave 3. The prognostic model correctly identifies 73 % of Norwegian nurses at risk of high SA, although additional predictors are needed before the model can be used to screen working populations for risk of high SA.

  13. Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden

    Directory of Open Access Journals (Sweden)

    Pär Bjelkmar

    2017-04-01

    Full Text Available Abstract Background In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skellefteå municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s and the potential for earlier detection using calls to a health advice line. Methods The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Results Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skellefteå in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. Conclusions We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

  14. Selenium and hazardous elements distribution in plant-soil-water system and human health risk assessment of Lower Cambrian, Southern Shaanxi, China.

    Science.gov (United States)

    Du, Yajun; Luo, Kunli; Ni, Runxiang; Hussain, Rahib

    2018-03-01

    The natural selenium poisoning due to toxic Se levels in food chain had been observed in humans and animals in Lower Cambrian outcrop areas in Southern Shaanxi, China. To find out the distribution pattern of selenium and other hazardous elements in the plant, soil and water of Lower Cambrian in Southern Shaanxi, China, and their possible potential health risk, a total of 30 elements were analyzed and the health risk assessment of 18 elements was calculated. Results showed that the soil, plant and natural water of Lower Cambrian all had relatively high Se levels. In Lower Cambrian, the soil was enriched with Se, As, Ba, Cu, Mo, Ni, Zn, Ga, Cd and Cr (1.68 food intake was the major pathway. For minimizing potential health risk, the local inhabitants should use the mix-imported food with local growing foods.

  15. Bayesian based Prognostic Model for Predictive Maintenance of Offshore Wind Farms

    DEFF Research Database (Denmark)

    Asgarpour, Masoud; Sørensen, John Dalsgaard

    2018-01-01

    The operation and maintenance costs of offshore wind farms can be significantly reduced if existing corrective actions are performed as efficient as possible and if future corrective actions are avoided by performing sufficient preventive actions. In this paper a prognostic model for degradation...... monitoring, fault prediction and predictive maintenance of offshore wind components is defined. The diagnostic model defined in this paper is based on degradation, remaining useful lifetime and hybrid inspection threshold models. The defined degradation model is based on an exponential distribution...

  16. Bayesian based Prognostic Model for Predictive Maintenance of Offshore Wind Farms

    DEFF Research Database (Denmark)

    Asgarpour, Masoud; Sørensen, John Dalsgaard

    2018-01-01

    monitoring, fault prediction and predictive maintenance of offshore wind components is defined. The diagnostic model defined in this paper is based on degradation, remaining useful lifetime and hybrid inspection threshold models. The defined degradation model is based on an exponential distribution......The operation and maintenance costs of offshore wind farms can be significantly reduced if existing corrective actions are performed as efficient as possible and if future corrective actions are avoided by performing sufficient preventive actions. In this paper a prognostic model for degradation...

  17. Bayesian based Prognostic Model for Predictive Maintenance of Offshore Wind Farms

    DEFF Research Database (Denmark)

    Asgarpour, Masoud

    2017-01-01

    monitoring, fault detection and predictive maintenance of offshore wind components is defined. The diagnostic model defined in this paper is based on degradation, remaining useful lifetime and hybrid inspection threshold models. The defined degradation model is based on an exponential distribution......The operation and maintenance costs of offshore wind farms can be significantly reduced if existing corrective actions are performed as efficient as possible and if future corrective actions are avoided by performing sufficient preventive actions. In this paper a prognostic model for degradation...

  18. Technical Needs for Prototypic Prognostic Technique Demonstration for Advanced Small Modular Reactor Passive Components

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Ryan M.; Coble, Jamie B.; Hirt, Evelyn H.; Ramuhalli, Pradeep; Mitchell, Mark R.; Wootan, David W.; Berglin, Eric J.; Bond, Leonard J.; Henager, Charles H.

    2013-05-17

    This report identifies a number of requirements for prognostics health management of passive systems in AdvSMRs, documents technical gaps in establishing a prototypical prognostic methodology for this purpose, and describes a preliminary research plan for addressing these technical gaps. AdvSMRs span multiple concepts; therefore a technology- and design-neutral approach is taken, with the focus being on characteristics that are likely to be common to all or several AdvSMR concepts. An evaluation of available literature is used to identify proposed concepts for AdvSMRs along with likely operational characteristics. Available operating experience of advanced reactors is used in identifying passive components that may be subject to degradation, materials likely to be used for these components, and potential modes of degradation of these components. This information helps in assessing measurement needs for PHM systems, as well as defining functional requirements of PHM systems. An assessment of current state-of-the-art approaches to measurements, sensors and instrumentation, diagnostics and prognostics is also documented. This state-of-the-art evaluation, combined with the requirements, may be used to identify technical gaps and research needs in the development, evaluation, and deployment of PHM systems for AdvSMRs. A preliminary research plan to address high-priority research needs for the deployment of PHM systems to AdvSMRs is described, with the objective being the demonstration of prototypic prognostics technology for passive components in AdvSMRs. Greater efficiency in achieving this objective can be gained through judicious selection of materials and degradation modes that are relevant to proposed AdvSMR concepts, and for which significant knowledge already exists. These selections were made based on multiple constraints including the analysis performed in this document, ready access to laboratory-scale facilities for materials testing and measurement, and

  19. Treatment Results and Prognostic Indicators in Thymic Epithelial Tumors: A Clinicopathological Analysis of 45 Patients

    Directory of Open Access Journals (Sweden)

    Mansour Ansari

    2014-07-01

    Full Text Available Background: Thymomas are rare epithelial tumors arising from thymus gland. This study aims at investigating the clinical presentation, prognostic factors and treatment outcome of forty five patients with thymoma and thymic carcinoma. Methods: Forty-five patients being histologically diagnosed with thymoma or thymic carcinoma that were treated and followed-up at a tertiary academic hospital during January 1987 and December 2008 were selected for the present study. Twelve patients were solely treated with surgery, 14 with surgery followed by adjuvant radiotherapy, 12 with sequential combined treatment of surgery, radiotherapy and/or chemotherapy and 7 with non-surgical approach including radiotherapy and/or chemotherapy. Tumors were classified based on the new World Health Organization (WHO histological classification. Results: There were 18 women and 27 men with a median age of 43 years. Twelve patients (26.7% had stage I, 7 (17.8% had stage II, 23 (51% had stage III and 2 (4.5% had stage IV disease. Tumors types were categorized as type A (n=4, type AB (n=10, type B1 (n=9, type B2 (n=10, type B3 (n=5 and type C (n=7. In univariate analysis for overall survival, disease stage (P=0.001, tumor size (P=0.017 and the extent of surgical resection (P<0.001 were prognostic factors. Regarding the multivariate analysis, only the extent of the surgical resection (P<0.001 was the independent prognostic factor and non-surgical treatment had a negative influence on the survival. The 5-year and 10-year overall survival rates were 70.8% and 62.9%, respectively. Conclusion: Complete surgical resection is the most important prognostic factor in patients with thymic epithelial tumors.

