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Sample records for highly inhospitable regions

  1. Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall.

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    Cartagena, L J; Kang, A; Munnangi, S; Jordan, A; Nweze, I C; Sasthakonar, V; Boutin, A; George Angus, L D

    2017-06-01

    Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94 ± 8.16 years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16 %. Head injury constituted the most common injury sustained in patients who died (77 %). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P fall patients. Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.

  2. Does accelerometer feedback on high-quality chest compression improve survival rate? An in-hospital cardiac arrest simulation.

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    Jung, Min Hee; Oh, Je Hyeok; Kim, Chan Woong; Kim, Sung Eun; Lee, Dong Hoon; Chang, Wen Joen

    2015-08-01

    We investigated whether visual feedback from an accelerometer device facilitated high-quality chest compressions during an in-hospital cardiac arrest simulation using a manikin. Thirty health care providers participated in an in-hospital cardiac arrest simulation with 1 minute of continuous chest compressions. Chest compressions were performed on a manikin lying on a bed according to visual feedback from an accelerometer feedback device. The manikin and accelerometer recorded chest compression data simultaneously. The simulated patient was deemed to have survived when the chest compression data satisfied all of the preset high-quality chest compression criteria (depth ≥51 mm, rate >100 per minute, and ≥95% full recoil). Survival rates were calculated from the feedback device and manikin data. The survival rate according to the feedback device data was 80%; however, the manikin data indicated a significantly lower survival rate (46.7%; P = .015). The difference between the accelerometer and manikin survival rates was not significant for participants with a body mass index greater than or equal to 20 kg/m(2) (93.3 vs 73.3%, respectively; P = .330); however, the difference in survival rate was significant in participants with body mass index less than 20 kg/m(2) (66.7 vs 20.0%, respectively; P = .025). The use of accelerometer feedback devices to facilitate high-quality chest compression may not be appropriate for lightweight rescuers because of the potential for compression depth overestimation. Clinical Research Information Service (KCT0001449). Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies

    NARCIS (Netherlands)

    Monincx, W. M.; Birnie, E.; Zondervan, H. A.; Bleker, O. P.; Bonsel, G. J.

    2001-01-01

    To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. A university hospital. Three groups: 130 high-risk

  4. Correlation between Serum High Sensitivity CRP Level and Inhospital Cardiac Events in the Patients with Unstable Angina

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    H. Kazerani

    2007-10-01

    Full Text Available Introduction & Objective: Several studies have been performed to evaluate correlation of serum high sensitivity CRP (hs-CRP level with the prognosis of the patients with diagnosis of unstable angina, and by now different results were reported. The aim of this study was to assess correlation between serum hs-CRP level and inhospital prognosis and cardiac events in the patients with unstable angina. Materials & Methods: This descriptive analytic study was performed from Sep 2004 till Feb 2006 in Shahid Beheshti hospital. Kermanshah, Iran. Sera were collected from 250 patients for hs-CRP measurement. Exclusion criteria were: acute ST elevation MI, non ST elevation MI, patients with history of recent infection, patients with recent trauma and patients with serum high sensitive CRP level more than 10 mg/lit. Patients were divided into two groups, first group whose serum hs-CRP level was less than 3 mg/lit and second group whose serum hs-CRP level was between 3 and 10 mg/lit. They were followed for recurrent chest pain, arrhythmias, pulmonary edema, acute myocardial infarction and in hospital death. Results were analyzed using x² and t-test. Results: Mean age were 57±7.8 and 58±11.5 years in first group and second group respectively. There was statistically significant difference in some cardiac complications such as dyspnea, duration of hospitalization, recurrent chest pain, CCU admission (p<0.001 and in hospital myocardial infarction (p=0.03, between two groups. Some complications did not have significant difference such as pulmonary edema, cardiogenic shock, arrhythmia, S3, S4 and pulmonary rates .There was no mortality in both groups. Conclusion: According to the results, we can use serum hs-CRP level for risk stratification in the patients with diagnosis of unstable angina. Obviously the patients with high serum hs-CRP level need more attention whether early invasive management help these patients, may be the matter of later studies.

  5. Association between in-hospital mortality and renal dysfunction in 186,219 patients hospitalized for acute stroke in the Emilia-Romagna region of Italy.

    Science.gov (United States)

    Fabbian, Fabio; Gallerani, Massimo; Pala, Marco; De Giorgi, Alfredo; Salmi, Raffaella; Dentali, Francesco; Ageno, Walter; Manfredini, Roberto

    2014-11-01

    Using a regional Italian database, we evaluated the relationship between renal dysfunction and in-hospital mortality (IHM) in patients with acute stroke (ischemic/hemorrhagic). Patients were classified on the basis of renal damage: without renal dysfunction, with chronic kidney disease (CKD), and with end-stage renal disease (ESRD). Of a total of 186,219 patients with a first episode of stroke, 1626 (0.9%) had CKD and 819 (0.4%) had ESRD. Stroke-related IHM (total cases) was independently associated with CKD, ESRD, atrial fibrillation (AF), age, and Charlson comorbidity index (CCI). In patients with ischemic stroke (n=154,026), IHM remained independently associated with CKD, ESRD, AF, and CCI. In patients with hemorrhagic stroke (n=32,189), variables that were independently associated with IHM were CKD, ESRD, and AF. Renal dysfunction is associated with IHM related to stroke, both ischemic and hemorrhagic, with even higher odds ratios than those of other established risk factors, such as age, comorbidities, and AF. © The Author(s) 2013.

  6. Determinants of in-hospital death after acute spinal cord injury: a population-based study.

    Science.gov (United States)

    Selassie, A W; Varma, A; Saunders, L L; Welldaregay, W

    2013-01-01

    First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. Population-based retrospective cohort study. Sixty-two acute care hospitals in South Carolina, USA. Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3+, 2 and 1 comorbid conditions were 2.19 (P<0.001), 1.73 (P=0.005) and 1.20 (P=0.322), respectively. For counts of 4+, 3 and 2 other injuries were 1.85 (P<0.001), 1.81 (P<0.001) and 1.46 (P=0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14. Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.

  7. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    International Nuclear Information System (INIS)

    Miranda, Matheus; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu; Juliano, Yara; Buffolo, Enio

    2014-01-01

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions

  8. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, Matheus, E-mail: matheus10miranda@gmail.com; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Juliano, Yara [Universidade de Santo Amaro, São Paulo, SP (Brazil); Buffolo, Enio [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

    2014-02-15

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

  9. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

    Science.gov (United States)

    Yoshihara, Hiroyuki; Yoneoka, Daisuke

    2014-02-01

    Unstable pelvic fracture is predominantly caused by high-energy blunt trauma and is associated with a high risk of mortality. The epidemiology in the United States is largely unknown. The purpose of this study was to examine the epidemiology of unstable pelvic fracture based on patient and hospital demographics in the United States during the last decade. The Nationwide Inpatient Sample was used to identify patients who were hospitalized with unstable pelvic fracture from 2000 to 2009, using the International Classification of Diseases--9th Rev.--Clinical Modification (ICD-9-CM) codes. The primary outcome parameter consisted of analyzing the temporal trends of in-hospital admissions for unstable pelvic fracture and the associated in-hospital mortality. The data were stratified by demographic variables, including age, sex, race, and hospital region in the United States. From 2000 to 2009, there were 24,059 patients in total; among these, 1,823 (7.6%) had open fractures, and 22,236 (92.4%) had closed fractures. The population growth-adjusted incidence was stable over time (p = 0.431). The incidence was the lowest in the northeastern region. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% (21.3% for open fracture, 7.2% for closed fracture) and remained stable over time (p = 0.089). The in-hospital mortality rate was higher in several subgroups of patients, such as older patients, male patients, African-American patients, and patients in the northeastern region. During the last decade, the incidence of unstable pelvic fracture has remained stable over time in the United States. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% and remained stable over time. The rate in patients with an open fracture was approximately three times higher than that in patients with a closed fracture. The incidence was the lowest, but the in-hospital mortality rate was the highest in the northeastern region compared with the

  10. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series.

    Directory of Open Access Journals (Sweden)

    Renata Báez-Saldaña

    Full Text Available Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART programs and epidemiology of infectious diseases.To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS.We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions.We studied 308 patients, of whom 206 (66.9% had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR: 30-150]. Seventy-five (24.4% cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP (n = 142, tuberculosis (n = 63, and bacterial community-acquired pneumonia (n = 60 were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR: 0.245, 95% Confidence Interval (CI: 0.08-0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06-0.75 of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses.HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower

  11. A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study

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    Madhab Ray

    2015-12-01

    Conclusions: The multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.

  12. Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus.

    Science.gov (United States)

    Ekmekci, Ahmet; Cicek, Gokhan; Uluganyan, Mahmut; Gungor, Baris; Osman, Faizel; Ozcan, Kazim Serhan; Bozbay, Mehmet; Ertas, Gokhan; Zencirci, Aycan; Sayar, Nurten; Eren, Mehmet

    2014-02-01

    Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose 145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

  13. [In-hospital mortality due to stroke].

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    Rodríguez Lucci, Federico; Pujol Lereis, Virginia; Ameriso, Sebastián; Povedano, Guillermo; Díaz, María F; Hlavnicka, Alejandro; Wainsztein, Néstor A; Ameriso, Sebastián F

    2013-01-01

    Overall mortality due to stroke has decreased in the last three decades probable due to a better control of vascular risk factors. In-hospital mortality of stroke patients has been estimated to be between 6 and 14% in most of the series reported. However, data from recent clinical trials suggest that these figures may be substantially lower. Data from FLENI Stroke Data Bank and institutional mortality records between 2000 and 2010 were reviewed. Ischemic stroke subtypes were classified according to TOAST criteria and hemorrhagic stroke subtypes were classified as intraparenchymal hematoma, aneurismatic subarachnoid hemorrhage, arterio-venous malformation, and other intraparenchymal hematomas. A total of 1514 patients were studied. Of these, 1079 (71%) were ischemic strokes,39% large vessels, 27% cardioembolic, 9% lacunar, 14% unknown etiology, and 11% others etiologies. There were 435 (29%) hemorrhagic strokes, 27% intraparenchymal hematomas, 30% aneurismatic subarachnoid hemorrhage, 25% arterio-venous malformation, and 18% other intraparenchymal hematomas. Moreover, 38 in-hospital deaths were recorded (17 ischemic strokes and 21 hemorrhagic strokes), accounting for 2.5% overall mortality (1.7% in ischemic strokes and 4.8% in hemorrhagic strokes). No deaths occurred associated with the use of intravenous fibrinolytics occurred. In our Centre in-hospital mortality in patients with stroke was low. Management of these patients in a Centre dedicated to neurological diseases along with a multidisciplinary approach from medical and non-medical staff trained in the care of cerebrovascular diseases could, at least in part, account for these results.

  14. From political opportunities to niche-openings: the dilemmas of mobilizing for immigrant rights in inhospitable environments

    NARCIS (Netherlands)

    Nicholls, W.J.

    2014-01-01

    This article examines how undocumented immigrants mobilize for greater rights in inhospitable political and discursive environments. We would expect that such environments would dissuade this particularly vulnerable group of immigrants from mobilizing in high profile campaigns because such campaigns

  15. Animal Fascioliasis: Perspectives from high altitudinal regions.

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    Lyngdoh, Damanbha; Sharma, Sunil; Roy, Bishnupada; Tandon, Veena

    2016-12-15

    The parasitic flukes of the genus Fasciola (Platyhelminthes: Trematoda: Digenea) cause fascioliasis or liver-rot disease in ruminant livestock in tropical and sub-tropical regions of the world. Classically, two species of Fasciola- F. hepatica and F. gigantica, are universally recognized as taxonomically valid species. Our survey studies on ovid and bovid animals including yak and mithun from high altitudinal mountainous regions in Northeast India revealed the occurrence of Fasciola gigantica and also Fasciola sp.- an intermediate form, at altitudes between 5000 and 14,085 feet above sea level (asl). Two morphotypes- F. hepatica - like and F. gigantica - like, of Fasciola species were reported from the high altitudinal areas of Northeast India; most of these locales constitute new-locality and first records for the occurrence of these liver flukes. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Highlighting High Performance: Whitman Hanson Regional High School; Whitman, Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    2006-06-01

    This brochure describes the key high-performance building features of the Whitman-Hanson Regional High School. The brochure was paid for by the Massachusetts Technology Collaborative as part of their Green Schools Initiative. High-performance features described are daylighting and energy-efficient lighting, indoor air quality, solar and wind energy, building envelope, heating and cooling systems, water conservation, and acoustics. Energy cost savings are also discussed.

  17. Regional approaches in high-rise construction

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    Iconopisceva, O. G.; Proskurin, G. A.

    2018-03-01

    The evolutionary process of high-rise construction is in the article focus. The aim of the study was to create a retrospective matrix reflecting the tasks of the study such as: structuring the most iconic high-rise objects within historic boundaries. The study is based on contemporary experience of high-rise construction in different countries. The main directions and regional specifics in the field of high-rise construction as well as factors influencing the further evolution process are analyzed. The main changes in architectural stylistics, form-building, constructive solutions that focus on the principles of energy efficiency and bio positivity of "sustainable buildings", as well as the search for a new typology are noted. The most universal constructive methods and solutions that turned out to be particularly popular are generalized. The new typology of high-rises and individual approach to urban context are noted. The results of the study as a graphical scheme made it possible to represent the whole high-rise evolution. The new spatial forms of high-rises lead them to new role within the urban environments. Futuristic hyperscalable concepts take the autonomous urban space functions itself and demonstrate us how high-rises can replace multifunctional urban fabric, developing it inside their shells.

  18. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study

    NARCIS (Netherlands)

    van Rijn, Marjon; Buurman, Bianca M.; MacNeil-Vroomen, Janet L.; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    2016-01-01

    to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality

  19. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients : retrospective observational study

    NARCIS (Netherlands)

    van Rijn, Marjon; Buurman, Bianca M.; Vroomen, Janet L. Macneil; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    Objectives: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days postdischarge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the

  20. High-intensification regions of gravitational lenses

    International Nuclear Information System (INIS)

    Benson, J.R.; Cooke, J.H.

    1979-01-01

    We examine the intensification, I, near the singular points in the object plane of an extended spherical gravitational lens. Geometrical optics predicts an infinite I for a point object located on a singularity. The function I, however, turns out to be integrable over the object plane. We make a detailed physical optics calculation for I. No singularities appear, and there are some interesting, marginally detectable diffraction phenomena. The two types of bright regions, the ''halo'' and the ''spike,'' behave very differently. Simple order-of-magnitude expressions give estimates for the brightness and duration of a high-intensification event

  1. In-hospital mortality following acute myocardial infarction in Kosovo : A single center study

    International Nuclear Information System (INIS)

    Gani Bajraktari

    2010-01-01

    Randomized trials have demonstrated that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction (AMI). The aim of this study was to assess the in-hospital mortality of patients with AMI admitted to the only tertiary care center in Kosovo, where coronary percutaneous intervention procedures are unavailable. We also assessed the impact of age and gender on in-hospital mortality. Patients and Consecutive patients with the diagnosis of AMI, admitted in our institution between 1999 and 2007, were included in this retrospective study. Of 2848 patients (mean age 61±11.3 years, 73.4% males) admitted with AMI, 292 (10.25%) patients died during in-hospital stay. The overall in-hospital mortality was 12.3% for women and 9.5% for men (P<.05). Women were significantly older than men (64.2±11 years vs 59.7±11.8 years, P<.05). Mean length of stay was 12.0±94 for women and 10.7±7.6 for men. From 1999 to 2007 there was an increase in the age of patients with AMI but the mortality rate remained stable.Compared to developed countries, patients with AMI in Kosovo present at an earlier age but have a higher mortality rate. Women with AMI had a significantly higher in-hospital mortality rate than men. The lack of percutaneous coronary intervention procedures in AMI patients may have contributed to the high in-hospital mortality in our population (Author).

  2. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

    2017-01-01

    OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

  3. ASA classification and in-hospital deaths in surgery | Chianakwana ...

    African Journals Online (AJOL)

    Background: ASA (American Society of Anesthesiologists') classification appears to have a direct relationship to in-hospital mortality in surgery, provided other factors that can equally affect mortality are favorable. Aims and objectives: To study the relationship between ASA classification and in-hospital mortality within the ...

  4. Performance of in-hospital mortality prediction models for acute hospitalization: Hospital Standardized Mortality Ratio in Japan

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    Motomura Noboru

    2008-11-01

    Full Text Available Abstract Objective In-hospital mortality is an important performance measure for quality improvement, although it requires proper risk adjustment. We set out to develop in-hospital mortality prediction models for acute hospitalization using a nation-wide electronic administrative record system in Japan. Methods Administrative records of 224,207 patients (patients discharged from 82 hospitals in Japan between July 1, 2002 and October 31, 2002 were randomly split into preliminary (179,156 records and test (45,051 records groups. Study variables included Major Diagnostic Category, age, gender, ambulance use, admission status, length of hospital stay, comorbidity, and in-hospital mortality. ICD-10 codes were converted to calculate comorbidity scores based on Quan's methodology. Multivariate logistic regression analysis was then performed using in-hospital mortality as a dependent variable. C-indexes were calculated across risk groups in order to evaluate model performances. Results In-hospital mortality rates were 2.68% and 2.76% for the preliminary and test datasets, respectively. C-index values were 0.869 for the model that excluded length of stay and 0.841 for the model that included length of stay. Conclusion Risk models developed in this study included a set of variables easily accessible from administrative data, and still successfully exhibited a high degree of prediction accuracy. These models can be used to estimate in-hospital mortality rates of various diagnoses and procedures.

  5. Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

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    Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

    2010-12-01

    In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

  6. First-day newborn weight loss predicts in-hospital weight nadir for breastfeeding infants.

    Science.gov (United States)

    Flaherman, Valerie J; Bokser, Seth; Newman, Thomas B

    2010-08-01

    Exclusive breastfeeding reduces infant infectious disease. Losing > or =10% birth weight may lead to formula use. The predictive value of first-day weight loss for subsequent weight loss has not been studied. The objective of the present study was to evaluate the relationship between weight loss at or =10%. For 1,049 infants, we extracted gestational age, gender, delivery method, feeding type, and weights from medical records. Weight nadir was defined as the lowest weight recorded during birth hospitalization. We used multivariate logistic regression to assess the effect of first-day weight loss on subsequent in-hospital weight loss. Mean in-hospital weight nadir was 6.0 +/- 2.6%, and mean age at in-hospital weight nadir was 38.7 +/- 18.5 hours. While in the hospital 6.4% of infants lost > or =10% of birth weight. Infants losing > or =4.5% birth weight at or =10% (adjusted odds ratio 3.57 [1.75, 7.28]). In this cohort, 798 (76.1%) infants did not have documented weight gain while in the hospital. Early weight loss predicts higher risk of > or =10% in-hospital weight loss. Infants with high first-day weight loss could be targeted for further research into improved interventions to promote breastfeeding.

  7. In-hospital mortality following acute myocardial infarction in Kosovo: Asingle center study

    International Nuclear Information System (INIS)

    Bajraktari, G.; Gjoka, S.; Rexhepaj, N.; Daullxhiu, I.; Thaqi, K.; Pacolli, S.; Sylejmani, X.; Elezi, S.

    2008-01-01

    Randomized trials have demonstrated that primary angioplasty is moreeffective than intravenous thrombolysis in reducing mortality and morbidityin patients with acute myocardial infarction (AMI). The aim of this study wasto assess the in-hospital mortality of patients with AMI admitted to the onlytertiary care center in Kosovo, where coronary percutaneous interventionprocedures are unavailable. We also assessed the impact of age and gender onin-hospital mortality. Consecutive patients with the diagnosis of AMI,admitted in our institution between 1999 and 2007, were included in thisretrospective study. Of 2848 patients (mean age 61+- 1.3 years, 73.4% males)admitted with AMI, 292 (10.25%) died during in-hospital stay. The overallin-hospital mortality was 12.3% for women and 9.5% for men (P<05). Women weresignificantly older than men (64.2+-11 years vs. 59.7+-11.8 years, P<.05).Mean length of stay was 12.0+-94 for women and 10.7+-7.6 for men. From 1999break was detected by the application of thepatients with Ami but themortality rate remained stable. Compared to developed countries, patientswith AMI in Kososvo present at an early age but have a higher mortality rate.Women with AMI had a significantly higher in-hospital mortality rate thanmen. The lack of percutaneous coronary intervention procedures in AMIpatients may have contributed to the high in-hospital mortality in ourpopulation. (auhor)

  8. Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

    Science.gov (United States)

    Hachet, Olivier; Guenancia, Charles; Stamboul, Karim; Daubail, Benoit; Richard, Carole; Béjot, Yannick; Yameogo, Valentin; Gudjoncik, Aurélie; Cottin, Yves; Giroud, Maurice; Lorgis, Luc

    2014-12-01

    . Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period. The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk. © 2014 American Heart Association, Inc.

  9. Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants.

    Science.gov (United States)

    Lee, Jan Hau; Smith, P Brian; Quek, M Bin Huey; Laughon, Matthew M; Clark, Reese H; Hornik, Christoph P

    2016-06-01

    To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit. We analyzed electronic medical records from 348 neonatal intensive care units for the period 1997 to 2012, and evaluated the associations among infant demographics, diagnoses, and pretracheostomy cardiopulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. We identified 885 of 887 910 infants (0.1%) who underwent tracheostomy at a median postnatal age of 72 days (IQR, 27-119 days) and a median postmenstrual age of 42 weeks (IQR, 39-46 weeks). The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia (396 of 885; 45%), other upper airway anomalies (202 of 885; 23%), and laryngeal anomalies (115 of 885; 13%). In-hospital mortality after tracheostomy was 14% (125 of 885). On adjusted analysis, near-term gestational age (GA), small for GA status, pulmonary diagnoses, number of days of forced fraction of inspired oxygen >0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P Tracheostomy is not commonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include near-term GA, small for GA status, and pulmonary diagnoses. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Survival and neurological outcome following in-hospital paediatric cardiopulmonary resuscitation in North India.

    Science.gov (United States)

    Rathore, Vinay; Bansal, Arun; Singhi, Sunit C; Singhi, Pratibha; Muralidharan, Jayashree

    2016-05-01

    Data on outcome of children undergoing in-hospital cardiopulmonary resuscitation (CPR) in low- and middle-income countries are scarce. To describe the clinical profile and outcome of children undergoing in-hospital CPR. This prospective observational study was undertaken in the Advanced Pediatric Center, PGIMER, Chandigarh. All patients aged 1 month to 12 years who underwent in-hospital CPR between July 2010 and March 2011 were included. Data were recorded using the 'Utstein style'. Outcome variables included 'sustained return of spontaneous circulation' (ROSC), survival at discharge and neurological outcome at 1 year. The incidence of in-hospital CPR in all hospital admissions (n = 4654) was 6.7% (n = 314). 64.6% (n = 203) achieved ROSC, 14% (n = 44) survived to hospital discharge and 11.1% (n = 35) survived at 1 year. Three-quarters of survivors had a good neurological outcome at 1-year follow-up. Sixty per cent of patients were malnourished. The Median Pediatric Risk of Mortality-III (PRISM-III) score was 16 (IQR 9-25). Sepsis (71%), respiratory (39.5%) and neurological (31.5%) illness were the most common diagnoses. The most common initial arrhythmia was bradycardia (52.2%). On multivariate logistic regression, duration of CPR, diagnosis of sepsis and requirement for vasoactive support prior to arrest were independent predictors of decreased hospital survival. The requirement for in-hospital CPR is common in PGIMER. ROSC was achieved in two-thirds of children, but mortality was higher than in high-income countries because of delayed presentation, malnutrition and severity of illness. CPR >15 min was associated with death. Survivors had good long-term neurological outcome, demonstrating the value of timely CPR.

  11. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  12. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    OpenAIRE

    Melani Carla; Fateh-Moghadam Pirous; dell'Omo Marco; de Giacomi Giovanna; Bena Antonella; Cooke Robin MT; Curti Stefania; Baldasseroni Alberto; Mattioli Stefano; Biocca Marco; Buiatti Eva; Campo Giuseppe; Zanardi Francesca; Violante Francesco S

    2008-01-01

    Abstract Background Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million) over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estima...

  13. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

    2018-04-01

    Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

  14. Asymptotically Honest Confidence Regions for High Dimensional

    DEFF Research Database (Denmark)

    Caner, Mehmet; Kock, Anders Bredahl

    While variable selection and oracle inequalities for the estimation and prediction error have received considerable attention in the literature on high-dimensional models, very little work has been done in the area of testing and construction of confidence bands in high-dimensional models. However...... develop an oracle inequality for the conservative Lasso only assuming the existence of a certain number of moments. This is done by means of the Marcinkiewicz-Zygmund inequality which in our context provides sharper bounds than Nemirovski's inequality. As opposed to van de Geer et al. (2014) we allow...

  15. In-hospital Mortality from Cerebrovascular Disease in the Province of Cienfuegos

    Directory of Open Access Journals (Sweden)

    Ada Sánchez Lozano

    2014-12-01

    Full Text Available Background: cerebrovascular disease is the second leading cause of death in some countries, causing 10 million annual deaths. In-hospital mortality from these diseases is high in our country. Objective: to describe mortality from cerebrovascular disease at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos during 2006-2010. Methods: a retrospective case series study involving all patients (4449 diagnosed with cerebrovascular disease discharged from the Dr. Gustavo Aldereguía Lima University General Hospital from January 1st, 2006 to December 31, 2010 was conducted. The variables analyzed included age, sex, status at discharge, types of cerebrovascular disease and hospital stay. Results: in-hospital mortality from cerebrovascular disease in the study period was 23.8 %. It was higher in men than in women (24.5 % and 22.9 %, respectively. According to the type of cerebrovascular disease, mortality rate of ischemic stroke was 20 %, subarachnoid hemorrhage, 22.4 % and intraparenchymal hemorrhage, 71.2 %. Conclusions: in-hospital mortality from cerebrovascular disease in Cienfuegos shows a downward trend, though it increased in 2010. It was more common in men. Death from stroke tends to decrease and, to a lesser extent, mortality due to brain hemorrhage, which remains high. There is also an increase in subarachnoid hemorrhage.

  16. In-hospital care and post-hospital followup.

    Science.gov (United States)

    Tanner, L M; Blackmon, H E; Stanley, I; English, N K

    1971-12-01

    Guidelines are given for nurses and social workers involved in abortion care before and after the in-hospital procedure. The California Nurses' Association Maternity Conference Group established guidelines for such care in October, 1970 as follows. The nurse should keep the patient informed of all aspects of the procedure, provide a supportive presence, perform standard physical monitoring during the operation and afterwards, provide contraceptive counseling, and act as a sounding board for discussion of interpersonal relationships and future plans. High quality nursing requires understanding the physical and psychosocial aspects of abortion reflecting the nurse's recognition of the cultural, religious, and socioeconomic factors involved. This requires a nurse who is fully aware of her own feelings and can adapt or defer them to the patient's needs. In cases of suction or dilation abortions, these actions are particularly important, since the patient is in the hospital only a short time and can be easily ignored. In cases of saline infusion, the nurse should be fully aware of possible complications, including retained placentae, hemorrhage, infection, or uterine perforation. If the patient is readmitted for any of these complications, the nurse should continue to play the informative, supportive role. The nurse and social worker should also be aware of the possible psychological sequelae of abortion and watch for mental health problems. It is concluded that postabortion counseling is the best time for contraceptive counseling. Conscientious professional support along these guidelines should insure a positive experience for the abortion patient.

  17. High tech in the Öresund region

    DEFF Research Database (Denmark)

    Hansen, Povl Adler; Serin, Göran Folke

    This book discusses the development conditions in the high tech sector for both high tech manufacturing and services. A central issue in the book is the differences in externalities which exist between various industries in the high tech sector. In this connection the confusion of externalities...... related to different parts of the high tech sector will be addressed. The location of the high tech sector in the Öresund region will be analysed and the region will also be related to other high tech regions in Europe....

  18. A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index.

    Science.gov (United States)

    Keskin, Muhammed; Güvenç, Tolga Sinan; Hayıroğlu, Mert İlker; Kaya, Adnan; Tatlısu, Mustafa Adem; Avşar, Şahin; Öz, Ahmet; Keskin, Taha; Uzun, Ahmet Okan; Kozan, Ömer

    2017-10-01

    Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate-high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. We retrospectively evaluated the in-hospital and long-term (4-year) prognostic impact of TRI in a total number of 456 patients with moderate-high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. In-hospital analysis revealed significantly higher rates of in-hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8-fold hazard of in-hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1-3 was associated with 3.1 fold hazard of 4-year mortality rate. TRI in Q4, as compared to Q1-3, was significantly predictive of short term and long-term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost-effective tool for rapid risk stratification in moderate-high and high risk PE patients who treated with thrombolytic agents. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures.

    Science.gov (United States)

    Gili-Miner, M; López-Méndez, J; Vilches-Arenas, A; Ramírez-Ramírez, G; Franco-Fernández, D; Sala-Turrens, J; Béjar-Prado, L

    2016-10-22

    The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

    2017-01-01

    Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

  1. Does diabetes mellitus comorbidity affect in-hospital mortality and length of stay? Analysis of administrative data in an Italian Academic Hospital.

    Science.gov (United States)

    Valent, Francesca; Tonutti, Laura; Grimaldi, Franco

    2017-12-01

    Hospitalized patients with comorbid diabetes mellitus may have worse outcomes than the others. We conducted a study to assess whether comorbid diabetes affects in-hospital mortality and length of stay. For this population-based study, we analyzed the administrative databases of the Regional Health Information System of the Region Friuli Venezia Giulia, where the Hospital of Udine is located. Hospital discharge data were linked at the individual patient level with the regional Diabetes Mellitus Registry to identify diabetic patients. For each 3-digit ICD-9-CM discharge diagnosis code, we assessed the difference in length of stay and in-hospital mortality between diabetic and non-diabetic patients. We conducted both univariate and multivariate analyses, adjusted for age, sex, Charlson's comorbidity score, and urgency of hospitalization, through linear and logistic regression models. After adjusting for potential confounders, diabetes significantly increased the risk of in-hospital death among patients hospitalized for bacterial pneumonia (OR = 1.94) and intestinal obstruction (OR = 4.23) and length of stay among those admitted for several diagnoses, including acute myocardial infarction and acute renal failure. Admission glucose blood level was associated with in-hospital death in patients with pneumonia and intestinal obstruction, and increased length of stay for several conditions. Patients with diabetes mellitus who are hospitalized for other health problems may have increased risk of in-hospital death and longer hospital stay. For this reason, diabetes should be promptly recognized upon admission and properly managed.

  2. [Successful patient-activated help call for a doctor during in-hospital stay].

    Science.gov (United States)

    Hansen, Mette Mejlby; Hasselkvist, Birgith; Thordal, Sofie; Riiskjær, Erik; Kelsen, Jens

    2014-09-29

    Department of Medicine, Randers Regional Hospital, conducted a study of patient-activated help call, involving 1,050 patients with nearly 3,700 days in-hospital stay. Patients were encou-raged to bypass traditional clinical hierarchy of communication when they felt, that their concern was not met by the staff. Three help calls were related to the management of pain. In two cases it resulted in a surgical procedure. A survey including 104 patients revealed that one third reported that patient safety was improved by the initiative and nearly three quarters re-ported that they would be willing to activate the call.

  3. Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

    Science.gov (United States)

    Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

    2015-01-01

    Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  4. Falls following discharge after an in-hospital fall

    Directory of Open Access Journals (Sweden)

    Kessler Lori A

    2009-12-01

    Full Text Available Abstract Background Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. Methods We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks. Time spent rehospitalized or institutionalized was censored in rate calculations. Results Of 95 hospitalized patients who fell during recruitment, 65 (68% met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days. Seventy-five percent were African-American and 43% were women. Sixteen patients (25% had multiple falls during hospitalization and 23 patients (35% suffered a fall-related injury during hospitalization. Nineteen patients (29% experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4. Twenty-three patients (35% were readmitted and 3(5% died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008. Conclusion Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population.

  5. Improving Magnet Designs With High and Low Field Regions

    DEFF Research Database (Denmark)

    Bjørk, Rasmus; Bahl, Christian Robert Haffenden; Smith, Anders

    2011-01-01

    A general scheme for increasing the difference in magnetic flux density between a high and a low magnetic field region by removing unnecessary magnet material is presented. This is important in, e.g., magnetic refrigeration where magnet arrays have to deliver high field regions in close proximity...... to low field regions. Also, a general way to replace magnet material with a high permeability soft magnetic material where appropriate is discussed. As an example, these schemes are applied to a two dimensional concentric Halbach cylinder design resulting in a reduction of the amount of magnet material...

  6. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients.

    Science.gov (United States)

    Kim, Hyosun; Jo, Sion; Lee, Jae Baek; Jin, Youngho; Jeong, Taeoh; Yoon, Jaechol; Lee, Jeong Moon; Park, Boyoung

    2018-01-01

    The predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. Using data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. 248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16-0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64-0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. Initial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. X-ray absorption intensity at high-energy region

    International Nuclear Information System (INIS)

    Fujikawa, Takashi; Kaneko, Katsumi

    2012-01-01

    We theoretically discuss X-ray absorption intensity in high-energy region far from the deepest core threshold to explain the morphology-dependent mass attenuation coefficient of some carbon systems, carbon nanotubes (CNTs), highly oriented pyrolytic graphite (HOPG) and fullerenes (C 60 ). The present theoretical approach is based on the many-body X-ray absorption theory including the intrinsic losses (shake-up losses). In the high-energy region the absorption coefficient has correction term dependent on the solid state effects given in terms of the polarization part of the screened Coulomb interaction W p . We also discuss the tail of the valence band X-ray absorption intensity. In the carbon systems C 2s contribution has some influence on the attenuation coefficient even in the high energy region at 20 keV.

  8. Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture.

    Science.gov (United States)

    Bouma, Wobbe; Wijdh-den Hamer, Inez J; Koene, Bart M; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E; van der Horst, Iwan C C; Gorman, Joseph H; Gorman, Robert C; Mariani, Massimo A

    2014-10-18

    Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear which patients are at highest risk. In this study we sought to determine in-hospital mortality and its predictors for patients who underwent mitral valve surgery for post-MI PMR. Between January 1990 and December 2012, 48 consecutive patients (mean age 64.9 ± 10.8 years) underwent mitral valve repair (n = 10) or replacement (n = 38) for post-MI PMR. Clinical data, echocardiographic data, catheterization data, and surgical reports were reviewed. Univariate and multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality. Intraoperative mortality was 4.2% and in-hospital mortality was 25.0%. Univariate and multivariate logistic regression analyses revealed the logistic EuroSCORE and EuroSCORE II as independent predictors of in-hospital mortality. Receiver operating characteristics curves showed an optimal cutoff value of 40% for the logistic EuroSCORE (area under the curve 0.85, 95% CI 0.71-1.00, P optimal cutoff ≥ 40%), EuroSCORE II (optimal cutoff ≥ 25%), complete PMR, and intraoperative IABP requirement are strong independent predictors of in-hospital mortality in patients undergoing mitral valve surgery for post-MI PMR. These predictors may aid in surgical decision making and they may help improve the quality of informed consent.

  9. Characteristics and in-hospital outcomes of patients with acute coronary syndromes and heart failure in the United Arab Emirates.

    Science.gov (United States)

    Shehab, Abdulla; Al-Dabbagh, Bayan; Almahmeed, Wael; Bustani, Nazar; Nagelkerke, Nicolaas; Yusufali, Afzal; Wassef, Adel; Ibrahim, Mohamed; Brek, Azan Bin

    2012-09-26

    Heart failure (HF) is a serious complication of acute coronary syndromes (ACS), and is associated with high in-hospital mortality and poor long-term survival. The aims of this study were to describe the clinical characteristics, management and in-hospital outcomes of coronary syndrome (ACS) patients with HF in the United Arab Emirates. The study was selected from the Gulf Registry of Acute Coronary Events (Gulf RACE), a prospective multi-national, multicenter registry of patients hospitalized with ACS in six Middle East countries. The present analysis was focused on participants admitted to various hospitals in the UAE with a diagnosis of ACS in 2007 and were analyzed in terms of HF (Killip class II/III and IV) on admission. Of 1691 patients (mean age: 52.6 ± 11.7 years; 210 Females, 1481 Males) with ACS, 356 (21%) had an admission diagnosis of HF (Killip class II/III and IV). HF patients were less frequently males (19.2% vs. 34.3%; P < 0.001). HF was more frequently associated with hypertension (64.3% vs. 43.9%; P < 0.001), hyperlipidemia (49.4% vs. 31.8%; P < 0.001) and diabetes mellitus (DM) (51.1% vs. 36.2%; P < 0.001). HF was significantly associated with in-hospital mortality (OR = 11.821; 95% CI: 5.385-25.948; P < 0.001). In multivariate logistic regression, age, hyperlipidemia, heart rate and DM were associated with higher in-hospital HF. HF is observed in about 1 in 5 patients with ACS in the UAE and is associated with a significant increase in in-hospital mortality and other adverse outcomes.

  10. Hyperglycemia and in-hospital outcomes after first myocardial infarction

    International Nuclear Information System (INIS)

    Khan, A.N.; Ambreen, F.; Qureshi, I.Z.

    2006-01-01

    To determine in-hospital outcomes post AMI hyperglycemia. 109 patients of acute myocardial infarction were included in this study. Physical examination, ECG tracings, random plasma glucose, serum cholesterol, triglycerides and cardiac enzymes (CPK, LDH and AST) were measured. Hyperglycemic patients (plasma glucose 126 mg/dl) were sub-divided into those with a previous history of diabetes and those without any such history. Post AMI plasma glucose levels were exceptionally higher in female patients aged 61-70 years while they were moderately higher in males of age groups 31-40 and 51-60, and females of age group 41-50 years. In-hospital mortality rate was greater in hyperglycemic patients. Most importantly also, significantly greater complications of the heart were encountered in hyperglycemics. Post AMI patients are at a greater risk of developing diabetes and concurrent AMI attack. (author)

  11. Turbine component casting core with high resolution region

    Science.gov (United States)

    Kamel, Ahmed; Merrill, Gary B.

    2014-08-26

    A hollow turbine engine component with complex internal features can include a first region and a second, high resolution region. The first region can be defined by a first ceramic core piece formed by any conventional process, such as by injection molding or transfer molding. The second region can be defined by a second ceramic core piece formed separately by a method effective to produce high resolution features, such as tomo lithographic molding. The first core piece and the second core piece can be joined by interlocking engagement that once subjected to an intermediate thermal heat treatment process thermally deform to form a three dimensional interlocking joint between the first and second core pieces by allowing thermal creep to irreversibly interlock the first and second core pieces together such that the joint becomes physically locked together providing joint stability through thermal processing.

  12. In-hospital pediatric cardiac arrest in Honduras.

    Science.gov (United States)

    Matamoros, Martha; Rodriguez, Roger; Callejas, Allison; Carranza, Douglas; Zeron, Hilda; Sánchez, Carlos; Del Castillo, Jimena; López-Herce, Jesús

    2015-01-01

    The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

  13. Serum angiotensin-converting enzyme 2 is an independent risk factor for in-hospital mortality following open surgical repair of ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nie, Wanpin; Wang, Yan; Yao, Kai; Wang, Zheng; Wu, Hao

    2016-01-01

    Open surgical repair (OSR) is a conventional surgical method used in the repair a ruptured abdominal aortic aneurysm (AAA); however, OSR results in high perioperative mortality rates. The level of serum angiotensin-converting enzyme 2 (ACE2) has been reported to be an independent risk factor for postoperative in-hospital mortality following major cardiopulmonary surgery. In the present study, the association of serum ACE2 levels with postoperative in-hospital mortality was investigated in patients undergoing OSR for ruptured AAA. The study enrolled 84 consecutive patients underwent OSR for ruptured AAA and were subsequently treated in the intensive care unit. Patients who succumbed postoperatively during hospitalization were defined as non-survivors. Serum ACE2 levels were measured in all patients prior to and following the surgery using ELISA kits. The results indicated that non-survivors showed significantly lower mean preoperative and postoperative serum ACE2 levels when compared with those in survivors. Multivariate logistic regression analysis also showed that, subsequent to adjusting for potential confounders, the serum ACE2 level on preoperative day 1 showed a significant negative association with the postoperative in-hospital mortality. This was confirmed by multivariate hazard ratio analysis, which showed that, subsequent to adjusting for the various potential confounders, the risk of postoperative in-hospital mortality remained significantly higher in the two lowest serum ACE2 level quartiles compared with that in the highest quartile on preoperative day 1. In conclusion, the present study provided the first evidence supporting that the serum ACE2 level is an independent risk factor for the in-hospital mortality following OSR for ruptured AAA. Furthermore, low serum ACE2 levels on preoperative day 1 were found to be associated with increased postoperative in-hospital mortality. Therefore, the serum ACE2 level on preoperative day 1 may be a potential

  14. In-hospital outcome in patients with ST elevation myocardial infarction and right bundle branch block. A sub-study from RENASICA II, a national multicenter registry.

    Science.gov (United States)

    Juárez-Herrera, Ursulo; Jerjes Sánchez, Carlos; González-Pacheco, Héctor; Martínez-Sánchez, Carlos

    2010-01-01

    Compare in-hospital outcome in patients with ST-elevation myocardial infarction with right versus left bundle branch block. RENASICA II, a national Mexican registry enrolled 8098 patients with final diagnosis of acute coronary syndrome secondary to ischemic heart disease. In 4555 STEMI patients, 545 had bundle branch block, 318 (58.3%) with right and 225 patients with left (41.6%). Both groups were compared in terms of in-hospital outcome through major cardiovascular adverse events; (cardiovascular death, recurrent ischemia and reinfarction). Multivariable analysis was performed to identify in-hospital mortality risk among right and left bundle branch block patients. There were not statistical differences in both groups regarding baseline characteristics, time of ischemia, myocardial infarction location, ventricular dysfunction and reperfusion strategies. In-hospital outcome in bundle branch block group was characterized by a high incidence of major cardiovascular adverse events with a trend to higher mortality in patients with right bundle branch block (OR 1.70, CI 1.19 - 2.42, p right bundle branch block accompanying ST-elevation myocardial infarction of any location at emergency room presentation was an independent predictor of high in-hospital mortality.