  20. Treatment results and prognostic indicators in thymic epithelial tumors: a clinicopathological analysis of 45 patients.

    Science.gov (United States)

    Ansari, Mansour; Dehsara, Farzin; Mohammadianpanah, Mohammad; Mosalaei, Ahmad; Omidvari, Shapour; Ahmadloo, Niloofar

    2014-07-01

    Thymomas are rare epithelial tumors arising from thymus gland. This study aims at investigating the clinical presentation, prognostic factors and treatment outcome of forty five patients with thymoma and thymic carcinoma. Forty-five patients being histologically diagnosed with thymoma or thymic carcinoma that were treated and followed-up at a tertiary academic hospital during January 1987 and December 2008 were selected for the present study. Twelve patients were solely treated with surgery, 14 with surgery followed by adjuvant radiotherapy, 12 with sequential combined treatment of surgery, radiotherapy and/or chemotherapy and 7 with non-surgical approach including radiotherapy and/or chemotherapy.  Tumors were classified based on the new World Health Organization (WHO) histological classification. There were 18 women and 27 men with a median age of 43 years. Twelve patients (26.7%) had stage I, 7 (17.8%) had stage II, 23 (51%) had stage III and 2 (4.5%) had stage IV disease. Tumors types were categorized as type A (n=4), type AB (n=10), type B1 (n=9), type B2 (n=10), type B3 (n=5) and type C (n=7). In univariate analysis for overall survival, disease stage (P=0.001), tumor size (P=0.017) and the extent of surgical resection (P<0.001) were prognostic factors. Regarding the multivariate analysis, only the extent of the surgical resection (P<0.001) was the independent prognostic factor and non-surgical treatment had a negative influence on the survival. The 5-year and 10-year overall survival rates were 70.8% and 62.9%, respectively. Complete surgical resection is the most important prognostic factor in patients with thymic epithelial tumors.

  1. A prognostic tool to identify adolescents at high risk of becoming daily smokers

    Directory of Open Access Journals (Sweden)

    Paradis Gilles

    2011-08-01

    Full Text Available Abstract Background The American Academy of Pediatrics advocates that pediatricians should be involved in tobacco counseling and has developed guidelines for counseling. We present a prognostic tool for use by health care practitioners in both clinical and non-clinical settings, to identify adolescents at risk of becoming daily smokers. Methods Data were drawn from the Nicotine Dependence in Teens (NDIT Study, a prospective investigation of 1293 adolescents, initially aged 12-13 years, recruited in 10 secondary schools in Montreal, Canada in 1999. Questionnaires were administered every three months for five years. The prognostic tool was developed using estimated coefficients from multivariable logistic models. Model overfitting was corrected using bootstrap cross-validation. Goodness-of-fit and predictive ability of the models were assessed by R2, the c-statistic, and the Hosmer-Lemeshow test. Results The 1-year and 2-year probability of initiating daily smoking was a joint function of seven individual characteristics: age; ever smoked; ever felt like you needed a cigarette; parent(s smoke; sibling(s smoke; friend(s smoke; and ever drank alcohol. The models were characterized by reasonably good fit and predictive ability. They were transformed into user-friendly tables such that the risk of daily smoking can be easily computed by summing points for responses to each item. The prognostic tool is also available on-line at http://episerve.chumontreal.qc.ca/calculation_risk/daily-risk/daily_smokingadd.php. Conclusions The prognostic tool to identify youth at high risk of daily smoking may eventually be an important component of a comprehensive tobacco control system.

  2. Providing Health Sciences Services in a Joint-Use Distributed Learning Library System: An Organizational Case Study.

    Science.gov (United States)

    Enslow, Electra; Fricke, Suzanne; Vela, Kathryn

    2017-01-01

    The purpose of this organizational case study is to describe the complexities librarians face when serving a multi-campus institution that supports both a joint-use library and expanding health sciences academic partnerships. In a system without a centralized health science library administration, liaison librarians are identifying dispersed programs and user groups and collaborating to define their unique service and outreach needs within a larger land-grant university. Using a team-based approach, health sciences librarians are communicating to integrate research and teaching support, systems differences across dispersed campuses, and future needs of a new community-based medical program.

  3. A comparison of alternative methods of calculating complementary cumulative distribution functions of health effects following an atmospheric radioactive release

    International Nuclear Information System (INIS)

    Ponting, A.C.; Nair, S.

    1984-04-01

    A concept extensively used in studying the consequences of accidental atmospheric radioactive releases is that of the Complementary Cumulative Distribution Function, CCDF. Various methods of calculating CCDFs have been developed with particular applications in putting degraded core accidents in perspective and in identifying release sequences leading to high risks. This note compares three methods with specific reference to their accuracy and computational efficiency. For two of the methods (that used in the US Reactor Safety Study code CRAC2 and extended version of that method), the effects of varying the sector width and considering site-specific population distributions have been determined. For the third method it is only necessary to consider the effects of site-specific population distributions. (author)

  4. Prognostic significance of urinary NGAL in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Patel ML

    2015-10-01

    Full Text Available Munna Lal Patel,1 Rekha Sachan,2 Ravi Misra,3 Ritul Kamal,4 Radhey Shyam,5 Pushpalata Sachan6 1Department of Medicine, King George Medical University, Lucknow, India; 2Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India; 3Department of Internal Medicine, King George Medical University, Lucknow, India; 4Epidemiology Division, Council of Scientific and Industrial Research-Indian Institute of Toxicology Research (CSIR-IITR, Lucknow, India; 5Department of Geriatric Intensive Care Unit, King George Medical University, Lucknow, India; 6Department of Physiology, Career Institute of Medical Sciences, Lucknow, India Background: Chronic kidney disease (CKD is a worldwide public health problem. Recently urinary NGAL (uNGAL has been proven to be a useful (potentially ideal biomarker for early detection of CKD. The aim of the present study was to examine the correlation of uNGAL with severity of renal impairment in CKD and to evaluate its prognostic value in these subjects. Methods: This was a prospective study carried out over a period of 24 months in subjects with CKD due to primary chronic glomerulonephritis. New cases of CKD stage II, III, IV aged between 18 and 65 years were enrolled as per KDIGO (Kidney Disease: Improving Global Outcomes guidelines 2012. A total of 90 subjects completed the study up to the end-point. The primary follow-up end-point was 18 months, or decreased glomerular filtration rate of less than 15 mL/min. Secondary follow-up end-point was the number of subjects who expired during this period. Results: Multiple regression model of estimated glomerular filtration rate showed significant associations with log uNGAL (β=0.38, P<0.001, Ca×PO4 (β=0.60, P<0.001, hemoglobin (β=0.37, P<0.001, urine protein (β=0.34, P<0.001, serum albumin (β=0.48, P<0.001, and systolic blood pressure (β=0.76, P<0.001. Receiver operator curve for uNGAL considering the progression of CKD showed area under the curve

  5. Local distributions of wealth to describe health inequalities in India: a new approach for analyzing nationally representative household survey data, 1992-2008.