  15. A High-resolution Reanalysis for the European CORDEX Region

    Science.gov (United States)

    Bentzien, Sabrina; Bollmeyer, Christoph; Crewell, Susanne; Friederichs, Petra; Hense, Andreas; Keller, Jan; Keune, Jessica; Kneifel, Stefan; Ohlwein, Christian; Pscheidt, Ieda; Redl, Stephanie; Steinke, Sandra

    2014-05-01

    A High-resolution Reanalysis for the European CORDEX Region Within the Hans-Ertel-Centre for Weather Research (HErZ), the climate monitoring branch concentrates efforts on the assessment and analysis of regional climate in Germany and Europe. In joint cooperation with DWD (German Meteorological Service), a high-resolution reanalysis system based on the COSMO model has been developed. Reanalyses gain more and more importance as a source of meteorological information for many purposes and applications. Several global reanalyses projects (e.g., ERA, MERRA, CSFR, JMA9) produce and verify these data sets to provide time series as long as possible combined with a high data quality. Due to a spatial resolution down to 50-70km and 3-hourly temporal output, they are not suitable for small scale problems (e.g., regional climate assessment, meso-scale NWP verification, input for subsequent models such as river runoff simulations). The implementation of regional reanalyses based on a limited area model along with a data assimilation scheme is able to generate reanalysis data sets with high spatio-temporal resolution. The work presented here focuses on the regional reanalysis for Europe with a domain matching the CORDEX-EURO-11 specifications, albeit at a higher spatial resolution, i.e., 0.055° (6km) instead of 0.11° (12km). The COSMO reanalysis system comprises the assimilation of observational data using the existing nudging scheme of COSMO and is complemented by a special soil moisture analysis and boundary conditions given by ERA-interim data. The reanalysis data set currently covers 6 years (2007-2012). The evaluation of the reanalyses is done using independent observations with special emphasis on precipitation and high-impact weather situations. The development and evaluation of the COSMO-based reanalysis for the CORDEX-Euro domain can be seen as a preparation for joint European activities on the development of an ensemble system of regional reanalyses for Europe.

  16. High intensity region segmentation in MR imaging of multiple sclerosis

    International Nuclear Information System (INIS)

    Rodrigo, F; Filipuzzi, M; Graffigna, J P; Isoardi, R; Noceti, M

    2013-01-01

    Numerous pathologies are often manifest in Magnetic Resonance Imaging (MRI) as hyperintense or bright regions as compared to normal tissue. It is of particular interest to develop an algorithm to detect, identify and define those Regions of Interest (ROI) when analyzing MRI studies, particularly for lesions of Multiple Sclerosis (MS). The objective of this study is to analyze those parameters which optimize segmentation of the areas of interest. To establish which areas should be considered as hyperintense regions, we developed a database (DB), with studies of patients diagnosed with MS. This disease causes axonal demyelination and it is expressed as bright regions in PD, T2 and FLAIR MRI sequences. Thus, with more than 4300 hyperintense regions validated by an expert physician, an algorithm was developed to detect such spots, approximating the results the expert obtained. Alongside these hyperintense lesion regions, it also detected bone regions with high intensity levels, similar to the intensity of the lesions, but with other features that allow a good differentiation.The algorithm will then detect ROIs with similar intensity levels and performs classification through data mining techniques

  17. High beta and second stability region transport and stability analysis

    International Nuclear Information System (INIS)

    1990-01-01

    This document summarizes progress made on the research of high beta and second region transport and stability. In the area second stability region studies we report on an investigation of the possibility of second region access in the center of TFTR ''supershots.'' The instabilities found may coincide with experimental observation. Significant progress has been made on the resistive stability properties of high beta poloidal ''supershot'' discharges. For these studies profiles were taken from the TRANSP transport analysis code which analyzes experimental data. Invoking flattening of the pressure profile on mode rational surfaces causes tearing modes to persist into the experimental range of interest. Further, the experimental observation of the modes seems to be consistent with the predictions of the MHD model. In addition, code development in several areas has proceeded

  18. Regional development via high-speed rail : A study of the Stockholm-Mälaren region and possibilities for Melbourne-regional Victoria

    OpenAIRE

    Bayley, Michael

    2012-01-01

    The purpose of this thesis is to examine, based on a study of the regional high-speed corridors in the Stockholm-Mälaren Region, the possibilities for regional high-speed rail in Melbourne-regional Victoria (Australia) to improve accessibility, and achieve regional development and balanced growth between the capital and its surrounding regions. It deals with the concept of 'regional' high-speed rail, a variant of classic high-speed rail that serves centres along regional corridors stemming fr...

  19. Evaluation of a High-Resolution Regional Reanalysis for Europe

    Science.gov (United States)

    Ohlwein, C.; Wahl, S.; Keller, J. D.; Bollmeyer, C.

    2014-12-01

    Reanalyses gain more and more importance as a source of meteorological information for many purposes and applications. Several global reanalyses projects (e.g., ERA, MERRA, CSFR, JMA9) produce and verify these data sets to provide time series as long as possible combined with a high data quality. Due to a spatial resolution down to 50-70km and 3-hourly temporal output, they are not suitable for small scale problems (e.g., regional climate assessment, meso-scale NWP verification, input for subsequent models such as river runoff simulations). The implementation of regional reanalyses based on a limited area model along with a data assimilation scheme is able to generate reanalysis data sets with high spatio-temporal resolution. Within the Hans-Ertel-Centre for Weather Research (HErZ), the climate monitoring branch concentrates efforts on the assessment and analysis of regional climate in Germany and Europe. In joint cooperation with DWD (German Meteorological Service), a high-resolution reanalysis system based on the COSMO model has been developed. The regional reanalysis for Europe matches the domain of the CORDEX EURO-11 specifications, albeit at a higher spatial resolution, i.e., 0.055° (6km) instead of 0.11° (12km) and comprises the assimilation of observational data using the existing nudging scheme of COSMO complemented by a special soil moisture analysis with boundary conditions provided by ERA-Interim data. The reanalysis data set covers 6 years (2007-2012) and is currently extended to 16 years. Extensive evaluation of the reanalysis is performed using independent observations with special emphasis on precipitation and high-impact weather situations indicating a better representation of small scale variability. Further, the evaluation shows an added value of the regional reanalysis with respect to the forcing ERA Interim reanalysis and compared to a pure high-resolution dynamical downscaling approach without data assimilation.

  20. The high-resolution regional reanalysis COSMO-REA6

    Science.gov (United States)

    Ohlwein, C.

    2016-12-01

    Reanalyses gain more and more importance as a source of meteorological information for many purposes and applications. Several global reanalyses projects (e.g., ERA, MERRA, CSFR, JMA9) produce and verify these data sets to provide time series as long as possible combined with a high data quality. Due to a spatial resolution down to 50-70km and 3-hourly temporal output, they are not suitable for small scale problems (e.g., regional climate assessment, meso-scale NWP verification, input for subsequent models such as river runoff simulations). The implementation of regional reanalyses based on a limited area model along with a data assimilation scheme is able to generate reanalysis data sets with high spatio-temporal resolution. Within the Hans-Ertel-Centre for Weather Research (HErZ), the climate monitoring branch concentrates efforts on the assessment and analysis of regional climate in Germany and Europe. In joint cooperation with DWD (German Meteorological Service), a high-resolution reanalysis system based on the COSMO model has been developed. The regional reanalysis for Europe matches the domain of the CORDEX EURO-11 specifications, albeit at a higher spatial resolution, i.e., 0.055° (6km) instead of 0.11° (12km) and comprises the assimilation of observational data using the existing nudging scheme of COSMO complemented by a special soil moisture analysis with boundary conditions provided by ERA-Interim data. The reanalysis data set covers the past 20 years. Extensive evaluation of the reanalysis is performed using independent observations with special emphasis on precipitation and high-impact weather situations indicating a better representation of small scale variability. Further, the evaluation shows an added value of the regional reanalysis with respect to the forcing ERA Interim reanalysis and compared to a pure high-resolution dynamical downscaling approach without data assimilation.

  1. A high-resolution regional reanalysis for Europe

    Science.gov (United States)

    Ohlwein, C.

    2015-12-01

    Reanalyses gain more and more importance as a source of meteorological information for many purposes and applications. Several global reanalyses projects (e.g., ERA, MERRA, CSFR, JMA9) produce and verify these data sets to provide time series as long as possible combined with a high data quality. Due to a spatial resolution down to 50-70km and 3-hourly temporal output, they are not suitable for small scale problems (e.g., regional climate assessment, meso-scale NWP verification, input for subsequent models such as river runoff simulations). The implementation of regional reanalyses based on a limited area model along with a data assimilation scheme is able to generate reanalysis data sets with high spatio-temporal resolution. Within the Hans-Ertel-Centre for Weather Research (HErZ), the climate monitoring branch concentrates efforts on the assessment and analysis of regional climate in Germany and Europe. In joint cooperation with DWD (German Meteorological Service), a high-resolution reanalysis system based on the COSMO model has been developed. The regional reanalysis for Europe matches the domain of the CORDEX EURO-11 specifications, albeit at a higher spatial resolution, i.e., 0.055° (6km) instead of 0.11° (12km) and comprises the assimilation of observational data using the existing nudging scheme of COSMO complemented by a special soil moisture analysis with boundary conditions provided by ERA-Interim data. The reanalysis data set covers the past 20 years. Extensive evaluation of the reanalysis is performed using independent observations with special emphasis on precipitation and high-impact weather situations indicating a better representation of small scale variability. Further, the evaluation shows an added value of the regional reanalysis with respect to the forcing ERA Interim reanalysis and compared to a pure high-resolution dynamical downscaling approach without data assimilation.

  2. Processes of in-hospital psychiatric care and subsequent criminal behaviour among patients with schizophrenia: a national population-based, follow-up study.

    Science.gov (United States)

    Pedersen, Charlotte Gjørup; Olrik Wallenstein Jensen, Signe; Johnsen, Søren Paaske; Nordentoft, Merete; Mainz, Jan

    2013-09-01

    It is unknown whether evidence-based, in-hospital processes of care may influence the risk of criminal behaviour among patients with schizophrenia. Our study aimed to examine the association between guideline recommended in-hospital psychiatric care and criminal behaviour among patients with schizophrenia. Danish patients with schizophrenia (18 years or older) discharged from a psychiatric ward between January 2004 and March 2009 were identified using a national population-based schizophrenia registry (n = 10 757). Data for in-hospital care and patient characteristics were linked with data on criminal charges obtained from the Danish Crime Registry until November 2010. Twenty per cent (n = 2175) of patients were charged with a crime during follow-up (median = 428 days). Violent crimes accounted for 59% (n = 1282) of the criminal offences. The lowest risk of crime was found among patients receiving the most processes of in-hospital care (top quartile of received recommended care, compared with bottom quartiles, adjusted hazard ratio = 0.86, 95% CI 0.75 to 0.99). The individual processes of care associated with the lowest risk of criminal behaviour were antipsychotic treatment and staff contact with relatives. High-quality, in-hospital psychiatric care was associated with a lower risk of criminal behaviour after discharge among patients with schizophrenia.

  3. High beta and second stability region transport and stability analysis

    International Nuclear Information System (INIS)

    1991-01-01

    This document describes ideal and resistive MHD studies of high-beta plasmas and of the second stability region. Significant progress is reported on the resistive stability properties of high beta poloidal ''supershot'' discharges. For these studies initial profiles were taken from the TRANSP code which is used extensively to analyze experimental data. When an ad hoc method of removing the finite pressure stabilization of tearing modes is implemented it is shown that there is substantial agreement between MHD stability computation and experiment. In particular, the mode structures observed experimentally are consistent with the predictions of the resistive MHD model. We also report on resistive stability near the transition to the second region in TFTR. Tearing modes associated with a nearby infernal mode may explain the increase in MHD activity seen in high beta supershots and which impede the realization of Q∼1. We also report on a collaborative study with PPPL involving sawtooth stabilization with ICRF

  4. Correlation between the pionization region and the fragmentation region in high energy proton-proton collisions

    CERN Document Server

    Albrow, M G; Barber, D P; Bogaerts, A; Bosnjakovic, B; Brooks, J R; Clegg, A B; Erné, F C; Gee, C N P; Locke, D H; Loebinger, F K; Murphy, P G; Rudge, A; Sens, Johannes C

    1973-01-01

    Measurements are reported of two-particle correlations in high energy proton-proton collisions with one particle in the pionization region and the other a proton in the fragmentation region. The correlation function is independent of x of the fragmentation proton for 0.55

  5. Patterns of injury, outcomes, and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients.

    Science.gov (United States)

    Hwabejire, John O; Kaafarani, Haytham M A; Lee, Jarone; Yeh, Daniel D; Fagenholz, Peter; King, David R; de Moya, Marc A; Velmahos, George C

    2014-10-01

    higher and to 78.7% if mechanical ventilation was required. Most NCTPs required rehabilitation; only 8.9% were discharged to home. Despite low in-hospital mortality, the cumulative mortality rate among NCTPs at 1 year after discharge is significant, particularly in the presence of head injury, spine injury, mechanical ventilation, high injury severity, or prolonged length of hospital stay. These considerations can help guide clinical decisions and family discussions.

  6. [Relationship between previous severity of illness and outcome of in-hospital cardiac arrest].

    Science.gov (United States)

    Serrano, M; Rodríguez, J; Espejo, A; del Olmo, R; Llanos, S; Del Castillo, J; López-Herce, J

    2014-07-01

    To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  7. A Randomized Comparison of In-hospital Rescuer Positions for Endotracheal Intubation in a Difficult Airway

    OpenAIRE

    Le Parc, Joanna M.; Bischof, Jason J.; King, Andrew M.; Greenberger, Sarah; Way, David P.; Panchal, Ashish R.; Finnegan, Geoffrey I.; Terndrup, Thomas E.

    2018-01-01

    Introduction: Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited. While we adhere to strict standards for the administration of ETI, we posited that perhaps requiring in-hospital rescuers to stand for ETI is an obstacle to effectiveness. Our objectiv...

  8. Seasonal variations of the high-latitude F region for

    International Nuclear Information System (INIS)

    Sojka, J.J.; Schunk, R.W.; Raitt, W.J.

    1982-01-01

    We combined a plasma convection model with an inosphere-atmospheric composition model in order to study the seasonal variations of the high-latitude F region for strong convection. Our numerical study produced time-dependent, three-dimensional, ion density distributions for the ions NO + , O 2 + , N 2 + , O + , N + , and He + . We covered the high-latitude ionosphere above 42 0 N magnetic latitude and at altitudes between 160 and 800 km for a time period of one complete day. From our study we found the following: (1) For strong convection, the high-altitude ionosphere exhibits a significant UT variation both during winter and summer. (2) In general, the electron density is lower in winter than in summer. However, at certain universal times the electron density in the dayside polar cap is larger in winter than in summer owing to the effect of the mid-latitude 'winter anomaly' in combination with strong antisunward convection. (3) In both summer and winter, the major region of low electron density is associated with the main or mid-latitudde trough. The trough is deeper and its local time extend is much greater in winter than in summer. (4) Typically, the electron density exhibits a much larger variation with altitude in winter than in summer. (5) The ion composition and molecular/atomic ion transition altitude are highly UT dependent in both summer and winter. (6) The ion composition also displays a significant seasonal variation. However, at a given location the seasonal variation can be opposite at different universal times. (7) High-speed convection cells should display a marked seasonal variation, with a much larger concentration of molecular ions near the F region peak in summer than in winter

  9. Multidisciplinary in-hospital teams improve patient outcomes: A review.

    Science.gov (United States)

    Epstein, Nancy E

    2014-01-01

    The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses' aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient "staff" satisfaction. Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers' performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.

  10. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

    Directory of Open Access Journals (Sweden)

    Badia BISBIS

    2016-06-01

    Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

  11. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.

    Science.gov (United States)

    Regueiro, Ander; Linke, Axel; Latib, Azeem; Ihlemann, Nikolaj; Urena, Marina; Walther, Thomas; Husser, Oliver; Herrmann, Howard C; Nombela-Franco, Luis; Cheema, Asim N; Le Breton, Hervé; Stortecky, Stefan; Kapadia, Samir; Bartorelli, Antonio L; Sinning, Jan Malte; Amat-Santos, Ignacio; Munoz-Garcia, Antonio; Lerakis, Stamatios; Gutiérrez-Ibanes, Enrique; Abdel-Wahab, Mohamed; Tchetche, Didier; Testa, Luca; Eltchaninoff, Helene; Livi, Ugolino; Castillo, Juan Carlos; Jilaihawi, Hasan; Webb, John G; Barbanti, Marco; Kodali, Susheel; de Brito, Fabio S; Ribeiro, Henrique B; Miceli, Antonio; Fiorina, Claudia; Dato, Guglielmo Mario Actis; Rosato, Francesco; Serra, Vicenç; Masson, Jean-Bernard; Wijeysundera, Harindra C; Mangione, Jose A; Ferreira, Maria-Cristina; Lima, Valter C; Carvalho, Luiz A; Abizaid, Alexandre; Marino, Marcos A; Esteves, Vinicius; Andrea, Julio C M; Giannini, Francesco; Messika-Zeitoun, David; Himbert, Dominique; Kim, Won-Keun; Pellegrini, Costanza; Auffret, Vincent; Nietlispach, Fabian; Pilgrim, Thomas; Durand, Eric; Lisko, John; Makkar, Raj R; Lemos, Pedro A; Leon, Martin B; Puri, Rishi; San Roman, Alberto; Vahanian, Alec; Søndergaard, Lars; Mangner, Norman; Rodés-Cabau, Josep

    2016-09-13

    [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors). Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

  12. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates.

    Science.gov (United States)

    Mizuno, Seiko; Kunisawa, Susumu; Sasaki, Noriko; Fushimi, Kiyohide; Imanaka, Yuichi

    2016-10-01

    Many hospitals experience a reduction in the number of available physicians on days when national scientific meetings are conducted. This study investigates the relationship between in-hospital mortality in acute myocardial infarction (AMI) patients and admission during national cardiology meeting dates. Using an administrative database, we analyzed patients with AMI admitted to acute care hospitals in Japan from 2011 to 2013. There were 3 major national cardiology meetings held each year. A hierarchical logistic regression model was used to compare in-hospital mortality and treatment patterns between patients admitted on meeting dates and those admitted on identical days during the week before and after the meeting dates. We identified 6,332 eligible patients, with 1,985 patients admitted during 26 meeting days and 4,347 patients admitted during 52 non-meeting days. No significant differences between meeting and non-meeting dates were observed for in-hospital mortality (7.4% vs. 8.5%, respectively; p=0.151, unadjusted odds ratio: 0.861, 95% confidence interval: 0.704-1.054) and the proportion of percutaneous coronary intervention (PCI) performed on the day of admission (75.9% vs. 76.2%, respectively; p=0.824). We also found that some low-staffed hospitals did not treat AMI patients during meeting dates. Little or no "national meeting effect" was observed on in-hospital mortality in AMI patients, and PCI rates were similar for both meeting and non-meeting dates. Our findings also indicated that during meeting dates, AMI patients may have been consolidated to high-performance and sufficiently staffed hospitals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations

    Directory of Open Access Journals (Sweden)

    Kei Ouchi

    2017-04-01

    Full Text Available Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED intubations. Methods: We used Vizient administrative data from hospitalizations of 22,374 adults ≥75 years who underwent non-traumatic ED intubation from 2008–2015 at nearly 300 U.S. hospitals to develop and validate an index to predict in-hospital mortality. We randomly selected one half of participants for the development cohort and one half for the validation cohort. Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality. We calculated risk scores using points derived from the final model’s beta coefficients. To evaluate calibration and discrimination of the final model, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis and compared mortality by risk groups in the development and validation cohorts. Results: Death during the index hospitalization occurred in 40% of cases. The final model included six variables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer, age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Those with low-risk scores (10 had 58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09, and the c-statistic was 0.62 in the validation cohort. Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.

  14. A high-resolution regional reanalysis for the European CORDEX region

    Science.gov (United States)

    Bollmeyer, Christoph; Keller, Jan; Ohlwein, Christian; Wahl, Sabrina

    2015-04-01

    Within the Hans-Ertel-Centre for Weather Research (HErZ), the climate monitoring branch concentrates efforts on the assessment and analysis of regional climate in Germany and Europe. In joint cooperation with DWD (German Weather Service), a high-resolution reanalysis system based on the COSMO model has been developed. Reanalyses gain more and more importance as a source of meteorological information for many purposes and applications. Several global reanalyses projects (e.g., ERA, MERRA, CSFR, JMA9) produce and verify these data sets to provide time series as long as possible combined with a high data quality. Due to a spatial resolution down to 50-70km and 3-hourly temporal output, they are not suitable for small scale problems (e.g., regional climate assessment, meso-scale NWP verification, input for subsequent models such as river runoff simulations, renewable energy applications). The implementation of regional reanalyses based on a limited area model along with a data assimilation scheme is able to generate reanalysis data sets with high spatio-temporal resolution. The work presented here focuses on two regional reanalyses for Europe and Germany. The European reanalysis COSMO-REA6 matches the CORDEX EURO-11 specifications, albeit at a higher spatial resolution, i.e., 0.055° (6km) instead of 0.11° (12km). Nested into COSMO-REA6 is COSMO-REA2, a convective-scale reanalysis with 2km resolution for Germany. COSMO-REA6 comprises the assimilation of observational data using the existing nudging scheme of COSMO and is complemented by a special soil moisture analysis and boundary conditions given by ERA-Interim data. COSMO-REA2 also uses the nudging scheme complemented by a latent heat nudging of radar information. The reanalysis data set currently covers 17 years (1997-2013) for COSMO-REA6 and 4 years (2010-2013) for COSMO-REA2 with a very large set of output variables and a high temporal output step of hourly 3D-fields and quarter-hourly 2D-fields. The evaluation

  15. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care.

    Directory of Open Access Journals (Sweden)

    Tanneke Herklots

    Full Text Available to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC, maternal near-miss (MNM or maternal death (MD. Quality of in-hospital care was assessed using the mortality index (MI defined as ratio between mortality and severe maternal outcome (SMO where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.5551 women were included. 569 (10.3% had a potentially life-threatening condition and 65 (1.2% a severe maternal outcome (SMO: 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.

  16. The ATLAS high level trigger region of interest builder

    International Nuclear Information System (INIS)

    Blair, R.; Dawson, J.; Drake, G.; Haberichter, W.; Schlereth, J.; Zhang, J.; Ermoline, Y.; Pope, B.; Aboline, M.; High Energy Physics; Michigan State Univ.

    2008-01-01

    This article describes the design, testing and production of the ATLAS Region of Interest Builder (RoIB). This device acts as an interface between the Level 1 trigger and the high level trigger (HLT) farm for the ATLAS LHC detector. It distributes all of the Level 1 data for a subset of events to a small number of (16 or less) individual commodity processors. These processors in turn provide this information to the HLT. This allows the HLT to use the Level 1 information to narrow data requests to areas of the detector where Level 1 has identified interesting objects

  17. Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure.

    Directory of Open Access Journals (Sweden)

    Takeshi Yagyu

    Full Text Available Patients with acute heart failure (AHF show various clinical courses during hospitalization. We aimed to identify time course predictors of in-hospital mortality and to establish a sequentially assessable risk model.We enrolled 1,035 consecutive AHF patients into derivation (n = 597 and validation (n = 438 cohorts. For risk assessments at admission, we utilized Get With the Guidelines-Heart Failure (GWTG-HF risk scores. We examined significant predictors of in-hospital mortality from 11 variables obtained during hospitalization and developed a risk stratification model using multiple logistic regression analysis. Across both cohorts, 86 patients (8.3% died during hospitalization. Using backward stepwise selection, we identified five time-course predictors: catecholamine administration, minimum platelet concentration, maximum blood urea nitrogen, total bilirubin, and C-reactive protein levels; and established a time course risk score that could sequentially assess a patient's risk status. The addition of a time course risk score improved the discriminative ability of the GWTG-HF risk score (c-statistics in derivation and validation cohorts: 0.776 to 0.888 [p = 0.002] and 0.806 to 0.902 [p<0.001], respectively. A calibration plot revealed a good relationship between observed and predicted in-hospital mortalities in both cohorts (Hosmer-Lemeshow chi-square statistics: 6.049 [p = 0.642] and 5.993 [p = 0.648], respectively. In each group of initial low-intermediate risk (GWTG-HF risk score <47 and initial high risk (GWTG-HF risk score ≥47, in-hospital mortality was about 6- to 9-fold higher in the high time course risk score group than in the low-intermediate time course risk score group (initial low-intermediate risk group: 20.3% versus 2.2% [p<0.001], initial high risk group: 57.6% versus 8.5% [p<0.001].A time course assessment related to in-hospital mortality during the hospitalization of AHF patients can clearly categorize a patient's on

  18. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    Directory of Open Access Journals (Sweden)

    Melani Carla

    2008-10-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare. Incidence rates of in-hospital cases of CTS were estimated based on 1 codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence on regional databases; 2 demographic general population data for each region. We compared (using the χscore test age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years of in-hospital cases of CTS were 166 in women and 44 in men (106 overall. Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60 in women, and 1.42 (95% CI, 1.40–1.45 in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts. Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  19. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status.

    Science.gov (United States)

    Mattioli, Stefano; Baldasseroni, Alberto; Curti, Stefania; Cooke, Robin M T; Bena, Antonella; de Giacomi, Giovanna; dell'Omo, Marco; Fateh-Moghadam, Pirous; Melani, Carla; Biocca, Marco; Buiatti, Eva; Campo, Giuseppe; Zanardi, Francesca; Violante, Francesco S

    2008-10-28

    Carpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Seven regions were considered (overall population, 14.9 million) over 3-6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the chiscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women. Age-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57-1.60) in women, and 1.42 (95% CI, 1.40-1.45) in men. As compared with married women/men, widows/widowers both showed 2-3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts). This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  20. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children.

    Science.gov (United States)

    Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Gildea, Marianne R; Scholefield, Barnaby R; Shankaran, Seetha; Hutchison, Jamie S; Berger, John T; Ofori-Amanfo, George; Newth, Christopher J L; Topjian, Alexis; Bennett, Kimberly S; Koch, Joshua D; Pham, Nga; Chanani, Nikhil K; Pineda, Jose A; Harrison, Rick; Dalton, Heidi J; Alten, Jeffrey; Schleien, Charles L; Goodman, Denise M; Zimmerman, Jerry J; Bhalala, Utpal S; Schwarz, Adam J; Porter, Melissa B; Shah, Samir; Fink, Ericka L; McQuillen, Patrick; Wu, Theodore; Skellett, Sophie; Thomas, Neal J; Nowak, Jeffrey E; Baines, Paul B; Pappachan, John; Mathur, Mudit; Lloyd, Eric; van der Jagt, Elise W; Dobyns, Emily L; Meyer, Michael T; Sanders, Ronald C; Clark, Amy E; Dean, J Michael

    2017-01-26

    Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse

  1. A Review Of In-Hospital Surgical Mortality At The Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    Aims and Objectives: A retrospective study to determine In-hospital surgical mortality rate, gender and age distribution of cases and operations associated with In-hospital surgical mortality at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. Patients and Methods: Data was collected from the theatre operation ...

  2. Microinstabilities in the high latitude F region: a brief review

    International Nuclear Information System (INIS)

    Gary, S.P.

    1983-01-01

    This is a review of the theory of plasma microinstabilities that may arise in the high latitude F region ionosphere below 1000 km. Three free energy sources are considered: a density gradient perpendicular to the ambient magnetic field B, a current parallel to B and a steady electric field perpendicular to B. The BGK model for charged-neutral collisions is used, and the short wavelength properties of the universal density drift, current convective and E x B gradient drift instabilities are compared. At sufficiently high altitudes and sufficiently steep gradients, the universal instability is the short wavelength mode most likely to grow and, through wave-particle diffusion, to cause relatively steep wavenumber dependences in power spectra

  3. Modelization of highly nonlinear waves in coastal regions

    Science.gov (United States)

    Gouin, Maïté; Ducrozet, Guillaume; Ferrant, Pierre

    2015-04-01

    The proposed work deals with the development of a highly non-linear model for water wave propagation in coastal regions. The accurate modelization of surface gravity waves is of major interest in ocean engineering, especially in the field of marine renewable energy. These marine structures are intended to be settled in coastal regions where the effect of variable bathymetry may be significant on local wave conditions. This study presents a numerical model for the wave propagation with complex bathymetry. It is based on High-Order Spectral (HOS) method, initially limited to the propagation of non-linear wave fields over flat bottom. Such a model has been developed and validated at the LHEEA Lab. (Ecole Centrale Nantes) over the past few years and the current developments will enlarge its application range. This new numerical model will keep the interesting numerical properties of the original pseudo-spectral approach (convergence, efficiency with the use of FFTs, …) and enable the possibility to propagate highly non-linear wave fields over long time and large distance. Different validations will be provided in addition to the presentation of the method. At first, Bragg reflection will be studied with the proposed approach. If the Bragg condition is satisfied, the reflected wave generated by a sinusoidal bottom patch should be amplified as a result of resonant quadratic interactions between incident wave and bottom. Comparisons will be provided with experiments and reference solutions. Then, the method will be used to consider the transformation of a non-linear monochromatic wave as it propagates up and over a submerged bar. As the waves travel up the front slope of the bar, it steepens and high harmonics are generated due to non-linear interactions. Comparisons with experimental data will be provided. The different test cases will assess the accuracy and efficiency of the method proposed.

  4. High beta and second stability region transport and stability analysis

    International Nuclear Information System (INIS)

    Hughes, M.H.; Phillps, M.W.; Todd, A.M.M.; Krishnaswami, J.; Hartley, R.

    1992-09-01

    This report describes ideal and resistive studies of high-beta plasmas and of the second stability region. Emphasis is focused on ''supershot'' plasmas in TFIR where MHD instabilities are frequently observed and which spoil their confinement properties. Substantial results are described from the analysis of these high beta poloidal plasmas. During these studies, initial pressure and safety factor profiles were obtained from the TRANSP code, which is used extensively to analyze experimental data. Resistive MBD stability studies of supershot equilibria show that finite pressure stabilization of tearing modes is very strong in these high βp plasmas. This has prompted a detailed re-examination of linear tearing mode theory in which we participated in collaboration with Columbia University and General Atomics. This finite pressure effect is shown to be highly sensitive to small scale details of the pressure profile. Even when an ad hoc method of removing this stabilizing mechanism is implemented, however, it is shown that there is only superficial agreement between resistive MBD stability computation and the experimental data. While the mode structures observed experimentally can be found computationally, there is no convincing correlation with the experimental observations when the computed results are compared with a large set of supershot data. We also describe both the ideal and resistive stability properties of TFIR equilibria near the transition to the second region. It is shown that the highest β plasmas, although stable to infinite-n ideal ballooning modes, can be unstable to the so called ''infernal'' modes associated with small shear. The sensitivity of these results to the assumed pressure and current density profiles is discussed. Finally, we describe results from two collaborative studies with PPPL. The first involves exploratory studies of the role of the 1/1 mode in tokamaks and, secondly, a study of sawtooth stabilization using ICRF

  5. Predictors of in-hospital mortality among older patients

    Directory of Open Access Journals (Sweden)

    Thiago J. A. Silva

    2009-01-01

    Full Text Available OBJECTIVE: The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit. INTRODUCTION: The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality. METHODS: This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine. RESULTS: The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65-6.44, P1.3mg/dL (OR=2.39, CI=1.53-3.72, P<.001, history of heart failure (OR=1.97, CI=1.20-3.22, P=.007, immobility (OR=1.84, CI=1.16-2.92, P =.009, and advanced age (OR=1.03, CI=1.01-1.06, P=.019. CONCLUSIONS: This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.

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

    Science.gov (United States)

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

    2017-04-05

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

  7. Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management.

    Science.gov (United States)

    Parissis, John T; Nikolaou, Maria; Mebazaa, Alexandre; Ikonomidis, Ignatios; Delgado, Juan; Vilas-Boas, Fabio; Paraskevaidis, Ioannis; Mc Lean, Antony; Kremastinos, Dimitrios; Follath, Ferenc

    2010-11-01

    Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). ALARM-HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in-hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P chronic renal disease (P renal function, and history may identify high-risk APE patients.

  8. Ways to Reduce In-Hospital Mortality in Patients with Cardiogenic Shock in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    G. V. Artamonova

    2013-01-01

    Full Text Available Objective: to analyze a medical care system for acute coronary syndrome (ACS in a large city in terms of in-hospital cardiogenic shock mortality risk management. Materials and methods. The health care facility management system for a risk for cardiogenic shock (CS and its poor outcome (death was a methodological basis of this study. The information from case histories of ACS patients consecutively admitted to the Kemerovo Cardiology Dispensary (Kemerovo, Russia in the period 2006 to 2011 was used to develop an electronic database. Sampling included 19281 patients with ACS, 6537 with myocardial infarction (MI, 493 with CS. Results and discussion. The medical care system for patients with ACS encompasses an emergency team (a prehospital level, a specialized cardiac hospital (an in-hospital level with a multistage therapeutic and diagnostic process in relation the severity of a patient’s status. The management is based on the principle of continuity of care, by applying the well-defined activity algorithms through valid information exchange and risk stratification for poor outcomes of ACS. An antishock team working just in the admission unit of a hospital was set up to treat high CS risk patients. A systems approach allowed the strategy of early specialized medical care to be developed with a priority of primary percutaneous coronary interventions (PCI as reperfusion therapy in patients with ST-elevation MI. In 2006-2011, every three patients with suspected ACS had verified MI that was com_ plicated by CS in 7.5%. In the CS group, the in-hospital mortality rates totaled 88.0% of cases; that after primary Адрес для корреспонденции (Correspondence to: PCI was 62.2%. In the examined period, the introduction of innovation clinical and organizational approaches provided a reduction in this indicator by 17.6 and 37.5%, respectively. Conclusion. The efficiency of risk management for CS and its poor outcomes in patients with ACS is

  9. Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry.

    Science.gov (United States)

    Li, Shawn X; Chaudry, Hannah I; Lee, Jiyong; Curran, Theodore B; Kumar, Vishesh; Wong, Kendrew K; Andrus, Bruce W; DeVries, James T

    2018-02-01

    Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.

  10. Developing a high-resolution regional atmospheric reanalysis for Australia

    Science.gov (United States)

    White, Christopher; Fox-Hughes, Paul; Su, Chun-Hsu; Jakob, Dörte; Kociuba, Greg; Eisenberg, Nathan; Steinle, Peter; Harris, Rebecca; Corney, Stuart; Love, Peter; Remenyi, Tomas; Chladil, Mark; Bally, John; Bindoff, Nathan

    2017-04-01

    A dynamically consistent, long-term atmospheric reanalysis can be used to support high-quality assessments of environmental risk and likelihood of extreme events. Most reanalyses are presently based on coarse-scale global systems that are not suitable for regional assessments in fire risk, water and natural resources, amongst others. The Australian Bureau of Meteorology is currently working to close this gap by producing a high-resolution reanalysis over the Australian and New Zealand region to construct a sequence of atmospheric conditions at sub-hourly intervals over the past 25 years from 1990. The Australia reanalysis consists of a convective-scale analysis nested within a 12 km regional-scale reanalysis, which is bounded by a coarse-scale ERA-Interim reanalysis that provides the required boundary and initial conditions. We use an unchanging atmospheric modelling suite based on the UERRA system used at the UK Met Office and the more recent version of the Bureau of Meteorology's operational numerical prediction model used in ACCESS-R (Australian Community Climate and Earth-System Simulator-Regional system). An advanced (4-dimensional variational) data assimilation scheme is used to optimally combine model physics with multiple observations from aircrafts, sondes, surface observations and satellites to create a best estimate of state of the atmosphere over a 6-hour moving window. This analysis is in turn used to drive a higher-resolution (1.5 km) downscaling model over selected subdomains within Australia, currently eastern New South Wales and Tasmania, with the capability to support this anywhere in the Australia-New Zealand domain. The temporal resolution of the gridded analysis fields for both the regional and higher-resolution subdomains are generally one hour, with many fields such as 10 m winds and 2 m temperatures available every 10 minutes. The reanalysis also produces many other variables that include wind, temperature, moisture, pressure, cloud cover

  11. Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial.

    Science.gov (United States)

    Panella, M; Marchisio, S; Demarchi, M L; Manzoli, L; Di Stanislao, F

    2009-10-01

    Hospital treatment of heart failure (HF) frequently does not follow published guidelines, potentially contributing to HF high morbidity, mortality and economic cost. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was undertaken to determine how clinical pathways (CP) for hospital treatment of HF affected care variability, guidelines adherence, in-hospital mortality and outcomes at discharge. Methods/ Two-arm, cluster-randomised trial. Fourteen community hospitals were randomised either to the experimental arm (CP: appropriate therapeutic guidelines use, new organisation and procedures, patient education) or to the control arm (usual care). The main outcome was in-hospital mortality; secondary outcomes were length and appropriateness of the stay, rate of unscheduled readmissions, customer satisfaction, usage of diagnostic and therapeutic procedures during hospital stay and quality indicators at discharge. All outcomes were measured using validated instruments available in literature. In-hospital mortality was 5.6% in the experimental arm (n = 12); 15.4% in controls (n = 33, p = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association score, hypertension and source of referral, patients in the CP group, as compared to controls, had a significantly lower risk of in-hospital death (OR 0.18; 95% CI 0.07 to 0.46) and unscheduled readmissions (OR 0.42; 95% CI 0.20 to 0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. Except for electrocardiography, all recommended diagnostic procedures were used more in the CP group. Similarly, pharmaceuticals use was significantly greater in CP, with the exception of diuretics and anti-platelets agents. The introduction of a specifically tailored CP for the hospital

  12. Extravasation of contrast (Spot Sign) predicts in-hospital mortality in ruptured arteriovenous malformation.

    Science.gov (United States)

    Ye, Zengpanpan; Ai, Xiaolin; Zheng, Jun; Hu, Xin; You, Chao; Andrew M, Faramand; Fang, Fang

    2017-10-09

    The spot sign is a highly specific and sensitive predictor of hematoma expansion in following primary intracerebral hemorrhage (ICH). Rare cases of the spot sign have been documented in patients with intracranial hemorrhage secondary to arteriovenous malformation (AVM). The purpose of this retrospective study is to assess the accuracy of spot sign in predicting clinical outcomes in patients with ruptured AVM. A retrospective analysis of a prospectively maintained database was performed for patients who presented to West China Hospital with ICH secondary to AVM in the period between January 2009 and September 2016. Two radiologists blinded to the clinical data independently assessed the imaging data, including the presence of spot sign. Statistical analysis using univariate testing, multivariate logistic regression testing, and receiver operating characteristic curve (AUC) analysis was performed. A total of 116 patients were included. Overall, 18.9% (22/116) of subjects had at least 1 spot sign detected by CT angiography, 7% (8/116) died in hospital, and 27% (31/116) of the patients had a poor outcome after 90 days. The spot sign had a sensitivity of 62.5% and specificity of 84.3% for predicting in-hospital mortality (p = .02, AUC 0.734). No correlation detected between the spot sign and 90-day outcomes under multiple logistic regression (p = .19). The spot sign is an independent predictor for in-hospital mortality. The presence of spot sign did not correlate with the 90 day outcomes in this patient cohort. The results of this report suggest that patients with ruptured AVM with demonstrated the spot sign on imaging must receive aggressive treatment early on due to the high risk of mortality.

  13. Properties of Highly Rotationally Excited H2 in Photodissociation Regions

    Science.gov (United States)

    Cummings, Sally Jane; Wan, Yier; Stancil, Phillip C.; Yang, Benhui H.; Zhang, Ziwei

    2018-06-01

    H2 is the dominant molecular species in the vast majority of interstellar environments and it plays a crucial role as a radiative coolant. In photodissociation regions, it is one of the primary emitters in the near to mid-infrared which are due to lines originating from highly excited rotational levels. However, collisional data for rotational levels j>10 are sparse, particularly for H2-H2 collisions. Utilizing new calculations for para-H2 and ortho-H2 collisional rate coefficients with H2 for j as high as 30, we investigate the effects of the new results in standard PDR models with the spectral simulation package Cloudy. We also perform Cloudy models of the Orion Bar and use Radex to explore rotational line ratio diagnostics. The resulting dataset of H2 collisional data should find wide application to other molecular environments. This work was support by Hubble Space Telescope grant HST-AR-13899.001-A and NASA grants NNX15AI61G and NNX16AF09G.

  14. In-hospital management and outcome of patients on warfarin undergoing coronary stent implantation: results of the multicenter, prospective WARfarin and coronary STENTing (WAR-STENT) registry.

    Science.gov (United States)

    Rubboli, Andrea; Sciahbasi, Alessandro; Briguori, Carlo; Saia, Francesco; Palmieri, Cataldo; Moroni, Luigi Andrea; Calabrò, Paolo; Leone, Antonio Maria; Franco, Nicoletta; Valgimigli, Marco; Varani, Elisabetta; Santi, Michela; Pasqualini, Paola; Capecchi, Alessandro; Piccalò, Giacomo; Margheri, Massimo; di Pasquale, Giuseppe; Galvani, Marcello; Bolognese, Leonardo; Gonzini, Lucio; Maggioni, Aldo Pietro

    2013-04-01

    The in-hospital management of patients on warfarin undergoing coronary stent implantation (PCI-S) is variable, and the in-hospital outcome incompletely defined. To determine the adherence to the current recommendations, and the incidence of adverse events, we carried out the prospective, multicenter, observational WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319). All consecutive patients on warfarin undergoing PCI-S at 37 Italian centers were enrolled and followed for 12 months. Outcome measures were: major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, need for urgent revascularization, stroke, and venous thromboembolism, and major and minor bleeding. In this paper, we report the in-hospital findings. Out of the 411 patients enrolled, 92% were at non-low (ie, moderate or high) thromboembolic risk. The radial approach and bare-metal stents were used in 61% and 60% of cases, respectively. Drug-eluting stents were essentially reserved to patients with diabetes, which in turn, significantly predicted the implantation of drug-eluting stents (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.29-3.17; P=.002). The in-hospital MACE and major bleeding rates were 2.7% and 2.1%, respectively. At discharge, triple therapy (TT) of warfarin, aspirin, and clopidogrel was prescribed to 76% of patients. Prescription of TT was significantly more frequent in the non-low thromboembolic risk group. Non-low thromboembolic risk, in turn, was a significant predictor of TT prescription (OR, 11.2; 95% CI, 4.83-26.3; P<.0001). In conclusion, real-world warfarin patients undergoing PCI-S are largely managed according to the current recommendations. As a consequence, the risk of in-hospital MACE and major bleedings appears limited and acceptable.

  15. Nationwide time trends and risk factors for in-hospital falls-related major injuries

    DEFF Research Database (Denmark)

    Jorgensen, T. S. H.; Hansen, A. H.; Sahlberg, M.