    Science.gov (United States)

    Bassani, Diego G; Corsi, Daniel J; Gaffey, Michelle F; Barros, Aluisio J D

    2014-01-01

    Worse health outcomes including higher morbidity and mortality are most often observed among the poorest fractions of a population. In this paper we present and validate national, regional and state-level distributions of national wealth index scores, for urban and rural populations, derived from household asset data collected in six survey rounds in India between 1992-3 and 2007-8. These new indices and their sub-national distributions allow for comparative analyses of a standardized measure of wealth across time and at various levels of population aggregation in India. Indices were derived through principal components analysis (PCA) performed using standardized variables from a correlation matrix to minimize differences in variance. Valid and simple indices were constructed with the minimum number of assets needed to produce scores with enough variability to allow definition of unique decile cut-off points in each urban and rural area of all states. For all indices, the first PCA components explained between 36% and 43% of the variance in household assets. Using sub-national distributions of national wealth index scores, mean height-for-age z-scores increased from the poorest to the richest wealth quintiles for all surveys, and stunting prevalence was higher among the poorest and lower among the wealthiest. Urban and rural decile cut-off values for India, for the six regions and for the 24 major states revealed large variability in wealth by geographical area and level, and rural wealth score gaps exceeded those observed in urban areas. The large variability in sub-national distributions of national wealth index scores indicates the importance of accounting for such variation when constructing wealth indices and deriving score distribution cut-off points. Such an approach allows for proper within-sample economic classification, resulting in scores that are valid indicators of wealth and correlate well with health outcomes, and enables wealth-related analyses at

  6. Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review

    Science.gov (United States)

    2013-01-01

    Introduction Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. Methods A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. Results Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did. Conclusions This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth. PMID:23915121

  7. Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review.

    Science.gov (United States)

    Campos-Serna, Javier; Ronda-Pérez, Elena; Artazcoz, Lucia; Moen, Bente E; Benavides, Fernando G

    2013-08-05

    Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did. This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.

  8. Distribution of health-related social surplus in pharmaceuticals: an estimation of consumer and producer surplus in the management of high blood lipids and COPD.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; Camejo, Rodrigo Refoios; McGrath, Clare; Miraldo, Marisa; Rutten, Frans

    2014-05-01

    Following suggestions that developers should be allowed to capture a defined share of the total value generated by their technologies, the amount of surplus accruing to the pharmaceutical industry has become an important concept when discussing policies to encourage innovation in healthcare. Observational clinical and market data spanning over a period of 20 years were applied in order to estimate the social surplus generated by pharmaceuticals used in the management of high cholesterol and chronic obstructive pulmonary disease (COPD). The distribution of social surplus between consumers and producers was also computed and the dynamics of rent extraction examined. Health-related social surplus increased consistently over time for both disease areas, mostly due to the launch of more effective technologies and a greater number of patients being treated for the conditions. However, the growth rate of social surplus differed for each disease and dissimilar patterns of distribution between consumer and producer surplus emerged across the years. For lipid-lowering therapies, yearly consumer surplus reaches 85 % of total health-related social surplus after the loss of exclusivity of major molecules, whilst for COPD it ranges from 54 to 69 %. Average producer surplus is approximately 25 % of total health-related social surplus in the lipid-lowering market between 1990 and 2010, and 37 % for COPD between 2001 and 2010. The share of surplus captured by non-innovative generic producers also varies differently across periods for both markets, reaching 11.12 % in the case of lipid-lowering therapies but just 1.55 % in the case of COPD. A considerable amount of the value may be recouped by consumers only towards the end of the lifecycle. Elements affecting the distribution of social surplus vary across disease areas and include the market pricing structure and the pattern of clinical effectiveness observed over time. The application of a longer-term disease specific perspective

  9. Prognostic, quantitative histopathologic variables in lobular carcinoma of the breast

    DEFF Research Database (Denmark)

    Ladekarl, M; Sørensen, Flemming Brandt

    1993-01-01

    BACKGROUND: A retrospective investigation of 53 consecutively treated patients with operable lobular carcinoma of the breast, with a median follow-up of 6.6 years, was performed to examine the prognostic value of quantitative histopathologic parameters.METHODS: The measurements were performed...... of disease, vv(nuc), MI, and NI were of significant independent, prognostic value. On the basis of the multivariate analyses, a prognostic index with highly distinguishing capacity between prognostically poor and favorable cases was constructed.CONCLUSION: Quantitative histopathologic variables are of value...... for objective grading of malignancy in lobular carcinomas. The new parameter--estimates of the mean nuclear volume--is highly reproducible and suitable for routine use. However, larger and prospective studies are needed to establish the true value of the quantitative histopathologic variables in the clinical...

  10. Prognostic, quantitative histopathologic variables in lobular carcinoma of the breast

    DEFF Research Database (Denmark)

    Ladekarl, M; Sørensen, Flemming Brandt

    1993-01-01

    BACKGROUND: A retrospective investigation of 53 consecutively treated patients with operable lobular carcinoma of the breast, with a median follow-up of 6.6 years, was performed to examine the prognostic value of quantitative histopathologic parameters. METHODS: The measurements were performed...... of disease, vv(nuc), MI, and NI were of significant independent, prognostic value. On the basis of the multivariate analyses, a prognostic index with highly distinguishing capacity between prognostically poor and favorable cases was constructed. CONCLUSION: Quantitative histopathologic variables are of value...... for objective grading of malignancy in lobular carcinomas. The new parameter--estimates of the mean nuclear volume--is highly reproducible and suitable for routine use. However, larger and prospective studies are needed to establish the true value of the quantitative histopathologic variables in the clinical...

  11. Prognostic value of proliferation in pleomorphic soft tissue sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke M; Jönsson, Mats; Bendahl, Pär-Ola O

    2012-01-01

    = 1.6-12.1), Top2a (hazard ratio = 2.2, CI = 1.2-3.5) and high S-phase fraction (hazard ratio = 1.8, CI = 1.2-3.7) significantly correlated with risk for metastasis. When combined with currently used prognostic factors, Ki-67, S-phase fraction and Top2a fraction contributed to refined identification...... of prognostic risk groups. Proliferation, as assessed by expression of Ki-67 and Top2a and evaluation of S-phase fraction and applied to statistical decision-tree models, provides prognostic information in soft tissue sarcomas of the extremity and trunk wall. Though proliferation contributes independently...... to currently applied prognosticators, its role is particularly strong when few other factors are available, which suggests a role in preoperative decision-making related to identification of high-risk individuals who would benefit from neoadjuvant therapy....

  12. Model Adaptation for Prognostics in a Particle Filtering Framework

    Data.gov (United States)

    National Aeronautics and Space Administration — One of the key motivating factors for using particle filters for prognostics is the ability to include model parameters as part of the state vector to be estimated....

  13. Model-based Prognostics with Concurrent Damage Progression Processes

    Data.gov (United States)

    National Aeronautics and Space Administration — Model-based prognostics approaches rely on physics-based models that describe the behavior of systems and their components. These models must account for the several...

  14. Prognostic significance of diagnostic laparoscopy for spontaneous fertility

    NARCIS (Netherlands)

    Mol, B. W.; Swart, P.; Bossuyt, P. M.; van der Veen, F.

    1999-01-01

    OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact

  15. Prognostic significance of symptoms of hospitalised advanced cancer patients

    NARCIS (Netherlands)

    Teunissen, Saskia C.; de Graeff, Alexander; de Haes, Hanneke C.; Voest, Emile E.

    2006-01-01

    To assess the prognostic value of symptoms in hospitalised advanced cancer patients. A prospective analysis was performed of 181 hospitalised patients referred to a Palliative Care Team. Comprehensive symptom questionnaire, functional status, estimated life expectancy and survival were assessed.

  16. Prognostic Value of EEG in Asphyxiated Newborns Treated with Hypothermia

    OpenAIRE

    J Gordon Millichap

    2008-01-01

    Researchers at Children’s Hospitals in Milan, Italy, determined the prognostic value of electroencephalographic patterns in 23 newborns with severe perinatal hypoxic-ischemic encephalopathy, treated with hypothermia.

  17. Prognostic Factors and Outcome of Management of Ischemic ...

    African Journals Online (AJOL)

    management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ..... Financial support and sponsorship. Nil. ... European Association of Urology guidelines on.

  18. Model-based Prognostics with Fixed-lag Particle Filters

    Data.gov (United States)

    National Aeronautics and Space Administration — Model-based prognostics exploits domain knowl- edge of the system, its components, and how they fail by casting the underlying physical phenom- ena in a...

  19. Multimodality therapy and prognostic analysis of thymoma

    International Nuclear Information System (INIS)

    Chen Jie; Wang Ping; Song Yongchun

    2007-01-01

    Objective: The aim of this study is to draft the judicious treatment methods by analyzing the Long-term survival result of thymoma and evaluating the effect that prognosis analysis has on thymoma. Methods: Retrospective analysis of the clinical material of 142 patients with thymoma in the Tianjin Medical University Cancer Hospital from January 1954 to January 2001. Statistical analysis was performed using the SPSS software package. The Kaplan-Meier method was used single variable analysis, The Log-rank test was used to compare survival between groups, The Cox' s proportional hazards model was used to multi-factor analysis. Results: The 5- and 10-year survival rate of the 142 patients was 59.9% and 45.8%, respectively. Staging was adopted on the Masaoka's way, 5- and 10-year survival rates was: 93.8%, 79.2% in stage I; 79.3%, 55.2% in stage II; 53.1%, 34.4% in stage III; and 0 and 0 in stage IV. Among 30 patients associated with myasthenia gravis, 19 patients suffered from generalized myasthenia gravis and 11 patients of ocular myasthenia gravis, with 5- and 10-year survival rate of 83.3% and 60.0%, respectively. Three patients finally died of myasthenia gravis. The 5- and 10-year survival rate of 112 patients without myasthenia gravis was 53.6% and 42.0%, respectively. Among 116 patients, treated with surgery-, resection was carried out in 84 patients, palliative resection in 9 patients, and biopsy only in 23 patients. Eighty-nine patients were given radiotherapy and 55 patients had postoperative radiotherapy. Single variable analysis showed that Masaoka clinical staging, association with myasthenia gravis, histopathologic subtype and the method of treatment were prognostic factor's. Finally, drawing the conclusion through muhivariable analysis; Masaoka clinical staging, association with myasthenia gravis and the treatment method were prognostic factors. Conclusions: The diagnosis of thymoma is made clinically and pathologically. The treatment principle should be

  20. Prognostic significance of erythropoietin in pancreatic adenocarcinoma.

    Directory of Open Access Journals (Sweden)

    Thilo Welsch

    Full Text Available BACKGROUND: Erythropoietin (Epo administration has been reported to have tumor-promoting effects in anemic cancer patients. We investigated the prognostic impact of endogenous Epo in patients with pancreatic ductal adenocarcinoma (PDAC. METHODOLOGY: The clinico-pathological relevance of hemoglobin (Hb, n = 150, serum Epo (sEpo, n = 87 and tissue expression of Epo/Epo receptor (EpoR, n = 104 was analyzed in patients with PDAC. Epo/EpoR expression, signaling, growth, invasion and chemoresistance were studied in Epo-exposed PDAC cell lines. RESULTS: Compared to donors, median preoperative Hb levels were reduced by 15% in both chronic pancreatitis (CP, p<0.05 and PDAC (p<0.001, reaching anemic grade in one third of patients. While inversely correlating to Hb (r = -0.46, 95% of sEPO values lay within the normal range. The individual levels of compensation were adequate in CP (observed to predicted ratio, O/P = 0.99 but not in PDAC (O/P = 0.85. Strikingly, lower sEPO values yielding inadequate Epo responses were prominent in non-metastatic M0-patients, whereas these parameters were restored in metastatic M1-group (8 vs. 13 mU/mL; O/P = 0.82 vs. 0.96; p<0.01--although Hb levels and the prevalence of anemia were comparable. Higher sEpo values (upper quartile ≥ 16 mU/ml were not significantly different in M0 (20% and M1 (30% groups, but were an independent prognostic factor for shorter survival (HR 2.20, 10 vs. 17 months, p<0.05. The pattern of Epo expression in pancreas and liver suggested ectopic release of Epo by capillaries/vasa vasorum and hepatocytes, regulated by but not emanating from tumor cells. Epo could initiate PI3K/Akt signaling via EpoR in PDAC cells but failed to alter their functions, probably due to co-expression of the soluble EpoR isoform, known to antagonize Epo. CONCLUSION/SIGNIFICANCE: Higher sEPO levels counteract anemia but worsen outcome in PDAC patients. Further trials are required to clarify how overcoming a sEPO threshold

  1. Prognostic factors in sensory recovery after digital nerve repair

    OpenAIRE

    Bulut, Tugrul; Akgun, Ulas; Citlak, Atilla; Aslan, Cihan; Sener, Ufuk; Sener, Muhittin

    2018-01-01

    Objective: The prognostic factors that affect sensory nerve recovery after digital nerve repair are variable because of nonhomogeneous data, subjective tests, and different assessment/scoring methods. The aim of this study was to evaluate the success of sensory nerve recovery after digital nerve repair and to investigate the prognostic factors in sensorial healing.Methods: Ninety-six digital nerve repairs of 63 patients were retrospectively evaluated. All nerves were repaired with end-to-end ...