    2015-01-01

    BackgroundAccidental falls during hospitalisation have a range of complications and more information is needed to improve prevention. We investigated patterns of in-hospital fall-related major injuries in the period 2000-2012 and the association between chronic conditions and in-hospital fall......-related major injuries. MethodsUsing administrative databases, patients aged 65+ years with in-hospital falls causing fractures or head injuries with need for surgery or intensive observation were identified as cases and were individually matched with five controls. Joinpoint regression was used to examine time...... trends and conditional logistic regression was used to analyse odds ratio (OR) for in-hospital falls-related major injuries according to a range of comorbidities. ResultsFour thousand seven hundred and fifty-four cases were identified from 2000 to 2012 and the most common injury was femur fracture (61...

  16. Quality and Safety of Home ICP Monitoring Compared with In-Hospital Monitoring

    DEFF Research Database (Denmark)

    Andresen, Morten; Juhler, Marianne; Munch, Tina Nørgaard

    2012-01-01

    Introduction: Intracranial pressure (ICP) monitoring is usually conducted in-hospital using stationary devices. Modern mobile ICP monitoring systems present new monitoring possibilities more closely following the patients' daily life. We reviewed patient safety, quality of technical data...

  17. Occult large epidural hemorrhage in a newborn infant after in-hospital fall.

    Science.gov (United States)

    Sato, R

    2018-05-23

    Management of newborn infants fell in-hospital is especially challenging given the limited signs and symptoms of intracranial hemorrhage in this age group. We present a case of a four day old well appearing newborn infant found to have a severe epidural hemorrhage requiring emergent surgical drainage. Development of imaging protocols for newborn infants suffering in-hospital falls need to consider the potential consequences of missing actionable intracranial hemorrhage when relying on clinical observation as a management strategy.

  18. Impact of early in-hospital medication review by clinical pharmacists on health services utilization.

    Directory of Open Access Journals (Sweden)

    Corinne M Hohl

    Full Text Available Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients.We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient's medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use.Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058 in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03, representing 11% reduction in the median length of stay

  19. Basic Practices Aiding High-Performance Homeland Security Regional Partnerships

    National Research Council Canada - National Science Library

    Caudle, Sharon

    2006-01-01

    ....1 A national priority under the Goal is the use of geographic regions across the nation to share risk, engage in joint planning, and share resources to develop and sustain risk-based capability levels...

  20. Elevated serum osteoprotegerin levels predict in-hospital major adverse cardiac events in patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Çanga, Aytun; Durakoğlugil, Murtaza Emre; Erdoğan, Turan; Kirbaş, Aynur; Yilmaz, Adnan; Çiçek, Yüksel; Ergül, Elif; Çetin, Mustafa; Kocaman, Sinan Altan

    2012-11-01

    The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-κB (RANK)/RANK ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels displayed higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarction (TIMI) risk score, TIMI risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed vessels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of cardiovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd

  1. Outcome among patients suffering from in-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Trpković Sladjana

    2014-01-01

    Full Text Available Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA. Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC. Results. Most patients (61% had cardiac etiology. Return of spontaneous circulation (ROSC was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69±11.37, (p<0.05, non-surgical patients (76.1%, (p<0.01 and in patients who were in continuous monitoring (66.7% (p<0.05. The outcome of CPR was significantly better in patients who received advanced life support (ALS (76.6% (p<0.01. Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67±1.13 min, (p<0.01. A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

  2. Dose field research of analysis room for in-hospital neutron irradiator

    International Nuclear Information System (INIS)

    Zhang Zizhu; Song Mingzhe; Li Wei; Chen Jun; Yang Yong; Li Yiguo

    2012-01-01

    Neutron equivalent dose rate and y ray dose rate inside the analysis room of the in-hospital neutron irradiator (IHNI) and outdoor were measured. The results show that γ ray dose rate inside the analysis room exceeds calculation value many times and γ/ ray dose rate outdoor is higher than supervision region dose limit of 7.5 μSv/h. According to the measurement results and the Monte Carlo simulation, the following shielding plan was adopted. Lead shielding with thickness of 16 cm was installed on the wall, which faces the neutron beam, to shield γ ray, and lithium polyethylene plate with thickness of l cm was installed on all the wall (not including ceiling and floor) to shield scattering neutron. After shielding transformation, the highest γ ray dose rate point inside the analysis room decreased 277 times, the neutron equivalent dose rate decreased 5.8 times, and the outdoor γ/ray dose rate decreased nearly 90 times. (authors)

  3. Beam test results of CMS RPCs at high eta region under high-radiation environment

    CERN Document Server

    Park, S; Bahk, S Y; Hong, B; Hong, S J; Kang, D H; Kang, T I; Kim, T J; Kim, Y J; Kim, Y U; Koo, D G; Lee, H W; Lee, K S; Lee, S J; Lim, J K; Moon, D H; Nam, S K; Oh, J K; Park, W J; Rhee, J T; Ryu, M S; Shim, H H; Sim, K S

    2004-01-01

    The Compact Muon Solenoid (CMS) forward resistivity plate chambers (RPCs) at the high eta region must be operated in presence of a radiation-induced rate as high as 1 kHz/cm**2. It is still unknown if the RPCs coated with linseed oil can be operated under such a high- radiation environment over the lifetime of CMS. Non-oiled RPCs may be one of the options since phenolic or melamine-coated bakelite is chemically stabler than linseed oil. We have constructed oiled and non-oiled RPCs at the high eta region of CMS using phenolic bakelite and tested them in the Gamma Irradiation Facility at CERN. While both RPCs show the same characteristics in the efficiency and the strip multiplicity, the non-oiled RPC generates an intrinsic noise rate of 50 Hz/cm**2, compared to only 5 Hz/cm**2 for the oiled RPC, both at 10.0kV which is about 100 V above the 95% knee of the efficiency curve.

  4. Beam test results of CMS RPCs at high eta region under high-radiation environment

    International Nuclear Information System (INIS)

    Park, S.; Ahn, S.H.; Bahk, S.Y.; Hong, B.; Hong, S.J.; Kang, D.H.; Kang, T.I.; Kim, T.J.; Kim, Y.J.; Kim, Y.U.; Koo, D.G.; Lee, H.W.; Lee, K.S.; Lee, S.J.; Lim, J.K.; Moon, D.H.; Nam, S.K.; Oh, J.K.; Park, W.J.; Rhee, J.T.; Ryu, M.S.; Shim, H.H.; Sim, K.S.

    2004-01-01

    The Compact Muon Solenoid (CMS) forward resistivity plate chambers (RPCs) at the high eta region must be operated in presence of a radiation-induced rate as high as 1kHz/cm2. It is still unknown if the RPCs coated with linseed oil can be operated under such a high-radiation environment over the lifetime of CMS. Non-oiled RPCs may be one of the options since phenolic or melamine-coated bakelite is chemically stabler than linseed oil. We have constructed oiled and non-oiled RPCs at the high eta region of CMS using phenolic bakelite and tested them in the Gamma Irradiation Facility at CERN. While both RPCs show the same characteristics in the efficiency and the strip multiplicity, the non-oiled RPC generates an intrinsic noise rate of 50Hz/cm2, compared to only 5Hz/cm2 for the oiled RPC, both at 10.0kV which is about 100V above the 95% knee of the efficiency curve

  5. ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality.

    Science.gov (United States)

    Malik, Ali Osama; Abela, Oliver; Allenback, Gayle; Devabhaktuni, Subodh; Lui, Calvin; Singh, Aditi; Diep, Jimmy; Yamashita, Takashi; Yoo, Ji Won; Malhotra, Sanjay; Ahsan, Chowdhury

    2017-08-01

    Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed. Outpatient-onset STEMI patients were identified. The state of Nevada was divided into three divisions based on population densities, defined as population per square mile. Division A included counties with population density of 200 per square mile. Trends in use of STEMI-related therapies and the impact on in-hospital mortality rates were compared. Almost 20% of the patients with outpatient-onset STEMI do not get any STEMI-related therapy and have significantly higher mortality rate. Patients from Division A do not have direct access to percutaneous coronary intervention (PCI) centers. These patients receive less STEMI-related therapies. Low-volume PCI centers had equivalent mortality rates for STEMI patients who got PCI, compared to high-volume PCI centers. Policies must be created and processes streamlined so all STEMI patients in Nevada receive appropriate treatment. Copyright © 2017. Published by Elsevier B.V.

  6. High-Resolution Regional Phase Attenuation Models of the Iranian Plateau and Surrounding Regions

    Science.gov (United States)

    2014-03-03

    crustal structure or sediment thickness across much of the Iranian plateau. The lone exception is the region between the central Zagros and the Lut block...L11303, 2007. Meunier, P., N. Hovius, and J. A. Haines, Topographic site effects and the location of earthquake induced landslides, Earth Planet . Sci

  7. The Regional-Matrix Approach to the Training of Highly Qualified Personnel for the Sustainable Development of the Mining Region

    Science.gov (United States)

    Zhernov, Evgeny; Nehoda, Evgenia

    2017-11-01

    The state, regional and industry approaches to the problem of personnel training for building an innovative knowledge economy at all levels that ensures sustainable development of the region are analyzed in the article using the cases of the Kemerovo region and the coal industry. A new regional-matrix approach to the training of highly qualified personnel is proposed, which allows to link the training systems with the regional economic matrix "natural resources - cognitive resources" developed by the author. A special feature of the new approach is the consideration of objective conditions and contradictions of regional systems of personnel training, which have formed as part of economic systems of regions differ-entiated in the matrix. The methodology of the research is based on the statement about the interconnectivity of general and local knowledge, from which the understanding of the need for a combination of regional, indus-try and state approaches to personnel training is derived. A new form of representing such a combination is the proposed approach, which is based on matrix analysis. The results of the research can be implemented in the practice of modernization of professional education of workers in the coal industry of the natural resources extractive region.

  8. Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter?

    Science.gov (United States)

    Casazza, Franco; Becattini, Cecilia; Rulli, Eliana; Pacchetti, Ilaria; Floriani, Irene; Biancardi, Marco; Scardovi, Angela Beatrice; Enea, Iolanda; Bongarzoni, Amedeo; Pignataro, Luigi; Agnelli, Giancarlo

    2016-09-01

    Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.

  9. Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

    Science.gov (United States)

    Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

    2014-01-01

    Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital

  10. In-hospital fellow coverage reduces communication errors in the surgical intensive care unit.

    Science.gov (United States)

    Williams, Mallory; Alban, Rodrigo F; Hardy, James P; Oxman, David A; Garcia, Edward R; Hevelone, Nathanael; Frendl, Gyorgy; Rogers, Selwyn O

    2014-06-01

    Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events. A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods. Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (Pcommunicated 89% of events during IHFC vs 51% of events during HC (PCommunication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, Pcommunicated 66% of events (94% IHFC vs 52% HC, PCommunication errors were lower in all ICUs during IHFC (Pcommunication errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. [The role of patient flow and surge capacity for in-hospital response in mass casualty events].

    Science.gov (United States)

    Sefrin, Peter; Kuhnigk, Herbert

    2008-03-01

    Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

  12. Basic geriatric assessment does not predict in-hospital mortality after PEG placement

    Directory of Open Access Journals (Sweden)

    Smoliner Christine

    2012-09-01

    Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. Methods All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. Results A total of 1232 patients (60.4% women with a median age of 82 years (range 60 to 99 years were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664, with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%. In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR 1.030, 95% confidence interval (CI 1.003-1.056, male sex (OR 1.741, 95% CI 1.216-2.493, and pneumonia (OR 2.641, 95% CI 1.457-4.792 or the diagnosis group ‘miscellaneous disease’ (OR 1.864, 95% CI 1

  13. Trial of accelerator cells machining with high precision and high efficiency at Okayama region

    International Nuclear Information System (INIS)

    Yoshikawa, Mitsuo; Yoden, Hiroyuki; Yokomizo, Seiichi; Sumida, Tsuneto; Kunishida, Jun; Oshita, Isao

    2005-01-01

    In the framework of the project 'Promotion of Science and Technology in Regional Areas' by the Ministry of Education, Culture, Sports, Science and Technology, we have prepared a special apparatus for machining accelerator cells with a high precision and a high efficiency for the future linear collider. A machining with as small an error as 2 micrometers has been realized. Necessary time to finish one accelerator cell is reduced from 128 minutes to 34 minutes due to the suppression of the heating of the object at the machining. If newly developed one chuck method was employed, the precision and efficiency would be further improved. By cutting at both sides of the spindle, the necessary time for machining would be reduced by half. (author)

  14. High Regional Variation in Urethroplasty in the United States

    Science.gov (United States)

    Figler, Bradley D.; Gore, John L.; Holt, Sarah K.; Voelzke, Bryan B.; Wessells, Hunter

    2015-01-01

    Purpose We identified clinical and regional factors associated with the use of urethroplasty vs repeat endoscopic management for urethral stricture disease. Materials and Methods We analyzed claims for patients 18 to 65 years old in the 2007 to 2011 MarketScan ® Commercial Claims and Encounters Database with a diagnosis of urethral stricture. The primary outcome was treatment with urethroplasty vs repeat endoscopic management, defined as more than 2 dilations or direct vision internal urethrotomies. The likelihood of urethroplasty vs repeat endoscopic management was determined for each major metropolitan area in the United States. Multivariate logistic regression was done to identify factors associated with urethroplasty. Results We identified 41,056 patients with urethral stricture, yielding a diagnosis rate of 296/100,000 men in MarketScan. Repeat endoscopic management and urethroplasty were performed in 2,700 and 1,444 patients, respectively. Compared to patients treated with repeat endoscopic management those with urethroplasty were younger (median age 44 vs 54 years) and more likely to have a Charlson comorbidity score of 0 (84% vs 77%), have traveled out of a metropolitan area for care (34% vs 17%) and have a reconstructive urologist in the treatment metropolitan area (76% and 62%, each p urethroplasty vs repeat endoscopic management. Conclusions Despite the well established benefits of urethroplasty compared to repeat endoscopic management a strong bias for repeat endoscopic management exists in many regions in the United States. PMID:25072180

  15. SUSTAINABLE DEVELOPMENT OF HIGHLY TOURISTIC REGION OF ISTRIA

    Directory of Open Access Journals (Sweden)

    Jasmina GRZINIC

    2010-01-01

    Full Text Available As the scale of tourism grows, the resource use threatens to become unsustainable. Withought environmental responsibility the levels of cheaper mass tourism will increase, forcing more “nature-based” tourism to move on to new destinations. This scenario is opposite to the “Croatian Tourism Development by 2010” strategy. With a favourable geographic position, almost at the heart of Europe, Istria has always represented a bridge connecting the Middle European continental area with the Mediterranean. This area is the most visited Croatian tourist region with 27% of all visitors and 35% of time spent in all of Croatia. The Croatian National Bank’s preliminary figures for 2007 show that international tourism generated 18.4% of Croatian GDP. For these reasons the Istrian tourism industry can not ignore environmental issues in its management and requires the informed participation of all relevant stakeholders (according to the Agenda 21 for tourism industry. Properly planned tourism development, combined with environmental protection, produces the concept of sustainable tourism. Environmentally sustainable form of tourism represents a step forward from "sea and sun" mass tourism developed at the coastal part of Istria. There are a myriad of definitions for Sustainable Tourism, including eco-tourism, green travel, environmentally and culturally responsible tourism, fair trade and ethical travel. Mentioned selective tourism forms are adopted as the concept of the present and future Istrian destination development.

  16. Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction.

    Science.gov (United States)

    Wei, Xue-Biao; Liu, Yuan-Hui; He, Peng-Cheng; Jiang, Lei; Zhou, Ying-Ling; Chen, Ji-Yan; Tan, Ning; Yu, Dan-Qing

    2017-01-01

    To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMI ≤3, n = 213), moderate-risk group (TIMI 4-6, n = 285), and high-risk group (TIMI ≥7, n = 175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3 %, p risk group. Multivariate analysis showed that TIMI risk score (OR 1.24, 95 % CI 1.04-1.48, P = 0.015) and LVEF (OR 3.85, 95 % CI 1.58-10.43, P = 0.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, p = 0.571) or 1-year death (AUC: 0.743 vs 0.728, p = 0.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, p = 0.033) or 1-year death (AUC: 0.763 vs 0.728, p = 0.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, p value to TIMI risk score.

  17. Health effects in residents of regions with high background radiation

    International Nuclear Information System (INIS)

    Hanson, G.P.

    1984-01-01

    Possible health problems created by high natural levels of background radiation are hard to detect, partly because the health problems involved would exist to some degree irrespective of radiation exposure, partly because other factors affect the incidence of such problems, and partly because the differences between normal background radiation levels and radiation levels found in most high-radiation areas are not extreme. Nevertheless, the need to know about such health effects is evident, and so various studies conducted over the past 30 years have sought to determine whether those effects exist and what they are. Overall, however, the fragmentary and uncertain nature of many of these findings makes it hard to draw firm conclusions about the health risks involved or the desirability of countermeasures. So despite considerable efforts and some progress over the past three decades, the need for a clear quantitative assessment of the consequences is as great as ever

  18. Trends in in-hospital mortality among patients with stroke in China.

    Directory of Open Access Journals (Sweden)

    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  19. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Faraoni, David; DiNardo, James A; Goobie, Susan M

    2016-12-01

    The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

  20. In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

    Science.gov (United States)

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

    2016-02-15

    Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Prevalence of prediabetes in patients with acute coronary syndrome: impact on in-hospital outcomes.

    Science.gov (United States)

    AbuShady, M M; Mohamady, Y; Enany, B; Nammas, W

    2015-02-01

    Prediabetes is a serious condition that is associated with an increase in cardiovascular morbidity and mortality. We sought to explore the prevalence of prediabetes in patients admitted with acute coronary syndrome (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Prospectively, we enrolled 200 patients not known to have diabetes or prediabetes, admitted with ACS. Laboratory tests included fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) after 75 g glucose, HbA1c and lipid profile. Electrocardiogram and echocardiography were done. The primary end-point was in-hospital major adverse cardiovascular events (MACE). Mean age was 50.9 ± 6.8 years (70.5% males). The prevalence of patients with diabetes and patients with prediabetes was 24.5% and 20% respectively. Newly discovered diabetic patients were excluded. Compared with patients without diabetes, prediabetic patients had a higher body mass index (BMI) (P = 0.002) and a longer hospital stay (P = 0.09). In-hospital MACE occurred in 10 (25%) patients with prediabetes versus six (5.4%) in patients without diabetes (P = 0.001). In-hospital MACE correlated with prediabetes (r = 0.28, P prediabetes as the only independent predictor of in-hospital MACE. Prediabetes is common in patients presenting with ACS who are not previously known to have diabetes. Prediabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. © 2014 Royal Australasian College of Physicians.

  2. Simple Scoring System to Predict In-Hospital Mortality After Surgery for Infective Endocarditis.

    Science.gov (United States)

    Gatti, Giuseppe; Perrotti, Andrea; Obadia, Jean-François; Duval, Xavier; Iung, Bernard; Alla, François; Chirouze, Catherine; Selton-Suty, Christine; Hoen, Bruno; Sinagra, Gianfranco; Delahaye, François; Tattevin, Pierre; Le Moing, Vincent; Pappalardo, Aniello; Chocron, Sidney

    2017-07-20

    Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m 2 (odds ratio [OR], 1.79; P =0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P =0.032), and critical state (OR, 2.37; P =0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  3. The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

    Science.gov (United States)

    Sakhnini, Ali; Saliba, Walid; Schwartz, Naama; Bisharat, Naiel

    2017-06-01

    Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance

  4. High-risk regions and outbreak modelling of tularemia in humans.

    Science.gov (United States)

    Desvars-Larrive, A; Liu, X; Hjertqvist, M; Sjöstedt, A; Johansson, A; Rydén, P

    2017-02-01

    Sweden reports large and variable numbers of human tularemia cases, but the high-risk regions are anecdotally defined and factors explaining annual variations are poorly understood. Here, high-risk regions were identified by spatial cluster analysis on disease surveillance data for 1984-2012. Negative binomial regression with five previously validated predictors (including predicted mosquito abundance and predictors based on local weather data) was used to model the annual number of tularemia cases within the high-risk regions. Seven high-risk regions were identified with annual incidences of 3·8-44 cases/100 000 inhabitants, accounting for 56·4% of the tularemia cases but only 9·3% of Sweden's population. For all high-risk regions, most cases occurred between July and September. The regression models explained the annual variation of tularemia cases within most high-risk regions and discriminated between years with and without outbreaks. In conclusion, tularemia in Sweden is concentrated in a few high-risk regions and shows high annual and seasonal variations. We present reproducible methods for identifying tularemia high-risk regions and modelling tularemia cases within these regions. The results may help health authorities to target populations at risk and lay the foundation for developing an early warning system for outbreaks.

  5. Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ong CT

    2016-06-01

    Full Text Available Cheung-Ter Ong,1,2 Yi-Sin Wong,3 Chi-Shun Wu,1 Yu-Hsiang Su1 1Department of Neurology, Chia-Yi Christian Hospital, 2Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, 3Department of Family Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan, Republic of China Background/purpose: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients.Materials and methods: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed.Results: Of the 2,556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of the 2,556 patients (3.1% died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9% died during hospitalization. History of atrial fibrillation (AF, P<0.01 and stroke severity (P<0.01 were independent risk factors of in-hospital mortality. AF, stroke severity, cardioembolism stroke, and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complications of stroke that were attributed to in-hospital mortality. Approximately 70% of in-hospital mortality was related to stroke severity (total middle cerebral artery occlusion with herniation, basilar artery occlusion, and hemorrhagic transformation. The other 30% of in-hospital mortality was related to sepsis, heart disease, and other complications.Conclusion: AF is associated with higher in-hospital mortality rate than in patients without AF. For improving outcome of stroke patients, we also need to focus to reduce serious neurological

  6. Health effects in residents of high background radiation regions

    International Nuclear Information System (INIS)

    Hanson, G.P.; Komarov, E.

    1983-01-01

    Studies carried out in various countries and by the World Health Organization on health effects of exposure of populations to high levels of natural background radiation result in observations of different significance. There are indications of changes in chromosome aberration rate; Down's syndrome has been observed to be possibly related to radiation exposure; malignant neoplasms in bone apparently correspond to high concentrations of 226 Ra in drinking water. Although various researchers have looked for them, effects have not been demonstrated regarding cancer mortality (other than malignant neoplasms involving bone), gross congenital abnormalities, fertility index, growth and development, hereditary disease (other than the possibility of Down's syndrome), infant mortality, longevity, multiple births, sex ratio, or spontaneous abortion rate. On the basis of reported data clear quantitative conception of the risk of low-level radiation from natural sources could not be developed and feasibility studies of further epidemiological programmes should be organized. The possibility of reducing the collective population dose from natural sources could be further explored and a basis for necessary legal action on establishment of standards for possible sources of natural radiation, such as building materials, fertilizers, natural gas and water, might be developed. (author)

  7. WEAK LINE QUASARS AT HIGH REDSHIFT: EXTREMELY HIGH ACCRETION RATES OR ANEMIC BROAD-LINE REGIONS?

    International Nuclear Information System (INIS)

    Shemmer, Ohad; Trakhtenbrot, Benny; Netzer, Hagai; Anderson, Scott F.; Brandt, W. N.; Schneider, Donald P.; Diamond-Stanic, Aleksandar M.; Fan Xiaohui; Lira, Paulina; Plotkin, Richard M.; Richards, Gordon T.; Strauss, Michael A.

    2010-01-01

    We present Gemini-North K-band spectra of two representative members of the class of high-redshift quasars with exceptionally weak rest-frame ultraviolet emission lines (WLQs), SDSS J114153.34+021924.3 at z = 3.55 and SDSS J123743.08+630144.9 at z = 3.49. In both sources, we detect an unusually weak broad Hβ line and place tight upper limits on the strengths of their [O III] lines. Virial, Hβ-based black hole mass determinations indicate normalized accretion rates of L/L Edd =0.4 for these sources, which is well within the range observed for typical quasars with similar luminosities and redshifts. We also present high-quality XMM-Newton imaging spectroscopy of SDSS J114153.34+021924.3 and find a hard-X-ray photon index of Γ = 1.91 +0.24 -0.22 , which supports the virial L/L Edd determination in this source. Our results suggest that the weakness of the broad emission lines in WLQs is not a consequence of an extreme continuum-emission source but instead due to abnormal broad emission line region properties.

  8. Health effects in residents of high background radiation regions

    International Nuclear Information System (INIS)

    Hanson, G.P.

    1984-01-01

    Although the health effects of radiation doses in occupationally exposed persons had received attention, it was not until the 1950s, when the atmospheric atom bomb tests of the United States and the Soviet Union had raised the level of environmental radioactivity, that the long-term effects of low-level radiation dosage became a matter of popular concern throughout the world. The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) was created, and the World Health Organization (WHO) appointed an expert committee to provide advice concerning radiation and human health. In its first report, the WHO expert committee identified several areas of high natural radiation where studies of the exposed population might possibly provide information concerning the effects of chromic low-level radiation dosage

  9. Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system

    DEFF Research Database (Denmark)

    Bunkenborg, Gitte; Samuelson, Karin Samuelsonkarin; Poulsen, Ingrid

    2014-01-01

    In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional u...... of early warning scoring, structured observation charts, and clinical algorithms for bedside action....

  10. Soft Skills in Health Careers Programs: A Case Study of A Regional Vocational Technical High School

    Science.gov (United States)

    Park, Chong Myung

    2017-01-01

    The purpose of this study is to develop an understanding of the ways in which educational experiences might differ between a regional vocational technical high school (RVTH) and short-term career-training programs. A particular regional vocational technical high school was selected for its outstanding academic records and placement rates, and a…

  11. Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest.

    Science.gov (United States)

    Singal, Rohit K; Singal, Deepa; Bednarczyk, Joseph; Lamarche, Yoan; Singh, Gurmeet; Rao, Vivek; Kanji, Hussein D; Arora, Rakesh C; Manji, Rizwan A; Fan, Eddy; Nagpal, A Dave

    2017-01-01

    Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. Development and Validation of the Geriatric In-Hospital Nursing Care Questionnaire

    NARCIS (Netherlands)

    Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde

    ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development.

  13. Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe

    DEFF Research Database (Denmark)

    Draper, Elizabeth S; Manktelow, Bradley N; Cuttini, Marina

    2017-01-01

    to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death. METHODS: Standardized data collection for a geographically defined prospective cohort of VPTs (22(+0)-31(+6) weeks gestation...

  14. Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.

    Science.gov (United States)

    Launcelott, Sebastian; Ouzounian, Maral; Buth, Karen J; Légaré, Jean-Francois

    2012-09-01

    The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations. All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk. A total of 1,521 patients underwent redo procedures between 1995 and 2010 at a single institution. Coronary bypass procedures were the most common previous (58%) or planned operations (54%). The unadjusted in-hospital mortality for all redo cases was higher than for first-time procedures (9.7% vs. 3.4%; pscorecard was generated using these independent predictors, stratifying patients undergoing redo cardiac operations into 6 risk categories of in-hospital mortality ranging from risk to >40%. Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. In-hospital Death Prediction by Multilevel Logistic Regressin in Patients with Acute Coronary Syndromes

    Czech Academy of Sciences Publication Activity Database

    Reissigová, Jindra; Monhart, Z.; Zvárová, Jana; Hanzlíček, Petr; Grünfeldová, H.; Janský, P.; Vojáček, J.; Widimský, P.

    2013-01-01

    Roč. 9, č. 1 (2013), s. 11-17 ISSN 1801-5603 Institutional support: RVO:67985807 Keywords : multilevel logistic regression * acute coronary syndromes * risk factors * in-hospital death Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/img/ejbi/2013/1/Reissigova_en.pdf

  16. In-Hospital Death Prediction in Patients with Acute Coronary Syndrome

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Reissigová, Jindra; Zvárová, Jana; Grünfeldová, H.; Janský, P.; Vojáček, J.; Widimský, P.

    2013-01-01

    Roč. 1, č. 1 (2013), s. 52-52 ISSN 1805-8698. [EFMI 2013 Special Topic Conference. 17.04.2013-19.04.2013, Prague] Institutional support: RVO:67985807 Keywords : acute coronary syndrome * in-hospital death * prediction * multilevel logistic regression * non- PCI hospital Subject RIV: IN - Informatics, Computer Science

  17. Value in co-creation: Subjecting innovative in-hospital technologies to multi-stakeholder appraisal

    NARCIS (Netherlands)

    Abrishami Shirazi, Payam; Boer, Albert; Horstman, Klasien

    2017-01-01

    Abstract: This article addresses how we can account for a value-driven introduction of in-hospital innovations when value is prone to – sometimes considerable – uncertainty. The contribution of multi-disciplinary, evidenceinformed multi-stakeholder deliberation (MSD) to deal with value issues is

  18. Risk Factors for In-Hospital Mortality among Ischemic Stroke Patients in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Cheung-Ter Ong

    2016-06-01

    Conclusion: Nearly 30% of in-hospital mortality is associated with preventable factors. The prognosis of acute stroke can be improved by increased focus on reducing serious complications after stroke, particularly on the prevention of infection, heart disease, and increased intracranial pressure.

  19. In-Hospital Basic Life Support: Major Differences in Duration, Retraining Intervals, and Training Methods - A Danish Nationwide Study

    DEFF Research Database (Denmark)

    Rasmussen, Ditte K; Glerup Lauridsen, Kasper; Staerk, Mathilde

    2017-01-01

    Introduction: High-quality chest compressions and early defibrillation is essential to improve survival following in-hospital cardiac arrest. Efficient training in basic life support (BLS) for clinical staff is therefore important. This study aimed to investigate duration, training methods...... and retraining intervals for BLS training of clinical staff in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team. Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires inquired information on: A) Course duration...... and retraining interval, and B) Training methods and setting.Results: In total, 44 hospitals replied (response rate: 96%). BLS training for clinical staff was conducted in 41 hospitals (93%). Median (Q1;Q3) course duration was 1.5 (1;2.5) hours. Retraining was conducted every year (17%), every second year (56...

  20. Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism

    Science.gov (United States)

    Guo, Lu; Chughtai, Aamer Rasheed; Jiang, Hongli; Gao, Lingyun; Yang, Yan; Yang, Yang; Liu, Yuejian

    2016-01-01

    Backgrounds Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. Methods We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III–V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. Results We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04–1.66). Conclusions Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. PMID:28066591

  1. Exome sequencing generates high quality data in non-target regions

    Directory of Open Access Journals (Sweden)

    Guo Yan

    2012-05-01

    Full Text Available Abstract Background Exome sequencing using next-generation sequencing technologies is a cost efficient approach to selectively sequencing coding regions of human genome for detection of disease variants. A significant amount of DNA fragments from the capture process fall outside target regions, and sequence data for positions outside target regions have been mostly ignored after alignment. Result We performed whole exome sequencing on 22 subjects using Agilent SureSelect capture reagent and 6 subjects using Illumina TrueSeq capture reagent. We also downloaded sequencing data for 6 subjects from the 1000 Genomes Project Pilot 3 study. Using these data, we examined the quality of SNPs detected outside target regions by computing consistency rate with genotypes obtained from SNP chips or the Hapmap database, transition-transversion (Ti/Tv ratio, and percentage of SNPs inside dbSNP. For all three platforms, we obtained high-quality SNPs outside target regions, and some far from target regions. In our Agilent SureSelect data, we obtained 84,049 high-quality SNPs outside target regions compared to 65,231 SNPs inside target regions (a 129% increase. For our Illumina TrueSeq data, we obtained 222,171 high-quality SNPs outside target regions compared to 95,818 SNPs inside target regions (a 232% increase. For the data from the 1000 Genomes Project, we obtained 7,139 high-quality SNPs outside target regions compared to 1,548 SNPs inside target regions (a 461% increase. Conclusions These results demonstrate that a significant amount of high quality genotypes outside target regions can be obtained from exome sequencing data. These data should not be ignored in genetic epidemiology studies.

  2. Epidemiology, pathophysiology, and in-hospital management of pulmonary edema: data from the Romanian Acute Heart Failure Syndromes registry.

    Science.gov (United States)

    Chioncel, Ovidiu; Ambrosy, Andrew P; Bubenek, Serban; Filipescu, Daniela; Vinereanu, Dragos; Petris, Antoniu; Christodorescu, Ruxandra; Macarie, Cezar; Gheorghiade, Mihai; Collins, Sean P

    2016-02-01

    The objective of this study was to evaluate the clinical presentation, inpatient management, and in-hospital outcome of patients hospitalized for acute heart failure syndromes (AHFS) and classified as pulmonary edema (PE). The Romanian Acute Heart Failure Syndromes (RO-AHFS) study was a prospective, national, multicenter registry of all consecutive patients admitted with AHFS over a 12-month period. Patients were classified at initial presentation by clinician-investigators into the following clinical profiles: acute decompensated HF, cardiogenic shock, PE, right HF, or hypertensive HF. RO-AHFS enrolled 3224 patients and 28.7% (n = 924) were classified as PE. PE patients were more likely to present with pulmonary congestion, tachypnea, tachycardia, and elevated systolic blood pressure and less likely to have peripheral congestion and body weight increases. Mechanical ventilation was required in 8.8% of PE patients. PE patients received higher doses (i.e. 101.4 ± 27.1 mg) of IV furosemide for a shorter duration (i.e. 69.3 ± 22.3 hours). Vasodilators were given to 73.6% of PE patients. In-hospital all-cause mortality (ACM) in PE patients was 7.4%, and 57% of deaths occurred on day one. Increasing age, concurrent acute coronary syndromes, life-threatening ventricular arrhythmias, elevated BUN, left bundle branch block, inotrope therapy, and requirement for invasive mechanical ventilation were independent risk factors for ACM. In this national registry, the PE profile was found to be a high-acuity clinical presentation with distinctive treatment patterns and a poor short-term prognosis. Advances in the management of PE may necessitate both the development of novel targeted therapies as well as systems-based strategies to identify high-risk patients early in their course.

  3. Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.

    Science.gov (United States)

    Martínez-Martínez, M M; Martínez-Sánchez, P; Fuentes, B; Cazorla-García, R; Ruiz-Ares, G; Correas-Callero, E; Lara-Lara, M; Díez-Tejedor, E

    2013-02-01

    Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  4. Are n-3 PUFA dietary recommendations met in in-hospital and school catering?

    Science.gov (United States)

    Molendi-Coste, O; Legry, V; Leclercq, I A

    2011-06-01

    Literature provides compelling evidence for the health benefits of n-3 polyunsaturated fatty acids (PUFA) consumption and low n-6/n-3 ratio, in particular, on inflammation and metabolic syndrome prevention and treatment. Consequently, recommendations were established for adequate n-3 PUFA supplies in the general population. The aim of our study was to evaluate the fatty acid (FA) profile in collective catering in relation to those recommendations. We obtained composition of lunches provided by the Township of Lille (France) to children and adults, and of "standard", "low-fat" and "for diabetic" menus from the catering service of St Luc university hospital (Brussels, Belgium). The average proportions of fish, meat, oils, and dairy were used to estimate total, saturated, monounsaturated and polyunsaturated (n-6 and n-3) FA contents. We used official tables of foodstuffs composition provided by the French Agency for Food Safety, the project "Nutritional Composition of Aquatic Products", the French Institute for Nutrition, and the USDA National Nutrient Database for Standard Reference. French guidelines were taken as reference for daily recommended intakes. n-3 PUFA content in lunches provided by municipal catering and in in-hospital menus were slightly below recommended intakes. In the latter, n-3 PUFA enriched margarine contributed for 50% to daily intakes. Despite, the n-6/n-3 ratio was too high, especially in municipal catering (around 20), related to excessive n-6 PUFA supply. Our results highlight that meeting n-3 PUFA nutritional recommendation remains challenging for collective catering. A detailed analysis of provided menus represents a powerful tool to increase awareness and foster improvement in practice.

  5. Variability in case-mix adjusted in-hospital cardiac arrest rates.

    Science.gov (United States)

    Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

    2012-02-01

    It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; PCase-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

  6. The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

    Science.gov (United States)

    Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

    2011-01-01

    Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited 20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (presuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

  7. Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality.

    Science.gov (United States)

    Dharmarajan, Kumar; Swami, Sunil; Gou, Ray Y; Jones, Richard N; Inouye, Sharon K

    2017-05-01

    (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. Large academic hospital. Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  8. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

    Directory of Open Access Journals (Sweden)

    Machado Cristiano V

    2011-06-01

    Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

  9. In-hospital management and outcomes of acute coronary syndromes in relation to prior history of heart failure.

    Science.gov (United States)

    Zhang, Hanfei; Goodman, Shaun G; Yan, Raymond T; Steg, Ph Gabriel; Kornder, Jan M; Gyenes, Gabor T; Grondin, Francois R; Brieger, David; DeYoung, J Paul; Gallo, Richard; Yan, Andrew T

    2016-06-01

    The prognostic significance of prior heart failure in acute coronary syndromes has not been well studied. Accordingly, we evaluated the baseline characteristics, management patterns and clinical outcomes in patients with acute coronary syndromes who had prior heart failure. The study population consisted of acute coronary syndrome patients in the Global Registry of Acute Coronary Events, expanded Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events between 1999 and 2008. Of the 13,937 eligible patients (mean age 66±13 years, 33% female and 28.3% with ST-elevation myocardial infarction), 1498 (10.7%) patients had a history of heart failure. Those with prior heart failure tended to be older, female and had lower systolic blood pressure, higher Killip class and creatinine on presentation. Prior heart failure was also associated with significantly worse left ventricular systolic function and lower rates of cardiac catheterization and coronary revascularization. The group with previous heart failure had significantly higher rates of acute decompensated heart failure, cardiogenic shock, myocardial (re)infarction and mortality in hospital. In multivariable analysis, prior heart failure remained an independent predictor of in-hospital mortality (odds ratio 1.48, 95% confidence interval 1.08-2.03, p=0.015). Prior heart failure was associated with high risk features on presentation and adverse outcomes including higher adjusted in-hospital mortality in acute coronary syndrome patients. However, acute coronary syndrome patients with prior heart failure were less likely to receive evidence-based therapies, suggesting potential opportunities to target more intensive treatment to improve their outcome. © The European Society of Cardiology 2015.

  10. Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study.

    Science.gov (United States)

    Sutter, R; Semmlack, S; Spiegel, R; Tisljar, K; Rüegg, S; Marsch, S

    2017-09-01

    The aim was to determine differences of clinical, treatment and outcome characteristics between patients with in-hospital and out-of-hospital status epilepticus (SE). From 2005 to 2014, clinical data were assessed in adults with SE treated in an academic medical care centre. Clinical characteristics, treatment and outcomes were compared between patients with in-hospital and out-of-hospital SE. Amongst 352 patients, 213 were admitted with SE and 139 developed in-hospital SE. Patients with in-hospital SE had more acute/fatal aetiologies (60% vs. 35%, P Status Epilepticus Severity Score (STESS) was an independent predictor for death in both groups, increased Charlson Comorbidity Index and treatment refractory SE were associated with death only in patients with in-hospital SE. Continuous anaesthesia for refractory SE was associated with increased mortality only in patients with out-of-hospital SE. The area under the receiver operating curve was 0.717 for prediction of death by STESS in patients with in-hospital SE and 0.811 in patients with out-of-hospital SE. Patients with in-hospital SE had more fatal aetiologies and comorbidities, refractory SE, less return to functional baseline, and increased mortality compared to patients with out-of-hospital SE. Whilst the STESS was a robust predictor for death in both groups, the association between continuous anaesthesia and death was limited to out-of-hospital SE. © 2017 EAN.

  11. Multifaceted intervention to curb in-hospital over-prescription of proton pump inhibitors: A longitudinal multicenter quasi-experimental before-and-after study.

    Science.gov (United States)

    Del Giorno, Rosaria; Ceschi, Alessandro; Pironi, Michela; Zasa, Anna; Greco, Angela; Gabutti, Luca

    2018-04-01

    Proton pump inhibitors (PPIs) are indicated for a restricted number of clinical conditions, and their misuse can lead to several adverse effects. Despite that, the proportion of overuse is alarmingly high. To test the efficacy of a multifaceted strategy in order to achieve a significant reduction of new PPI prescriptions at discharge in hospitalized patients. Multicenter longitudinal quasi-experimental before-and-after study conducted from July 1st, 2014 to June 30th, 2017. 44,973 admissions in a network of 5 public teaching hospitals of the Italian-speaking region of Switzerland. Multifaceted strategy consisting in a continuous transparent monitoring-benchmarking and in capillary educational interventions applied in the internal medicine departments. To confirm the causality of the results we monitored the trend of new PPI prescriptions in the, not exposed to the intervention, surgery departments of the same hospital network. New PPI prescriptions at hospital discharge. Over the 36month study period 44,973 patient files were analyzed. At admission, comparing internal medicine vs. surgery departments, 44.9% vs. 23.3% of patients were already being treated with a PPI. The annual rate of new PPI prescriptions, for internal medicine showed a decreasing trend: 19, 19, 18, 16% in years 2014, 2015, 2016, 2017, respectively (pintroduction of a multifaceted intervention significantly reduced the time trend of PPI prescriptions at hospital discharge in internal medicine departments. Further studies are needed to confirm whether the strategy proposed could contribute to optimize the in-hospital drug prescription behavior in other healthcare settings as well. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. High genetic diversity in the coat protein and 3' untranslated regions

    Indian Academy of Sciences (India)

    The 3′ terminal region consisting of the coat protein (CP) coding sequence and 3′ untranslated region (3′UTR) was cloned and sequenced from seven isolates. Sequence comparisons revealed considerable genetic diversity among the isolates in their CP and 3′UTR, making CdMV one of the highly variable members ...

  13. 77 FR 35357 - Atlantic Highly Migratory Species; Commercial Atlantic Region Non-Sandbar Large Coastal Shark...

    Science.gov (United States)

    2012-06-13

    ... Highly Migratory Species; Commercial Atlantic Region Non-Sandbar Large Coastal Shark Fishery Opening Date... commercial Atlantic region non-sandbar large coastal shark fishery. This action is necessary to inform... large coastal shark fishery will open on July 15, 2012. FOR FURTHER INFORMATION CONTACT: Karyl Brewster...

  14. Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Sola, Michael; Venkatesh, Kiran; Caughey, Melissa; Rayson, Robert; Dai, Xuming; Stouffer, George A; Yeung, Michael

    2017-09-01

    To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P  4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. Lipid paradox in acute myocardial infarction-the association with 30-day in-hospital mortality.

    Science.gov (United States)

    Cheng, Kai-Hung; Chu, Chih-Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng-Hsiung; Lai, Wen-Ter

    2015-06-01

    Elevated low-density lipoprotein cholesterol and triglycerides are major risk factors for coronary artery disease. However, fatty acids from triglycerides are a major energy source, low-density lipoprotein cholesterol is critical for cell membrane synthesis, and both are critical for cell survival. This study was designed to clarify the relationship between lipid profile, morbidity as assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction. A noninterventional observational study. Coronary care unit in a university hospital. Seven hundred twenty-four patients with acute myocardial infarction in the coronary care program of the Bureau of Health Promotion were analyzed. None. Low-density lipoprotein cholesterol and triglyceride levels were significantly lower in high-Killip (III+IV) patients compared with low-Killip (I+II) patients and in those who died compared with those who survived beyond 30 days (both pvalues for predicting 30-day mortality and were associated with hazard ratios of 1.65 (95% CI, 1.18-2.30) and 5.05 (95% CI, 1.75-14.54), and the actual mortality rates were 23% in low low-density lipoprotein, 6% in high low-density lipoprotein, 14% in low triglycerides, and 3% in high triglycerides groups, respectively. To test the synergistic effect, high-Killip patients with triglycerides less than 62.5 mg/dL and low-density lipoprotein cholesterol less than 110 mg/dL had a 10.9-fold higher adjusted risk of mortality than low-Killip patients with triglycerides greater than or equal to 62.5 mg/dL and low-density lipoprotein cholesterol greater than or equal to 110 mg/dL (pparadox also improved acute myocardial infarction short-term outcomes prediction on original Killip and thrombolytic in myocardial infarction scores. Low low-density lipoprotein cholesterol, low triglycerides, and high Killip severity were associated with significantly higher 30-day in-hospital mortality in patients presenting with acute myocardial

  16. [Door-to-balloon time and in-hospital mortality in patients with ST-evaluation myocardial infarction: a network experience in a province in northwest Tuscany, Italy].

    Science.gov (United States)

    Paradossi, Umberto; Palmieri, Cataldo; Trianni, Giuseppe; Ravani, Marcello; Vaghetti, Marco; Rizza, Antonio; Gianetti, Jacopo; Cardullo, Simona; Chabane, Hakim; Maffei, Stefano; Berti, Sergio

    2010-05-01

    A network system for ST-elevation myocardial infarction (STEMI) patients offers a quick diagnosis and a rapid transfer to a specialized center for primary percutaneous coronary intervention. The aim of our study was to evaluate the relationship between door-to-balloon time and in-hospital mortality in our network of STEMI patients. Our Hub & Spoke network in the province of Massa-Carrara in the northwest of Tuscany Region, Italy, began in April 2006. This program involved 5 Spoke and 1 Hub centers, 1 medical helicopter, 3 advanced life support ambulances with direct transmission of the ECG and vital parameters to our cath lab on call 24h a day for primary percutaneous coronary intervention. Data regarding clinical, echocardiographic and hemodynamic parameters, the door-to-balloon (DTB) time and their impact on mortality were analyzed. Up to January 2008, 312 STEMI patients were enrolled (242 male, mean age 66.6 +/- 12.3 years). The DTB time was 93 min (79-117, 25th-75th percentile, respectively). The gold standard of a DTB mountain area. Patients from the coast (n = 238) had a DTB time lower than patients from the mountain area (89.5 vs 122.5 min, p < 0.0001), and the risk of in-hospital mortality was significantly and independently correlated with the increase in DTB time (p = 0.04). CONCLUSIONS; Our data confirm the correlation between DTB time and in-hospital mortality. More efforts are necessary to reduce the time to treatment and mortality rates.

  17. The clinical epidemiology of spontaneous ICH in a sub-Sahara African country in the CT scan era: a neurosurgical in-hospital cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Amos Olufemi Adeleye

    2015-08-01

    Full Text Available Background There is paucity of data-driven scientific reports from sub-Saharan Africa on the burden of spontaneous intracerebral haemorrhage (sICH. We have maintained a prospective consecutive in-hospital data base of cases of sICH referred for neurosurgical intervention over a 5-year period. Methods This is a cross-sectional descriptive study of the clinical epidemiology and brain-CT characterization of sICH from the data base in this region in the current era. Results There were 63 subjects, 38 (60.3% males, aged 28 to 85 years, mean 55.7 (SD, 12.7, the modal age distribution being the sixth decade. Uncontrolled hypertension was the main predisposition in the study: present, premorbid, in 79% but uncontrolled in 88% of these known cases, and exhibited malignant derangements of blood pressure in more than half. The clinical ictus to in-hospital presentation was delayed, median 72 hours; was in severe clinical state in 70%; 57% was comatose, and was complicated with fever in 57% and respiratory morbidity also in 55.6%. The main clinical symptomatology was hemiparesis, headache, vomiting and aphasia. The sICH was supratentorial on brain CT in 85.7%, ganglionic in 50.8% and thalamic in 58.3% of the latter. The bleed had CT evidence of mass effect and intraventricular extension in more than half. Twenty three patients (36.5% underwent operative interventionsConclusions In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH. In-hospital clinical presentation is delayed and in critical state, and, the bleeding is uncontrolled hypertension related in >95%.

  18. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

    Directory of Open Access Journals (Sweden)

    Librero Julián

    2012-01-01

    Full Text Available Abstract Background While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair. Methods A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery ( Results Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%. However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis. Conclusions Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.

  19. Achieving high baryon densities in the fragmentation regions in heavy ion collisions at top RHIC energy

    International Nuclear Information System (INIS)

    Li, Ming; Kapusta, Joseph I.

    2017-01-01

    Heavy ion collisions at extremely high energy, such as the top energy at RHIC, exhibit the property of transparency where there is a clear separation between the almost net-baryon-free central rapidity region and the net-baryon-rich fragmentation region. We calculate the net-baryon rapidity loss and the nuclear excitation energy using the energy-momentum tensor obtained from the McLerran-Venugopalan model. Nuclear compression during the collision is further estimated using a simple space-time picture. The results show that extremely high baryon densities, about twenty times larger than the normal nuclear density, can be achieved in the fragmentation regions. (paper)

  20. The Far East taiga forest: unrecognized inhospitable terrain for migrating Arctic-nesting waterbirds?

    Directory of Open Access Journals (Sweden)

    Xin Wang

    2018-02-01

    Full Text Available The degree of inhospitable terrain encountered by migrating birds can dramatically affect migration strategies and their evolution as well as influence the way we develop our contemporary flyway conservation responses to protect them. We used telemetry data from 44 tagged individuals of four large-bodied, Arctic breeding waterbird species (two geese, a swan and one crane species to show for the first time that these birds fly non-stop over the Far East taiga forest, despite their differing ecologies and migration routes. This implies a lack of suitable taiga refuelling habitats for these long-distance migrants. These results underline the extreme importance of northeast China spring staging habitats and of Arctic areas prior to departure in autumn to enable birds to clear this inhospitable biome, confirming the need for adequate site safeguard to protect these populations throughout their annual cycle.

  1. Impact of professionalism in nursing on in-hospital bedside monitoring practice

    DEFF Research Database (Denmark)

    Bunkenborg, Gitte; Samuelson, Karin; Akeson, Jonas

    2013-01-01

    practice) and two sub-themes (Knowledge and skills and Involvement in clinical practice through reflections) were identified. Three categories (Decision-making, Sharing of knowledge, and Intra- and interprofessional interaction) were found to be associated with the theme, the sub-themes, and with each...... other. CONCLUSION: Clinical monitoring practice varies considerably between nurses with different individual levels of professionalism. Future initiatives to improve patient safety by further developing professionalism among nurses need to embrace individual and organizational attributes to strengthen......AIM: This article reports a study exploring nursing practice of monitoring in-hospital patients including intra- and interprofessional communication and collaboration. BACKGROUND: Sub-optimal care in general in-hospital wards may lead to admission for intensive care, cardiac arrest, or sudden death...

  2. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

    DEFF Research Database (Denmark)

    Regueiro, Ander; Linke, Axel; Latib, Azeem

    2016-01-01

    IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective...... endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter...... aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20...

  3. Admission Serum Uric Acid Levels and In-Hospital Outcomes in Patients with Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Abu Sadique Abdullah

    2015-05-01

    Full Text Available Background: Uric acid is an independent risk factor for cardiovascular disease. Hospital admission for ischemic heart disease (IHD is increasing rapidly in our country. Although studies were conducted abroad regarding association of serum uric acid with in-hospital outcomes in patients with acute coronary syndrome (ACS, no data is yet available to show the association in our country. Objective: The objective of this study was to assess the association of serum uric acid level on admission with in-hospital outcomes of the patients with ACS. Materials and Methods: This cross sectional comparative study was done in the Department of Cardiology, Dhaka Medical College Hospital (DMCH from January to December 2012. After proper ethical consideration total 93 ACS patients were enrolled in the study by nonrandom sampling. Serum uric acid of all subjects was measured within 24 hours of admission. Then in-hospital outcomes were observed in all subjects. Results: The frequency of hyperuricemia among ACS patients was 24.7% (22.54% in male and 31.82% in female. Hyperuricemic patients significantly developed heart failure (30.4% vs 11.4%, p=0.032 and conduction defect (13.0% vs 1.4%, p=0.017 than normouricemic subjects. The mean ejection fraction was significantly lower in hyperuricemic patients than patients with normal uric acid level (50.87 ± 10.27% vs 55.94 ± 6.66%. The mean ± SD duration of hospital stay of hyperuricemic group was significantly longer in patients with ACS (8.26 ± 1.18 vs 7.51±1.18 days, p=0.010. Conclusion: The measurement of serum uric acid level, an easily available and inexpensive biochemical tool, might turn out as a valuable risk marker for prediction of in-hospital outcomes in patients with ACS.

  4. Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty.

    Science.gov (United States)

    Erkocak, Omer F; Yoo, Joanne Y; Restrepo, Camilo; Maltenfort, Mitchell G; Parvizi, Javad

    2016-11-01

    Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality. We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m 2 ) in a 2:1 ratio to 718 control patients. The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality. We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Inhospital Mortality in Patients with Type 2 Diabetes Mellitus: A Prospective Cohort Study in Lima, Peru.

    Science.gov (United States)

    Zelada, Henry; Bernabe-Ortiz, Antonio; Manrique, Helard

    2016-01-01

    Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR) and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%), respiratory infections (35.7%), and stroke (16.7%). During hospital stay, 42 (8.4%) patients died. In multivariable models, respiratory infections (HR = 6.55, p < 0.001), stroke (HR = 7.05, p = 0.003), and acute renal failure (HR = 16.9, p = 0.001) increased the risk of death. In addition, having 2+ (HR = 7.75, p < 0.001) and 3+ (HR = 21.1, p < 0.001) conditions increased the risk of dying. Conclusion. Respiratory infections, stroke, and acute renal disease increased the risk of inhospital mortality among hospitalized patients with T2D. Infections are not the only cause of inhospital mortality. Certain causes of hospitalization require standardized and aggressive management to decrease mortality.

  6. In-hospital cerebrovascular complications following orthotopic liver transplantation: A retrospective study

    Directory of Open Access Journals (Sweden)

    Liang Zhijian

    2008-12-01

    Full Text Available Abstract Background Cerebrovascular complications are severe events following orthotopic liver transplantation (OLT. This study aimed to observe the clinical and neuroimaging features and possible risk factors of in-hospital cerebrovascular complications in the patients who underwent OLT. Patients and methods We retrospectively reviewed 337 consecutive patients who underwent 358 OLTs. Cerebrovascular complications were determined by clinical and neuroimaging manifestations, and the possible risk factors were analyzed in the patients with intracranial hemorrhage. Results Ten of 337 (3.0% patients developed in-hospital cerebrovascular complications (8 cases experienced intracranial hemorrhage and 2 cases had cerebral infarction, and 6 of them died. The clinical presentations were similar to common stroke, but with rapid deterioration at early stage. The hematomas on brain CT scan were massive, irregular, multifocal and diffuse, and most of them were located at brain lobes and might enlarge or rebleed. Infarcts presented lacunar and multifocal lesions in basal gangliar but with possible hemorrhagic transformation. The patients with intracranial hemorrhage had older age and a more frequency of systemic infection than non-intracranial hemorrhage patients. (P = 0.011 and 0.029, respectively. Conclusion Posttransplant cerebrovascular complications have severe impact on outcome of the patients who received OLT. Older age and systemic infection may be the possible risk factors of in-hospital intracranial hemorrhage following OLT.

  7. Inhospital Mortality in Patients with Type 2 Diabetes Mellitus: A Prospective Cohort Study in Lima, Peru

    Directory of Open Access Journals (Sweden)

    Henry Zelada

    2016-01-01

    Full Text Available Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%, respiratory infections (35.7%, and stroke (16.7%. During hospital stay, 42 (8.4% patients died. In multivariable models, respiratory infections (HR = 6.55, p<0.001, stroke (HR = 7.05, p=0.003, and acute renal failure (HR = 16.9, p=0.001 increased the risk of death. In addition, having 2+ (HR = 7.75, p<0.001 and 3+ (HR = 21.1, p<0.001 conditions increased the risk of dying. Conclusion. Respiratory infections, stroke, and acute renal disease increased the risk of inhospital mortality among hospitalized patients with T2D. Infections are not the only cause of inhospital mortality. Certain causes of hospitalization require standardized and aggressive management to decrease mortality.

  8. [in-hospital mortality in patient with acute ischemic and hemorrhagic stroke].

    Science.gov (United States)

    Sadamasa, Nobutake; Yoshida, Kazumichi; Narumi, Osamu; Chin, Masaki; Yamagata, Sen

    2011-09-01

    There is a lack of evidence to compare in-hospital mortality with different types of stroke. The purpose of this study was to elucidate the in-hospital mortality after acute ischemic/hemorrhagic stroke and compare the factors associated with the mortality among stroke subtypes. All patients admitted to Kurashiki Central Hospital in Japan between January 2009 and December 2009, and diagnosed with acute ischemic/hemorrhagic stroke were included in this study. Demographics and clinical data pertaining to the patients were obtained from their medical records. Out of 738 patients who had an acute stroke, 53 (7.2%) died in the hospital. The in-hospital mortality was significantly lower in the cerebral infarction group than in the intracerebral hemorrhage and subarachnoid hemorrhage group (3.5%, 15.1%, and 17.9%, respectively; Phemorrhage group than in the other 2 groups. With regard to past history, diabetes mellitus was significantly found to be a complication in mortality cases of intracranial hemorrhage. Further investigation is needed to clarify the effect of diabetes on mortality after intracranial hemorrhage.

  9. Predictors of in-hospital mortality in surgically treated valvular infective endocarditis cases at National Heart Institute, Egypt

    Directory of Open Access Journals (Sweden)

    Ahmed Elmasry

    2017-03-01

    Conclusions: Surgery for IE continues to be challenging. EuroSCORE II has a good discrimination ability to predict in-hospital mortality in IE surgery. Satisfactory results can be obtained with valve repair in IE.

  10. Highlighting High Performance: Blackstone Valley Regional Vocational Technical High School; Upton, Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    2006-10-01

    This brochure describes the key high-performance building features of the Blackstone Valley High School. The brochure was paid for by the Massachusetts Technology Collaborative as part of their Green Schools Initiative. High-performance features described are daylighting and energy-efficient lighting, indoor air quality, solar energy, building envelope, heating and cooling systems, and water conservation. Energy cost savings are also discussed.

  11. Sporadic-E and spread-F in high latitude region

    International Nuclear Information System (INIS)

    Tao, Kazuhiko

    1974-01-01

    The heretofore made morphological studies of sporadic-E and spread-F as the typical irregularities of electron density are reviewed. These phenomena have close correlation with other geophysical phenomena which occur in the atmosphere of superhigh altitude in high latitude region. Many of these phenomena occur from same causes. Although the quantitative data are insufficient, the sporadic-E and spread-F in high latitude region are supposed to be caused by the precipitating charged particles falling from magnetosphere. A system, which can observe such phenomena simultaneously using the measuring instruments carried by satellites in the atmosphere of high altitude over high latitude region, is desirable to solve such problems. In detail, the morphological study on sporadic-E obtained from the observation of vertically projected ionosphere and the morphological study on sporadic-E from the observation of forward scattering and slanting entrance are reviewed. The correlation of the occurrence frequency of sporadic-E with solar activity, geomagnetic activity and other phenomena was studied. The morphological study on spread-F occurrence is reviewed. The observation of the spread-F in high latitude region by the application of top side sounding is reviewed. The correlation of the sporadic-E and spread-F in high latitude region with other geophysical phenomena is discussed. Finally, the discrete phenomenon and the diffuse phenomenon are discussed too. (Iwakiri, K.)

  12. Asthma in Patients Climbing to High and Extreme Altitudes in the Tibetan Everest Region

    NARCIS (Netherlands)

    Huismans, Henrike K.; Douma, W. Rob; Kerstjens, Huib A. M.; Renkema, Tineke E. J.

    Objectives: The aim of this study was to investigate the behavior of asthma in patients traveling to high and extreme altitudes. Methods: Twenty-four Dutch patients with mild asthma did a trekking at high and extreme altitudes (up to 6410 m = 21030 ft) in the Tibetan Everest region. Asthma symptoms,

  13. Spectral classification of medium-scale high-latitude F region plasma density irregularities

    International Nuclear Information System (INIS)

    Singh, M.; Rodriguez, P.; Szuszczewicz, E.P.; Sachs Freeman Associates, Bowie, MD)

    1985-01-01

    The high-latitude ionosphere represents a highly structured plasma. Rodriguez and Szuszczewicz (1984) reported a wide range of plasma density irregularities (150 km to 75 m) at high latitudes near 200 km. They have shown that the small-scale irregularities (7.5 km to 75 m) populated the dayside oval more often than the other phenomenological regions. It was suggested that in the lower F region the chemical recombination is fast enough to remove small-scale irregularities before convection can transport them large distances, leaving structured particle precipitation as the dominant source term for irregularities. The present paper provides the results of spectral analyses of pulsed plasma probe data collected in situ aboard the STP/S3-4 satellite during the period March-September 1978. A quantitative description of irregularity spectra in the high-latitude lower F region plasma density is given. 22 references

  14. Arctide2017, a high-resolution regional tidal model in the Arctic Ocean

    DEFF Research Database (Denmark)

    Cancet, M.; Andersen, O. B.; Lyard, F.

    2018-01-01

    The Arctic Ocean is a challenging region for tidal modelling. The accuracy of the global tidal models decreases by several centimeters in the Polar Regions, which has a large impact on the quality of the satellite altimeter sea surface heights and the altimetry-derived products. NOVELTIS, DTU Space...... and LEGOS have developed Arctide2017, a regional, high-resolution tidal atlas in the Arctic Ocean, in the framework of an extension of the CryoSat Plus for Ocean (CP4O) ESA STSE (Support to Science Element) project. In particular, this atlas benefits from the assimilation of the most complete satellite...... assimilation and validation. This paper presents the implementation methodology and the performance of this new regional tidal model in the Arctic Ocean, compared to the existing global and regional tidal models....

  15. Relaxed impact craters on Ganymede: Regional variation and high heat flows

    Science.gov (United States)

    Singer, Kelsi N.; Bland, Michael T.; Schenk, Paul M.; McKinnon, William B.

    2018-01-01

    Viscously relaxed craters provide a window into the thermal history of Ganymede, a satellite with copious geologic signs of past high heat flows. Here we present measurements of relaxed craters in four regions for which suitable imaging exists: near Anshar Sulcus, Tiamat Sulcus, northern Marius Regio, and Ganymede's south pole. We describe a technique to measure apparent depth, or depth of the crater with respect to the surrounding terrain elevation. Measured relaxation states are compared with results from finite element modeling to constrain heat flow scenarios [see companion paper: Bland et al. (2017)]. The presence of numerous, substantially relaxed craters indicates high heat flows—in excess of 30–40 mW m−2 over 2 Gyr, with many small (heat flows. Crater relaxation states are bimodal for some equatorial regions but not in the region studied near the south pole, which suggests regional variations in Ganymede's thermal history.

  16. Relaxed impact craters on Ganymede: Regional variation and high heat flows

    Science.gov (United States)

    Singer, Kelsi N.; Bland, Michael T.; Schenk, Paul M.; McKinnon, William B.

    2018-05-01

    Viscously relaxed craters provide a window into the thermal history of Ganymede, a satellite with copious geologic signs of past high heat flows. Here we present measurements of relaxed craters in four regions for which suitable imaging exists: near Anshar Sulcus, Tiamat Sulcus, northern Marius Regio, and Ganymede's south pole. We describe a technique to measure apparent depth, or depth of the crater with respect to the surrounding terrain elevation. Measured relaxation states are compared with results from finite element modeling to constrain heat flow scenarios [see companion paper: Bland et al. (2017)]. The presence of numerous, substantially relaxed craters indicates high heat flows-in excess of 30-40 mW m-2 over 2 Gyr, with many small (heat flows. Crater relaxation states are bimodal for some equatorial regions but not in the region studied near the south pole, which suggests regional variations in Ganymede's thermal history.

  17. In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study.

    Science.gov (United States)

    Pucciarelli, S; Zorzi, M; Gennaro, N; Gagliardi, G; Restivo, A; Saugo, M; Barina, A; Rugge, M; Zuin, M; Maretto, I; Nitti, D

    2017-07-01

    The simultaneous assessment of multiple indicators for quality of care is essential for comparisons of performance between hospitals and health care systems. The aim of this study was to assess the rates of in-hospital mortality and 30-day readmission and length of hospital stay (LOS) in patients who underwent surgical procedures for colorectal cancer between 2005 and 2014 in Italy. All patients in the National Italian Hospital Discharge Dataset who underwent a surgical procedure for colorectal cancer during the study period were included. The adjusted odd ratios for risk factors for in-hospital mortality, 30-day readmission, and LOS were calculated using multilevel multivariable logistic regression. Among the 353 941 patients, rates of in-hospital mortality and 30-day readmission were 2.5% and 6%, respectively, and the median LOS was 13 days. High comorbidity, emergent/urgent admission, male gender, creation of a stoma, and an open approach increased the risks of all the outcomes at multivariable analysis. Age, hospital volume, hospital geographic location, and discharge to home/non-home produced different effects depending on the outcome considered. The most frequent causes of readmission were infection (19%) and bowel obstruction (14.6%). We assessed national averages for mortality, LOS and readmission and related trends over a 10-year time. Laparoscopic surgery was the only one that could be modified by improving surgical education. Higher hospital volume was associated with a LOS reduction, but our findings only partially support a policy of centralization for colorectal cancer procedures. Surgical site infection was identified as the most preventable cause of readmission. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  18. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

    Science.gov (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

    2017-11-01

    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001). An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

  19. Spatio-Spectral Method for Estimating Classified Regions with High Confidence using MODIS Data

    International Nuclear Information System (INIS)

    Katiyal, Anuj; Rajan, Dr K S

    2014-01-01

    In studies like change analysis, the availability of very high resolution (VHR)/high resolution (HR) imagery for a particular period and region is a challenge due to the sensor revisit times and high cost of acquisition. Therefore, most studies prefer lower resolution (LR) sensor imagery with frequent revisit times, in addition to their cost and computational advantages. Further, the classification techniques provide us a global estimate of the class accuracy, which limits its utility if the accuracy is low. In this work, we focus on the sub-classification problem of LR images and estimate regions of higher confidence than the global classification accuracy within its classified region. The spectrally classified data was mined into spatially clustered regions and further refined and processed using statistical measures to arrive at local high confidence regions (LHCRs), for every class. Rabi season MODIS data of January 2006 and 2007 was used for this study and the evaluation of LHCR was done using the APLULC 2005 classified data. For Jan-2007, the global class accuracies for water bodies (WB), forested regions (FR) and Kharif crops and barren lands (KB) were 89%, 71.7% and 71.23% respectively, while the respective LHCRs had accuracies of 96.67%, 89.4% and 80.9% covering an area of 46%, 29% and 14.5% of the initially classified areas. Though areas are reduced, LHCRs with higher accuracies help in extracting more representative class regions. Identification of such regions can facilitate in improving the classification time and processing for HR images when combined with the more frequently acquired LR imagery, isolate pure vs. mixed/impure pixels and as training samples locations for HR imagery

  20. Flow conditioning for improved optical propagation of beams through regions bounded by surfaces of high solidity

    International Nuclear Information System (INIS)

    Robey, H.F.; Albrecht, G.F.; Freitas, B.L.

    1991-01-01

    A flow conditioning system has been designed to maximize the thermal homogeneity in an enclosed region through which a laser beam must propagate. In the present application, such an enclosed region exists between the Nd:glass disks of a high average power solid-state laser amplifier. Experiments have been conducted on a test facility to quantify the magnitude of the beam losses due to thermal scattering. It is shown that the intensity of the incoherent light which is thermally scattered from this region can be reduced to less than 0.1% of the incident-beam intensity under apropriate flow and cooling conditions

  1. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes

    Science.gov (United States)

    Frisch, Kayt E.; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-01-01

    Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. Purpose: To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Study Design: Descriptive epidemiology study. Methods: A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Results: Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. Conclusion: When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain

  2. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes.

    Science.gov (United States)

    Frisch, Kayt E; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-06-01

    Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Descriptive epidemiology study. A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball ( P = .01) and lifting weights out of season ( P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain may be correlated with volume of previous volleyball experience.

  3. Temporal Patterns of In-Hospital Falls of Elderly Patients.

    Science.gov (United States)

    López-Soto, Pablo J; Smolensky, Michael H; Sackett-Lundeen, Linda L; De Giorgi, Alfredo; Rodríguez-Borrego, María A; Manfredini, Roberto; Pelati, Cristiano; Fabbian, Fabio

    these moderate- to high-amplitude temporal patterns in hospital falls of elderly patients advances the knowledge of fall epidemiology by identifying the times of day, week, and year and nursing shifts of elevated risk that is of critical importance to improving hospital patient safety programs.

  4. Knowledge Organisations and High-Tech Regional Innovation Systems in Developing Countries: Evidence from Argentina

    Directory of Open Access Journals (Sweden)

    Carolina Pasciaroni

    2016-06-01

    Full Text Available In the globally and knowledge based economy, the universities and other knowledge organisations are valued for their ability to contribute to the regional innovation processes. This is particularly relevant for the developing countries in South America since their R&D spending is highly concentrated on the public knowledge infrastructure. However, there are few studies examining the role of knowledge organizations at regional level in Latin America. The proposed study aims to analyse the role played by knowledge organisations in the formation of a high-tech Regional Innovation Systems in Argentina. This country has a number of attractive features relative to the positive evolution of its R&D spending and the recent implementation of a policy that promotes cooperation between firms and knowledge organisations among high-tech sectors. As evidenced in developed regions, the organisations under study play a key role in the promotion of a high-tech Regional Innovation Systems. However, this prominent role is not based on those local factors identified in the literature, such as organisational and institutional local assets, but on national science and technology policies and individual initiatives conducted by the faculties involved.

  5. The Identification of Technology Platforms and Innovation Areas with High Regional Impact

    Directory of Open Access Journals (Sweden)

    Nataša Urbančíková

    2011-10-01

    Full Text Available The paper is focused on the process of identification of the technological platforms and innovation areas with high regional impact. The aim is to discover future fields of technological innovation which are having a high qualitative and quantitative demand of high potentials. The research has been undertaken within project Innovative Development of European Areas by fostering transnational Knowledge Development – IDEA/ 2CE1175P1 funded by Central Europe Programme. The aim of IDEA project is the development of an adequate strategy which enables the small and medium sized enterprises in the regions of Central Europe to face the increasing demand of high potentials with tested methods and instruments. The target group of IDEA project are so called “high potentials” in the engineering and scientific sector where future-oriented technologies are one of the main sources of innovation.

  6. Search for Very High-energy Gamma Rays from the Northern Fermi Bubble Region with HAWC

    OpenAIRE

    Abeysekara, AU; Albert, A; Alfaro, R; Alvarez, C; Alvarez, JD; Arceo, R; Arteaga-Velázquez, JC; Ayala Solares, HA; Barber, AS; Bautista-Elivar, N; Becerril, A; Belmont-Moreno, E; BenZvi, SY; Berley, D; Braun, J

    2017-01-01

    © 2017. The American Astronomical Society. All rights reserved. We present a search for very high-energy gamma-ray emission from the Northern Fermi Bubble region using data collected with the High Altitude Water Cherenkov gamma-ray observatory. The size of the data set is 290 days. No significant excess is observed in the Northern Fermi Bubble region, so upper limits above 1 TeV are calculated. The upper limits are between and . The upper limits disfavor a proton injection spectrum that exten...

  7. High-Resolution Regional Reanalysis in China: Evaluation of 1 Year Period Experiments

    Science.gov (United States)

    Zhang, Qi; Pan, Yinong; Wang, Shuyu; Xu, Jianjun; Tang, Jianping

    2017-10-01

    Globally, reanalysis data sets are widely used in assessing climate change, validating numerical models, and understanding the interactions between the components of a climate system. However, due to the relatively coarse resolution, most global reanalysis data sets are not suitable to apply at the local and regional scales directly with the inadequate descriptions of mesoscale systems and climatic extreme incidents such as mesoscale convective systems, squall lines, tropical cyclones, regional droughts, and heat waves. In this study, by using a data assimilation system of Gridpoint Statistical Interpolation, and a mesoscale atmospheric model of Weather Research and Forecast model, we build a regional reanalysis system. This is preliminary and the first experimental attempt to construct a high-resolution reanalysis for China main land. Four regional test bed data sets are generated for year 2013 via three widely used methods (classical dynamical downscaling, spectral nudging, and data assimilation) and a hybrid method with data assimilation coupled with spectral nudging. Temperature at 2 m, precipitation, and upper level atmospheric variables are evaluated by comparing against observations for one-year-long tests. It can be concluded that the regional reanalysis with assimilation and nudging methods can better produce the atmospheric variables from surface to upper levels, and regional extreme events such as heat waves, than the classical dynamical downscaling. Compared to the ERA-Interim global reanalysis, the hybrid nudging method performs slightly better in reproducing upper level temperature and low-level moisture over China, which improves regional reanalysis data quality.

  8. Retinopathy of prematurity: the high cost of screening regional and remote infants.

    Science.gov (United States)

    Yu, Tzu-Ying; Donovan, Tim; Armfield, Nigel; Gole, Glen A

    2018-01-25

    Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. A total of 131 infants were included in this study. Individual infant costs were calculated from analysis of clinical and administrative records. Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

  9. REGIONAL BINNING FOR CONTINUED STORAGE OF SPENT NUCLEAR FUEL AND HIGH-LEVEL WASTES

    Energy Technology Data Exchange (ETDEWEB)

    W. Lee Poe, Jr

    1998-10-01

    In the Continued Storage Analysis Report (CSAR) (Reference 1), DOE decided to analyze the environmental consequences of continuing to store the commercial spent nuclear fuel (SNF) at 72 commercial nuclear power sites and DOE-owned spent nuclear fuel and high-level waste at five Department of Energy sites by region rather than by individual site. This analysis assumes that three commercial facilities pairs--Salem and Hope Creek, Fitzpatrick and Nine-Mile Point, and Dresden and Moms--share common storage due to their proximity to each other. The five regions selected for this analysis are shown on Figure 1. Regions 1, 2, and 3 are the same as those used by the Nuclear Regulatory Commission in their regulatory oversight of commercial power reactors. NRC Region 4 was subdivided into two regions to more appropriately define the two different climates that exist in NRC Region 4. A single hypothetical site in each region was assumed to store all the SNF and HLW in that region. Such a site does not exist and has no geographic location but is a mathematical construct for analytical purposes. To ensure that the calculated results for the regional analyses reflect appropriate inventory, facility and material degradation, and radionuclide transport, the waste inventories, engineered barriers, and environmental conditions for the hypothetical sites were developed from data for each of the existing sites within the given region. Weighting criteria to account for the amount and types of SNF and HLW at each site were used in the development of the environmental data for the regional site, such that the results of the analyses for the hypothetical site were representative of the sum of the results of each actual site if they had been modeled independently. This report defines the actual site data used in development of this hypothetical site, shows how the individual site data was weighted to develop the regional site, and provides the weighted data used in the CSAR analysis. It is

  10. REGIONAL BINNING FOR CONTINUED STORAGE OF SPENT NUCLEAR FUEL AND HIGH-LEVEL WASTES

    International Nuclear Information System (INIS)

    W. Lee Poe, Jr.

    1998-01-01

    In the Continued Storage Analysis Report (CSAR) (Reference 1), DOE decided to analyze the environmental consequences of continuing to store the commercial spent nuclear fuel (SNF) at 72 commercial nuclear power sites and DOE-owned spent nuclear fuel and high-level waste at five Department of Energy sites by region rather than by individual site. This analysis assumes that three commercial facilities pairs--Salem and Hope Creek, Fitzpatrick and Nine-Mile Point, and Dresden and Moms--share common storage due to their proximity to each other. The five regions selected for this analysis are shown on Figure 1. Regions 1, 2, and 3 are the same as those used by the Nuclear Regulatory Commission in their regulatory oversight of commercial power reactors. NRC Region 4 was subdivided into two regions to more appropriately define the two different climates that exist in NRC Region 4. A single hypothetical site in each region was assumed to store all the SNF and HLW in that region. Such a site does not exist and has no geographic location but is a mathematical construct for analytical purposes. To ensure that the calculated results for the regional analyses reflect appropriate inventory, facility and material degradation, and radionuclide transport, the waste inventories, engineered barriers, and environmental conditions for the hypothetical sites were developed from data for each of the existing sites within the given region. Weighting criteria to account for the amount and types of SNF and HLW at each site were used in the development of the environmental data for the regional site, such that the results of the analyses for the hypothetical site were representative of the sum of the results of each actual site if they had been modeled independently. This report defines the actual site data used in development of this hypothetical site, shows how the individual site data was weighted to develop the regional site, and provides the weighted data used in the CSAR analysis. It is

  11. CD 1550 – bread wheat cultivar with high gluten strength for the cooler regions of Brazil

    Directory of Open Access Journals (Sweden)

    Francisco de Assis Franco

    2015-03-01

    Full Text Available Cultivar CD 1550 is well-suited for the wheat-growing regions 1 and 2 of Rio Grande do Sul, Santa Catarina and Paraná and 3 of Paraná. It has the characteristics of bread wheat and high gluten strength. The average potential yield is 3828 kg ha-1, 7% higher than that of the controls.

  12. Access to highly active antiretroviral therapy (HAART) in the WHO European Region 2003-2005

    DEFF Research Database (Denmark)

    Bollerup, Annemarie R; Donoghoe, Martin C; Lazarus, Jeff

    2008-01-01

    To assess changes in access to highly active antiretroviral therapy (HAART) between the end of 2002 and the end of 2005, and to review the capacity for further HAART scale-up in the then 52 Member States of the WHO European Region....

  13. Meaningful use of health information technology and declines in in-hospital adverse drug events.

    Science.gov (United States)

    Furukawa, Michael F; Spector, William D; Rhona Limcangco, M; Encinosa, William E

    2017-07-01

    Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking. Data came from the 2010-2013 Medicare Patient Safety Monitoring System and the 2008-2013 Healthcare Information and Management Systems Society (HIMSS) Analytics Database. Two-level random intercept logistic regression was used to estimate the association of MU capabilities and occurrence of ADEs, adjusting for patient characteristics, hospital characteristics, and year of observation. Rates of in-hospital ADEs declined by 19% from 2010 to 2013. Adoption of MU capabilities was associated with 11% lower odds of an ADE (95% confidence interval [CI], 0.84-0.96). Interoperability capability was associated with 19% lower odds of an ADE (95% CI, 0.67- 0.98). Adoption of MU capabilities explained 22% of the observed reduction in ADEs, or 67,000 fewer ADEs averted by MU. Concurrent with the rapid uptake of MU and interoperability, occurrence of in-hospital ADEs declined significantly from 2010 to 2013. MU capabilities and interoperability were associated with lower occurrence of ADEs, but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities. Findings support the contention that adoption of MU capabilities and interoperability spurred by the Health Information Technology for Economic and Clinical Health Act contributed in part to the recent decline in ADEs. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  14. Age-related in-hospital mortality among patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Abid, A.R.; Rafique, S.; Ahmed, R.Z.; Anjum, A.H.; Tarin, S.M.A.

    2004-01-01

    Objective: To evaluate the in-hospital mortality of acute myocardial infarction among different age groups. Subjects and Methods: The subjects were 460 admitted patients of acute myocardial infarction who fulfilled our inclusion criteria. Patients were divided into four age groups. Group-I included patients in 20-40 years, group-II (41-50 years), group-III (51-60 years) and group-IV (>60 years). Mortality was compared between different age groups by Chi-square and linear-regression models. Results: The total in-hospital mortality was 16.7%. It gradually increased from 5.6% in group-I (20-40 years) patients to 21% in group-IV (>60 years) patients. While mortality in groups group-II (41-50 years) and group-III (51-60 years) patients was 16.7% and 18.6% respectively. A marked increase in mortality was noted with increase in age. Group- IV (>60 years) patients presented 2 hours late to the hospital than the group-I (20-40 years) patients. There was no statistical difference in site of infarction in different age groups. Old age (group-IV i.e. >60 years old) was more associated with heart failure (higher Killip class) on presentation. Lesser number of patients in group-IV received thrombolytic therapy than group-I. Only 31.09% patients in group-IV and 62.5% patients in group-I received streptokinase therapy respectively. Conclusion: In patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. (author)

  15. Patient-prosthesis mismatch has no influence on in-hospital mortality after aortic valve replacement.

    Science.gov (United States)

    Yottasurodom, Chaiwut; Namthaisong, Kriengkrai; Porapakkham, Pramote; Kasemsarn, Choosak; Chotivatanapong, Taweesak; Chaiseri, Pradistchai; Wongdit, Suwannee; Yasotarin, Suwanna

    2012-08-01

    To analyze the relationship between prosthetic aortic valve orifice and body surface area (Effective Orifice Area Index, EOAI) and in-hospital mortality after aortic valve replacement. A prospective study was conducted between October 2007 to September 2010, 536 patients underwent isolated aortic valve replacement (AVR) was recorded on preoperative, operative and postoperative data. Patient Prosthesis Mismatch (PPM) was classified by Effective Orifice Area Indexed (EOAI) by prosthetic valve area divided by body surface area as mild or no significance if the EOAI is greater than 0.85 cm2/m2, moderate if between 0.65 cm2/m2 and 0.85 cm2/m2, and severe if less than 0.65 cm2/m2. Statistical differences were analyzed by Chi-square and student t-test with p-value less than 0.05 considered significant. There were 304 men, mean age was 60.98 years, mean valve orifice area 1.69 cm2, body surface area 1.60 m2, cross clamp time 1.13 hrs., bypass time 1.67 hrs. Mechanical valves were used in 274 patients (51.2%) and Bioprosthesis were used in 181 patients (48.8%). PPM was found in 33.7%, 6.7% was severe PPM, 27% was moderate PPM and 66.3% has no significant PPM Over all in-hospital mortality was 1.5%. There was no significant difference in hospital mortality between no PPM group, moderate PPM and severe PPM group (1.4% vs. 1.4% vs. 5.4%, p-value = 0.86). In a large aortic valve surgery population, moderate and severe patient prosthesis mismatch occurred in 35.6% of patients but had no influence on in-hospital mortality.

  16. Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

    Directory of Open Access Journals (Sweden)

    Michel Lelo Tshikwela

    2012-01-01

    . It needs to be validated among large African hypertensive populations with a high rate of 30-day in-hospital mortality.

  17. [In-hospital management of victims of chemical weapons of mass destruction].

    Science.gov (United States)

    Barelli, Alessandro; Gargano, Flavio; Proietti, Rodolfo

    2005-01-01

    Emergency situations caused by chemical weapons of mass destruction add a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and conventional emergencies is the potential for risk from contamination to health care professionals, patients, equipment and facilities of the Emergency Department. Accurate and specific guidance is needed to describe the procedures to be followed by emergency medical personnel to safely care for a patient, as well as to protect equipment and people. This review is designed to familiarize readers with the concepts, terminology and key operational considerations that affect the in-hospital management of incidents by chemical weapons.

  18. Association of In-Hospital Mortality and Dysglycemia in Septic Patients.

    Directory of Open Access Journals (Sweden)

    Hsiao-Yun Chao

    Full Text Available The associations between dysglycemia and mortality in septic patients with and without diabetes are yet to be confirmed. Our aim was to analyze the association of diabetes and sepsis mortality, and to examine how dysglycemia (hyperglycemia, hypoglycemia and glucose variability affects in-hospital mortality of patients with suspected sepsis in emergency department (ED and intensive care units.Clinically suspected septic patients admitted to ED were included, and stratified into subgroups according to in-hospital mortality and the presence of diabetes. We analyzed patients' demographics, comorbidities, clinical and laboratory parameters, admission glucose levels and severity of sepsis. Odds ratio of mortality was assessed after adjusting for possible confounders. The correlations of admission glucose and CoV (blood glucose coefficients of variation and mortality in diabetes and non-diabetes were also tested.Diabetes was present in 58.3% of the patients. Diabetic patients were older, more likely to have end-stage renal disease and undergoing hemodialysis, but had fewer malignancies, less sepsis severity (lower Mortality in Emergency Department Sepsis Score, less steroid usage in emergency department, and lower in-hospital mortality rate (aOR:0.83, 95% CI 0.65-0.99, p = 0.044. Hyperglycemia at admission (glucose≥200 mg/dL was associated with higher risks of in-hospital mortality among the non-diabetes patients (OR:1.83 vs. diabetes, 95% CI 1.20-2.80, p = 0.005 with the same elevated glucose levels at admission. In addition, CoV>30% resulted in higher risk of death as well (aOR:1.88 vs. CoV between 10 and 30, 95%CI 1.24-2.86 p = 0.003.This study indicates that while diabetes mellitus seems to be a protective factor in sepsis patients, hyper- or hypoglycemia status on admission, and increased blood glucose variation during hospital stays, were independently associated with increased odds ratio of mortality.

  19. U.S. and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review.

    Science.gov (United States)

    Harvey, Michael J; Gaies, Michael G; Prosser, Lisa A

    2015-08-01

    The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'. Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs. Data extraction was completed by one author, using predefined criteria. From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g., range of total in-hospital costs of treatment: USD 42,554-537,554 [in 2013 values]). In the U.S.A., the

  20. Comparison of Two Grid Refinement Approaches for High Resolution Regional Climate Modeling: MPAS vs WRF

    Science.gov (United States)

    Leung, L.; Hagos, S. M.; Rauscher, S.; Ringler, T.