  2. Distinguishing prognostic and predictive biomarkers: An information theoretic approach.

    Science.gov (United States)

    Sechidis, Konstantinos; Papangelou, Konstantinos; Metcalfe, Paul D; Svensson, David; Weatherall, James; Brown, Gavin

    2018-05-02

    The identification of biomarkers to support decision-making is central to personalised medicine, in both clinical and research scenarios. The challenge can be seen in two halves: identifying predictive markers, which guide the development/use of tailored therapies; and identifying prognostic markers, which guide other aspects of care and clinical trial planning, i.e. prognostic markers can be considered as covariates for stratification. Mistakenly assuming a biomarker to be predictive, when it is in fact largely prognostic (and vice-versa) is highly undesirable, and can result in financial, ethical and personal consequences. We present a framework for data-driven ranking of biomarkers on their prognostic/predictive strength, using a novel information theoretic method. This approach provides a natural algebra to discuss and quantify the individual predictive and prognostic strength, in a self-consistent mathematical framework. Our contribution is a novel procedure, INFO+, which naturally distinguishes the prognostic vs predictive role of each biomarker and handles higher order interactions. In a comprehensive empirical evaluation INFO+ outperforms more complex methods, most notably when noise factors dominate, and biomarkers are likely to be falsely identified as predictive, when in fact they are just strongly prognostic. Furthermore, we show that our methods can be 1-3 orders of magnitude faster than competitors, making it useful for biomarker discovery in 'big data' scenarios. Finally, we apply our methods to identify predictive biomarkers on two real clinical trials, and introduce a new graphical representation that provides greater insight into the prognostic and predictive strength of each biomarker. R implementations of the suggested methods are available at https://github.com/sechidis. konstantinos.sechidis@manchester.ac.uk. Supplementary data are available at Bioinformatics online.

  3. Prognostic Assessment in Patients with Indolent B-Cell Lymphomas

    Directory of Open Access Journals (Sweden)

    Luca Arcaini

    2012-01-01

    Full Text Available Follicular lymphoma (FL is an indolent lymphoma with long median survival. Many studies have been performed to build up prognostic scores potentially useful to identify patients with poorer outcome. In 2004, an international consortium coordinated by the International Follicular Lymphoma Prognostic Factor project was established and a new prognostic study was launched (FLIPI2 using progression-free survival (PFS as main endpoint and integrating all the modern parameters prospectively collected. Low-grade non-Hodgkin lymphomas were once considered as a heterogenous group of lymphomas characterized by an indolent clinical course. Each entity is characterized by unique clinicobiologic features. Some studies have been focused on prognostic factors in single lymphoma subtypes, with the development of specific-entity scores based on retrospective series, for instance splenic marginal zone lymphoma (SMZL. A widely accepted prognostic tool for clinical usage for indolent non-follicular B-cell lymphomas is largely awaited. In this paper we summarized the current evidence regarding prognostic assessment of indolent follicular and non-follicular lymphomas.

  4. Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning.

    Science.gov (United States)

    Chiffi, Daniele; Zanotti, Renzo

    2017-10-01

    Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. © 2016 John Wiley & Sons, Ltd.

  5. Prognostic Marker before Treatment of Patients with Malignant Glioma

    Directory of Open Access Journals (Sweden)

    Norbert Galldiks

    2012-11-01

    Full Text Available The purpose of this positron emission tomography (PET study was to compare the prognostic value of pretreatment volume of [11C] methionine (MET uptake and semiquantitative MET uptake ratio in patients with malignant glioma. The study population comprised 40 patients with malignant glioma. Pretreatment magnetic resonance imaging (MRI and MET-PET imaging were performed before the initiation of glioma treatment in all patients. The pretreatment MET uptake ratios and volumes were assessed. To create prognostically homogeneous subgroups, patients′ pretreatment prognostic factors were stratified according to the six classes of Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA. Univariate and multivariate analyses were performed to determine significant prognostic factors. Survival analyses identified the pretreatment volume of MET uptake and a higher RTOG RPA class as significant predictors. In contrast, pretreatment maximum areas of contrast enhancement on MRI and semiquantitative MET uptake ratios could not be identified as significant prognostic factors. The patients′ outcomes and Karnofsky Performance Scale scores were significantly correlated with pretreatment volume of MET uptake but not with semiquantitative MET uptake ratio. The data suggest that pretreatment volumetry of MET uptake but not the semiquantitative MET uptake ratio is a useful biologic prognostic marker in patients with malignant glioma.

  6. Vibration Analysis and Time Series Prediction for Wind Turbine Gearbox Prognostics

    Directory of Open Access Journals (Sweden)

    Hossam A. Gabbar

    2013-01-01

    Full Text Available Premature failure of a gearbox in a wind turbine poses a high risk of increasing the operational and maintenance costs and decreasing the profit margins. Prognostics and health management (PHM techniques are widely used to access the current health condition of the gearbox and project it in future to predict premature failures. This paper proposes such techniques for predicting gearbox health condition index extracted from the vibration signals emanating from the gearbox. The progression of the monitoring index is predicted using two different prediction techniques, adaptive neuro-fuzzy inference system (ANFIS and nonlinear autoregressive model with exogenous inputs (NARX. The proposed prediction techniques are evaluated through sun-spot data-set and applied on vibration based health related monitoring index calculated through psychoacoustic phenomenon. A comparison is given for their prediction accuracy. The results are helpful in understanding the relationship of machine conditions, the corresponding indicating features, the level of damage/degradation, and their progression.

  7. Prognostic significance of the prognostic nutritional index in esophageal cancer patients undergoing neoadjuvant chemotherapy.