    2012-12-01

    This study compares two grid refinement approaches using global variable resolution model and nesting for high-resolution regional climate modeling. The global variable resolution model, Model for Prediction Across Scales (MPAS), and the limited area model, Weather Research and Forecasting (WRF) model, are compared in an idealized aqua-planet context with a focus on the spatial and temporal characteristics of tropical precipitation simulated by the models using the same physics package from the Community Atmosphere Model (CAM4). For MPAS, simulations have been performed with a quasi-uniform resolution global domain at coarse (1 degree) and high (0.25 degree) resolution, and a variable resolution domain with a high-resolution region at 0.25 degree configured inside a coarse resolution global domain at 1 degree resolution. Similarly, WRF has been configured to run on a coarse (1 degree) and high (0.25 degree) resolution tropical channel domain as well as a nested domain with a high-resolution region at 0.25 degree nested two-way inside the coarse resolution (1 degree) tropical channel. The variable resolution or nested simulations are compared against the high-resolution simulations that serve as virtual reality. Both MPAS and WRF simulate 20-day Kelvin waves propagating through the high-resolution domains fairly unaffected by the change in resolution. In addition, both models respond to increased resolution with enhanced precipitation. Grid refinement induces zonal asymmetry in precipitation (heating), accompanied by zonal anomalous Walker like circulations and standing Rossby wave signals. However, there are important differences between the anomalous patterns in MPAS and WRF due to differences in the grid refinement approaches and sensitivity of model physics to grid resolution. This study highlights the need for "scale aware" parameterizations in variable resolution and nested regional models.

  1. Detection of genomic variation by selection of a 9 mb DNA region and high throughput sequencing.

    Directory of Open Access Journals (Sweden)

    Sergey I Nikolaev

    Full Text Available Detection of the rare polymorphisms and causative mutations of genetic diseases in a targeted genomic area has become a major goal in order to understand genomic and phenotypic variability. We have interrogated repeat-masked regions of 8.9 Mb on human chromosomes 21 (7.8 Mb and 7 (1.1 Mb from an individual from the International HapMap Project (NA12872. We have optimized a method of genomic selection for high throughput sequencing. Microarray-based selection and sequencing resulted in 260-fold enrichment, with 41% of reads mapping to the target region. 83% of SNPs in the targeted region had at least 4-fold sequence coverage and 54% at least 15-fold. When assaying HapMap SNPs in NA12872, our sequence genotypes are 91.3% concordant in regions with coverage > or = 4-fold, and 97.9% concordant in regions with coverage > or = 15-fold. About 81% of the SNPs recovered with both thresholds are listed in dbSNP. We observed that regions with low sequence coverage occur in close proximity to low-complexity DNA. Validation experiments using Sanger sequencing were performed for 46 SNPs with 15-20 fold coverage, with a confirmation rate of 96%, suggesting that DNA selection provides an accurate and cost-effective method for identifying rare genomic variants.

  2. Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data

    Directory of Open Access Journals (Sweden)

    Andrzej Kotela

    2015-01-01

    Full Text Available Total knee arthroplasty (TKA is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA.

  3. The WASCAL high-resolution regional climate simulation ensemble for West Africa: concept, dissemination and assessment

    Science.gov (United States)

    Heinzeller, Dominikus; Dieng, Diarra; Smiatek, Gerhard; Olusegun, Christiana; Klein, Cornelia; Hamann, Ilse; Salack, Seyni; Bliefernicht, Jan; Kunstmann, Harald

    2018-04-01

    Climate change and constant population growth pose severe challenges to 21st century rural Africa. Within the framework of the West African Science Service Center on Climate Change and Adapted Land Use (WASCAL), an ensemble of high-resolution regional climate change scenarios for the greater West African region is provided to support the development of effective adaptation and mitigation measures. This contribution presents the overall concept of the WASCAL regional climate simulations, as well as detailed information on the experimental design, and provides information on the format and dissemination of the available data. All data are made available to the public at the CERA long-term archive of the German Climate Computing Center (DKRZ) with a subset available at the PANGAEA Data Publisher for Earth & Environmental Science portal (https://doi.pangaea.de/10.1594/PANGAEA.880512" target="_blank">https://doi.pangaea.de/10.1594/PANGAEA.880512). A brief assessment of the data are presented to provide guidance for future users. Regional climate projections are generated at high (12 km) and intermediate (60 km) resolution using the Weather Research and Forecasting Model (WRF). The simulations cover the validation period 1980-2010 and the two future periods 2020-2050 and 2070-2100. A brief comparison to observations and two climate change scenarios from the Coordinated Regional Downscaling Experiment (CORDEX) initiative is presented to provide guidance on the data set to future users and to assess their climate change signal. Under the RCP4.5 (Representative Concentration Pathway 4.5) scenario, the results suggest an increase in temperature by 1.5 °C at the coast of Guinea and by up to 3 °C in the northern Sahel by the end of the 21st century, in line with existing climate projections for the region. They also project an increase in precipitation by up to 300 mm per year along the coast of Guinea, by up to 150 mm per year in the Soudano region adjacent in the north and

  4. The implementation of sea ice model on a regional high-resolution scale

    Science.gov (United States)

    Prasad, Siva; Zakharov, Igor; Bobby, Pradeep; McGuire, Peter

    2015-09-01

    The availability of high-resolution atmospheric/ocean forecast models, satellite data and access to high-performance computing clusters have provided capability to build high-resolution models for regional ice condition simulation. The paper describes the implementation of the Los Alamos sea ice model (CICE) on a regional scale at high resolution. The advantage of the model is its ability to include oceanographic parameters (e.g., currents) to provide accurate results. The sea ice simulation was performed over Baffin Bay and the Labrador Sea to retrieve important parameters such as ice concentration, thickness, ridging, and drift. Two different forcing models, one with low resolution and another with a high resolution, were used for the estimation of sensitivity of model results. Sea ice behavior over 7 years was simulated to analyze ice formation, melting, and conditions in the region. Validation was based on comparing model results with remote sensing data. The simulated ice concentration correlated well with Advanced Microwave Scanning Radiometer for EOS (AMSR-E) and Ocean and Sea Ice Satellite Application Facility (OSI-SAF) data. Visual comparison of ice thickness trends estimated from the Soil Moisture and Ocean Salinity satellite (SMOS) agreed with the simulation for year 2010-2011.

  5. High resolution radio observations of nuclear and circumnuclear regions of luminous infrared galaxies (LIRGs)

    Energy Technology Data Exchange (ETDEWEB)

    Alberdi, A; Perez-Torres, M A [Instituto de Astrofisica de Andalucia (IAA, CSIC), PO Box 3004, 18080-Granada (Spain); Colina, L [Instituto de Estructura de la Materia - IEM, CSIC, C, Serrano 115, 28005 Madrid (Spain); Torrelles, J M [Instituto de Ciencias del Espacio (ICE, CSIC) and IEEC, Gran Capita 2-4, 08034 Barcelona (Spain)], E-mail: antxon@iaa.es, E-mail: torres@iaa.es, E-mail: colina@damir.iem.csic.es, E-mail: torrelle@ieec.fcr.es

    2008-10-15

    High-resolution radio observations of the nuclear region of Luminous and Ultraluminous Infrared Galaxies (ULIRGs) have shown that its radio structure consists of a compact high surface-brightness central radio source immersed in a diffuse low brightness circumnuclear halo. While the central component could be associated with an AGN or compact star-forming regions where radio supernovae are exploding, it is well known that the circumnuclear regions host bursts of star-formation. The studies of radio supernovae can provide essential information about stellar evolution and CSM/ISM properties in regions hidden by dust at optical and IR wavelengths. In this contribution, we show results from radio interferometric observations from NGC 7469, IRAS 18293-3413 and IRAS 17138-1017 where three extremely bright radio supernovae have been found. High-resolution radio observations of these and other LIRGs would allow us to determine the core-collapse supernova rate in them as well as their star-formation rate.

  6. Selective suppression of high-order harmonics within phase-matched spectral regions.

    Science.gov (United States)

    Lerner, Gavriel; Diskin, Tzvi; Neufeld, Ofer; Kfir, Ofer; Cohen, Oren

    2017-04-01

    Phase matching in high-harmonic generation leads to enhancement of multiple harmonics. It is sometimes desired to control the spectral structure within the phase-matched spectral region. We propose a scheme for selective suppression of high-order harmonics within the phase-matched spectral region while weakly influencing the other harmonics. The method is based on addition of phase-mismatched segments within a phase-matched medium. We demonstrate the method numerically in two examples. First, we show that one phase-mismatched segment can significantly suppress harmonic orders 9, 15, and 21. Second, we show that two phase-mismatched segments can efficiently suppress circularly polarized harmonics with one helicity over the other when driven by a bi-circular field. The new method may be useful for various applications, including the generation of highly helical bright attosecond pulses.

  7. Highly accessible AU-rich regions in 3’ untranslated regions are hotspots for binding of regulatory factors

    Science.gov (United States)

    2017-01-01

    Post-transcriptional regulation is regarded as one of the major processes involved in the regulation of gene expression. It is mainly performed by RNA binding proteins and microRNAs, which target RNAs and typically affect their stability. Recent efforts from the scientific community have aimed at understanding post-transcriptional regulation at a global scale by using high-throughput sequencing techniques such as cross-linking and immunoprecipitation (CLIP), which facilitates identification of binding sites of these regulatory factors. However, the diversity in the experimental procedures and bioinformatics analyses has hindered the integration of multiple datasets and thus limited the development of an integrated view of post-transcriptional regulation. In this work, we have performed a comprehensive analysis of 107 CLIP datasets from 49 different RBPs in HEK293 cells to shed light on the complex interactions that govern post-transcriptional regulation. By developing a more stringent CLIP analysis pipeline we have discovered the existence of conserved regulatory AU-rich regions in the 3’UTRs where miRNAs and RBPs that regulate several processes such as polyadenylation or mRNA stability bind. Analogous to promoters, many factors have binding sites overlapping or in close proximity in these hotspots and hence the regulation of the mRNA may depend on their relative concentrations. This hypothesis is supported by RBP knockdown experiments that alter the relative concentration of RBPs in the cell. Upon AGO2 knockdown (KD), transcripts containing “free” target sites show increased expression levels compared to those containing target sites in hotspots, which suggests that target sites within hotspots are less available for miRNAs to bind. Interestingly, these hotspots appear enriched in genes with regulatory functions such as DNA binding and RNA binding. Taken together, our results suggest that hotspots are functional regulatory elements that define an extra layer

  8. Hg in snow cover and snowmelt waters in high-sulfide tailing regions (Ursk tailing dump site, Kemerovo region, Russia).

    Science.gov (United States)

    Gustaytis, M A; Myagkaya, I N; Chumbaev, A S

    2018-07-01

    Gold-bearing polymetallic Cu-Zn deposits of sulphur-pyrite ores were discovered in the Novo-Ursk region in the 1930s. The average content of mercury (Hg) was approximately 120 μg/g at the time. A comprehensive study of Hg distribution in waste of metal ore enrichment industry was carried out in the cold season on the tailing dump site and in adjacent areas. Mercury concentration in among snow particulate, dissolved and colloid fractions was determined. The maximal Hg content in particulate fraction from the waste tailing site ranged 230-573 μg/g. Such indices as the frequency of aerosol dust deposition events per units of time and area, enrichment factor and the total load allowed to establish that the territory of the tailing waste dump site had a snow cover highly contaminated with dust deposited at a rate of 247-480 mg/(m 2 ∙day). Adjacent areas could be considered as area with low Hg contamination rate with average deposition rate of 30 mg/(m 2 ∙day). The elemental composition of the aerosol dust depositions was determined as well, which allowed to reveal the extent of enrichment waste dispersion throughout adjacent areas. The amount of Hg entering environment with snowmelt water discharge was estimated. As a result of snowmelting, in 2014 the nearest to the dump site hydrographic network got Hg as 7.1 g with colloids and as 5880 g as particles. The results obtained allowed to assess the degree of Hg contamination of areas under the impact of metal enrichment industry. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Design of a High Gradient Quadrupole for the LHC Interaction Regions

    International Nuclear Information System (INIS)

    Bossert, R.; Gourlay, S.A.; Heger, T.; Huang, Y.; Kerby, J.; Lamm, M.J.; Limon, P.J.; Mazur, P.O.; Nobrega, F.; Ozelis, J.P.; Sabbi, G.; Strait, J.; Zlobin, A.V.; Caspi, S.; Dell'orco, D.; McInturff, A.D.; Scanlan, R.M.; Van Oort, J.M.; Gupta, R.C.

    1997-03-01

    A collaboration of Fermilab, Lawrence Berkeley National Laboratory and Brookhaven National Laboratory is currently engaged in the design of a high gradient quadrupole suitable for use in the LHC interaction regions. The cold iron design incorporates a two-shell, cos2θ coil geometry with a 70 mm aperture. This paper summarizes the progress on a magnetic and mechanical design that meets the requirements of maximum gradient ≥250 T/m, operation at 1.8K, high field quality and provision for adequate cooling in a high radiation environment

  10. Development of a high gradient quadrupole for the LHC Interaction Regions

    International Nuclear Information System (INIS)

    Bossert, R.; Feher, S.; Gourlay, S.A.

    1997-04-01

    A collaboration of Fermilab, Lawrence Berkeley National Laboratory and Brookhaven National Laboratory is engaged in the design of a high gradient quadrupole suitable for use in the LHC interaction regions. The cold iron design incorporates a two-layer, cos(2θ) coil geometry with a 70 mm aperture operating in superfluid helium. This paper summarizes the progress on a magnetic, mechanical and thermal design that meets the requirements of maximum gradient above 250 T/m, high field quality and provision for adequate cooling in a high radiation environment

  11. Natural radionuclides in rocks and soils of the high-mountain regions of the Great Caucasus

    Science.gov (United States)

    Asvarova, T. A.; Abdulaeva, A. S.; Magomedov, M. A.

    2012-06-01

    The results of the radioecological survey in the high-mountain regions of the Great Caucasus at the heights from 2200 to 3800 m a.s.l. are considered. This survey encompassed the territories of Dagestan, Azerbaijan, Georgia, Chechnya, Northern Ossetia-Alania, Kabardino-Balkaria, Karachay-Cherkessia, and the Stavropol and Krasnodar regions. The natural γ background radiation in the studied regions is subjected to considerable fluctuations and varies from 6 to 40 μR/h. The major regularities of the migration of natural radionuclides 238U, 232Th, 226Ra, and 40K in soils in dependence on the particular environmental conditions (the initial concentration of the radionuclides in the parent material; the intensity of pedogenesis; the intensity of the vertical and horizontal migration; and the geographic, climatic, and landscape-geochemical factors) are discussed.

  12. The substantiation of methodical instrumentation to increase the tempo of high-rise construction in region

    Science.gov (United States)

    Belyaeva, Svetlana; Makeeva, Tatyana; Chugunov, Andrei; Andreeva, Peraskovya

    2018-03-01

    One of the important conditions of effective renovation of accommodation in region on the base of realization of high-rise construction projects is attraction of investments by forming favorable investment climate, as well as reduction if administrative barriers in construction and update of main funds of housing and communal services. The article proposes methodological bases for assessing the state of the investment climate in the region, as well as the methodology for the formation and evaluation of the investment program of the housing and communal services enterprise. The proposed methodologies are tested on the example of the Voronezh region. Authors also showed the necessity and expediency of using the consulting mechanism in the development of state and non-state investment projects and programs.

  13. Innovation, regional development and relations between high- and low-tech industries

    DEFF Research Database (Denmark)

    Hansen, Teis; Winther, Lars

    2011-01-01

    The current European policy agenda strongly accentuates the importance of research and development (R&D) as a driver of economic growth. The basic assumption is that high European wage levels make it unlikely that less research-intensive parts of the economy can withstand competition from low......-wage countries with increasingly skilled labour forces. Thus, the inferior growth of the European Union (EU) in the 1990s compared with the USA has been explained by the latter’s higher rate of R&D investments. The paper challenges this rather simplistic view of innovation and examines the regional consequences...... of such policies. EU growth has caught up with that of the USA during recent years and low-tech industries continue to have considerable economic importance in Europe in terms of jobs and value added, especially outside the main growth regions, but also in the major urban regions. Empirical evidence from Denmark...

  14. The substantiation of methodical instrumentation to increase the tempo of high-rise construction in region

    Directory of Open Access Journals (Sweden)

    Belyaeva Svetlana

    2018-01-01

    Full Text Available One of the important conditions of effective renovation of accommodation in region on the base of realization of high-rise construction projects is attraction of investments by forming favorable investment climate, as well as reduction if administrative barriers in construction and update of main funds of housing and communal services. The article proposes methodological bases for assessing the state of the investment climate in the region, as well as the methodology for the formation and evaluation of the investment program of the housing and communal services enterprise. The proposed methodologies are tested on the example of the Voronezh region. Authors also showed the necessity and expediency of using the consulting mechanism in the development of state and non-state investment projects and programs.

  15. High-spin states and coexisting states in the Pt-Au transition region

    International Nuclear Information System (INIS)

    Riedinger, L.L.; Carpenter, M.P.; Courtney, L.H.; Janzen, V.P.; Schmitz, W.

    1986-01-01

    High-spin states in the N = 104 to 108 region have been studied by in-beam spectroscopy techniques in a number of Ir, Pt, and Au nuclei. These measurements have been performed at tandem Van de Graaff facilities at the Oak Ridge National Laboratory and at McMaster University. Through comparison of band crossings in a variety of odd-A and even-A nuclei, we are able to assign the first neutron and first proton alignment processes, which are nearly degenerate for 184 Pt. These measurements yield the trend of these crossing frequencies with N and Z in this region. Knowledge of this trend is important, since these crossing frequencies can give an estimate of how the shape parameters vary across this transitional region. 22 refs., 7 figs., 1 tab

  16. Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial.

    Science.gov (United States)

    Sullivan, Nancy J; Duval-Arnould, Jordan; Twilley, Marida; Smith, Sarah P; Aksamit, Deborah; Boone-Guercio, Pam; Jeffries, Pamela R; Hunt, Elizabeth A

    2015-01-01

    Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

    Directory of Open Access Journals (Sweden)

    Atci Ibrahim Burak

    2017-12-01

    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  18. Impact of perioperative liver dysfunction on in-hospital mortality and long-term survival in infective endocarditis patients.

    Science.gov (United States)

    Diab, M; Sponholz, C; von Loeffelholz, C; Scheffel, P; Bauer, M; Kortgen, A; Lehmann, T; Färber, G; Pletz, M W; Doenst, T

    2017-12-01

    Infective endocarditis (IE) is often associated with multiorgan dysfunction and mortality. The impact of perioperative liver dysfunction (LD) on outcome remains unclear and little is known about factors leading to postoperative LD. We performed a retrospective, single-center analysis on 285 patients with left-sided IE without pre-existing chronic liver disease referred to our center between 2007 and 2013 for valve surgery. Sequential organ failure assessment (SOFA) score was used to evaluate organ dysfunction. Chi-square, Cox regression, and multivariate analyses were used for evaluation. Preoperative LD (Bilirubin >20 μmol/L) was present in 68 of 285 patients. New, postoperative LD occurred in 54 patients. Hypoxic hepatitis presented the most common origin of LD, accompanied with high short-term mortality. In-hospital mortality was higher in patients with preoperative and postoperative LD compared to patients without LD (51.5, 24.1, and 10.4%, respectively, p endocarditis is an independent predictor of short- and long-term mortalities. After surviving the hospital stay, 5-year prognosis is not different and quality of life is not affected by LD. S. aureus and duration of cardiopulmonary bypass represent risk factors for postoperative LD.

  19. High-resolution regional climate model evaluation using variable-resolution CESM over California

    Science.gov (United States)

    Huang, X.; Rhoades, A.; Ullrich, P. A.; Zarzycki, C. M.

    2015-12-01

    Understanding the effect of climate change at regional scales remains a topic of intensive research. Though computational constraints remain a problem, high horizontal resolution is needed to represent topographic forcing, which is a significant driver of local climate variability. Although regional climate models (RCMs) have traditionally been used at these scales, variable-resolution global climate models (VRGCMs) have recently arisen as an alternative for studying regional weather and climate allowing two-way interaction between these domains without the need for nudging. In this study, the recently developed variable-resolution option within the Community Earth System Model (CESM) is assessed for long-term regional climate modeling over California. Our variable-resolution simulations will focus on relatively high resolutions for climate assessment, namely 28km and 14km regional resolution, which are much more typical for dynamically downscaled studies. For comparison with the more widely used RCM method, the Weather Research and Forecasting (WRF) model will be used for simulations at 27km and 9km. All simulations use the AMIP (Atmospheric Model Intercomparison Project) protocols. The time period is from 1979-01-01 to 2005-12-31 (UTC), and year 1979 was discarded as spin up time. The mean climatology across California's diverse climate zones, including temperature and precipitation, is analyzed and contrasted with the Weather Research and Forcasting (WRF) model (as a traditional RCM), regional reanalysis, gridded observational datasets and uniform high-resolution CESM at 0.25 degree with the finite volume (FV) dynamical core. The results show that variable-resolution CESM is competitive in representing regional climatology on both annual and seasonal time scales. This assessment adds value to the use of VRGCMs for projecting climate change over the coming century and improve our understanding of both past and future regional climate related to fine

  20. The Effect of High Ambient Temperature on the Elderly Population in Three Regions of Sweden

    Directory of Open Access Journals (Sweden)

    Joacim Rocklöv

    2010-06-01

    Full Text Available The short-term effects of high temperatures are a serious concern in the context of climate change. In areas that today have mild climates the research activity has been rather limited, despite the fact that differences in temperature susceptibility will play a fundamental role in understanding the exposure, acclimatization, adaptation and health risks of a changing climate. In addition, many studies employ biometeorological indexes without careful investigation of the regional heterogeneity in the impact of relative humidity. We aimed to investigate the effects of summer temperature and relative humidity and regional differences in three regions of Sweden allowing for heterogeneity of the effect over the scale of summer temperature. To do so, we collected mortality data for ages 65+ from Stockholm, Göteborg and Skåne from the Swedish National Board of Health and Welfare and the Swedish Meteorological and Hydrological Institute for the years 1998 through 2005. In Stockholm and Skåne on average 22 deaths per day occurred, while in Göteborg the mean frequency of daily deaths was 10. We fitted time-series regression models to estimate relative risks of high ambient temperatures on daily mortality using smooth functions to control for confounders, and estimated non-linear effects of exposure while allowing for auto-regressive correlation of observations within summers. The effect of temperature on mortality was found distributed over the same or following day, with statistically significant cumulative combined relative risk of about 5.1% (CI = 0.3, 10.1 per °C above the 90th percentile of summer temperature. The effect of high relative humidity was statistically significant in only one of the regions, as was the effect of relative humidity (above 80th percentile and temperature (above 90th percentile. In the southernmost region studied there appeared to be a significant increase in mortality with decreasing low summer temperatures that was not

  1. Homicide and mental disorder in a region with a high homicide rate.

    Science.gov (United States)

    Golenkov, Andrei; Large, Matthew; Nielssen, Olav; Tsymbalova, Alla

    2016-10-01

    There are few studies of the relationship between mental disorder and homicide offences from regions with high rates of homicide. We examined the characteristics and psychiatric diagnoses of homicide offenders from the Chuvash Republic of the Russian Federation, a region of Russia with a high total homicide rate. In the 30 years between 1981 and 2010, 3414 homicide offenders were the subjected to pre-trial evaluations by experienced psychiatrists, almost half of whom (1596, 46.7%) met the international classification of diseases (ICD) 10 criteria for at least one mental disorder. The six most common individual diagnoses were alcohol dependence (15.9%), acquired organic mental disorder (7.3%), personality disorder (7.1%), schizophrenia (4.4%) and intellectual disability (3.6%). More than one disorder was found in 7.4% of offenders and alcohol dependence was the most frequently diagnosed co-morbid disorder. One in ten offenders were found to be not criminally responsible for their actions. Few homicides involved the use of substances other than alcohol, and firearms were used in 1.6% of homicides. The finding that people with mental disorders other than psychosis committed a high proportion of homicides in a region with a high rate of homicide, suggests that people with mental disorders are vulnerable to similar sociological factors to those that contribute to homicide offences by people who do not have mental disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Regional Groundwater Flow Assessment in a Prospective High-Level Radioactive Waste Repository of China

    Directory of Open Access Journals (Sweden)

    Xiaoyuan Cao

    2017-07-01

    Full Text Available The production of nuclear energy will result in high-level radioactive waste (HLRW, which brings potential environmental dangers. Selecting a proper disposal repository is a crucial step in the development of nuclear energy. This paper introduces firstly the hydrogeological conditions of the Beishan area in China. Next, a regional groundwater model is constructed using a multiphase flow simulator to analyze the groundwater flow pattern in the Beishan area. Model calibration shows that the simulated and observed hydraulic heads match well, and the simulated regional groundwater flow pattern is similar to the surface flow pattern from the channel network, indicating that the groundwater flow is mainly dependent on the topography. In addition, the simulated groundwater storage over the period from 2003 to 2014 is similar to the trend derived from the Gravity Recovery and Climate Experiment satellite-derived results. Last, the established model is used to evaluate the influences of the extreme climate and regional faults on the groundwater flow pattern. It shows that they do not have a significant influence on the regional groundwater flow patterns. This study will provide a preliminary reference for the regional groundwater flow assessment in the site of the HLRW in China.

  3. The guideline for in-hospital manufactured FDG for PET examinations

    International Nuclear Information System (INIS)

    2001-01-01

    The guideline made by the three working groups of Japan Society of Nuclear Medicine, of subcommittee on Medical Application of Cyclotron-Produced Radionuclides in Medical and Pharmaceutical Science Committee of Japan Radioisotope Association (JRA) and of Radiopharmaceuticals Committee of JRA, deals with working environment and management system of FDG ( 18 F-2-deoxy-2-fluoro-D-glucose) manufacturing, standards for FDG synthetic equipment and its installation, quality and methods of synthesis and assay, PET apparatus and clinical application, for the purpose of safe and effective use of the FDG made in-hospital for its future application into public health insurance. FDG is synthesized in-hospital from 18 F generated from either 20 Ne irradiated by deuteron or 18 O, by proton. For the confirmation in the quality standard, the peaks only at 511 and 1022 keV should be observed by gamma-spectrometry with the half life of 105-115 min. The PET apparatus usable must be a defined one in the Pharmaceutical Affairs Law like that for positron CT, positron camera and PET camera. In clinical application, FDG is formulated for injection and used for examinations of brain/myocardium and cerebral/myocardial glucose consumption, of tumor and tumor FDG uptake and so on. Precautions involve general contraindications and usage in pregnancy, aged people and infants. (K.H.)

  4. Documentation of in-hospital falls on incident reports: qualitative investigation of an imperfect process.

    Science.gov (United States)

    Haines, Terry P; Cornwell, Petrea; Fleming, Jennifer; Varghese, Paul; Gray, Len

    2008-12-11

    Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  5. Documentation of in-hospital falls on incident reports: Qualitative investigation of an imperfect process

    Directory of Open Access Journals (Sweden)

    Fleming Jennifer

    2008-12-01

    Full Text Available Abstract Background Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. Methods This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Results Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting, secondary (patient injury, and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. Conclusion A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

  6. Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

    Science.gov (United States)

    Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

    2017-04-01

    To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

  7. A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.

    Science.gov (United States)

    Smith, Eric E; Shobha, Nandavar; Dai, David; Olson, DaiWai M; Reeves, Mathew J; Saver, Jeffrey L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C; Schwamm, Lee H

    2013-01-28

    We aimed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%; SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines-Stroke database were used. In-hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH, 27.2%; SAH, 25.1%; unknown type, 6.0%; Pmortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. A single prediction score for all stroke types can be used to predict risk of in-hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.

  8. A characteristics of East Asian climate using high-resolution regional climate model

    Science.gov (United States)

    Yhang, Y.

    2013-12-01

    Climate research, particularly application studies for water, agriculture, forestry, fishery and energy management require fine scale multi-decadal information of meteorological, oceanographic and land states. Unfortunately, spatially and temporally homogeneous multi-decadal observations of these variables in high horizontal resolution are non-existent. Some long term surface records of temperature and precipitation exist, but the number of observation is very limited and the measurements are often contaminated by changes in instrumentation over time. Some climatologically important variables, such as soil moisture, surface evaporation, and radiation are not even measured over most of East Asia. Reanalysis is one approach to obtaining long term homogeneous analysis of needed variables. However, the horizontal resolution of global reanalysis is of the order of 100 to 200 km, too coarse for many application studies. Regional climate models (RCMs) are able to provide valuable regional finescale information, especially in regions where the climate variables are strongly regulated by the underlying topography and the surface heterogeneity. In this study, we will provide accurately downscaled regional climate over East Asia using the Global/Regional Integrated Model system [GRIMs; Hong et al. 2013]. A mixed layer model is embedded within the GRIMs in order to improve air-sea interaction. A detailed description of the characteristics of the East Asian summer and winter climate will be presented through the high-resolution numerical simulations. The increase in horizontal resolution is expected to provide the high-quality data that can be used in various application areas such as hydrology or environmental model forcing.

  9. Regional-Scale High-Latitude Extreme Geoelectric Fields Pertaining to Geomagnetically Induced Currents

    Science.gov (United States)

    Pulkkinen, Antti; Bernabeu, Emanuel; Eichner, Jan; Viljanen, Ari; Ngwira, Chigomezyo

    2015-01-01

    Motivated by the needs of the high-voltage power transmission industry, we use data from the high-latitude IMAGE magnetometer array to study characteristics of extreme geoelectric fields at regional scales. We use 10-s resolution data for years 1993-2013, and the fields are characterized using average horizontal geoelectric field amplitudes taken over station groups that span about 500-km distance. We show that geoelectric field structures associated with localized extremes at single stations can be greatly different from structures associated with regionally uniform geoelectric fields, which are well represented by spatial averages over single stations. Visual extrapolation and rigorous extreme value analysis of spatially averaged fields indicate that the expected range for 1-in-100-year extreme events are 3-8 V/km and 3.4-7.1 V/km, respectively. The Quebec reference ground model is used in the calculations.

  10. Significance of scatter radar studies of E and F region irregularities at high latitudes

    International Nuclear Information System (INIS)

    Greenwald, R.A.

    1983-01-01

    This chapter considers the mechanisms by which electron density irregularities may be generated in the high latitude ionosphere and the techniques through which they are observed with ground base radars. The capabilities of radars used for studying these irregularities are compared with the capabilities of radars used for incoherent scatter measurements. The use of irregularity scatter techniques for dynamic studies of larger scale structured phenomena is discussed. Topics considered include E-region irregularities, observations with auroral radars, plasma drifts associated with a westward travelling surge, and ionospheric plasma motions associated with resonant waves. It is shown why high latitude F-region irregularity studies must be made in the HF frequency band (3-30 MHz). The joint use of the European Incoherent Scatter Association (EISCAT), STARE and SAFARI facilities is examined, and it is concluded that the various techniques will enhance each other and provide a better understanding of the various processes being studied

  11. Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008

    Science.gov (United States)

    2013-01-01

    Background Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap. Methods Swiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed. Results Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates. PMID:23530470

  12. High-resolution, regional-scale crop yield simulations for the Southwestern United States

    Science.gov (United States)

    Stack, D. H.; Kafatos, M.; Medvigy, D.; El-Askary, H. M.; Hatzopoulos, N.; Kim, J.; Kim, S.; Prasad, A. K.; Tremback, C.; Walko, R. L.; Asrar, G. R.

    2012-12-01

    Over the past few decades, there have been many process-based crop models developed with the goal of better understanding the impacts of climate, soils, and management decisions on crop yields. These models simulate the growth and development of crops in response to environmental drivers. Traditionally, process-based crop models have been run at the individual farm level for yield optimization and management scenario testing. Few previous studies have used these models over broader geographic regions, largely due to the lack of gridded high-resolution meteorological and soil datasets required as inputs for these data intensive process-based models. In particular, assessment of regional-scale yield variability due to climate change requires high-resolution, regional-scale, climate projections, and such projections have been unavailable until recently. The goal of this study was to create a framework for extending the Agricultural Production Systems sIMulator (APSIM) crop model for use at regional scales and analyze spatial and temporal yield changes in the Southwestern United States (CA, AZ, and NV). Using the scripting language Python, an automated pipeline was developed to link Regional Climate Model (RCM) output with the APSIM crop model, thus creating a one-way nested modeling framework. This framework was used to combine climate, soil, land use, and agricultural management datasets in order to better understand the relationship between climate variability and crop yield at the regional-scale. Three different RCMs were used to drive APSIM: OLAM, RAMS, and WRF. Preliminary results suggest that, depending on the model inputs, there is some variability between simulated RCM driven maize yields and historical yields obtained from the United States Department of Agriculture (USDA). Furthermore, these simulations showed strong non-linear correlations between yield and meteorological drivers, with critical threshold values for some of the inputs (e.g. minimum and

  13. Human genetics studies in areas of high natural radiation.V. regional and populational characteristics

    International Nuclear Information System (INIS)

    Freire-Maia, A.

    1974-01-01

    The region with high level of background radiation studied in our project is described. In the total, 8.572 couples and 43.930 pregnancy terminations were analyzed. The populational distribution of the 'relaive time of exposure to radiation' (coefficient R) is presented. The distributions of ethnic groups, alien ancestrals, mortality, morbidity, sex ratio, conditions of the household, instruction of the mother, and mean coefficients of inbreeding are also given, all the distributions are given comparatively for control and irradiated groups [pt

  14. Human genetics studies in areas of high natural radiation. V. regional and populational characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Freire-Maia, A [Faculdade de Ciencias Medicas e Biologicas de Botucatu (Brazil). Departamento de Genetica

    1974-12-01

    The region with high level of background radiation studied in our project is described. In the total, 8.572 couples and 43.930 pregnancy terminations were analyzed. The populational distribution of the 'relaive time of exposure to radiation' (coefficient R) is presented. The distributions of ethnic groups, alien ancestrals, mortality, morbidity, sex ratio, conditions of the household, instruction of the mother, and mean coefficients of inbreeding are also given, all the distributions are given comparatively for control and irradiated groups.

  15. Current Sharing inside a High Power IGBT Module at the Negative Temperature Coefficient Operating Region

    CERN Document Server

    AUTHOR|(CDS)2084596; Papastergiou, Konstantinos; Bongiorno, M; Thiringer, T

    2016-01-01

    This work investigates the current sharing effect of a high power Soft Punch Through IGBT module in the Negative Temperature Coefficient region. The unbalanced current sharing between two of the substrates is demonstrated for different current and temperature levels and its impact on the thermal stressing of the device is evaluated. The results indicate that the current asymmetry does not lead to a significant thermal stressing unbalance between the substrates.

  16. The Optical/Near-infrared Extinction Law in Highly Reddened Regions

    Science.gov (United States)

    Hosek, Matthew W., Jr.; Lu, Jessica R.; Anderson, Jay; Do, Tuan; Schlafly, Edward F.; Ghez, Andrea M.; Clarkson, William I.; Morris, Mark R.; Albers, Saundra M.

    2018-03-01

    A precise extinction law is a critical input when interpreting observations of highly reddened sources such as young star clusters and the Galactic Center (GC). We use Hubble Space Telescope observations of a region of moderate extinction and a region of high extinction to measure the optical and near-infrared extinction law (0.8–2.2 μm). The moderate-extinction region is the young massive cluster Westerlund 1 (Wd1; A Ks ∼ 0.6 mag), where 453 proper-motion selected main-sequence stars are used to measure the shape of the extinction law. To quantify the shape, we define the parameter {{ \\mathcal S }}1/λ , which behaves similarly to a color-excess ratio, but is continuous as a function of wavelength. The high-extinction region is the GC (A Ks ∼ 2.5 mag), where 819 red clump stars are used to determine the normalization of the law. The best-fit extinction law is able to reproduce the Wd1 main-sequence colors, which previous laws misestimate by 10%–30%. The law is inconsistent with a single power law, even when only the near-infrared filters are considered, and has A F125W/A Ks and A F814W/A Ks values that are 18% and 24% higher than the commonly used Nishiyama et al. law, respectively. Using this law, we recalculate the Wd1 distance to be 3905 ± 422 pc from published observations of the eclipsing binary W13. This new extinction law should be used for highly reddened populations in the Milky Way, such as the Quintuplet cluster and Young Nuclear Cluster. A python code is provided to generate the law for future use.

  17. Radon variations in active volcanoes and in regions with high seismicity: internal and external factors

    International Nuclear Information System (INIS)

    Segovia, N.; Cruz-Reyna, S. De la; Mena, M.

    1986-01-01

    The results of 4 years of observations of radon concentrations in soils of active volcanoes of Costa Rica and a highly seismic region in Mexico are discussed. A distinction is made between the influences of external (mostly meteorological) and internal (magmatic or tectonic) factors on the variation in radon levels. The geological meaning of the radon data can be thus enhanced if the external factors are excluded. (author)

  18. Calculations for nuclear data evaluation for Nb, Zr and W in the high energy region

    Energy Technology Data Exchange (ETDEWEB)

    Kitsuki, Hirohiko; Maruyama, Shin-ichi; Ishibashi, Kenji [Kyushu Univ., Fukuoka (Japan)

    1998-03-01

    Neutron total cross sections on Nb, Zr and W were calculated in the high energy region. In this calculation, we used the neutron optical-model potentials derived from those for proton incidence with introducing the symmetry term. Proton-induced activation yields for Nb and Zr was calculated by means of HETC/KFA2 and QMD plus SDM at incident energies up to 5 GeV. (author)

  19. Measurement of circumsolar ratio in high dust loading regions using a photographic method

    Science.gov (United States)

    Al-Ansary, Hany; Shafiq, Talha; Rizvi, Arslan; El-Leathy, Abdelrahman

    2017-06-01

    Performance of concentrating solar power (CSP) plants is highly affected by direct normal irradiance (DNI). However, it is also important to consider circumsolar radiation in any simulation of a CSP plant, especially in desert regions where dust loading in the atmosphere is expected. There are a number of methods to measure circumsolar radiation. However, most of them require expensive instrumentation. This work introduces a simple method to estimate circumsolar radiation. It involves taking high-resolution photographs of the sun and processing them using a computer code that identifies the sun's disk. The code then uses pixel intensities to obtain the solar intensity distribution across the sun's disk and in the aureole region. The solar intensity distribution is then used to obtain the circumsolar ratio (CSR) which represents the shape of the sun. To test this method, numerous photos of the sun were taken during the month of April and September 2016 at King Saud University in Riyadh, Saudi Arabia. Riyadh is a region that is well known for high dust-loading, especially during the summer. Two days of different atmospheric conditions were selected in September for comparative analysis. Results show that this method produces repeatable results, and that the CSR can increase significantly due to high dust loading and passing clouds. The CSR is found to be a strong function of DNI, ranging from about 4.5% at DNI values above 800 W/m2 and increasing to as much as 8.5% when DNI drops to about 400 W/m2, due to passing clouds. Furthermore, the results show that circumsolar ratio tends to be high in the early morning and late afternoon due to the high air mass, while its values tend to be lowest around solar noon when the air mass is lowest.

  20. Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study.

    Science.gov (United States)

    Hars, Mélany; Audet, Marie-Claude; Herrmann, François; De Chassey, Jean; Rizzoli, René; Reny, Jean-Luc; Gold, Gabriel; Ferrari, Serge; Trombetti, Andrea

    2018-05-01

    Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p performances on all functional tests predicted in-hospital falls and injurious falls (p poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral Research.

  1. Wave-mixing with high-order harmonics in extreme ultraviolet region

    International Nuclear Information System (INIS)

    Dao, Lap Van; Dinh, Khuong Ba; Le, Hoang Vu; Gaffney, Naylyn; Hannaford, Peter

    2015-01-01

    We report studies of the wave-mixing process in the extreme ultraviolet region with two near-infrared driving and controlling pulses with incommensurate frequencies (at 1400 nm and 800 nm). A non-collinear scheme for the two beams is used in order to spatially separate and to characterise the properties of the high-order wave-mixing field. We show that the extreme ultraviolet frequency mixing can be treated by perturbative, very high-order nonlinear optics; the modification of the wave-packet of the free electron needs to be considered in this process

  2. Very high resolution UV and X-ray spectroscopy and imagery of solar active regions

    Science.gov (United States)

    Bruner, M.; Brown, W. A.; Haisch, B. M.

    1987-01-01

    A scientific investigation of the physics of the solar atmosphere, which uses the techniques of high resolution soft X-ray spectroscopy and high resolution UV imagery, is described. The experiments were conducted during a series of three sounding rocket flights. All three flights yielded excellent images in the UV range, showing unprecedented spatial resolution. The second flight recorded the X-ray spectrum of a solar flare, and the third that of an active region. A normal incidence multi-layer mirror was used during the third flight to make the first astronomical X-ray observations using this new technique.

  3. Primary drug resistance in a region with high burden of tuberculosis. A critical problem.

    Science.gov (United States)

    Villa-Rosas, Cecilia; Laniado-Laborín, Rafael; Oceguera-Palao, Lorena

    2015-01-01

    To determine rates of drug resistance in new cases of pulmonary tuberculosis in a region with a high burden of the disease. New case suspects were referred for drug susceptibility testing. 28.9% of new cases were resistant to at least one first line drug; 3.9% had a multidrug-resistant strain, 15.6% a monoresistant strain and 9.4% a polyresistant strain. Our rate of drug resistant tuberculosis in new cases is very high; this has important clinical implications, since even monoresistance can have a negative impact on the outcome of new cases treated empirically with a six month regimen.

  4. Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry

    Directory of Open Access Journals (Sweden)

    Anjala Chelvanathan

    2016-01-01

    Full Text Available Objective. Out of hospital cardiac arrest (OHCA patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C and without catheterization (MTH + NC between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C and 110 patients did not undergo cardiac catheterization (MTH + NC. Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009. Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.

  5. Region Templates: Data Representation and Management for High-Throughput Image Analysis.

    Science.gov (United States)

    Teodoro, George; Pan, Tony; Kurc, Tahsin; Kong, Jun; Cooper, Lee; Klasky, Scott; Saltz, Joel

    2014-12-01

    We introduce a region template abstraction and framework for the efficient storage, management and processing of common data types in analysis of large datasets of high resolution images on clusters of hybrid computing nodes. The region template abstraction provides a generic container template for common data structures, such as points, arrays, regions, and object sets, within a spatial and temporal bounding box. It allows for different data management strategies and I/O implementations, while providing a homogeneous, unified interface to applications for data storage and retrieval. A region template application is represented as a hierarchical dataflow in which each computing stage may be represented as another dataflow of finer-grain tasks. The execution of the application is coordinated by a runtime system that implements optimizations for hybrid machines, including performance-aware scheduling for maximizing the utilization of computing devices and techniques to reduce the impact of data transfers between CPUs and GPUs. An experimental evaluation on a state-of-the-art hybrid cluster using a microscopy imaging application shows that the abstraction adds negligible overhead (about 3%) and achieves good scalability and high data transfer rates. Optimizations in a high speed disk based storage implementation of the abstraction to support asynchronous data transfers and computation result in an application performance gain of about 1.13×. Finally, a processing rate of 11,730 4K×4K tiles per minute was achieved for the microscopy imaging application on a cluster with 100 nodes (300 GPUs and 1,200 CPU cores). This computation rate enables studies with very large datasets.

  6. Astronomers Find World with Thick, Inhospitable Atmosphere and an Icy Heart

    Science.gov (United States)

    2009-12-01

    planets, they found that the observed radius exceeds the models' predictions: there is something more than the planet's solid surface blocking the star's light - a surrounding atmosphere, 200 km thick. "This atmosphere is much thicker than that of the Earth, so the high pressure and absence of light would rule out life as we know it," says Charbonneau, "but these conditions are still very interesting, as they could allow for some complex chemistry to take place." "Because the planet is too hot to have kept an atmosphere for long, GJ1214b represents the first opportunity to study a newly formed atmosphere enshrouding a world orbiting another star," adds team member Xavier Bonfils. "Because the planet is so close to us, it will be possible to study its atmosphere even with current facilities." The planet was first discovered as a transiting object within the MEarth project, which follows about 2000 low-mass stars to look for transits by exoplanets [4]. To confirm the planetary nature of GJ1214b and to obtain its mass (using the so-called Doppler method), the astronomers needed the full precision of the HARPS spectrograph, attached to ESO's 3.6-metre telescope at La Silla. An instrument with unrivalled stability and great precision, HARPS is the world's most successful hunter for small exoplanets. "This is the second super-Earth exoplanet for which the mass and radius could be obtained, allowing us to determine the density and to infer the inner structure," adds co-author Stephane Udry. "In both cases, data from HARPS was essential to characterise the planet." "The differences in composition between these two planets are relevant to the quest for habitable worlds," concludes Charbonneau. If super-Earth planets in general are surrounded by an atmosphere similar to that of GJ1214b, they may well be inhospitable to the development of life as we know it on our own planet. Notes [1] A super-Earth is defined as a planet between one and ten times the mass of the Earth. An exoplanet

  7. Automated breast tissue density assessment using high order regional texture descriptors in mammography

    Science.gov (United States)

    Law, Yan Nei; Lieng, Monica Keiko; Li, Jingmei; Khoo, David Aik-Aun

    2014-03-01

    Breast cancer is the most common cancer and second leading cause of cancer death among women in the US. The relative survival rate is lower among women with a more advanced stage at diagnosis. Early detection through screening is vital. Mammography is the most widely used and only proven screening method for reliably and effectively detecting abnormal breast tissues. In particular, mammographic density is one of the strongest breast cancer risk factors, after age and gender, and can be used to assess the future risk of disease before individuals become symptomatic. A reliable method for automatic density assessment would be beneficial and could assist radiologists in the evaluation of mammograms. To address this problem, we propose a density classification method which uses statistical features from different parts of the breast. Our method is composed of three parts: breast region identification, feature extraction and building ensemble classifiers for density assessment. It explores the potential of the features extracted from second and higher order statistical information for mammographic density classification. We further investigate the registration of bilateral pairs and time-series of mammograms. The experimental results on 322 mammograms demonstrate that (1) a classifier using features from dense regions has higher discriminative power than a classifier using only features from the whole breast region; (2) these high-order features can be effectively combined to boost the classification accuracy; (3) a classifier using these statistical features from dense regions achieves 75% accuracy, which is a significant improvement from 70% accuracy obtained by the existing approaches.

  8. Segmenting high-frequency intracardiac ultrasound images of myocardium into infarcted, ischemic, and normal regions.

    Science.gov (United States)

    Hao, X; Bruce, C J; Pislaru, C; Greenleaf, J F

    2001-12-01

    Segmenting abnormal from normal myocardium using high-frequency intracardiac echocardiography (ICE) images presents new challenges for image processing. Gray-level intensity and texture features of ICE images of myocardium with the same structural/perfusion properties differ. This significant limitation conflicts with the fundamental assumption on which existing segmentation techniques are based. This paper describes a new seeded region growing method to overcome the limitations of the existing segmentation techniques. Three criteria are used for region growing control: 1) Each pixel is merged into the globally closest region in the multifeature space. 2) "Geographic similarity" is introduced to overcome the problem that myocardial tissue, despite having the same property (i.e., perfusion status), may be segmented into several different regions using existing segmentation methods. 3) "Equal opportunity competence" criterion is employed making results independent of processing order. This novel segmentation method is applied to in vivo intracardiac ultrasound images using pathology as the reference method for the ground truth. The corresponding results demonstrate that this method is reliable and effective.

  9. Adapting the HSV polarization-color mapping for regions with low irradiance and high polarization.

    Science.gov (United States)

    Scott Tyo, J; Ratliff, Bradley M; Alenin, Andrey S

    2016-10-15

    Many mappings from polarization into color have been developed so that polarization information can be displayed. One of the most common of these maps the angle of linear polarization into color hue and degree of linear polarization into color saturation, while preserving the irradiance information from the polarization data. While this strategy enjoys wide popularity, there is a large class of polarization images for which it is not ideal. It is common to have images where the strongest polarization signatures (in terms of degree of polarization) occur in regions of relatively low irradiance: either in shadow in reflective bands or in cold regions in emissive bands. Since the irradiance is low, the chromatic properties of the resulting images are generally not apparent. Here we present an alternate mapping that uses the statistics of the angle of polarization as a measure of confidence in the polarization signature, then amplifies the irradiance in regions of high confidence, and leaves it unchanged in regions of low confidence. Results are shown from an LWIR and a visible spectrum imager.

  10. An integrated tool to study MHC region: accurate SNV detection and HLA genes typing in human MHC region using targeted high-throughput sequencing.

    Directory of Open Access Journals (Sweden)

    Hongzhi Cao

    Full Text Available The major histocompatibility complex (MHC is one of the most variable and gene-dense regions of the human genome. Most studies of the MHC, and associated regions, focus on minor variants and HLA typing, many of which have been demonstrated to be associated with human disease susceptibility and metabolic pathways. However, the detection of variants in the MHC region, and diagnostic HLA typing, still lacks a coherent, standardized, cost effective and high coverage protocol of clinical quality and reliability. In this paper, we presented such a method for the accurate detection of minor variants and HLA types in the human MHC region, using high-throughput, high-coverage sequencing of target regions. A probe set was designed to template upon the 8 annotated human MHC haplotypes, and to encompass the 5 megabases (Mb of the extended MHC region. We deployed our probes upon three, genetically diverse human samples for probe set evaluation, and sequencing data show that ∼97% of the MHC region, and over 99% of the genes in MHC region, are covered with sufficient depth and good evenness. 98% of genotypes called by this capture sequencing prove consistent with established HapMap genotypes. We have concurrently developed a one-step pipeline for calling any HLA type referenced in the IMGT/HLA database from this target capture sequencing data, which shows over 96% typing accuracy when deployed at 4 digital resolution. This cost-effective and highly accurate approach for variant detection and HLA typing in the MHC region may lend further insight into immune-mediated diseases studies, and may find clinical utility in transplantation medicine research. This one-step pipeline is released for general evaluation and use by the scientific community.

  11. Climate Change Impacts on Sediment Yield in Headwaters of a High-latitude Region in China

    Science.gov (United States)

    Zhou, Y.; Xu, Y. J.; Wang, J., , Dr; Weihua, X.; Huang, Y.

    2017-12-01

    Climate change is expected to have strongest effects in higher latitude regions. Despite intensive research on possible hydrological responses to global warming in these regions, our knowledge of climate change on surface erosion and sediment yield in high-latitude headwaters is limited. In this study, we used the Soil and Water Assessment Tool (SWAT) to predict future runoff and sediment yield from the headwaters of a high-latitude river basin in China's far northeast. The SWAT model was first calibrated with historical discharge records and the model parameterization achieved satisfactory validation. The calibrated model was then applied to two greenhouse gas concentration trajectories, RCP4.5 and RCP8.5, for the period from 2020 to 2050 to estimate future runoff. Sediment yields for this period were predicted using a discharge-sediment load rating curve developed from field measurements in the past nine years. Our preliminary results show an increasing trend of sediment yield under both climate change scenarios, and that the increase is more pronounced in the summer and autumn months. Changes in precipitation and temperature seem to exert variable impacts on runoff and sediment yield at interannual and seasonal scales in these headwaters. These findings imply that the current river basin management in the region needs to be reviewed and improved in order to be effective under a changing climate.

  12. Assessing carbon dioxide removal through global and regional ocean alkalinization under high and low emission pathways

    Science.gov (United States)

    Lenton, Andrew; Matear, Richard J.; Keller, David P.; Scott, Vivian; Vaughan, Naomi E.

    2018-04-01

    Atmospheric carbon dioxide (CO2) levels continue to rise, increasing the risk of severe impacts on the Earth system, and on the ecosystem services that it provides. Artificial ocean alkalinization (AOA) is capable of reducing atmospheric CO2 concentrations and surface warming and addressing ocean acidification. Here, we simulate global and regional responses to alkalinity (ALK) addition (0.25 PmolALK yr-1) over the period 2020-2100 using the CSIRO-Mk3L-COAL Earth System Model, under high (Representative Concentration Pathway 8.5; RCP8.5) and low (RCP2.6) emissions. While regionally there are large changes in alkalinity associated with locations of AOA, globally we see only a very weak dependence on where and when AOA is applied. On a global scale, while we see that under RCP2.6 the carbon uptake associated with AOA is only ˜ 60 % of the total, under RCP8.5 the relative changes in temperature are larger, as are the changes in pH (140 %) and aragonite saturation state (170 %). The simulations reveal AOA is more effective under lower emissions, therefore the higher the emissions the more AOA is required to achieve the same reduction in global warming and ocean acidification. Finally, our simulated AOA for 2020-2100 in the RCP2.6 scenario is capable of offsetting warming and ameliorating ocean acidification increases at the global scale, but with highly variable regional responses.

  13. High-spin states in 136La and possible structure change in the N =79 region

    Science.gov (United States)

    Nishibata, H.; Leguillon, R.; Odahara, A.; Shimoda, T.; Petrache, C. M.; Ito, Y.; Takatsu, J.; Tajiri, K.; Hamatani, N.; Yokoyama, R.; Ideguchi, E.; Watanabe, H.; Wakabayashi, Y.; Yoshinaga, K.; Suzuki, T.; Nishimura, S.; Beaumel, D.; Lehaut, G.; Guinet, D.; Desesquelles, P.; Curien, D.; Higashiyama, K.; Yoshinaga, N.

    2015-05-01

    High-spin states in the odd-odd nucleus 136La, which is located close to the β -stability line, have been investigated in the radioactive-beam-induced fusion-evaporation reaction 124Sn(17N,5 n ). The use of the radioactive beam enabled a highly sensitive and successful search for a new isomer [14+,T1 /2=187 (27 ) ns] in 136La. In the A =130 -140 mass region, no such long-lived isomer has been observed at high spin in odd-odd nuclei. The 136La level scheme was revised, incorporating the 14+ isomer and six new levels. The results were compared with pair-truncated shell model (PTSM) calculations which successfully explain the level structure of the π h11 /2⊗ν h11/2 -1 bands in 132La and 134La. The isomerism of the 14+ state was investigated also by a collective model, the cranked Nilsson-Strutinsky (CNS) model, which explains various high-spin structures in the medium-heavy mass region. It is suggested that a new type of collective structure is induced in the PTSM model by the increase of the number of π g7 /2 pairs, and/or in the CNS model by the configuration change associated with the shape change in 136La.

  14. Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review.

    Science.gov (United States)

    Lodewijckx, C; Sermeus, W; Panella, M; Deneckere, S; Leigheb, F; Decramer, M; Vanhaecht, K

    2011-11-01

    In-hospital management of COPD exacerbation is suboptimal, and outcomes are poor. Care pathways are a possible strategy for optimizing care processes and outcomes. The aim of the literature review was to explore characteristics of existing care pathways for in-hospital management of COPD exacerbations and to address their impact on performance of care processes, clinical outcomes, and team functioning. A literature search was conducted for articles published between 1990 and 2010 in the electronic databases of Medline, CINAHL, EMBASE, and Cochrane Library. Main inclusion criteria were (I) patients hospitalized for a COPD exacerbation; (II) implementation and evaluation of a care pathway; (III) report of original research, including experimental and quasi experimental designs, variance analysis, and interviews of professionals and patients about their perception on pathway effectiveness. Four studies with a quasi experimental design were included. Three studies used a pre-post test design; the fourth study was a non randomized controlled trial comparing an experimental group where patients were treated according to a care pathway with a control group where usual care was provided. The four studied care pathways were multidisciplinary structured care plans, outlining time-specific clinical interventions and responsibilities by discipline. Statistic analyses were rarely performed, and the trials used very divergent indicators to evaluate the impact of the care pathways. The studies described positive effects on blood sampling, daily weight measurement, arterial blood gas measurement, referral to rehabilitation, feelings of anxiety, length of stay, readmission, and in-hospital mortality. Research on COPD care pathways is very limited. The studies described few positive effects of the care pathways on diagnostic processes and on clinical outcomes. Though due to limited statistical analysis and weak design of the studies, the internal validity of results is limited

  15. Polonium-210 and Lead-210 in marine biota from a coastal region with high natural radioactivity

    International Nuclear Information System (INIS)

    Zafrul Kabir, M.; Deeba, Farah; Hossain, Sushmita; Fharim, Massoud; Md Moniruzzaman; Carvalho, Fernando P.; Oliveira, João M.; Malta, M.; Silva, L.

    2013-01-01

    Coastal sediments and marine fish from a region with high natural radioactivity in Cox Bazar Bangladesh, were analyzed in order to investigate the levels of naturally occurring radionuclides. Sediment from the sea shore in high ambient radiation dose rate areas contained naturally occurring radionuclides at high concentrations. These sediments displayed 226 Ra, 232 Th and 235 U activity concentrations of 2184 ± 88 Bq kg -1 dry weight (d.w.), 3808 ± 200 Bq kg -1 (d.w.) and 123 ± 15 Bq kg -1 (d.w.), respectively. In contrast with these high values, radionuclide concentrations in sand from other areas of the Cox's Bazar coast were as low as 42 ± 3, 70 ± 4 and < 8 Bq kg -1 (d.w.) for the same radionuclides, respectively, which are comparable to concentrations determined in many coastal areas elsewhere. The presence of sand deposits with high concentration of uranium series radionuclides could potentially originate high accumulation of alpha emitting radionuclides such as 210 Po in marine biota, and food chain transfer to man. 210 Po is a major contributor to the radiation dose both in marine organisms and sea food consumers. Determination of 210 Po in marine fish and shrimp from the area lead to concentration values ranging from 4.5±0.3 to 124±3 Bq kg -1 (d.w.) in fish and 82.9±1.6 Bq kg -1 (d.w.) in shrimp. Similar concentrations are commonly reported in marine biota from several regions. Therefore, in spite of the deposits of heavy mineral sands containing high concentrations of radionuclides such as 210 Pb and 210 Po no significant raise in the accumulation of these radionuclides in biota seems to occur, which suggests that radionuclides are tightly bound in sediment grains and are not significantly bioavailable. (author)

  16. In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project.

    Science.gov (United States)

    Neumann, L; Hoffmann, V S; Golgert, S; Hasford, J; Von Renteln-Kruse, W

    2013-03-01

    In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy. Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation. Geriatric clinic at an academic teaching hospital in Hamburg, Germany. 4,735 hospitalised patients ≥65 years. Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated. There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3. Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.

  17. Application of Mastic Asphalt Waterproofing Layer in High-Speed Railway Track in Cold Regions

    Directory of Open Access Journals (Sweden)

    Song Liu

    2018-04-01

    Full Text Available Freeze-thaw damage is a typical distress incurred in road and railway engineering in cold regions. Concrete waterproofing layer is commonly used in high-speed railway tracks to prevent the penetration of surface water, however, it cracks easily under thermal stress, especially in cold regions. Recently solutions have been proposed to increase the waterproofing layer’s cracking resistance by using asphalt layers. Nonetheless, the use of emulsified asphalt as well as dense-graded asphalt mixture were not effective enough. To improve the effectiveness, in this study, mastic asphalt was designed for application as the waterproofing layer on the subgrade surface of high-speed railway tracks in cold regions. The overall performance of mastic asphalt was preliminarily evaluated by laboratory tests, then a 200-m test section was constructed for field validation in northeastern China as part of a new high-speed railway line, and water content sensors were placed inside the subgrade to monitor the performance of the mastic asphalt waterproofing layer (MAWL. The subsequent field investigation and monitoring data during the two years operation showed that MAWL dramatically outperformed the conventional concrete waterproofing layer in terms of waterproof performance. Plenty of serious cracks were found in the conventional concrete waterproofing layer, but only a limited number of local cracks were observed in MAWL. As a result, MAWL keeps the water content of subgrade at a stable level. In addition, MAWL showed relatively high stability during the two years investigation period, and no obvious deterioration was observed in the test section.

  18. What Causes the High Apparent Speeds in Chromospheric and Transition Region Spicules on the Sun?

    Energy Technology Data Exchange (ETDEWEB)

    De Pontieu, Bart; Martínez-Sykora, Juan; Chintzoglou, Georgios, E-mail: bdp@lmsal.com [Lockheed Martin Solar and Astrophysics Laboratory, Palo Alto, CA 94304 (United States)

    2017-11-01

    Spicules are the most ubuiquitous type of jets in the solar atmosphere. The advent of high-resolution imaging and spectroscopy from the Interface Region Imaging Spectrograph ( IRIS ) and ground-based observatories has revealed the presence of very high apparent motions of order 100–300 km s{sup −1} in spicules, as measured in the plane of the sky. However, line of sight measurements of such high speeds have been difficult to obtain, with values deduced from Doppler shifts in spectral lines typically of order 30–70 km s{sup −1}. In this work, we resolve this long-standing discrepancy using recent 2.5D radiative MHD simulations. This simulation has revealed a novel driving mechanism for spicules in which ambipolar diffusion resulting from ion-neutral interactions plays a key role. In our simulation, we often see that the upward propagation of magnetic waves and electrical currents from the low chromosphere into already existing spicules can lead to rapid heating when the currents are rapidly dissipated by ambipolar diffusion. The combination of rapid heating and the propagation of these currents at Alfvénic speeds in excess of 100 km s{sup −1} leads to the very rapid apparent motions, and often wholesale appearance, of spicules at chromospheric and transition region temperatures. In our simulation, the observed fast apparent motions in such jets are actually a signature of a heating front, and much higher than the mass flows, which are of order 30–70 km s{sup −1}. Our results can explain the behavior of transition region “network jets” and the very high apparent speeds reported for some chromospheric spicules.

  19. Synchronous fire activity in the tropical high Andes: an indication of regional climate forcing.

    Science.gov (United States)

    Román-Cuesta, R M; Carmona-Moreno, C; Lizcano, G; New, M; Silman, M; Knoke, T; Malhi, Y; Oliveras, I; Asbjornsen, H; Vuille, M

    2014-06-01

    Global climate models suggest enhanced warming of the tropical mid and upper troposphere, with larger temperature rise rates at higher elevations. Changes in fire activity are amongst the most significant ecological consequences of rising temperatures and changing hydrological properties in mountainous ecosystems, and there is a global evidence of increased fire activity with elevation. Whilst fire research has become popular in the tropical lowlands, much less is known of the tropical high Andean region (>2000 masl, from Colombia to Bolivia). This study examines fire trends in the high Andes for three ecosystems, the Puna, the Paramo and the Yungas, for the period 1982-2006. We pose three questions: (i) is there an increased fire response with elevation? (ii) does the El Niño- Southern Oscillation control fire activity in this region? (iii) are the observed fire trends human driven (e.g., human practices and their effects on fuel build-up) or climate driven? We did not find evidence of increased fire activity with elevation but, instead, a quasicyclic and synchronous fire response in Ecuador, Peru and Bolivia, suggesting the influence of high-frequency climate forcing on fire responses on a subcontinental scale, in the high Andes. ENSO variability did not show a significant relation to fire activity for these three countries, partly because ENSO variability did not significantly relate to precipitation extremes, although it strongly did to temperature extremes. Whilst ENSO did not individually lead the observed regional fire trends, our results suggest a climate influence on fire activity, mainly through a sawtooth pattern of precipitation (increased rainfall before fire-peak seasons (t-1) followed by drought spells and unusual low temperatures (t0), which is particularly common where fire is carried by low fuel loads (e.g., grasslands and fine fuel). This climatic sawtooth appeared as the main driver of fire trends, above local human influences and fuel build

  20. Radiation damage considerations in a high luminosity collider: The interaction region

    International Nuclear Information System (INIS)

    Lee, D.M.

    1992-01-01

    The interaction region in a high luminosity collider will be a source of radiation for all components in the vicinity and will place stringent requirements on their design. The major components in the vicinity and will place stingent requirements on their design. The major components in the vicinity of the interaction region are the physics detectors that surround the beam pipe and the focusing quadrupole magnets nearby. We will present the radiation levels in such a physics detector and the power in the forward direction that will be deposited in the forward calorimeters and quad magnets. The implications of the levels on a variety of detector components and electronics will be presented. The calculational techniques and limitation will be reviewed

  1. High-Resolution Melting (HRM) of Hypervariable Mitochondrial DNA Regions for Forensic Science.

    Science.gov (United States)

    Dos Santos Rocha, Alípio; de Amorim, Isis Salviano Soares; Simão, Tatiana de Almeida; da Fonseca, Adenilson de Souza; Garrido, Rodrigo Grazinoli; Mencalha, Andre Luiz

    2018-03-01

    Forensic strategies commonly are proceeding by analysis of short tandem repeats (STRs); however, new additional strategies have been proposed for forensic science. Thus, this article standardized the high-resolution melting (HRM) of DNA for forensic analyzes. For HRM, mitochondrial DNA (mtDNA) from eight individuals were extracted from mucosa swabs by DNAzol reagent, samples were amplified by PCR and submitted to HRM analysis to identify differences in hypervariable (HV) regions I and II. To confirm HRM, all PCR products were DNA sequencing. The data suggest that is possible discriminate DNA from different samples by HRM curves. Also, uncommon dual-dissociation was identified in a single PCR product, increasing HRM analyzes by evaluation of melting peaks. Thus, HRM is accurate and useful to screening small differences in HVI and HVII regions from mtDNA and increase the efficiency of laboratory routines based on forensic genetics. © 2017 American Academy of Forensic Sciences.

  2. High-resolution recombination patterns in a region of human chromosome 21 measured by sperm typing.

    Directory of Open Access Journals (Sweden)

    Irene Tiemann-Boege

    2006-05-01

    Full Text Available For decades, classical crossover studies and linkage disequilibrium (LD analysis of genomic regions suggested that human meiotic crossovers may not be randomly distributed along chromosomes but are focused instead in "hot spots." Recent sperm typing studies provided data at very high resolution and accuracy that defined the physical limits of a number of hot spots. The data were also used to test whether patterns of LD can predict hot spot locations. These sperm typing studies focused on several small regions of the genome already known or suspected of containing a hot spot based on the presence of LD breakdown or previous experimental evidence of hot spot activity. Comparable data on target regions not specifically chosen using these two criteria is lacking but is needed to make an unbiased test of whether LD data alone can accurately predict active hot spots. We used sperm typing to estimate recombination in 17 almost contiguous ~5 kb intervals spanning 103 kb of human Chromosome 21. We found two intervals that contained new hot spots. The comparison of our data with recombination rates predicted by statistical analyses of LD showed that, overall, the two datasets corresponded well, except for one predicted hot spot that showed little crossing over. This study doubles the experimental data on recombination in men at the highest resolution and accuracy and supports the emerging genome-wide picture that recombination is localized in small regions separated by cold areas. Detailed study of one of the new hot spots revealed a sperm donor with a decrease in recombination intensity at the canonical recombination site but an increase in crossover activity nearby. This unique finding suggests that the position and intensity of hot spots may evolve by means of a concerted mechanism that maintains the overall recombination intensity in the region.

  3. Regional reductions in sleep electroencephalography power in obstructive sleep apnea: a high-density EEG study.

    Science.gov (United States)

    Jones, Stephanie G; Riedner, Brady A; Smith, Richard F; Ferrarelli, Fabio; Tononi, Giulio; Davidson, Richard J; Benca, Ruth M

    2014-02-01

    Obstructive sleep apnea (OSA) is associated with significant alterations in neuronal integrity resulting from either hypoxemia and/or sleep loss. A large body of imaging research supports reductions in gray matter volume, alterations in white matter integrity and resting state activity, and functional abnormalities in response to cognitive challenge in various brain regions in patients with OSA. In this study, we used high-density electroencephalography (hdEEG), a functional imaging tool that could potentially be used during routine clinical care, to examine the regional distribution of neural activity in a non-clinical sample of untreated men and women with moderate/severe OSA. Sleep was recorded with 256-channel EEG in relatively healthy subjects with apnea-hypopnea index (AHI) > 10, as well as age-, sex-, and body mass index-matched controls selected from a research population initially recruited for a study on sleep and meditation. Sleep laboratory. Nine subjects with AHI > 10 and nine matched controls. N/A. Topographic analysis of hdEEG data revealed a broadband reduction in EEG power in a circumscribed region overlying the parietal cortex in OSA subjects. This parietal reduction in neural activity was present, to some extent, across all frequency bands in all stages and episodes of nonrapid eye movement sleep. This investigation suggests that regional deficits in electroencephalography (EEG) power generation may be a useful clinical marker for neural disruption in obstructive sleep apnea, and that high-density EEG may have the sensitivity to detect pathological cortical changes early in the disease process.

  4. High resolution of black carbon and organic carbon emissions in the Pearl River Delta region, China.

    Science.gov (United States)

    Zheng, Junyu; He, Min; Shen, Xingling; Yin, Shasha; Yuan, Zibing

    2012-11-01

    A high-resolution regional black carbon (BC) and organic carbon (OC) emission inventory for the year 2009 was developed for the Pearl River Delta (PRD) region, China, based on the collected activity data and the latest emission factors. PM(2.5), BC and OC emissions were estimated to be 303 kt, 39 kt and 31 kt, respectively. Industrial processes were major contributing sources to PM(2.5) emissions. BC emissions were mainly from mobile sources, accounting for 65.0%, while 34.1% of OC emissions were from residential combustion. The primary OC/BC ratios for individual cities in the PRD region were dependent on the levels of economic development due to differences in source characteristics, with high ratios in the less developed cities and low ratios in the central and southern developed areas. The preliminary temporal profiles were established, showing the highest OC emissions in winter and relatively constant BC emissions throughout the year. The emissions were spatially allocated into grid cells with a resolution of 3 km × 3 km. Large amounts of BC emissions were distributed over the central-southern PRD city clusters, while OC emissions exhibited a relatively even spatial distribution due to the significant biomass burning emissions from the outlying area of the PRD region. Uncertainties in carbonaceous aerosol emissions were usually higher than in other primary pollutants like SO(2), NO(x), and PM(10). One of the key uncertainty sources was the emission factor, due to the absence of direct measurements of BC and OC emission rates. Copyright © 2012 Elsevier B.V. All rights reserved.

  5. An investigation of tropical Atlantic bias in a high-resolution coupled regional climate model

    Energy Technology Data Exchange (ETDEWEB)

    Patricola, Christina M.; Saravanan, R.; Hsieh, Jen-Shan [Texas A and M University, Department of Atmospheric Sciences, College Station, TX (United States); Li, Mingkui; Xu, Zhao [Texas A and M University, Department of Oceanography, College Station, TX (United States); Ocean University of China, Key Laboratory of Physical Oceanography of Ministry of Education, Qingdao (China); Chang, Ping [Texas A and M University, Department of Oceanography, College Station, TX (United States); Ocean University of China, Key Laboratory of Physical Oceanography of Ministry of Education, Qingdao (China); Second Institute of Oceanography, State Key Laboratory of Satellite Ocean Environment Dynamics, Hangzhou, Zhejiang (China)

    2012-11-15

    Coupled atmosphere-ocean general circulation models (AOGCMs) commonly fail to simulate the eastern equatorial Atlantic boreal summer cold tongue and produce a westerly equatorial trade wind bias. This tropical Atlantic bias problem is investigated with a high-resolution (27-km atmosphere represented by the Weather Research and Forecasting Model, 9-km ocean represented by the Regional Ocean Modeling System) coupled regional climate model. Uncoupled atmospheric simulations test climate sensitivity to cumulus, land-surface, planetary boundary layer, microphysics, and radiation parameterizations and reveal that the radiation scheme has a pronounced impact in the tropical Atlantic. The CAM radiation simulates a dry precipitation (up to -90%) and cold land-surface temperature (up to -8 K) bias over the Amazon related to an over-representation of low-level clouds and almost basin-wide westerly trade wind bias. The Rapid Radiative Transfer Model and Goddard radiation simulates doubled Amazon and Congo Basin precipitation rates and a weak eastern Atlantic trade wind bias. Season-long high-resolution coupled regional model experiments indicate that the initiation of the warm eastern equatorial Atlantic sea surface temperature (SST) bias is more sensitive to the local rather than basin-wide trade wind bias and to a wet Congo Basin instead of dry Amazon - which differs from AOGCM simulations. Comparisons between coupled and uncoupled simulations suggest a regional Bjerknes feedback confined to the eastern equatorial Atlantic amplifies the initial SST, wind, and deepened thermocline bias, while barrier layer feedbacks are relatively unimportant. The SST bias in some CRCM simulations resembles the typical AOGCM bias indicating that increasing resolution is unlikely a simple solution to this problem. (orig.)

  6. Very high-resolution regional climate simulations over Scandinavia-present climate

    DEFF Research Database (Denmark)

    Christensen, Ole B.; Christensen, Jens H.; Machenhauer, Bennert

    1998-01-01

    realistically simulated. It is found in particular that in mountainous regions the high-resolution simulation shows improvements in the simulation of hydrologically relevant fields such as runoff and snow cover. Also, the distribution of precipitation on different intensity classes is most realistically...... on a high-density station network for the Scandinavian countries compiled for the present study. The simulated runoff is compared with observed data from Sweden extracted from a Swedish climatological atlas. These runoff data indicate that the precipitation analyses are underestimating the true...... simulated in the high-resolution simulation. It does, however, inherit certain large-scale systematic errors from the driving GCM. In many cases these errors increase with increasing resolution. Model verification of near-surface temperature and precipitation is made using a new gridded climatology based...

  7. High Frequency Backscatter from the Polar and Auroral E-Region Ionosphere

    Science.gov (United States)

    Forsythe, Victoriya V.

    The Earth's ionosphere contains collisional and partially-ionized plasma. The electric field, produced by the interaction between the Earth's magnetosphere and the solar wind, drives the plasma bulk motion, also known as convection, in the F-region of the ionosphere. It can also destabilize the plasma in the E-region, producing irregularities or waves. Intermediate-scale waves with wavelengths of hundreds of meters can cause scintillation and fading of the Global Navigation Satellite System (GNSS) signals, whereas the small-scale waves (lambda Network (SuperDARN). The theoretical part of this work focuses on symmetry properties of the general dispersion relation that describes wave propagation in the collisional plasma in the two-stream and gradient-drift instability regimes. The instability growth rate and phase velocity are examined under the presence of a background parallel electric field, whose influence is demonstrated to break the spatial symmetry of the wave propagation patterns. In the observational part of this thesis, a novel dual radar setup is used to examine E-region irregularities in the magnetic polar cap by probing the E-region along the same line from opposite directions. The phase velocity analysis together with raytracing simulations demonstrated that, in the polar cap, the radar backscatter is primarily controlled by the plasma density conditions. In particular, when the E-region layer is strong and stratified, the radar backscatter properties are controlled by the convection velocity, whereas for a tilted E-layer, the height and aspect angle conditions are more important. Finally, the fundamental dependence of the E-region irregularity phase velocity on the component of the plasma convection is investigated using two new SuperDARN radars at high southern latitudes where plasma convection estimates are accurately deduced from all SuperDARN radars in the southern hemisphere. Statistical analysis is presented showing that the predominance of the

  8. An improved permanent magnet quadrupole design with larger good field region for high intensity proton linacs

    Energy Technology Data Exchange (ETDEWEB)

    Mathew, Jose V., E-mail: josev.mathew@gmail.com; Rao, S.V.L.S.; Krishnagopal, S.; Singh, P.

    2013-11-01

    The Low Energy High Intensity Proton Accelerator (LEHIPA), being developed at the Bhabha Atomic Research Centre (BARC) will produce a 20 MeV, 30 mA, continuous wave (CW) proton beam. At these low velocities, space-charge forces dominate, and could lead to larger beam sizes and beam halos. Hence in the design of the focusing lattice of the LEHIPA drift tube linac (DTL) using permanent magnet quadrupoles (PMQs), a larger good field region is preferred. Here we study, using the two dimensional (2D) and three dimensional (3D) simulation codes PANDIRA and RADIA, four different types of cylindrical PMQ designs: 16-segment trapezoidal Halbach configuration, bullet-nosed geometry and 8- and 16-segment rectangular geometries. The trapezoidal Halbach geometry is used in a variety of accelerators since it provides very high field gradients in small bores, while the bullet-nosed geometry, which is a combination of the trapezoidal and rectangular designs, is used in some DTLs. This study shows that a larger good field region is possible in the 16-segment rectangular design as compared to the Halbach and bullet-nosed designs, making it more attractive for high-intensity proton linacs. An improvement in good-field region by ∼16% over the Halbach design is obtained in the optimized 16-segment rectangular design, although the field gradient is lower by ∼20%. Tolerance studies show that the rectangular segment PMQ design is substantially less sensitive to the easy axis orientation errors and hence will be a better choice for DTLs. -- Highlights: • An improved permanent magnet quadrupole (PMQ) design with larger good field region is proposed. • We investigate four PMQ designs, including the widely used Halbach and bullet nosed designs. • Analytical calculations are backed by 2D as well as 3D numerical solvers, PANDIRA and RADIA. • The optimized 16 segment rectangular PMQ design is identified to exhibit the largest good field region. • The effect of easy axis orientation

  9. An improved permanent magnet quadrupole design with larger good field region for high intensity proton linacs

    International Nuclear Information System (INIS)

    Mathew, Jose V.; Rao, S.V.L.S.; Krishnagopal, S.; Singh, P.

    2013-01-01

    The Low Energy High Intensity Proton Accelerator (LEHIPA), being developed at the Bhabha Atomic Research Centre (BARC) will produce a 20 MeV, 30 mA, continuous wave (CW) proton beam. At these low velocities, space-charge forces dominate, and could lead to larger beam sizes and beam halos. Hence in the design of the focusing lattice of the LEHIPA drift tube linac (DTL) using permanent magnet quadrupoles (PMQs), a larger good field region is preferred. Here we study, using the two dimensional (2D) and three dimensional (3D) simulation codes PANDIRA and RADIA, four different types of cylindrical PMQ designs: 16-segment trapezoidal Halbach configuration, bullet-nosed geometry and 8- and 16-segment rectangular geometries. The trapezoidal Halbach geometry is used in a variety of accelerators since it provides very high field gradients in small bores, while the bullet-nosed geometry, which is a combination of the trapezoidal and rectangular designs, is used in some DTLs. This study shows that a larger good field region is possible in the 16-segment rectangular design as compared to the Halbach and bullet-nosed designs, making it more attractive for high-intensity proton linacs. An improvement in good-field region by ∼16% over the Halbach design is obtained in the optimized 16-segment rectangular design, although the field gradient is lower by ∼20%. Tolerance studies show that the rectangular segment PMQ design is substantially less sensitive to the easy axis orientation errors and hence will be a better choice for DTLs. -- Highlights: • An improved permanent magnet quadrupole (PMQ) design with larger good field region is proposed. • We investigate four PMQ designs, including the widely used Halbach and bullet nosed designs. • Analytical calculations are backed by 2D as well as 3D numerical solvers, PANDIRA and RADIA. • The optimized 16 segment rectangular PMQ design is identified to exhibit the largest good field region. • The effect of easy axis orientation

  10. A regional high-resolution carbon flux inversion of North America for 2004

    Science.gov (United States)

    Schuh, A. E.; Denning, A. S.; Corbin, K. D.; Baker, I. T.; Uliasz, M.; Parazoo, N.; Andrews, A. E.; Worthy, D. E. J.

    2010-05-01

    Resolving the discrepancies between NEE estimates based upon (1) ground studies and (2) atmospheric inversion results, demands increasingly sophisticated techniques. In this paper we present a high-resolution inversion based upon a regional meteorology model (RAMS) and an underlying biosphere (SiB3) model, both running on an identical 40 km grid over most of North America. Current operational systems like CarbonTracker as well as many previous global inversions including the Transcom suite of inversions have utilized inversion regions formed by collapsing biome-similar grid cells into larger aggregated regions. An extreme example of this might be where corrections to NEE imposed on forested regions on the east coast of the United States might be the same as that imposed on forests on the west coast of the United States while, in reality, there likely exist subtle differences in the two areas, both natural and anthropogenic. Our current inversion framework utilizes a combination of previously employed inversion techniques while allowing carbon flux corrections to be biome independent. Temporally and spatially high-resolution results utilizing biome-independent corrections provide insight into carbon dynamics in North America. In particular, we analyze hourly CO2 mixing ratio data from a sparse network of eight towers in North America for 2004. A prior estimate of carbon fluxes due to Gross Primary Productivity (GPP) and Ecosystem Respiration (ER) is constructed from the SiB3 biosphere model on a 40 km grid. A combination of transport from the RAMS and the Parameterized Chemical Transport Model (PCTM) models is used to forge a connection between upwind biosphere fluxes and downwind observed CO2 mixing ratio data. A Kalman filter procedure is used to estimate weekly corrections to biosphere fluxes based upon observed CO2. RMSE-weighted annual NEE estimates, over an ensemble of potential inversion parameter sets, show a mean estimate 0.57 Pg/yr sink in North America

  11. An automated approach for mapping persistent ice and snow cover over high latitude regions

    Science.gov (United States)

    Selkowitz, David J.; Forster, Richard R.

    2016-01-01

    We developed an automated approach for mapping persistent ice and snow cover (glaciers and perennial snowfields) from Landsat TM and ETM+ data across a variety of topography, glacier types, and climatic conditions at high latitudes (above ~65°N). Our approach exploits all available Landsat scenes acquired during the late summer (1 August–15 September) over a multi-year period and employs an automated cloud masking algorithm optimized for snow and ice covered mountainous environments. Pixels from individual Landsat scenes were classified as snow/ice covered or snow/ice free based on the Normalized Difference Snow Index (NDSI), and pixels consistently identified as snow/ice covered over a five-year period were classified as persistent ice and snow cover. The same NDSI and ratio of snow/ice-covered days to total days thresholds applied consistently across eight study regions resulted in persistent ice and snow cover maps that agreed closely in most areas with glacier area mapped for the Randolph Glacier Inventory (RGI), with a mean accuracy (agreement with the RGI) of 0.96, a mean precision (user’s accuracy of the snow/ice cover class) of 0.92, a mean recall (producer’s accuracy of the snow/ice cover class) of 0.86, and a mean F-score (a measure that considers both precision and recall) of 0.88. We also compared results from our approach to glacier area mapped from high spatial resolution imagery at four study regions and found similar results. Accuracy was lowest in regions with substantial areas of debris-covered glacier ice, suggesting that manual editing would still be required in these regions to achieve reasonable results. The similarity of our results to those from the RGI as well as glacier area mapped from high spatial resolution imagery suggests it should be possible to apply this approach across large regions to produce updated 30-m resolution maps of persistent ice and snow cover. In the short term, automated PISC maps can be used to rapidly

  12. Analysis of Canis mitochondrial DNA demonstrates high concordance between the control region and ATPase genes

    Directory of Open Access Journals (Sweden)

    White Bradley N

    2010-07-01

    Full Text Available Abstract Background Phylogenetic studies of wild Canis species have relied heavily on the mitochondrial DNA control region (mtDNA CR to infer species relationships and evolutionary lineages. Previous analyses of the CR provided evidence for a North American evolved eastern wolf (C. lycaon, that is more closely related to red wolves (C. rufus and coyotes (C. latrans than grey wolves (C. lupus. Eastern wolf origins, however, continue to be questioned. Therefore, we analyzed mtDNA from 89 wolves and coyotes across North America and Eurasia at 347 base pairs (bp of the CR and 1067 bp that included the ATPase6 and ATPase8 genes. Phylogenies and divergence estimates were used to clarify the evolutionary history of eastern wolves, and regional comparisons of nonsynonomous to synonomous substitutions (dN/dS at the ATPase6 and ATPase8 genes were used to elucidate the potential role of selection in shaping mtDNA geographic distribution. Results We found high concordance across analyses between the mtDNA regions studied. Both had a high percentage of variable sites (CR = 14.6%; ATP = 9.7% and both phylogenies clustered eastern wolf haplotypes monophyletically within a North American evolved lineage apart from coyotes. Divergence estimates suggest the putative red wolf sequence is more closely related to coyotes (DxyCR = 0.01982 ± 0.00494 SD; DxyATP = 0.00332 ± 0.00097 SD than the eastern wolf sequences (DxyCR = 0.03047 ± 0.00664 SD; DxyATP = 0.00931 ± 0.00205 SD. Neutrality tests on both genes were indicative of the population expansion of coyotes across eastern North America, and dN/dS ratios suggest a possible role for purifying selection in the evolution of North American lineages. dN/dS ratios were higher in European evolved lineages from northern climates compared to North American evolved lineages from temperate regions, but these differences were not statistically significant. Conclusions These results demonstrate high concordance between coding

  13. Research on the development efficiency of regional high-end talent in China: A complex network approach.

    Science.gov (United States)

    Zhang, Zhen; Wang, Minggang; Tian, Lixin; Zhang, Wenbin

    2017-01-01

    In this paper, based on the panel data of 31 provinces and cities in China from 1991 to 2016, the regional development efficiency matrix of high-end talent is obtained by DEA method, and the matrix is converted into a continuous change of complex networks through the construction of sliding window. Using a series of continuous changes in the complex network topology statistics, the characteristics of regional high-end talent development efficiency system are analyzed. And the results show that the average development efficiency of high-end talent in the western region is at a low level. After 2005, the national regional high-end talent development efficiency network has both short-range relevance and long-range relevance in the evolution process. The central region plays an important intermediary role in the national regional high-end talent development system. And the western region has high clustering characteristics. With the implementation of the high-end talent policies with regional characteristics by different provinces and cities, the relevance of high-end talent development efficiency in various provinces and cities presents a weakening trend, and the geographical characteristics of high-end talent are more and more obvious.