    Science.gov (United States)

    Nakatani, M; Migita, K; Matsumoto, S; Wakatsuki, K; Ito, M; Nakade, H; Kunishige, T; Kitano, M; Kanehiro, H

    2017-08-01

    Nutritional status is one of the most important issues faced by cancer patients. Several studies have shown that a low preoperative nutritional status is associated with a worse prognosis in patients with various types of cancer, including esophageal cancer (EC). Recently, neoadjuvant chemotherapy (NAC) and/or radiotherapy have been accepted as the standard treatment for resectable advanced EC. However, NAC has the potential to deteriorate the nutritional status of a patient. This study aimed to evaluate the prognostic significance of the nutritional status for EC patients who underwent NAC. We retrospectively reviewed 66 squamous cell EC patients who underwent NAC consisting of docetaxel, cisplatin, and 5-fluorouracil followed by subtotal esophagectomy at Nara Medical University Hospital between January 2009 and August 2015. To assess the patients' nutritional status, the prognostic nutritional index (PNI) before commencing NAC and prior to the operation was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). The cutoff value of the PNI was set at 45. A multivariable analysis was performed to identify prognostic factors for overall survival (OS) and relapse-free survival (RFS). The mean pre-NAC and preoperative PNI were 50.2 ± 5.7 and 48.1 ± 4.7, respectively (P = 0.005). The PNI decreased following NAC in 44 (66.7%) patients. Before initiating NAC, 9 (13.6%) patients had a low PNI, and 12 (18.2%) patients had a low PNI prior to the operation. The pre-NAC PNI and preoperative PNI were significantly associated with the OS (P = 0.013 and P = 0.004, respectively) and RFS (P = 0.036 and P = 0.005, respectively) rates. The multivariable analysis identified the preoperative PNI as an independent prognostic factor for poor OS and RFS, although the pre-NAC PNI was not an independent predictor. Our results suggest that the preoperative PNI is a useful marker for predicting the long-term outcomes of EC patients

  8. Prognostic factors after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Castoldi, M.C.; Cozzi, G.; Severini, A.; Pisani, P.; Ideo, G.; Bellomi, M.

    1991-01-01

    The authors reviewed the clinical charts and the radiographic files of 93 patients with obsructive jaundice -in 86 cases due to neoplasms -treated with PTBD. The test of differences from survival curves was used to identify the clinical parameters predictive of short survival after PTBD. The difference in survival curves was significant relative to serum indirect bilirubin (cut point: 7.6 mg%), to serum cholinesterase (cut point: 1290 mU/ml), to white blood cells counts (cut point: 8600/mm 3 ), to blood urea nitrogen (BUN) levels (cut point: 60 mg%). Because of the market negative prognostic value of high BUN levels, our data seemto indicate that PTBD should not be performed when severe renal insufficiency is present. Other parameters correlated with a short survival after PTBD were the histotype of metastasis (in comparison with the other ones) and in large neoplastic volume (in comparison with a small and medium ones). Through pre-PTBD radiological and laboratory data analysis, a group of patients can be selected in whom the procedure will increase neither well-being nor survival, as plotted against those patients who are likely to benefit from biliary drainage

  9. Prognostic Assessment in Patients with Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Rita García-Martínez

    2011-01-01

    Full Text Available Hepatic encephalopathy (HE is a common complication of liver failure that is associated with poor prognosis. However, the prognosis is not uniform and depends on the underlying liver disease. Acute liver failure is an uncommon cause of HE that carries bad prognosis but is potentially reversible. There are several prognostic systems that have been specifically developed for selecting patients for liver transplantation. In patients with cirrhosis the prognosis of the episode of HE is usually dictated by the underlying precipitating factor. Acute-on-chronic liver failure is the most severe form of decompensation of cirrhosis, the prognosis depends on the number of associated organ failures. Patients with cirrhosis that have experienced an episode of HE should be considered candidates for liver transplant. The selection depends on the underlying liver function assessed by the Model for End-stage Liver Disease (MELD index. There is a subgroup that exhibits low MELD and recurrent HE, usually due to the coexistence of large portosystemic shunts. The recurrence of HE is more common in patients that develop progressive deterioration of liver function and hyponatremia. The bouts of HE may cause sequels that have been shown to persist after liver transplant.

  10. Prognostic factors in acute cardiogenic pulmonary edema.

    Science.gov (United States)

    Le Conte, P; Coutant, V; N'Guyen, J M; Baron, D; Touze, M D; Potel, G

    1999-07-01

    The purpose of this study was to determine the clinical and biological findings at admission in the Department of Emergency Medicine associated with a poor prognosis, and to evaluate early response to treatment as a prognostic factor. It was a prospective cohort study with a 5-month follow-up. One hundred eighty-six patients admitted for acute cardiogenic pulmonary edema were included. Features were analyzed at the admission and on response to initial treatment. The main outcome measure was survival at 2 end-points: hospital discharge, and 5 months of follow-up. Multivariate analysis showed that in-hospital mortality was associated with marbleization (mottling) odd-ratio (OR) = 9.0), low diuresis (OR = 4.0), high breath rate 6 hours after admission (OR = 4.0), and chronic digoxin use (OR = 3.39). Five-month mortality was associated with a bedridden state (OR = 9.0), marbleization (mottling) (OR = 5.5), myocardial infarction (OR = 3), and poor early response to initial treatment (OR = 3.2). In addition to well-known factors, the response to initial treatment evaluated 6 hours after admission was a major determinant of outcome.

  11. Spatial distribution of trachoma cases in the City of Bauru, State of São Paulo, Brazil, detected in 2006: defining key areas for improvement of health resources

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Macharelli

    2013-04-01

    Full Text Available Introduction The objective of this study was to analyze the spatial behavior of the occurrence of trachoma cases detected in the City of Bauru, State of São Paulo, Brazil, in 2006 in order to use the information collected to set priority areas for optimization of health resources. Methods the trachoma cases identified in 2006 were georeferenced. The data evaluated were: schools where the trachoma cases studied, data from the 2000 Census, census tract, type of housing, water supply conditions, distribution of income and levels of education of household heads. In the Google Earth® software and TerraView® were made descriptive spatial analysis and estimates of the Kernel. Each area was studied by interpolation of the density surfaces exposing events to facilitate to recognize the clusters. Results Of the 66 cases detected, only one (1.5% was not a resident of the city's outskirts. A positive association was detected of trachoma cases and the percentage of heads of household with income below three minimum wages and schooling under eight years of education. Conclusions The recognition of the spatial distribution of trachoma cases coincided with the areas of greatest social inequality in Bauru City. The micro-areas identified are those that should be prioritized in the rationalization of health resources. There is the possibility of using the trachoma cases detected as an indicator of performance of micro priority health programs.

  12. Spatial distribution of trachoma cases in the City of Bauru, State of São Paulo, Brazil, detected in 2006: defining key areas for improvement of health resources

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Macharelli

    2013-02-01

    Full Text Available Introduction The objective of this study was to analyze the spatial behavior of the occurrence of trachoma cases detected in the City of Bauru, State of São Paulo, Brazil, in 2006 in order to use the information collected to set priority areas for optimization of health resources. Methods the trachoma cases identified in 2006 were georeferenced. The data evaluated were: schools where the trachoma cases studied, data from the 2000 Census, census tract, type of housing, water supply conditions, distribution of income and levels of education of household heads. In the Google Earth® software and TerraView® were made descriptive spatial analysis and estimates of the Kernel. Each area was studied by interpolation of the density surfaces exposing events to facilitate to recognize the clusters. Results Of the 66 cases detected, only one (1.5% was not a resident of the city's outskirts. A positive association was detected of trachoma cases and the percentage of heads of household with income below three minimum wages and schooling under eight years of education. Conclusions The recognition of the spatial distribution of trachoma cases coincided with the areas of greatest social inequality in Bauru City. The micro-areas identified are those that should be prioritized in the rationalization of health resources. There is the possibility of using the trachoma cases detected as an indicator of performance of micro priority health programs.