  14. A wearable device for a fully automated in-hospital staff and patient identification.

    Science.gov (United States)

    Cavalleri, M; Morstabilini, R; Reni, G

    2004-01-01

    In the health care context, devices for automated staff / patient identification provide multiple benefits, including error reduction in drug administration, an easier and faster use of the Electronic Health Record, enhanced security and control features when accessing confidential data, etc. Current identification systems (e.g. smartcards, bar codes) are not completely seamless to users and require mechanical operations that sometimes are difficult to perform for impaired subjects. Emerging wireless RFID technologies are encouraging, but cannot still be introduced in health care environments due to their electromagnetic emissions and the need for large size antenna to operate at reasonable distances. The present work describes a prototype of wearable device for automated staff and patient identification which is small in size and complies with the in-hospital electromagnetic requirements. This prototype also implements an anti-counterfeit option. Its experimental application allowed the introduction of some security functions for confidential data management.

  15. The prediction of in-hospital mortality by mid-upper arm circumference

    DEFF Research Database (Denmark)

    Opio, Martin Otyek; Namujwiga, Teopista; Nakitende, Imaculate

    2018-01-01

    There are few reports of the association of nutritional status with in-hospital mortality of acutely ill medical patients in sub-Saharan Africa. This is a prospective observational study comparing the predictive value of mid-upper arm circumference (MUAC) of 899 acutely ill medical patients...... patients in a resource-poor hospital in sub-Saharan Africa....... admitted to a resource-poor sub-Saharan hospital with mental alertness, mobility and vital signs. Mid-upper arm circumference ranged from 15 cm to 42 cm, and 12 (24%) of the 50 patients with a MUAC less than 20 cm died (OR 4.84, 95% CI 2.23-10.37). Of the 237 patients with a MUAC more than 28 cm only six...

  16. Is there a difference in survival between men and women suffering in-hospital cardiac arrest?

    Science.gov (United States)

    Israelsson, Johan; Persson, Carina; Strömberg, Anna; Arestedt, Kristofer

    2014-01-01

    To describe in-hospital cardiac arrest (CA) events with regard to sex and to investigate if sex is associated with survival. Previous studies exploring differences between sexes are incongruent with regard to clinical outcomes. In order to provide equality and improve care, further investigations into these aspects are warranted. This registry study included 286 CAs. To investigate if sex was associated with survival, logistic regression analyses were performed. The proportion of CA with a resuscitation attempt compared to CA without resuscitation was higher among men. There were no associations between sex and survival when controlling for previously known predictors and interaction effects. Sex does not appear to be a predictor for survival among patients suffering CA where resuscitation is attempted. The difference regarding proportion of resuscitation attempts requires more attention. It is important to consider possible interaction effects when studying the sex perspective. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Quantifying uncertainty due to internal variability using high-resolution regional climate model simulations

    Science.gov (United States)

    Gutmann, E. D.; Ikeda, K.; Deser, C.; Rasmussen, R.; Clark, M. P.; Arnold, J. R.

    2015-12-01

    The uncertainty in future climate predictions is as large or larger than the mean climate change signal. As such, any predictions of future climate need to incorporate and quantify the sources of this uncertainty. One of the largest sources comes from the internal, chaotic, variability within the climate system itself. This variability has been approximated using the 30 ensemble members of the Community Earth System Model (CESM) large ensemble. Here we examine the wet and dry end members of this ensemble for cool-season precipitation in the Colorado Rocky Mountains with a set of high-resolution regional climate model simulations. We have used the Weather Research and Forecasting model (WRF) to simulate the periods 1990-2000, 2025-2035, and 2070-2080 on a 4km grid. These simulations show that the broad patterns of change depicted in CESM are inherited by the high-resolution simulations; however, the differences in the height and location of the mountains in the WRF simulation, relative to the CESM simulation, means that the location and magnitude of the precipitation changes are very different. We further show that high-resolution simulations with the Intermediate Complexity Atmospheric Research model (ICAR) predict a similar spatial pattern in the change signal as WRF for these ensemble members. We then use ICAR to examine the rest of the CESM Large Ensemble as well as the uncertainty in the regional climate model due to the choice of physics parameterizations.

  18. Continuous High Frequency Activity: A peculiar SEEG pattern related to specific brain regions

    Science.gov (United States)

    Melani, Federico; Zelmann, Rina; Mari, Francesco; Gotman, Jean

    2015-01-01

    Objective While visually marking the high frequency oscillations in the stereo-EEG of epileptic patients, we observed a continuous/semicontinuous activity in the ripple band (80–250 Hz), which we defined continuous High Frequency Activity (HFA). We aim to analyze in all brain regions the occurrence and significance of this particular pattern. Methods Twenty patients implanted in mesial temporal and neocortical areas were studied. One minute of slow-wave sleep was reviewed. The background was classified as continuous/semicontinuous, irregular, or sporadic based on the duration of the fast oscillations. Each channel was classified as inside/outside the seizure onset zone (SOZ) or a lesion. Results The continuous/semicontinuous HFA occurred in 54 of the 790 channels analyzed, with a clearly higher prevalence in hippocampus and occipital lobe. No correlation was found with the SOZ or lesions. In the occipital lobe the continuous/semicontinuous HFA was present independently of whether eyes were open or closed. Conclusions We describe what appears to be a new physiological High Frequency Activity, independent of epileptogenicity, present almost exclusively in the hippocampus and occipital cortex but independent of the alpha rhythm. Significance The continuous HFA may be an intrinsic characteristic of specific brain regions, reflecting a particular type of physiological neuronal activity. PMID:23768436

  19. High carbon dioxide uptake by subtropical forest ecosystems in the East Asian monsoon region

    Science.gov (United States)

    Yu, Guirui; Chen, Zhi; Piao, Shilong; Peng, Changhui; Ciais, Philippe; Wang, Qiufeng; Li, Xuanran; Zhu, Xianjin

    2014-01-01

    Temperate- and high-latitude forests have been shown to contribute a carbon sink in the Northern Hemisphere, but fewer studies have addressed the carbon balance of the subtropical forests. In the present study, we integrated eddy covariance observations established in the 1990s and 2000s to show that East Asian monsoon subtropical forests between 20°N and 40°N represent an average net ecosystem productivity (NEP) of 362 ± 39 g C m−2 yr−1 (mean ± 1 SE). This average forest NEP value is higher than that of Asian tropical and temperate forests and is also higher than that of forests at the same latitudes in Europe–Africa and North America. East Asian monsoon subtropical forests have comparable NEP to that of subtropical forests of the southeastern United States and intensively managed Western European forests. The total NEP of East Asian monsoon subtropical forests was estimated to be 0.72 ± 0.08 Pg C yr−1, which accounts for 8% of the global forest NEP. This result indicates that the role of subtropical forests in the current global carbon cycle cannot be ignored and that the regional distributions of the Northern Hemisphere's terrestrial carbon sinks are needed to be reevaluated. The young stand ages and high nitrogen deposition, coupled with sufficient and synchronous water and heat availability, may be the primary reasons for the high NEP of this region, and further studies are needed to quantify the contribution of each underlying factor. PMID:24639529

  20. Thrombocytosis in splenic trauma: In-hospital course and association with venous thromboembolism.

    Science.gov (United States)

    Chia, Tze L; Chesney, Tyler R; Isa, David; Mnatzakanian, Gevork; Colak, Errol; Belmont, Caio; Hirpara, Dhruvin; Veigas, Precilla V; Acuna, Sergio A; Rizoli, Sandro; Rezende-Neto, Joao

    2017-01-01

    Thrombocytosis is common following elective splenectomy and major trauma. However, little is known about the in-hospital course of platelet count (PC) and incidence of thrombocytosis after splenic trauma. Extreme thrombocytosis (PC>1000×10 9 ) is associated with increased risk of venous thromboembolism (VTE) in primary thrombocytosis leading to the use of acetylsalicylic acid (ASA) for risk reduction, but the need for this agent in splenic trauma is undefined. Retrospective cohort study of all patients with splenic trauma between April 1, 2010 and March 31, 2014. The in-hospital course of PC was assessed based on splenic injury management type. The association of management type with thrombocytosis was evaluated using a multivariable logistic regression model adjusting for potential confounders. The association of thrombocytosis, extreme thrombocytosis, and ASA use for the outcome of VTE was explored. 156 patients were eligible, PC initially increased in all patients with the highest peak after total splenectomy. The incidence of thrombocytosis was 41.0% (64/156). Thrombocytosis was more likely following splenectomy compared with spleen preserving strategies independent of length of stay, injury grade, ISS, age and transfusion (OR 7.58, 95% CI: 2.26-25.45). Splenectomy was associated with extreme thrombocytosis (OR 10.39, 95% CI: 3.59-30.07). Thrombocytosis in splenic trauma is more likely after splenectomy than with spleen preserving strategies. Splenectomy is associated with extreme thrombocytosis. There was insufficient data in our study to determine the use of ASA as primary prevention of VTE after splenic trauma. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg

    2013-03-01

    Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

  2. Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Mohamad Saekhu

    2016-07-01

    Full Text Available Background: The outcome of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH is unsatisfactory. Inflammatory response secondary to brain injury as well as those resulted from surgical procedure were considered responsible of this outcome. This study was intended to elucidate the anti-inflammatory activity of tigecycline by measuring TNF-α level and its neuroprotective effect as represented by inhospital mortality rate.Methods: Patients with SSICH who were prepared for hematoma evacuation were randomized to receive either tigecycline (n=35 or fosfomycine (n=37 as prophylactic antibiotic. TNF-α level was measured in all subjects before surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was performed on postoperative day-7. The Glasgow outcome scale (GOS and length of stay (LOS were recorded at the time of hospital discharge. Data were analyzed using Mann-Whitney and Chi square test. Relative clinical effectiveness was measured by calculating the number needed to treat (NNT.Results: There was a significant difference regarding the proportion of subject who had  reduced TNF-α level on postoperative day-7 between the groups receiving tigecycline and fosfomycine (62% vs 29%, p=0.022. Decrease brain edema on CT control (86% vs 80%, p=0.580. Tigecycline administration showed a tendency of better clinical effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49; NNT=5 and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41; NNT=6. LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8.Conclusion: Tigecycline showed anti-inflammatory and neuroprotective activities. These activities were associated with improved clinical outcome in patients with SSICH after hematoma evacuation.

  3. Nonsyndromic retinitis pigmentosa is highly prevalent in the Jerusalem region with a high frequency of founder mutations.

    Science.gov (United States)

    Sharon, Dror; Banin, Eyal

    2015-01-01

    Nonsyndromic retinitis pigmentosa (RP) is the most common inherited retinal degeneration, and prevalence of the disease has been reported in populations of American and European origin with a relatively low consanguinity rate. Our aim was to determine the prevalence of nonsyndromic RP in the Jerusalem region, which has a population of about 1 million individuals with a high rate of consanguinity. The patients' clinical data included eye exam findings (visual acuity, anterior segment, and funduscopy) as well as electroretinographic (ERG) testing results under scotopic and photopic conditions. Mutation analysis on a subgroup of patients was performed mainly with candidate gene analysis and homozygosity mapping. We evaluated the medical records of patients with degenerative retinal diseases residing in the Jerusalem region who were examined over the past 20 years in a large tertiary medical center. A total of 453 individuals affected with nonsyndromic RP were diagnosed at our center, according to funduscopic findings and ERG testing. Based on the estimated population size of 945,000 individuals who reside in the vicinity of Jerusalem, the prevalence of nonsyndromic RP in this region is 1:2,086. The prevalence of RP was higher among Arab Muslims (1:1,798) compared to Jews (1:2,230), mainly due to consanguineous marriages that are more common in the Arab Muslim population. To identify the genetic causes of RP in our cohort, we recruited 383 patients from 183 different families for genetic analysis: 70 with autosomal recessive (AR) inheritance, 15 with autosomal dominant, 86 isolate cases, and 12 with an X-linked inheritance pattern. In 64 (35%) of the families, we identified the genetic cause of the disease, and we revised the inheritance pattern of 20 isolate cases to the AR pattern; 49% of the families in our cohort had AR inheritance. Interestingly, in 42 (66%) of the genetically identified families, the cause of disease was a founder mutation. Previous studies

  4. Estimative of the soil amount ingested by cattle in high natural radioactive region

    International Nuclear Information System (INIS)

    Rosa, Roosevelt; Silva, Lucia H.C.; Taddei, Maria H.T.

    1997-01-01

    Considering that Pocos de Caldas is a region of high natural radioactivity, where many environmental impacts have been studied, 27 samples of cattle faeces and 24 samples of local soil were collected and analyzed for Ti concentrations, during dry and rain periods. Using this element as an indicator, the percentage of soil ingestion by cattle were estimated for three management practices: confined, semi-confined and free. The results showed the management practices influence on the cattle soil ingestion percentage, and the importance of this pathway in the environmental impact assessment. (author). 7 refs., 1 tab

  5. HIGH QUALITY FACADE SEGMENTATION BASED ON STRUCTURED RANDOM FOREST, REGION PROPOSAL NETWORK AND RECTANGULAR FITTING

    Directory of Open Access Journals (Sweden)

    K. Rahmani

    2018-05-01

    Full Text Available In this paper we present a pipeline for high quality semantic segmentation of building facades using Structured Random Forest (SRF, Region Proposal Network (RPN based on a Convolutional Neural Network (CNN as well as rectangular fitting optimization. Our main contribution is that we employ features created by the RPN as channels in the SRF.We empirically show that this is very effective especially for doors and windows. Our pipeline is evaluated on two datasets where we outperform current state-of-the-art methods. Additionally, we quantify the contribution of the RPN and the rectangular fitting optimization on the accuracy of the result.

  6. The development of the region of basal nuclei in fetus using MRI of high field

    International Nuclear Information System (INIS)

    Geng Hequn; Zhang Zhonghe; Liu Shuwei

    2010-01-01

    Objective: To study the developmental process of the region of basal nuclei of postmortem fetuses by 3.0 T and 7.0 T MRI. Methods: One hundred and thirty-one postmortem fetuses of 14 to 40 weeks of gestational age (GA) were scanned by 3.0 T MR, of which 11 fetuses of 14-27 weeks of GA were chosen and scanned by 7.0 T MR. The time when the structures in the region of basal nuclei could be detected and the changes of MR signal intensity were analyzed for MRI of different Tesla. Results: On 3.0 T MRI, the dorsal thalamus could be delineated as early as 14 weeks of GA. The germinal matrix, caudate nucleus, and putamen could be visualized as early as 15 weeks of GA. The globus pallidus could be described as early as 18 weeks of GA, and the internal capsule and external capsule could be shown as early as 20 weeks of GA. The signal of the caudate nucleus during 15-30 weeks of GA was relatively hypointense on T 1 WI and hyperintense on T 2 WI, but during 31-40 weeks of GA, it was relatively hyperintense on T 1 WI and hypointense on T 2 WI. The putamen had a relatively high signal intensity on T 1 WI and low signal intensity on T 2 WI during 15-17 weeks of GA, and it appeared patchy during 18-25 weeks of GA, then it had a relatively low signal intensity on T 1 WI and high signal intensity on T 2 WI during 26-30 weeks of GA, and during 31-40 weeks of GA, its signal intensity was relatively high on T 1 WI and low on T 2 WI. The globus pallidus had a relatively high signal intensity on T 1 WI and low signal intensity on T 2 WI during 20- 40 weeks of GA. Compared to the 3.0 T MRI, the T 2 images of 7.0 T MRI were more clear, and most structures in the region of basal nuclei could be clearly displayed as early as 16 weeks of GA, such as the germinal matrix, caudate nucleus, dorsal thalamus, putamen, globus pallidus, internal capsule, and extemal capsule. The claustrum could be delineated as early as 18 weeks of GA on 7.0 T MRI. Conclusions: 3.0 T MRI could show the development

  7. Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia.

    Science.gov (United States)

    Holmes, Natasha E; Robinson, J Owen; van Hal, Sebastiaan J; Munckhof, Wendy J; Athan, Eugene; Korman, Tony M; Cheng, Allen C; Turnidge, John D; Johnson, Paul D R; Howden, Benjamin P

    2018-03-05

    Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

  8. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    Science.gov (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  9. Racial Differences in Hospice Use and In-Hospital Death among Medicare and Medicaid Dual-Eligible Nursing Home Residents

    Science.gov (United States)

    Kwak, Jung; Haley, William E.; Chiriboga, David A.

    2008-01-01

    Purpose: We investigated the role of race in predicting the likelihood of using hospice and dying in a hospital among dual-eligible (Medicare and Medicaid) nursing home residents. Design and Methods: This follow-back cohort study examined factors associated with hospice use and in-hospital death among non-Hispanic Black and non-Hispanic White…

  10. DTP with or after measles vaccination is associated with increased in-hospital mortality in Guinea-Bissau

    DEFF Research Database (Denmark)

    Aaby, Peter; Biai, Sidu; Veirum, Jens Erik

    2007-01-01

    The sequence of routine immunisations may be important for childhood mortality. Three doses of diphtheria-tetanus-pertussis vaccine (DTP) should be given at 6, 10, and 14 weeks and measles vaccine (MV) at 9 months of age. The sequence is not always respected. We examined in-hospital mortality...... of children having received DTP with or after measles vaccine....

  11. Nitrogen removal in shallow groundwater below three arable land systems in a high nitrogen loading region

    Science.gov (United States)

    Yan, X.; Zhou, W.

    2017-12-01

    The Taihu Lake region (TLR) is one of the most intensive agricultural regions with high nitrogen (N) loading in eastern China. Large inputs of synthetic N fertilizer have led to a series of environmental problems including eutrophication of surface waters, nitrate (NO3-) pollution of groundwater. To fully evaluate the risk of NO3- on groundwater environments, it is necessary to know the natural NO3- removal ability. In this study, denitrification capacity was assessed for two years through measuring the concentration of different N species (NO3-, NH4+, TN, excess N2 and dissolved N2O) in groundwater below three typical agricultural land-use types in the TLR. The results suggested that the conversion of paddy field (PF) to vineyard (VY) and vegetable (VF) significantly increased the groundwater NO3-N concentration, but denitrification consumed 76%, 83% and 65% of the groundwater NO3-N in VY, VF and PF, respectively. Because of the low O2 and high DOC concentrations in groundwater, denitrification activity was high in the study sites, resulting in high excess N2 accumulation in groundwater, and the concentration even exceeded the total active N in the deep layer. The large amounts of excess N2 observed in the VY and VF over all the sample times indicated that considerable N was stored as gaseous N2 in groundwater and should not be ignored in balancing N budgets in aquifers where denitrification is high. Our results also demonstrated that the indirect N2O emission factor (EF5-g) in VY (0.0052)and VF (0.0057)was significantly higher than PF (0.0011)as well as higher than the IPCC default values (0.0025. In view of the increasing trend of paddy fields being converted to uplands combined with the low GWT in the TLR, we thus concluded that the risk of NO3- contamination in groundwater and indirect N2O emission will intensify below arable land.

  12. High permeability cores to optimize the stimulation of deeply located brain regions using transcranial magnetic stimulation

    International Nuclear Information System (INIS)

    Salvador, R; Miranda, P C; Roth, Y; Zangen, A

    2009-01-01

    Efficient stimulation of deeply located brain regions with transcranial magnetic stimulation (TMS) poses many challenges, arising from the fact that the induced field decays rapidly and becomes less focal with depth. We propose a new method to improve the efficiency of TMS of deep brain regions that combines high permeability cores, to increase focality and field intensity, with a coil specifically designed to induce a field that decays slowly with increasing depth. The performance of the proposed design was investigated using the finite element method to determine the total electric field induced by this coil/core arrangement on a realistically shaped homogeneous head model. The calculations show that the inclusion of the cores increases the field's magnitude by as much as 25% while also decreasing the field's decay with depth along specific directions. The focality, as measured by the area where the field's norm is greater than 1/√2 of its maximum value, is also improved by as much as 15% with some core arrangements. The coil's inductance is not significantly increased by the cores. These results show that the presence of the cores might make this specially designed coil even more suited for the effective stimulation of deep brain regions.

  13. High permeability cores to optimize the stimulation of deeply located brain regions using transcranial magnetic stimulation

    Science.gov (United States)

    Salvador, R.; Miranda, P. C.; Roth, Y.; Zangen, A.

    2009-05-01

    Efficient stimulation of deeply located brain regions with transcranial magnetic stimulation (TMS) poses many challenges, arising from the fact that the induced field decays rapidly and becomes less focal with depth. We propose a new method to improve the efficiency of TMS of deep brain regions that combines high permeability cores, to increase focality and field intensity, with a coil specifically designed to induce a field that decays slowly with increasing depth. The performance of the proposed design was investigated using the finite element method to determine the total electric field induced by this coil/core arrangement on a realistically shaped homogeneous head model. The calculations show that the inclusion of the cores increases the field's magnitude by as much as 25% while also decreasing the field's decay with depth along specific directions. The focality, as measured by the area where the field's norm is greater than 1/\\sqrt 2 of its maximum value, is also improved by as much as 15% with some core arrangements. The coil's inductance is not significantly increased by the cores. These results show that the presence of the cores might make this specially designed coil even more suited for the effective stimulation of deep brain regions.

  14. High permeability cores to optimize the stimulation of deeply located brain regions using transcranial magnetic stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Salvador, R; Miranda, P C [Institute of Biophysics and Biomedical Engineering, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon (Portugal); Roth, Y [Advanced Technology Center, Sheba Medical Center, Tel-Hashomer (Israel); Zangen, A [Neurobiology Department, Weizmann Institute of Science, Rehovot 76100 (Israel)], E-mail: rnsalvador@fc.ul.pt

    2009-05-21

    Efficient stimulation of deeply located brain regions with transcranial magnetic stimulation (TMS) poses many challenges, arising from the fact that the induced field decays rapidly and becomes less focal with depth. We propose a new method to improve the efficiency of TMS of deep brain regions that combines high permeability cores, to increase focality and field intensity, with a coil specifically designed to induce a field that decays slowly with increasing depth. The performance of the proposed design was investigated using the finite element method to determine the total electric field induced by this coil/core arrangement on a realistically shaped homogeneous head model. The calculations show that the inclusion of the cores increases the field's magnitude by as much as 25% while also decreasing the field's decay with depth along specific directions. The focality, as measured by the area where the field's norm is greater than 1/{radical}2 of its maximum value, is also improved by as much as 15% with some core arrangements. The coil's inductance is not significantly increased by the cores. These results show that the presence of the cores might make this specially designed coil even more suited for the effective stimulation of deep brain regions.

  15. A First Baseline for the Magnets in the High Luminosity LHC Insertion Regions

    CERN Document Server

    Todesco, E; Ambrosio, G; Arduini, G; Cerutti, F; De Maria, R; Esposito, L; Fartoukh, S; Ferracin, P; Felice, H; Gupta, R; Kersevan, R; Mokhov, N; Nakamoto, T; Rakno, I; Rifflet, J M; Rossi, L; Sabbi, G L; Segreti, M; Toral, F; Xu, Q; Wanderer, P; van Weelderen, R

    2014-01-01

    The High Luminosity LHC (HL-LHC) project aims at accumulating 3000 fb-1 in the years 2023-2035, i.e. ten times more w.r.t. the nominal LHC performance expected for 2010- 2021. One key element to reach this challenging performance is a new insertion region to reduce the beam size in the interaction point by approximately a factor two. This requires larger aperture magnets in the region spanning from the interaction point to the matching section quadrupoles. This aperture has been fixed to 150 mm for the inner triplet quadrupoles in 2012. In this paper we give a first baseline of the interaction region. We discuss the main motivations that lead us to choose the technology, the combination of fields/gradients and lengths, the apertures, the quantity of superconductor, and the operational margin. Key elements are also the constraints given by the energy deposition in terms of heat load and radiation damage; we present the main features related to shielding and heat removal.

  16. Neuroradiological evaluation of benign extramedullary tumors in the high cervical region and at the foramen magnum

    Energy Technology Data Exchange (ETDEWEB)

    Nishiura, Iwao; Koyama, Tsunemaro; Tanaka, Kimito; Aii, Heihachirou

    1986-06-01

    Twelve cases of benign extramedullary tumors in the high cervical region and at the foramen magnum were experienced during past five years among eighty all spinal and paraspinal tumors. The diagnosis of masses in this region is very difficult because of the variety of clinical course, symptoms and neurological findings as pointed out by many reporters. Also in our cases, 70 % of the patients complained of the deteriorated motor weakness of the upper or lower extremities on admission, though they had noticed the onset of slight neck or occipital pain a few years ago. Neurological examination on admission clearly showed the symptom of myelopathy except in two cases with a tumor at the foramen magnum and C/sub 1/ level. The percentage of positive findings of plain X-rays was 50 %, that of metrizamide myelography was 92 % and that of IV. e. CT and met. e. CT was 100 %. NMR-CT was performed in 2 cases, and in one of them it was useful in confirming the tumor configuration and extension. Five interesting cases were described mainly from the neuroradiological aspects. Finally the differentiation between meningioma and neurinoma was discussed from the aspects of myelogram, CT and NMR-CT. As already pointed out, it is most important not to forget the existence of tumors in this region when one comes across the confused symptoms, afterwards not to overlook the slight positive neurological and neuroradiological findings.

  17. Timing of isoclinal folds in multiply deformed high metamorphic grade region using FIA succession

    Science.gov (United States)

    Cao, Hui; Cai, Zhihui

    2013-04-01

    Multiply deformed and isoclinally folded interlayered high metamorphic grade gneisses and schists can be very difficult rocks for resolving early formed stratigraphic and structural relationships. When such rocks contain porphyroblasts a new approach is possible because of the way in which porphyroblast growth is affected by crenulation versus reactivation of compositional layering. The asymmetries of the overprinting foliations preserved as inclusion trails that define the FIAs can be used to investigate whether an enigmatic isoclinal fold is an antiform or synform. This approach also reveals when the fold first formed during the tectonic history of the region. Isoclinally folded rocks in the Arkansas River region of Central Colorado contain relics of fold hinges that have been very difficult to ascertain whether they are antiforms or synforms because of younger refolding effects and the locally truncated nature of coarse compositional layering. With the realization that rocks with a schistosity parallel to bedding (S0 parallel S1) have undergone lengthy histories of deformation that predate the obvious first deformation came recognition that large scale regional folds can form early during this process and be preserved throughout orogenesis. This extensive history is lost within the matrix because of reactivational shear on the compositional layering. However, it can be extracted by measuring FIAs. Recent work using this approach has revealed that the trends of axial planes of all map scale folds, when plotted on a rose diagram, strikingly reflect the FIA trends. That is, although it was demonstrated that the largest scale regional folds commonly form early in the total history, other folds can form and be preserved from subsequent destruction in the strain shadows of plutons or through the partitioning of deformation due to heterogeneities at depth.

  18. Multiple frequency radar observations of high-latitude E region irregularities in the HF modified ionosphere

    International Nuclear Information System (INIS)

    Noble, S.T.; Djuth, F.T.; Jost, R.J.

    1987-01-01

    In September 1983, experiments were conducted in Scandinavia using the high-power heating facility near Tromso, Norway. The purpose of the HF ionospheric modification experiments was to investigate the behavior of artificially produced E region irregularities at auroral latitudes. The majority of observations were made with backscatter radars operating at 46.9 and 143.8 MHz, but limited observations were also made at 21.4 and 140.0 MHz. These radars are sensitive to irregularities having scale lengths of between 1 and 7 m across the geomagnetic field lines. The growth and decay of the irregularities are scale length dependent with the shorter lengths growing and dissipating more rapidly than the longer lengths (e-folding growth times = 10 1 --10 2 ms; decay times = 10 2 --10 3 ms). During periods of full power ordinary mode heating, irregularities having peak cross sections of 10 4 m 2 at 46.9 MHz and 10 5 m 2 at 143.8 MHz are observed. However, the cross sections normally measured are 1 to 2 orders of magnitude smaller than the peak values. The cross sections are nonlinearly dependent on the HF power and begin to saturate at levels greater than 50--75 percent of full power. Past E and F region data from Arecibo are used in conjunction with the Tromso measurements to ascertain the relative roles played by various mechanisms in exciting irregularities. In the E region, the results tend to favor those instability processes which operate at the upper hybrid resonance level (e.g., thermal parametric and resonance instabilities) over those that operate at the reflection level (e.g., parametric decay instability). However, it is likely that anyh of the mechanisms studied could at times contribute to irregularity production in the E regions

  19. A MID-INFRARED VIEW OF THE HIGH MASS STAR FORMATION REGION W51A

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, C. L. [Laboratório Nacional de Astrofísica, R. dos Estados Unidos, Bairro das Nações, CEP 37504-364, Itajubá—MG (Brazil); Blum, R. D. [National Optical Astronomy Observatory, Tucson, AZ 85719 (United States); Damineli, A. [Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, R. do Matão, 1226, Cid. Universitária, São Paulo 05508-900 (Brazil); Conti, P. S. [JILA, University of Colorado, Boulder, CO 80309-0440 (United States); Gusmão, D. M., E-mail: cassio.barbosa@pq.cnpq.br, E-mail: rblum@noao.edu, E-mail: augusto.damineli@iag.usp.br, E-mail: pconti@jila.colorado.edu, E-mail: danilo@univap.br [IP and D—Universidade do Vale do Paraíba, Av. Shishima Hifumi, 2911. São José dos Campos, SP, 12244-000 (Brazil)

    2016-07-01

    In this paper we present the results of a mid-infrared study of G49.5-0.4, or W51A, part of the massive starbirth complex W51. Combining public data from the Spitzer IRAC camera, and Gemini mid-infrared camera T-ReCS at 7.73, 9.69, 12.33, and 24.56 μ m, with a spatial resolution of ∼0.″5, we have identified the mid-infrared counterparts of eight ultracompact H ii regions, showing that two radio sources are deeply embedded in molecular clouds and another is a cloud of ionized gas. From the T-ReCS data we have unveiled the central core of the W51 region, revealing massive young stellar candidates. We modeled the spectral energy distribution of the detected sources. The results suggest that the embedded objects are sources with spectral types ranging from B3 to O5, but the majority of the fits indicate stellar objects with B1 spectral types. We also present an extinction map of IRS 2, showing that a region with lower extinction corresponds to the region where a proposed jet of gas has impacted the foreground cloud. From this map, we also derived the total extinction toward the enigmatic source IRS 2E, which amounts to ∼60 mag in the V band. We calculated the color temperature due to thermal emission of the circumstellar dust of the detected sources; the temperatures are in the interval of ∼100–150 K, which corresponds to the emission of dust located at 0.1 pc from the central source. Finally, we show a possible mid-infrared counterpart of a detected source at millimeter wavelengths that was found by Zapata et al. to be a massive young stellar object undergoing a high accretion rate.

  20. Universal time dependence of nighttime F region densities at high latitudes

    International Nuclear Information System (INIS)

    Beaujardiere, O.D.L.; Wickwar, V.B.; Caudal, G.

    1985-01-01

    Coordinated EISCAT, Chatanika, and Millstone Hill incoherent scatter radar observations have revealed that in the auroral zone, the nighttime F region densities vary substantially with the longitude of the observing site: EISCAT's densities are the largest and Millstone Hill's are the lowest. The nighttime F region densities measured by the individual radars are not uniform: the regions where the densities are maximum are the so-called ''blobs'' or ''patches'' that have been reported previously. The observations are consistent with the hypothesis that the nighttime densities are produced in significant amounts not by particle precipitation, but by solar EUV radiation, and that they have been transported across the polar cap. The observed differences can be explained by the offset of the geographic and geomagnetic poles. A larger portion of the magnetospheric convection pattern is sunlit when EISCAT is in the midnight sector than when Chatanika is. In winter, when Millstone Hill is in the midnight sector, almost all the auroral oval is in darkness. This universal time effect, which was observed on all coordinated three-radar experiments (September 1981 to February 1982), is illustrated using two periods of coincident radar and satellite observations: November 18--19, and December 15--16, 1981. These two periods were selected because they corresponded to relatively steady conditions. Dynamics Explorer (DE) measurements are used to aid in interpreting the radar observations. De 1 auroral images show what portion of the oval was sunlit. DE 2 data are used to measure the ion drift across the polar cap. Because the altitude of the ionization peak was high, the decay time of the F region density was substantially longer than the transit time across the polar cap

  1. High-effective position time spectrometer in actual measurements of low intensity region of electron spectra

    International Nuclear Information System (INIS)

    Babenkov, M.I.; Zhdanov, V.S.

    2002-01-01

    Magnetic position-time spectrometer was proposed in previous work, where not only electron coordinates in focal plane are measured by position sensitive detector (PSD) but places of their birth in beta source plane of a large area are fixed using another PSD, situated behind it, by quick effects, accompanying radioactive decay. PSD on the basis of macro-channel plates are used. It is succeeded in position-time spectrometer to combine beta sources of a large area with multichannel registration for a wide energy interval, that efficiency of measurements was two orders of magnitude increase d in comparison magnetic apparatus having PSD only in focal plane. Owing to two detectors' switching on coincidence the relation effect/background in increased minimum on two orders of magnitude in comparison with the same apparatus. At some complication of mathematical analysis it was obtained, that high characteristics of position-time spectrometer are kept during the use the magnetic field, providing double focusing. Owning to this focusing the gain the efficiency of measurements will make one more order of magnitude. Presented high-effective position-time spectrometer is supposed to use in the measurements of low-intensity region of electron spectra, which are important for development of fundamental physics. This is the first of all estimation of electron anti-neutrino mass by the form of beta spectrum of tritium in the region of boundary energy. Recently here there was problem of non physical negative values. This problem can be solved by using in measurement of different in principle high-effective spectrometers, which possess improved background properties. A position-time spectrometers belongs to these apparatus, which provides the best background conditions at very large effectiveness of the measurements of tritium beta spectrum in the region of boundary energy with acceptable high resolution. An important advantage of position-time spectrometer is the possibility of

  2. Cane pruning on Chardonnay grapevine in the high-altitude regions of Southern Brazil

    Directory of Open Access Journals (Sweden)

    Filho José Luiz Marcon

    2016-01-01

    Full Text Available High-altitude regions of southern Brazil, located above 900 m above sea level, the cordon training with spur pruning is widely used because of easier application. In these regions, Chardonnay wine grape shows potential to produce quality wines, however, in commercial vineyards, the training system used has not provided productivities that makes economically viable the cultivation of this variety. Given this, the present study aimed to evaluate the effect of different cane-pruning systems on the vegetative, productive and enological potential of Chardonnay grapevines grown in the high-altitude region of Southern Brazil. The experiment was conducted in a commercial Chardonnay vineyard, located in São Joaquim – Santa Catarina State (28o17 ′39”S and 49∘ 55′56” W, to 1230 m a.s.l during 2015 and 2016 vintages. Chardonnay vines (grafted on 1103 Paulsen were planted in 2010, with a 3.0 m (row × 1.0 m (vine spacing. The treatments consisted of different cane-pruning systems: Cordon spur-pruning (control; Sylvoz; Cazenave; Capovolto; single Guyot and double Guyot. Pruning was performed in August of each year when the buds were in the green tip developmental stage. Data was analyzed by Scott Knott test (p < 0.05 following a randomized block design with four replicates, each consisting of 12 vines per plot. We observed higher yield in the Cazenave and double Guyot training system with three and two more tons of grapes than spur-pruning respectively. The bud fertility was higher in plants trained in double Guyot. Vines spur-pruned showed higher relation of leaf area: production, with values above 100 cm2 g−1 grape at 2016 vintage. Commercial maturity of grapes (soluble solids, acidity and polyphenols did not differ among training systems studied. The results suggest that cane-pruning systems could be an alternative to increase production efficiency of Chardonnay in high-altitude region of southern Brazil.

  3. Primary drug resistance in a region with high burden of tuberculosis. A critical problem

    Directory of Open Access Journals (Sweden)

    Cecilia Villa-Rosas

    2015-03-01

    Full Text Available Objective. To determine rates of drug resistance in new cases of pulmonary tuberculosis in a region with a high burden of the disease. Materials and methods. New case suspects were referred for drug susceptibility testing. Results. 28.9% of new cases were resistant to at least one first line drug; 3.9% had a multidrug-resistant strain, 15.6% a monoresistant strain and 9.4% a polyresistant strain. Conclusion. Our rate of drug resistant tuberculosis in new cases is very high; this has important clinical implications, since even monoresistance can have a negative impact on the outcome of new cases treated empirically with a six month regimen.

  4. High Risk Human Papilloma Virus Genotypes in Kurdistan Region in Patients with Vaginal Discharge.

    Science.gov (United States)

    Hussein, Nawfal R; Balatay, Amer A; Assafi, Mahde S; AlMufty, Tamara Abdulezel

    2016-01-01

    The human papilloma virus (HPV) is considered as the major risk factor for the development of cervical cancer. This virus is of different genotypes and generally can be classified into high and low risk types. To determine the rate of high risk HPV genotypes in women with vaginal discharge and lower abdominal pain in Kurdistan region, Iraq. Cervical swabs were taken from 104 women. DNA was extracted and the polymerase chain reaction (PCR) technique was used to determine the presence of high risk genotypes. It was found that 13/104 (12.5%) of the samples were positive for high risk HPV genotypes. Amongst those who were positive, 4/13 (30.7%) were typed as genotype 16 and 7/13 (53.8%) showed mixed genotyping. On the other hand, genotypes 53 and 56 were found in only one sample each. High risk HPV genotypes are not uncommon and further community based study is needed to determine the prevalence of HPV and its genotypes and plan for prevention of infection.

  5. Phytotherapy of High Blood Pressure in Three Phytogeographic Regions of Cameroon.

    Science.gov (United States)

    Tsabang, Nole; Yedjou, Clement G; Tchounwou, Paul B

    2017-01-01

    High blood pressure is a public health challenge worldwide. According to World Health Organization, 30% of men and 50% of women 65 to 75 years old are suffering from high blood pressure. The number of hypertensive patients in the world will attain 1.56 billion of people, with 60% increase in prevalence. The incidence of high blood pressure increases with age, but nowadays, is being noticed an increasing incidence in young people. The socio-cultural medicine may provide new solutions in the management of this pathology. Therefore this study was carried out to record and document plants used against high blood pressure in socio-cultural medicine for future drugs discovery worldwide. An ethno botanical survey was realized between 2002 and 2016 to identify manifold plants used to fight against high blood pressure. This survey was carried out in three phytogeographic regions of Cameroon. Amongst people living in those regions, 1131 randomly screened interviewees distributed in 58 socio-cultural groups were involved in this study. This survey reveals that about 70% of interviewees don't know high blood pressure which is a symptomless disease. A total of 28 species of plants were recorded. These plants belong to 25 genera and 24 families. They were used to prepare 28 herbal remedies for the treatment of high blood pressure. In the morphological point of view about 10/28 (36%) plants are herbs; 9/28 (32%) plants are trees and 9/28 (32%) plants are shrubs. Only 3/28 plants (11%) used including Allium sativum, Aloe barteri and Aloe buttneri) are cultivated. This means that the plants used in this study don't usually have some form of protection through cultivation which is encouraging in terms of their conservation. The uncontrolled use of a hypotensive plants can provoke a fatal hypotension in hypertensive patients. Therefore the use of hypotensive plants needs to be controlled by physician or by a patient verification using a blood pressure monitor. Recorded species which

  6. NASA's High Mountain Asia Team (HiMAT): collaborative research to study changes of the High Asia region

    Science.gov (United States)

    Arendt, A. A.; Houser, P.; Kapnick, S. B.; Kargel, J. S.; Kirschbaum, D.; Kumar, S.; Margulis, S. A.; McDonald, K. C.; Osmanoglu, B.; Painter, T. H.; Raup, B. H.; Rupper, S.; Tsay, S. C.; Velicogna, I.

    2017-12-01

    The High Mountain Asia Team (HiMAT) is an assembly of 13 research groups funded by NASA to improve understanding of cryospheric and hydrological changes in High Mountain Asia (HMA). Our project goals are to quantify historical and future variability in weather and climate over the HMA, partition the components of the water budget across HMA watersheds, explore physical processes driving changes, and predict couplings and feedbacks between physical and human systems through assessment of hazards and downstream impacts. These objectives are being addressed through analysis of remote sensing datasets combined with modeling and assimilation methods to enable data integration across multiple spatial and temporal scales. Our work to date has focused on developing improved high resolution precipitation, snow cover and snow water equivalence products through a variety of statistical uncertainty analysis, dynamical downscaling and assimilation techniques. These and other high resolution climate products are being used as input and validation for an assembly of land surface and General Circulation Models. To quantify glacier change in the region we have calculated multidecadal mass balances of a subset of HMA glaciers by comparing commercial satellite imagery with earlier elevation datasets. HiMAT is using these tools and datasets to explore the impact of atmospheric aerosols and surface impurities on surface energy exchanges, to determine drivers of glacier and snowpack melt rates, and to improve our capacity to predict future hydrological variability. Outputs from the climate and land surface assessments are being combined with landslide and glacier lake inventories to refine our ability to predict hazards in the region. Economic valuation models are also being used to assess impacts on water resources and hydropower. Field data of atmospheric aerosol, radiative flux and glacier lake conditions are being collected to provide ground validation for models and remote sensing

  7. Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume.

    Science.gov (United States)

    Saraidaridis, Julia T; Hashimoto, Daniel A; Chang, David C; Bordeianou, Liliana G; Kunitake, Hiroko

    2018-03-01

    General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume. The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models. Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p accounting for hospital and surgeon volume.