  13. A distributed scheme to manage the dynamic coexistence of IEEE 802.15.4-based health-monitoring WBANs.

    Science.gov (United States)

    Deylami, Mohammad N; Jovanov, Emil

    2014-01-01

    The overlap of transmission ranges between wireless networks as a result of mobility is referred to as dynamic coexistence. The interference caused by coexistence may significantly affect the performance of wireless body area networks (WBANs) where reliability is particularly critical for health monitoring applications. In this paper, we analytically study the effects of dynamic coexistence on the operation of IEEE 802.15.4-based health monitoring WBANs. The current IEEE 802.15.4 standard lacks mechanisms for effectively managing the coexistence of mobile WBANs. Considering the specific characteristics and requirements of health monitoring WBANs, we propose the dynamic coexistence management (DCM) mechanism to make IEEE 802.15.4-based WBANs able to detect and mitigate the harmful effects of coexistence. We assess the effectiveness of this scheme using extensive OPNET simulations. Our results indicate that DCM improves the successful transmission rates of dynamically coexisting WBANs by 20%-25% for typical medical monitoring applications.

  14. Distribution and health risk assessment of natural fluoride of drinking groundwater resources of Isfahan, Iran, using GIS.

    Science.gov (United States)

    Aghapour, Saba; Bina, Bijan; Tarrahi, Mohammad Javad; Amiri, Fahimeh; Ebrahimi, Afshin

    2018-02-13

    Fluoride (F) contamination in groundwater can be problematic to human health. This study evaluated the concentration of fluoride in groundwater resources of Isfahan Province, the central plateau of Iran, and its related health issues to the inhabitant populations. For this purpose, 573 drinking groundwater samples were analyzed in 2016 by using the spectrophotometric method. Non-carcinogenic health risks due to F exposure through consumption of drinking water were assessed using the US EPA method. In addition, the associated zoning maps of the obtained results were presented using geographic information system (GIS). The results indicated that F content in drinking water ranged from 0.02 to 2.8 mg/L. The F contents were less than 0.50 mg/L in 63% of the drinking groundwater samples, 0.51-1.5 mg/L in 33.15%, and higher than 1.5 mg/L in 3.85% (Iran and World Health Organization guidelines) of the drinking groundwater samples. The F levels in the west and the south groundwater resources of the study areas were lower than 0.5 mg/L, which is within the recommended values for controlling dental caries (0.50-1.0 mg/L). Therefore, these places require more attention and more research is needed to increase F intake for health benefit. The HQ index for children, teens and male and female adults had health hazards (HQ > 1) in 51, 17, 28, and 18 of samples, respectively. Groundwater resources having a risk of more than one were located in the counties of Nayin, Natanz, and Ardestan. So, in these areas, there are potential risks of dental fluorosis. The most vulnerable groups were children. The F levels must be reduced in this region to decrease endemic fluorosis.

  15. Moving Medicine, Moving Minds: Helping Developing Countries Overcome Barriers to Outsourcing Health Commodity Distribution to Boost Supply Chain Performance and Strengthen Health Systems

    OpenAIRE

    Agrawal, Priya; Barton, Iain; Bianco, Roberto Dal; Hovig, Dana; Sarley, David; Yadav, Prashant

    2016-01-01

    Senegal and other developing countries are improving access to health commodities by outsourcing supply chain logistics to private providers. To achieve broader, lasting reform, we must support further adoption of the outsourced model; assist country-led cost-benefit analyses; and help governments build capacity to manage contracts and overcome other barriers.

  16. Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: Long-term experience and prognostic factors

    International Nuclear Information System (INIS)

    Milker-Zabel, Stefanie; Zabel, Angelika; Schulz-Ertner, Daniela; Schlegel, Wolfgang; Wannenmacher, Michael; Debus, Juergen

    2005-01-01

    Purpose: To analyze our long-term experience and prognostic factors after fractionated stereotactic radiotherapy (FSRT) in patients with benign or atypical intracranial meningioma. Methods and materials: Between January 1985 and December 2001, 317 patients with a median age of 55.7 years were treated with FSRT for intracranial meningioma. The tumor distribution was World Health Organization (WHO) Grade 1 in 48.3%, WHO Grade 2 in 8.2%, and unknown in 43.5%. Of the 317 patients, 97 underwent RT as their primary treatment, 79 underwent postoperative RT (subtotal resection in 38 and biopsy only in 41), and 141 were treated for recurrent disease. The median target volume was 33.6 cm 3 (range, 1.0-412.6 cm 3 ). The median total dose was 57.6 Gy at 1.8 Gy/fraction five times weekly. Results: The median follow-up was 5.7 years (range, 1.2-14.3 years). The overall local tumor control rate was 93.1% (295 of 317). Of the 317 patients, 72 had a partial response on CT/MRI and 223 (70.4%) remained stable. At a median of 4.5 years after FSRT, 22 patients (6.9%) had local tumor progression on MRI. Local tumor failure was significantly greater in patients with WHO Grade 2 meningioma (p 60 cm 3 had a recurrence rate of 15.5% vs. 4.3% for those with a tumor volume of ≤60 cm 3 (p < 0.001). In 42.9% of the patients, preexisting neurologic deficits improved. Worsening of preexisting neurologic symptoms occurred in 8.2%. Eight patients developed new clinical symptoms, such as reduced vision, trigeminal neuralgia, and intermittent tinnitus located at the side of the irradiated meningioma after FSRT. Conclusion: These data have demonstrated that FSRT is an effective and safe treatment modality for local control of meningioma with a low risk of significant late toxicity. We identified the tumor volume, indication for FSRT, and histologic features of the meningioma as statistically significant prognostic factors

  17. Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: Long-term experience and prognostic factors

    Energy Technology Data Exchange (ETDEWEB)

    Milker-Zabel, Stefanie [Clinical Radiology, Radiation Therapy, University of Heidelberg, Heidelberg (Germany) and Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany); Zabel, Angelika [Clinical Radiology, Radiation Therapy, University of Heidelberg, Heidelberg (Germany); Schulz-Ertner, Daniela [Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany); Schlegel, Wolfgang [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Wannenmacher, Michael [Clinical Radiology, Radiation Therapy, University of Heidelberg, Heidelberg (Germany); Debus, Juergen [Clinical Radiology, Radiation Therapy, University of Heidelberg, Heidelberg a (Germany); Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany)

    2005-03-01

    Purpose: To analyze our long-term experience and prognostic factors after fractionated stereotactic radiotherapy (FSRT) in patients with benign or atypical intracranial meningioma. Methods and materials: Between January 1985 and December 2001, 317 patients with a median age of 55.7 years were treated with FSRT for intracranial meningioma. The tumor distribution was World Health Organization (WHO) Grade 1 in 48.3%, WHO Grade 2 in 8.2%, and unknown in 43.5%. Of the 317 patients, 97 underwent RT as their primary treatment, 79 underwent postoperative RT (subtotal resection in 38 and biopsy only in 41), and 141 were treated for recurrent disease. The median target volume was 33.6 cm{sup 3} (range, 1.0-412.6 cm{sup 3}). The median total dose was 57.6 Gy at 1.8 Gy/fraction five times weekly. Results: The median follow-up was 5.7 years (range, 1.2-14.3 years). The overall local tumor control rate was 93.1% (295 of 317). Of the 317 patients, 72 had a partial response on CT/MRI and 223 (70.4%) remained stable. At a median of 4.5 years after FSRT, 22 patients (6.9%) had local tumor progression on MRI. Local tumor failure was significantly greater in patients with WHO Grade 2 meningioma (p < 0.002) than in patients with WHO Grade 1 or unknown histologic features. Patients treated for recurrent meningioma showed a trend toward decreased progression-free survival compared with patients treated with primary therapy, after biopsy, or after subtotal resection (p < 0.06). Patients with a tumor volume >60 cm{sup 3} had a recurrence rate of 15.5% vs. 4.3% for those with a tumor volume of {<=}60 cm{sup 3} (p < 0.001). In 42.9% of the patients, preexisting neurologic deficits improved. Worsening of preexisting neurologic symptoms occurred in 8.2%. Eight patients developed new clinical symptoms, such as reduced vision, trigeminal neuralgia, and intermittent tinnitus located at the side of the irradiated meningioma after FSRT. Conclusion: These data have demonstrated that FSRT is an

  18. State Space Formulation of Nonlinear Vibration Responses Collected from a Dynamic Rotor-Bearing System: An Extension of Bearing Diagnostics to Bearing Prognostics.

    Science.gov (United States)

    Tse, Peter W; Wang, Dong

    2017-02-14

    Bearings are widely used in various industries to support rotating shafts. Their failures accelerate failures of other adjacent components and may cause unexpected machine breakdowns. In recent years, nonlinear vibration responses collected from a dynamic rotor-bearing system have been widely analyzed for bearing diagnostics. Numerous methods have been proposed to identify different bearing faults. However, these methods are unable to predict the future health conditions of bearings. To extend bearing diagnostics to bearing prognostics, this paper reports the design of a state space formulation of nonlinear vibration responses collected from a dynamic rotor-bearing system in order to intelligently predict bearing remaining useful life (RUL). Firstly, analyses of nonlinear vibration responses were conducted to construct a bearing health indicator (BHI) so as to assess the current bearing health condition. Secondly, a state space model of the BHI was developed to mathematically track the health evolution of the BHI. Thirdly, unscented particle filtering was used to predict bearing RUL. Lastly, a new bearing acceleration life testing setup was designed to collect natural bearing degradation data, which were used to validate the effectiveness of the proposed bearing prognostic method. Results show that the prediction accuracy of the proposed bearing prognostic method is promising and the proposed bearing prognostic method is able to reflect future bearing health conditions.

  19. State Space Formulation of Nonlinear Vibration Responses Collected from a Dynamic Rotor-Bearing System: An Extension of Bearing Diagnostics to Bearing Prognostics

    Directory of Open Access Journals (Sweden)

    Peter W. Tse

    2017-02-01

    Full Text Available Bearings are widely used in various industries to support rotating shafts. Their failures accelerate failures of other adjacent components and may cause unexpected machine breakdowns. In recent years, nonlinear vibration responses collected from a dynamic rotor-bearing system have been widely analyzed for bearing diagnostics. Numerous methods have been proposed to identify different bearing faults. However, these methods are unable to predict the future health conditions of bearings. To extend bearing diagnostics to bearing prognostics, this paper reports the design of a state space formulation of nonlinear vibration responses collected from a dynamic rotor-bearing system in order to intelligently predict bearing remaining useful life (RUL. Firstly, analyses of nonlinear vibration responses were conducted to construct a bearing health indicator (BHI so as to assess the current bearing health condition. Secondly, a state space model of the BHI was developed to mathematically track the health evolution of the BHI. Thirdly, unscented particle filtering was used to predict bearing RUL. Lastly, a new bearing acceleration life testing setup was designed to collect natural bearing degradation data, which were used to validate the effectiveness of the proposed bearing prognostic method. Results show that the prediction accuracy of the proposed bearing prognostic method is promising and the proposed bearing prognostic method is able to reflect future bearing health conditions.

  20. The health gains and cost savings of dietary salt reduction interventions, with equity and age distributional aspects

    Directory of Open Access Journals (Sweden)

    Nhung Nghiem

    2016-05-01

    Full Text Available Abstract Background A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. We therefore aimed to model health gains and costs (savings of salt reduction interventions related to salt substitution and maximum levels in bread, including by ethnicity and age. We also ranked these four interventions compared to eight other modelled interventions. Methods A Markov macro-simulation model was used to estimate QALYs gained and net health system costs for four dietary sodium reduction interventions, discounted at 3 % per annum. The setting was New Zealand (NZ (2.3 million adults, aged 35+ years which has detailed individual-level administrative cost data. Results The health gain was greatest for an intervention where most (59 % of the sodium in processed foods was replaced by potassium and magnesium salts. This intervention gained 294,000 QALYs over the remaining lifetime of the cohort (95 % UI: 238,000 to 359,000; 0.13 QALY per 35+ year old. Such salt substitution also produced the highest net cost-savings of NZ$ 1.5 billion (US$ 1.0 billion (95 % UI: NZ$ 1.1 to 2.0 billion. All interventions generated relatively larger per capita QALYs for men vs women and for the indigenous Māori population vs non-Māori (e.g., 0.16 vs 0.12 QALYs per adult for the 59 % salt substitution intervention. Of relevance to workforce productivity, in the first 10 years post-intervention, 22 % of the QALY gain was among those aged <65 years (and 37 % for those aged <70. Conclusions The benefits are consistent with the international literature, with large health gains and cost savings possible from some, but not all, sodium reduction interventions. Health gain appears likely to occur among working-age adults and all interventions contributed to reducing health inequalities.