  8. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

    Directory of Open Access Journals (Sweden)

    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  9. Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

    Science.gov (United States)

    Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

    2010-03-01

    The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

  10. A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.

    Science.gov (United States)

    Dégano, Irene R; Subirana, Isaac; Torre, Marina; Grau, María; Vila, Joan; Fusco, Danilo; Kirchberger, Inge; Ferrières, Jean; Malmivaara, Antti; Azevedo, Ana; Meisinger, Christa; Bongard, Vanina; Farmakis, Dimitros; Davoli, Marina; Häkkinen, Unto; Araújo, Carla; Lekakis, John; Elosua, Roberto; Marrugat, Jaume

    2015-03-01

    Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. The New York risk score for in-hospital and 30-day mortality for coronary artery bypass graft surgery.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Wechsler, Andrew; Jordan, Desmond; Lahey, Stephen J; Culliford, Alfred T; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R

    2013-01-01

    Simplified risk scores for coronary artery bypass graft surgery are frequently in lieu of more complicated statistical models and are valuable for informed consent and choice of intervention. Previous risk scores have been based on in-hospital mortality, but a substantial number of patients die within 30 days of the procedure. These deaths should also be accounted for, so we have developed a risk score based on in-hospital and 30-day mortality. New York's Cardiac Surgery Reporting System was used to develop an in-hospital and 30-day logistic regression model for patients undergoing coronary artery bypass graft surgery in 2009, and this model was converted into a simple linear risk score that provides estimated in-hospital and 30-day mortality rates for different values of the score. The accuracy of the risk score in predicting mortality was tested. This score was also validated by applying it to 2008 New York coronary artery bypass graft data. Subsequent analyses evaluated the ability of the risk score to predict complications and length of stay. The overall in-hospital and 30-day mortality rate for the 10,148 patients in the study was 1.79%. There are seven risk factors comprising the score, with risk factor scores ranging from 1 to 5, and the highest possible total score is 23. The score accurately predicted mortality in 2009 as well as in 2008, and was strongly correlated with complications and length of stay. The risk score is a simple way of estimating short-term mortality that accurately predicts mortality in the year the model was developed as well as in the previous year. Perioperative complications and length of stay are also well predicted by the risk score. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ha Nee Jang

    2017-08-01

    Full Text Available Background Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR] can predict in-hospital mortality in patients with severe trauma. Methods This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results Of the 315 patients, 72 (22.9% died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001. At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001. The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%. Conclusions Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

  13. Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.

    Directory of Open Access Journals (Sweden)

    Toshiki Kuno

    Full Text Available OBJECTIVE: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS patients undergoing percutaneous coronary intervention (PCI. BACKGROUND: Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. METHODS: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group and those with left-dominant anatomy (LD group. RESULTS: The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003. In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001. Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030. CONCLUSION: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

  14. Creation of a Scorecard to Predict In-Hospital Death in Patients Undergoing Operations for Acute Type A Aortic Dissection.

    Science.gov (United States)

    Leontyev, Sergey; Légaré, Jean-Francois; Borger, Michael A; Buth, Karen J; Funkat, Anne K; Gerhard, Jochann; Mohr, Friedrich W

    2016-05-01

    This study evaluated preoperative predictors of in-hospital death for the surgical treatment of patients with acute type A aortic dissection (Type A) and created an easy-to-use scorecard to predict in-hospital death. We reviewed retrospectively all consecutive patients who underwent operations for acute Type A between 1996 and 2011 at 2 tertiary care institutions. A logistic regression model was created to identify independent preoperative predictors of in-hospital death. The results were used to create a scorecard predicting operative risk. Emergency operations were performed in 534 consecutive patients for acute Type A. Mean age was 61 ± 14 years and 36.3% were women. Critical preoperative state was present in 31% of patients and malperfusion of one or more end organs in 36%. Unadjusted in-hospital mortality was 18.7% and not significantly different between institutions. Independent predictors of in-hospital death were age 50 to 70 years (odds ratio [OR], 3.8; p = 0.001), age older than 70 years (OR, 2.8; p = 0.03), critical preoperative state (OR, 3.2; p risk score based on these variables. The patients were stratified into four risk categories predicting in-hospital death: less than 10%, 10% to 25%, 25% to 50%, and more than 50%. This represents one of the largest series of patients with Type A in which a risk model was created. Using our approach, we have shown that age, critical preoperative state, and malperfusion syndrome were strong independent risk factors for early death and could be used for the preoperative risk assessment. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. High field FT-ICR mass spectrometry for molecular characterization of snow board from Moscow regions.

    Science.gov (United States)

    Mazur, Dmitry M; Harir, Mourad; Schmitt-Kopplin, Philippe; Polyakova, Olga V; Lebedev, Albert T

    2016-07-01

    High field Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry analysis of eight snow samples from Moscow city allowed us to identify more than 2000 various elemental compositions corresponding to regional air pollutants. The hierarchical cluster analysis (HCA) of the data showed good concordance of three main groups of samples with the main wind directions. The North-West group (A1) is represented by several homologous CHOS series of aliphatic organic aerosols. They may form as a result of enhanced photochemical reactions including oxidation of hydrocarbons with sulfonations due to higher amount of SO2 emissions in the atmosphere in this region. Group A2, corresponding to the South-East part of Moscow, contains large amount of oxidized hydrocarbons of different sources that may form during oxidation in atmosphere. These hydrocarbons appear correlated to emissions from traffic, neighboring oil refinery, and power plants. Another family of compounds specific for this region involves CHNO substances formed during oxidation processes including NOx and NO3 radical since emissions of NOx are higher in this part of the city. Group A3 is rich in CHO type of compounds with high H/C and low O/C ratios, which is characteristic of oxidized hydrocarbon-like organic aerosol. CHNO types of compounds in A3 group are probably nitro derivatives of condensed hydrocarbons such as PAH. This non-targeted profiling revealed site specific distribution of pollutants and gives a chance to develop new strategies in air quality control and further studies of Moscow environment. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. High resolution stream water quality assessment in the Vancouver, British Columbia region: a citizen science study.

    Science.gov (United States)

    Shupe, Scott M

    2017-12-15

    Changing land cover and climate regimes modify water quantity and quality in natural stream systems. In regions undergoing rapid change, it is difficult to effectively monitor and quantify these impacts at local to regional scales. In Vancouver, British Columbia, one of the most rapidly urbanizing areas in Canada, 750 measurements were taken from a total of 81 unique sampling sites representing 49 streams located in urban, forest, and agricultural-dominant watersheds at a frequency of up to 12 times per year between 2013 and 2016. Dissolved nitrate (NO 3 -N) and phosphate (PO 4 -P) concentrations, turbidity, water temperature, pH and conductivity were measured by citizen scientists in addition to observations of hydrology, vegetation, land use, and visible stream impacts. Land cover was mapped at a 15-m resolution using Landsat 8 OLI imagery and used to determine dominant land cover for each watershed in which a sample was recorded. Regional, seasonal, and catchment-type trends in measurements were determined using statistical analyses. The relationships of nutrients to land cover varied seasonally and on a catchment-type basis. Nitrate showed seasonal highs in winter and lows in summer, though phosphate had less seasonal variation. Overall, nitrate concentrations were positively associated to agriculture and deciduous forest and negatively associated with coniferous forest. In contrast, phosphate concentrations were positively associated with agricultural, deciduous forest, and disturbed land cover and negatively associated with urban land cover. Both urban and agricultural land cover were significantly associated with an increase in water conductivity. Increased forest land cover was associated with better water quality, including lower turbidity, conductivity, and water temperature. This study showed the importance of high resolution sampling in understanding seasonal and spatial dynamics of stream water quality, made possible with the large number of

  17. High Plasmodium malariae Prevalence in an Endemic Area of the Colombian Amazon Region.

    Science.gov (United States)

    Camargo-Ayala, Paola Andrea; Cubides, Juan Ricardo; Niño, Carlos Hernando; Camargo, Milena; Rodríguez-Celis, Carlos Arturo; Quiñones, Teódulo; Sánchez-Suárez, Lizeth; Patarroyo, Manuel Elkin; Patarroyo, Manuel Alfonso

    2016-01-01

    Malaria is a worldwide public health problem; parasites from the genus Plasmodium are the aetiological agent for this disease. The parasites are mostly diagnosed by conventional microscopy-based techniques; however, their limitations have led to under-registering the reported prevalence of Plasmodium species. This study has thus been aimed at evaluating the infection and coinfection prevalence of 3 species of Plasmodium spp., in an area of the Colombian Amazon region. Blood samples were taken from 671 symptomatic patients by skin puncture; a nested PCR amplifying the 18S ssRNA region was used on all samples to determine the presence of P. vivax, P. malariae and P. falciparum. Statistical analysis determined infection and coinfection frequency; the association between infection and different factors was established. The results showed that P. vivax was the species having the greatest frequency in the study population (61.4%), followed by P. malariae (43.8%) and P. falciparum (11.8%). The study revealed that 35.8% of the population had coinfection, the P. vivax/P. malariae combination occurring most frequently (28.3%); factors such as age, geographical origin and clinical manifestations were found to be associated with triple-infection. The prevalence reported in this study differed from previous studies in Colombia; the results suggest that diagnosis using conventional techniques could be giving rise to underestimating some Plasmodium spp. species having high circulation rates in Colombia (particularly in the Colombian Amazon region). The present study's results revealed a high prevalence of P. malariae and mixed infections in the population being studied. The results provide relevant information which should facilitate updating the epidemiological panorama and species' distribution so as to include control, prevention and follow-up measures.

  18. Migration of Frosts from High-Albedo Regions of Pluto: what New Horizons Reveals

    Science.gov (United States)

    Buratti, Bonnie J.; Stern, S. A.; Weaver, Hal A.; Young, Leslie A.; Olkin, Cathy B.; Ennico, Kimberly; Binzel, Richard P.; Zangari, Amanda; Earle, Alissa M.

    2015-11-01

    With its high eccentricity and obliquity, Pluto should exhibit seasonal volatile transport on its surface. Several lines of evidence support this transport: doubling of Pluto’s atmospheric pressure over the past two decades (Young et al., 2013, Ap. J. 766, L22; Olkin et al., 2015, Icarus 246, 230); changes in its historical rotational light curve, once all variations due to viewing geometry have been modelled (Buratti et al., 2015; Ap. J. 804, L6); and changes in HST albedo maps (Buie et al., 2010, Astron. J. 139, 1128). New Horizons LORRI images reveal that the region of greatest albedo change is not the polar cap(s) of Pluto, but the feature informally named Tombaugh Regio (TR). This feature has a normal reflectance as high as ~0.8 in some places, and it is superposed on older, lower-albedo pre-existing terrain with an albedo of only ~0.10. This contrast is larger than any other body in the Solar System, except for Iapetus. This albedo dichotomy leads to a complicated system of cold-trapping and thermal segregation, beyond the simple picture of seasonal volatile transport. Whatever the origin of TR, it initially acted as a cold trap, as the temperature differential between the high and low albedo regions could be enormous, possibly approaching 20K, based on their albedo differences and assuming their normalized phase curves are similar. This latter assumption will be refined as the full New Horizons data set is returned.Over six decades of ground-based photometry suggest that TR has been decreasing in albedo over the last 25 years. Possible causes include changing insolation angles, or sublimation from the edges where the high-albedo material impinges on a much warmer substrate.Funding by the NASA New Horizons Project acknowledged.

  19. Research on the sewage treatment in high altitude region based on Lhasa Sewage Treatment Plant

    Science.gov (United States)

    Xu, Jin; Li, Shuwen

    2017-12-01

    Sewage treatment is of great significance to enhance environmental quality, consolidate pollution prevention and ecological protection, and ensure sustainable economic and social development in high altitude region. However, there are numerous difficulties in sewage treatment due to the alpine climate, the relatively low economic development level, and the backward operation and management styles, etc. In this study, the characteristics of influent quality in the sewage treatment plant in Lhasa are investigated by analysing the influent BOD5/COD and BOD5/TN, comparing key indexes recorded from 2014 to 2016 with the hinterland. Results show that the concentration of influent COD, BOD5, NH3-N and SS in the Lhasa sewage treatment plant, in which the sewage belongs to low-concentration urban sewage, is smaller than that in the domestic sewage treatment plants in the mainland. The concentration ratio of BOD5/COD and BOD5/TN is below 0.4 and 4, which indicates that the biodegradation is poor and the carbon sources are in bad demand. The consequences obtained play a vital role in the design, operation and management of sewage treatment plants in high altitude region.

  20. Radon survey in the high natural radiation region of Niska Banja, Serbia

    International Nuclear Information System (INIS)

    Zunic, Z.S.; Yarmoshenko, I.V.; Birovljev, A.; Bochicchio, F.; Quarto, M.; Obryk, B.; Paszkowski, M.; Celikovic, I.; Demajo, A.; Ujic, P.; Budzanowski, M.; Olko, P.; McLaughlin, J.P.; Waligorski, M.P.R.

    2007-01-01

    A radon survey has been carried out around the town of Niska Banja (Serbia) in a region partly located over travertine formations, showing an enhanced level of natural radioactivity. Outdoor and indoor radon concentrations were measured seasonally over the whole year, using CR-39 diffusion type radon detectors. Outdoor measurements were performed at 56 points distributed over both travertine and alluvium sediment formations. Indoor radon concentrations were measured in 102 living rooms and bedrooms of 65 family houses. In about 50% of all measurement sites, radon concentration was measured over each season separately, making it possible to estimate seasonal variations, which were then used to correct values measured over different periods, and to estimate annual values. The average annual indoor radon concentration was estimated at over 1500 Bq/m 3 and at about 650 Bq/m 3 in parts of Niska Banja located over travertine and alluvium sediment formations, respectively, with maximum values exceeding 6000 Bq/m 3 . The average value of outdoor annual radon concentration was 57 Bq/m 3 , with a maximum value of 168 Bq/m 3 . The high values of indoor and outdoor radon concentrations found at Niska Banja make this region a high natural background radiation area. Statistical analysis of our data confirms that the level of indoor radon concentration depends primarily on the underlying soil and building characteristics

  1. Auroral lights created by high-power radiowaves in the ionospheric E region

    International Nuclear Information System (INIS)

    Kagan, L M

    2008-01-01

    Artificial auroral lights are optical emissions induced by high-power radiowaves in a manner similar to the creation of natural auroral lights due to precipitation of superthermal electrons. Here the Earth's atmosphere itself plays the role of a plasma laboratory. A high-power radio-transmitter creates superthermal electrons in situ due to radiowave interactions with the ionospheric plasma. Low-altitude (85-125 km) artificial aurora is a relatively rare phenomenon observed for the first time about 10 years ago. Analysis of available observations shows that its intensity and structure, as well as the very possibility of its generation at these altitudes, depend largely on the presence and features of so-called sporadic ionization, best known for its effect on navigation and communication. Thus, all other parameters unchanged, a 20 times increase in the height-extent of sporadic ionization clouds could under certain circumstances result in a 27-fold increase in the intensity of the low-altitude artificial aurora. Understanding the morphology and typical features of sporadic ionization clouds for a given location would allow proper planning of experimental campaigns and noticeably extend our knowledge of the atmosphere and its use for human needs. Equally important is that low-altitude artificial auroras give information about the horizontal structure and dynamics of E-region sporadic ionization, the airglow-source region, the energy of superthermal electrons and perhaps the local atmospheric temperature and water vapor content at 80-90 km

  2. Transcatheter embolization for high blood flow vascular malformations of oral maxillofacial region

    International Nuclear Information System (INIS)

    Sun Zengtao; Liu Zuoqin; Li Jijun; Tang Jun; Shang Jianqiang; Chen Jie

    2007-01-01

    Objective: To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods: 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results: Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions: Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region. (authors)

  3. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation.

    Science.gov (United States)

    Landi, F; Calvani, R; Ortolani, E; Salini, S; Martone, A M; Santoro, L; Santoliquido, A; Sisto, A; Picca, A; Marzetti, E

    2017-05-01

    This study evaluates the prevalence of sarcopenia among older people admitted to a rehabilitation unit after hip fracture and the association between sarcopenia and functional outcomes. The results show that sarcopenia had a negative impact on functional recovery. The assessment of sarcopenia among older adults receiving rehabilitation programs is crucial. Sarcopenia is a highly prevalent geriatric syndrome associated with adverse outcomes, including falls, disability, institutionalization, and mortality. Few studies assessed sarcopenia among older adults receiving rehabilitation programs. Patients aged 70 years or more consecutively admitted to in-hospital rehabilitation programs that had suffered from hip fracture entered the study. Sarcopenia was defined according to the Foundation for National Institutes of Health (FNIH) criteria. Multivariable linear regression models were used to analyze the association between the sarcopenia and functional recovery. The recruited population was composed of 127 patients, with a mean age of 81.3 ± 4.8 years, predominantly females (64.6%). Using the criteria proposed by the FNIH, patients with a diagnosis of sarcopenia were 43 (33.9%). After adjustment for potential confounders, participants with sarcopenia had a significant increased risk of incomplete functional recovery compared with non-sarcopenic patients (OR 3.07, 95% CI 1.07-8.75). Compared with participants without sarcopenia, those with sarcopenia showed lower Barthel index scores at the time of discharge from the rehabilitation unit (69.2 versus 58.9, respectively; p sarcopenia among older adults receiving rehabilitation programs to assist in the development of personalized treatment plans aimed at improving functional outcomes.

  4. African high-level regional meeting on energy and sustainable development. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Wamukonya, N [UNEP Collaborating Centre on Energy and Environment (Denmark)

    2001-07-01

    The United Nations Environment Programme (UNEP) jointly with the Government of Kenya and the UN Department for Economic and Social Affairs (DESA) organised the 'African High-Level Regional Meeting on Energy and Sustainable Development' in Januar 2001 at UNEP headquarters in Nairobi, Kenya. The purpose was to support the preparations for CSD 9 and enable African countries to discuss key issues related to energy for sustainable development in their regional context. This report presents the technical statements and papers prepared for the technical workshop. As the reader will quickly notice, the papers reflect the views of the range of experts who participated. Speakers and participants came from ministries or agencies dealing with energy issues, rural development and finance institutions, utilities, private enterprises, NGOs, and research institutions. The papers follow the thermes identified for the CSD 9 session but provide an Africa-specific perspective. In the region, increased access to energy is clearly still a major development issue and has strong links to another key theme - rural energy. A number of papers address these issues from the woodfuel or biomass side, as the majority of the rural population in African countries relies on this energy source and will continue to do so for the foreseeable future. At the same time, improved access to commercial energy forms, particularly through rural electrification programmes, received much attention and several papers present new approaches and experience gained in this area. On the commercial energy supply side the major challenge facing most African countries is the need to reform institutional structures, especially in the power sector. These reforms are generally part of larger economic reform packages promoted by the World Bank, International Monetary Fund, and other financial institutions. In the energy sector the reform process offers an opportunity to introduce more efficiency and competition but it must

  5. African high-level regional meeting on energy and sustainable development. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Wamukonya, N. (ed.) [UNEP Collaborating Centre on Energy and Environment (Denmark)

    2001-07-01

    The United Nations Environment Programme (UNEP) jointly with the Government of Kenya and the UN Department for Economic and Social Affairs (DESA) organised the 'African High-Level Regional Meeting on Energy and Sustainable Development' in Januar 2001 at UNEP headquarters in Nairobi, Kenya. The purpose was to support the preparations for CSD 9 and enable African countries to discuss key issues related to energy for sustainable development in their regional context. This report presents the technical statements and papers prepared for the technical workshop. As the reader will quickly notice, the papers reflect the views of the range of experts who participated. Speakers and participants came from ministries or agencies dealing with energy issues, rural development and finance institutions, utilities, private enterprises, NGOs, and research institutions. The papers follow the thermes identified for the CSD 9 session but provide an Africa-specific perspective. In the region, increased access to energy is clearly still a major development issue and has strong links to another key theme - rural energy. A number of papers address these issues from the woodfuel or biomass side, as the majority of the rural population in African countries relies on this energy source and will continue to do so for the foreseeable future. At the same time, improved access to commercial energy forms, particularly through rural electrification programmes, received much attention and several papers present new approaches and experience gained in this area. On the commercial energy supply side the major challenge facing most African countries is the need to reform institutional structures, especially in the power sector. These reforms are generally part of larger economic reform packages promoted by the World Bank, International Monetary Fund, and other financial institutions. In the energy sector the reform process offers an opportunity to introduce more efficiency and competition

  6. High current density ion beam obtained by a transition to a highly focused state in extremely low-energy region

    Energy Technology Data Exchange (ETDEWEB)

    Hirano, Y., E-mail: y.hirano@aist.go.jp, E-mail: hirano.yoichi@phys.cst.nihon-u.ac.jp [Innovative Plasma Processing Group, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568 (Japan); College of Science and Technologies, Nihon University, Chiyodaku, Tokyo 101-0897 (Japan); Kiyama, S.; Koguchi, H. [Innovative Plasma Processing Group, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568 (Japan); Fujiwara, Y.; Sakakita, H. [Innovative Plasma Processing Group, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki 305-8568 (Japan); Department of Engineering Mechanics and Energy, University of Tsukuba, Ibaraki 305-8577 (Japan)

    2015-11-15

    A high current density (≈3 mA/cm{sup 2}) hydrogen ion beam source operating in an extremely low-energy region (E{sub ib} ≈ 150–200 eV) has been realized by using a transition to a highly focused state, where the beam is extracted from the ion source chamber through three concave electrodes with nominal focal lengths of ≈350 mm. The transition occurs when the beam energy exceeds a threshold value between 145 and 170 eV. Low-level hysteresis is observed in the transition when E{sub ib} is being reduced. The radial profiles of the ion beam current density and the low temperature ion current density can be obtained separately using a Faraday cup with a grid in front. The measured profiles confirm that more than a half of the extracted beam ions reaches the target plate with a good focusing profile with a full width at half maximum of ≈3 cm. Estimation of the particle balances in beam ions, the slow ions, and the electrons indicates the possibility that the secondary electron emission from the target plate and electron impact ionization of hydrogen may play roles as particle sources in this extremely low-energy beam after the compensation of beam ion space charge.

  7. Selection of mRNA 5'-untranslated region sequence with high translation efficiency through ribosome display

    International Nuclear Information System (INIS)

    Mie, Masayasu; Shimizu, Shun; Takahashi, Fumio; Kobatake, Eiry

    2008-01-01

    The 5'-untranslated region (5'-UTR) of mRNAs functions as a translation enhancer, promoting translation efficiency. Many in vitro translation systems exhibit a reduced efficiency in protein translation due to decreased translation initiation. The use of a 5'-UTR sequence with high translation efficiency greatly enhances protein production in these systems. In this study, we have developed an in vitro selection system that favors 5'-UTRs with high translation efficiency using a ribosome display technique. A 5'-UTR random library, comprised of 5'-UTRs tagged with a His-tag and Renilla luciferase (R-luc) fusion, were in vitro translated in rabbit reticulocytes. By limiting the translation period, only mRNAs with high translation efficiency were translated. During translation, mRNA, ribosome and translated R-luc with His-tag formed ternary complexes. They were collected with translated His-tag using Ni-particles. Extracted mRNA from ternary complex was amplified using RT-PCR and sequenced. Finally, 5'-UTR with high translation efficiency was obtained from random 5'-UTR library

  8. Production of high-resolution digital terrain models in mountain regions to support risk assessment

    Directory of Open Access Journals (Sweden)

    Gianfranco Forlani

    2015-07-01

    Full Text Available Demand for high-accuracy digital terrain models (DTMs in the Alpine region has been steadily increasing in recent years in valleys as well as high mountains. In the former, the determination of the geo-mechanical parameters of rock masses is the main objective; global warming, which causes the retreat of glaciers and the reduction of permafrost, is the main drive of the latter. The consequence is the instability of rock masses in high mountains: new cost-effective monitoring techniques are required to deal with the peculiar characteristics of such environment, delivering results at short notice. After discussing the design and execution of photogrammetric surveys in such areas, with particular reference to block orientation and block control, the paper describes the production of DTMs of rock faces and glacier fronts with light instrumentation and data acquisition techniques, allowing highly automated data processing. To this aim, the PhotoGPS technique and structure from motion algorithms are used to speed up the orientation process, while dense matching area-based correlation techniques are used to generate the DTMs.

  9. Land Cover Mapping in Northern High Latitude Permafrost Regions with Satellite Data: Achievements and Remaining Challenges

    Directory of Open Access Journals (Sweden)

    Annett Bartsch

    2016-11-01

    Full Text Available Most applications of land cover maps that have been derived from satellite data over the Arctic require higher thematic detail than available in current global maps. A range of application studies has been reviewed, including up-scaling of carbon fluxes and pools, permafrost feature mapping and transition monitoring. Early land cover mapping studies were driven by the demand to characterize wildlife habitats. Later, in the 1990s, up-scaling of in situ measurements became central to the discipline of land cover mapping on local to regional scales at several sites across the Arctic. This includes the Kuparuk basin in Alaska, the Usa basin and the Lena Delta in Russia. All of these multi-purpose land cover maps have been derived from Landsat data. High resolution maps (from optical satellite data serve frequently as input for the characterization of periglacial features and also flux tower footprints in recent studies. The most used map to address circumpolar issues is the CAVM (Circum Arctic Vegetation Map based on AVHRR (1 km and has been manually derived. It provides the required thematic detail for many applications, but is confined to areas north of the treeline, and it is limited in spatial detail. A higher spatial resolution circumpolar land cover map with sufficient thematic content would be beneficial for a range of applications. Such a land cover classification should be compatible with existing global maps and applicable for multiple purposes. The thematic content of existing global maps has been assessed by comparison to the CAVM and regional maps. None of the maps provides the required thematic detail. Spatial resolution has been compared to used classes for local to regional applications. The required thematic detail increases with spatial resolution since coarser datasets are usually applied over larger areas covering more relevant landscape units. This is especially of concern when the entire Arctic is addressed. A spatial

  10. High-resolution mapping of biomass burning emissions in tropical regions across three continents

    Science.gov (United States)

    Shi, Yusheng; Matsunaga, Tsuneo; Saito, Makoto

    2015-04-01

    Biomass burning emissions from open vegetation fires (forest fires, savanna fires, agricultural waste burning), human waste and biofuel combustion contain large amounts of trace gases (e.g., CO2, CH4, and N2O) and aerosols (BC and OC), which significantly impact ecosystem productivity, global atmospheric chemistry, and climate . With the help of recently released satellite products, biomass density based on satellite and ground-based observation data, and spatial variable combustion factors, this study developed a new high-resolution emissions inventory for biomass burning in tropical regions across three continents in 2010. Emissions of trace gases and aerosols from open vegetation burning are estimated from burned areas, fuel loads, combustion factors, and emission factors. Burned areas were derived from MODIS MCD64A1 burned area product, fuel loads were mapped from biomass density data sets for herbaceous and tree-covered land based on satellite and ground-based observation data. To account for spatial heterogeneity in combustion factors, global fractional tree cover (MOD44B) and vegetation cover maps (MCD12Q1) were introduced to estimate the combustion factors in different regions by using their relationship with tree cover under less than 40%, between 40-60% and above 60% conditions. For emission factors, the average values for each fuel type from field measurements are used. In addition to biomass burning from open vegetation fires, the emissions from human waste (residential and dump) burning and biofuel burning in 2010 were also estimated for 76 countries in tropical regions across the three continents and then allocated into each pixel with 1 km grid based on the population density (Gridded Population of the World v3). Our total estimates for the tropical regions across the three continents in 2010 were 17744.5 Tg CO2, 730.3 Tg CO, 32.0 Tg CH4, 31.6 Tg NOx, 119.2 Tg NMOC, 6.3 Tg SO2, 9.8 NH3 Tg, 81.8 Tg PM2.5, 48.0 Tg OC, and 5.7 Tg BC, respectively. Open

  11. Developing High-resolution Soil Database for Regional Crop Modeling in East Africa

    Science.gov (United States)

    Han, E.; Ines, A. V. M.

    2014-12-01

    The most readily available soil data for regional crop modeling in Africa is the World Inventory of Soil Emission potentials (WISE) dataset, which has 1125 soil profiles for the world, but does not extensively cover countries Ethiopia, Kenya, Uganda and Tanzania in East Africa. Another dataset available is the HC27 (Harvest Choice by IFPRI) in a gridded format (10km) but composed of generic soil profiles based on only three criteria (texture, rooting depth, and organic carbon content). In this paper, we present a development and application of a high-resolution (1km), gridded soil database for regional crop modeling in East Africa. Basic soil information is extracted from Africa Soil Information Service (AfSIS), which provides essential soil properties (bulk density, soil organic carbon, soil PH and percentages of sand, silt and clay) for 6 different standardized soil layers (5, 15, 30, 60, 100 and 200 cm) in 1km resolution. Soil hydraulic properties (e.g., field capacity and wilting point) are derived from the AfSIS soil dataset using well-proven pedo-transfer functions and are customized for DSSAT-CSM soil data requirements. The crop model is used to evaluate crop yield forecasts using the new high resolution soil database and compared with WISE and HC27. In this paper we will present also the results of DSSAT loosely coupled with a hydrologic model (VIC) to assimilate root-zone soil moisture. Creating a grid-based soil database, which provides a consistent soil input for two different models (DSSAT and VIC) is a critical part of this work. The created soil database is expected to contribute to future applications of DSSAT crop simulation in East Africa where food security is highly vulnerable.

  12. Health Care Costs of Spontaneous Aneurysmal Subarachnoid Hemorrhage for Rehabilitation, Home Care, and In-Hospital Treatment for the First Year.

    Science.gov (United States)

    Ridwan, Sami; Urbach, Horst; Greschus, Susanne; von Hagen, Johanna; Esche, Jonas; Boström, Azize

    2017-01-01

    Given the young age of onset and high probability of long-term disability after subarachnoid hemorrhage (SAH), the financial impact is expected to be substantial. Our primary objective was to highlight subsequent treatment costs after the acute in-hospital stay, including rehabilitation and home care, compared with costs for ischemic stroke. The study included 101 patients (median age 52 years, 70 women) with aneurysmal SAH treated from July 2007 to April 2009. In-hospital costs were calculated using German diagnosis related groups. Rehabilitation costs depended on rehabilitation phase/grade and daily rate. Level of severity of care requirements determined the costs for home care. Of patients, 54% received coiling and 46% received clipping. The clipping group included more poor-grade patients than the coiling group (P = 0.039); 23 patients died. Of 78 surviving patients, 70 received rehabilitation treatment (68 in Germany). Mean rehabilitation costs were €16,030 per patient. Patients in the clipping group generated higher rehabilitation costs and longer treatment periods in rehabilitation facilities (P = 0.001 for costs [€20,290 vs. €11,771] and P = 0.011 for duration (54.4 days vs. 40.5 days). Of surviving patients, 32% needed home care, of whom 52% required constant care. Multivariate regression analysis identified longer intensive care unit stay and poor Hunt and Hess grade as independent predictors of higher costs. Aneurysmal SAH prevalently affects working individuals with long-term occupational disability necessitating long-term medical rehabilitation for most patients and subsequent nursing care in one third of survivors. Overall, SAH treatment generates far higher costs than reported for ischemic stroke. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A prolonged mumps outbreak among highly vaccinated Aboriginal people in the Kimberley region of Western Australia.

    Science.gov (United States)

    Bangor-Jones, Revle D; Dowse, Gary K; Giele, Carolien M; van Buynder, Paul G; Hodge, Meredith M; Whitty, Mary M

    2009-10-05

    To describe a prolonged outbreak of mumps in the Kimberley region of Western Australia in 2007-2008. Descriptive analysis of all mumps cases notified to the WA Notifiable Infectious Diseases Database for the period 1 July 2007 to 30 June 2008. Notified cases of mumps by patients' place of residence, age, Indigenous or non-Indigenous ethnicity, vaccination status and method of diagnosis. 84% (153/183) of mumps notifications in WA over the study period occurred in the Kimberley region or were directly linked to Kimberley cases. Median age of patients was 18 years (range, 2-63 years), and 54% of patients were aged less than 20 years. Almost all (92%) were Australian Aboriginal people; 67% (102/153) had received at least one dose of mumps vaccine, and 52% had received two doses. The highest notification rate (1816 cases per 100,000 population) was in the Aboriginal 15-19-years age group, and 92% of these patients had received at least one dose of mumps vaccine. Almost all outbreak cases (94%) were laboratory confirmed. Genotyping was performed on 20 mumps virus isolates: all were genotype J. A prolonged outbreak of mumps occurred in a well defined, highly vaccinated, predominantly young Aboriginal population in the remote Kimberley region of WA. This outbreak raises questions about the effectiveness and scheduling of the current vaccine (which is genotype A-derived), especially for Aboriginal people. Surveillance of circulating mumps virus genotypes and neutralisation studies will help in evaluating the protection provided by the current vaccine against genotypically different strains.

  14. Imaging derived cortical thickness reduction in high-functioning autism: key regions and temporal slope.

    Science.gov (United States)

    Scheel, Christian; Rotarska-Jagiela, Anna; Schilbach, Leonhard; Lehnhardt, Fritz G; Krug, Barbara; Vogeley, Kai; Tepest, Ralf

    2011-09-15

    Cortical thickness (CT) changes possibly contribute to the complex symptomatology of autism. The aberrant developmental trajectories underlying such differences in certain brain regions and their continuation in adulthood are a matter of intense debate. We studied 28 adults with high-functioning autism (HFA) and 28 control subjects matched for age, gender, IQ and handedness. A surface-based whole brain analysis utilizing FreeSurfer was employed to detect CT differences between the two diagnostic groups and to investigate the time course of age-related changes. Direct comparison with control subjects revealed thinner cortex in HFA in the posterior superior temporal sulcus (pSTS) of the left hemisphere. Considering the time course of CT development we found clusters around the pSTS and cuneus in the left and the paracentral lobule in the right hemisphere to be thinner in HFA with comparable age-related slopes in patients and controls. Conversely, we found clusters around the supramarginal gyrus and inferior parietal lobule (IPL) in the left and the precentral and postcentral gyrus in the right hemisphere to be thinner in HFA, but with different age-related slopes in patients and controls. In the latter regions CT showed a steady decrease in controls but no analogous thinning in HFA. CT analyses contribute in characterizing neuroanatomical correlates of HFA. Reduced CT is present in brain regions involved in social cognition. Furthermore, our results demonstrate that aberrant brain development leading to such differences is proceeding throughout adulthood. Discrepancies in prior morphometric studies may be induced by the complex time course of cortical changes. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. The Impact Snow Albedo Feedback over Mountain Regions as Examined through High-Resolution Regional Climate Change Experiments over the Rocky Mountains

    Science.gov (United States)

    Letcher, Theodore

    As the climate warms, the snow albedo feedback (SAF) will play a substantial role in shaping the climate response of mid-latitude mountain regions with transient snow cover. One such region is the Rocky Mountains of the western United States where large snow packs accumulate during the winter and persist throughout the spring. In this dissertation, the Weather Research and Forecast model (WRF) configured as a regional climate model is used to investigate the role of the SAF in determining the regional climate response to forced anthropogenic climate change. The regional effects of climate change are investigated by using the pseudo global warming (PGW) framework, which is an experimental configuration in a which a mean climate perturbation is added to the boundary forcing of a regional model, thus preserving the large-scale circulation entering the region through the model boundaries and isolating the mesoscale climate response. Using this framework, the impact of the SAF on the regional energetics and atmospheric dynamics is examined and quantified. Linear feedback analysis is used to quantify the strength of the SAF over the Headwaters region of the Colorado Rockies for a series of high-resolution PGW experiments. This technique is used to test sensitivity of the feedback strength to model resolution and land surface model. Over the Colorado Rockies, and integrated over the entire spring season, the SAF strength is largely insensitive to model resolution, however there are more substantial differences on the sub-seasonal (monthly) timescale. In contrast, the SAF strength over this region is very sensitive to choice of land surface model. These simulations are also used to investigate how spatial and diurnal variability in warming caused by the SAF influences the dynamics of thermally driven mountain-breeze circulations. It is shown that, the SAF causes stronger daytime mountain-breeze circulations by increasing the warming on the mountains slopes thus enhancing

  16. Amino Terminal Region of Dengue Virus NS4A Cytosolic Domain Binds to Highly Curved Liposomes

    Directory of Open Access Journals (Sweden)

    Yu-Fu Hung

    2015-07-01

    Full Text Available Dengue virus (DENV is an important human pathogen causing millions of disease cases and thousands of deaths worldwide. Non-structural protein 4A (NS4A is a vital component of the viral replication complex (RC and plays a major role in the formation of host cell membrane-derived structures that provide a scaffold for replication. The N-terminal cytoplasmic region of NS4A(1–48 is known to preferentially interact with highly curved membranes. Here, we provide experimental evidence for the stable binding of NS4A(1–48 to small liposomes using a liposome floatation assay and identify the lipid binding sequence by NMR spectroscopy. Mutations L6E;M10E were previously shown to inhibit DENV replication and to interfere with the binding of NS4A(1–48 to small liposomes. Our results provide new details on the interaction of the N-terminal region of NS4A with membranes and will prompt studies of the functional relevance of the curvature sensitive membrane anchor at the N-terminus of NS4A.

  17. Ecological surveys of the proposed high explosives wastewater treatment facility region

    International Nuclear Information System (INIS)

    Haarmann, T.

    1995-07-01

    Los Alamos National Laboratory (LANL) proposes to improve its treatment of wastewater from high explosives (HE) research and development activities. The proposed project would focus on a concerted waste minimization effort to greatly reduce the amount of wastewater needing treatment. The result would be a 99% decrease in the HE wastewater volume, from the current level of 6,760,000 L/mo (1,786,000 gal./mo) to 41,200 L/mo (11,000 gal./mo). This reduction would entail closure of HE wastewater outfalls, affecting some wetland areas that depend on HE wastewater effluents. The outfalls also provide drinking water for many wildlife species. Terminating the flow of effluents at outfalls would represent an improvement in water quality in the LANL region but locally could have a negative effect on some wetlands and wildlife species. None of the affected species are protected by any state or federal endangered species laws. The purpose of this report is to briefly discuss the different biological studies that have been done in the region of the project area. This report is written to give biological information and baseline data and the biota of the project area

  18. Forest decline caused by high soil water conditions in a permafrost region

    Directory of Open Access Journals (Sweden)

    H. Iwasaki

    2010-02-01

    Full Text Available In the permafrost region near Yakutsk, eastern Siberia, Russia, annual precipitation (June–May in 2005–2006 and 2006–2007 exceeded the 26-year (1982–2008 mean of 222±68 mm by 185 mm and 128 mm, respectively, whereas in 2007–2008 the excedent was only 48 mm, well within the range of variability. Yellowing and browning of larch (Larix cajanderi Mayr. trees occurred in an undisturbed forest near Yakutsk in the 2007 summer growing season. Soil water content at a depth of 0.20 m was measured along a roughly 400 m long line transect running through areas of yellowing and browning larch trees (YBL and of normal larch trees (NL. In the two years of supranormal precipitation, soil water content was very high compared to values recorded for the same area in previous studies. For both wet years, the mean degree of saturation (s was significantly greater in YBL than NL areas, whereas the converse was the case for the gas diffusivity in soil. This implies that rather than mitigating water stress suffered during normal precipitation years, elevated soil water conditions adversely affected the growth of larch trees. Eastern Siberia's taiga forest extends widely into the permafrost region. Was such supranormal annual precipitation to extend for more than two years, as might be expected under impending global climate changes, forest recovery may not be expected and emission of greenhouse gas might continue in future.

  19. [Nutritional status and food intake of populations from high altitude regions of the Northwest of Argentia].

    Science.gov (United States)

    Bassett, Maria Natalia; Gimenez, Maria Alejandra; Romaguera, Dora; Sammán, Norma

    2013-06-01

    The purpose of this work was to study the nutritional status and food intake of Andean populations of Northwest ofArgentine. A cross-sectional nutritional survey was carried out in representative samples of populations of highland from Argentine. Also anthropometric measurements, a food intake, a semi-quantitative food frequency questionnaire were performed and recorded. Stunting (height-for-age Z-score 85th and 95th percentile respectively, were the main nutritional problems among adolescents in the Valleys. Adult populations showed higher prevalence of overweight and obesity according to BMI determined. These are important risk factors for cardiovascular and chronic diseases.Usually the typical composition of the main food dish of regions has a base of rice, pasta, flour or corn, accompanied by tubers or eggs, or a few vegetables and beef. This dish varies little from one day to another, constituting a monotonous diet with a high intake of sugar (sugary drinks and sweets) and refined grains. Results suggest that these populations would be in early stages of nutritional transition and could be the starting point to promote them healthier food consumption and a diet less monotonous. It would be recommendable reincorporate native products of the region.

  20. High-latitude Pc 1 bursts arising in the dayside boundary layer region

    International Nuclear Information System (INIS)

    Hansen, H.J.; Fraser, B.J.; Menk, F.W.; Hu, Y.D.; Newell, P.T.; Meng, C.I.; Morris, R.J.

    1992-01-01

    Dayside Pc 1 geomagnetic pulsation bursts have been studied using a three-station array of induction magnetometers located at high latitudes. Associated magnetic variations in the form of solitary pulses often lead the Pc 1 bursts by 1 to 2 min. These pulses are typically associated with riometer absorption events and consequently the precipitation of fluxes of keV electrons. The Pc 1 bursts are interpreted as resulting from ion cyclotron waves which have propagated to the ionosphere from the equatorial boundary layer region. The associated boundary layer ions, identified by the low-altitude DMSP F7 satellite, range between 1 and 5 keV in energy. These particles are considered to be the most likely free energy source for the ion cyclotron waves. It is considered that such resonant ions enter the magnetosphere via the cleft and cusp because this enables a prenoon time of occurrence of most of the observations to be explained. Measured time delays of 40 to 120 s between the associated riometer absorption and Pc 2 bursts are consistent with an ion cyclotron wave generations region located in the equatorial magnetosphere

  1. Evaluation of trends in high temperature extremes in north-western Europe in regional climate models

    International Nuclear Information System (INIS)

    Min, E; Hazeleger, W; Van Oldenborgh, G J; Sterl, A

    2013-01-01

    Projections of future changes in weather extremes on the regional and local scale depend on a realistic representation of trends in extremes in regional climate models (RCMs). We have tested this assumption for moderate high temperature extremes (the annual maximum of the daily maximum 2 m temperature, T ann.max ). Linear trends in T ann.max from historical runs of 14 RCMs driven by atmospheric reanalysis data are compared with trends in gridded station data. The ensemble of RCMs significantly underestimates the observed trends over most of the north-western European land surface. Individual models do not fare much better, with even the best performing models underestimating observed trends over large areas. We argue that the inability of RCMs to reproduce observed trends is probably not due to errors in large-scale circulation. There is also no significant correlation between the RCM T ann.max trends and trends in radiation or Bowen ratio. We conclude that care should be taken when using RCM data for adaptation decisions. (letter)

  2. Ecological surveys of the proposed high explosives wastewater treatment facility region

    Energy Technology Data Exchange (ETDEWEB)

    Haarmann, T.

    1995-07-01

    Los Alamos National Laboratory (LANL) proposes to improve its treatment of wastewater from high explosives (HE) research and development activities. The proposed project would focus on a concerted waste minimization effort to greatly reduce the amount of wastewater needing treatment. The result would be a 99% decrease in the HE wastewater volume, from the current level of 6,760,000 L/mo (1,786,000 gal./mo) to 41,200 L/mo (11,000 gal./mo). This reduction would entail closure of HE wastewater outfalls, affecting some wetland areas that depend on HE wastewater effluents. The outfalls also provide drinking water for many wildlife species. Terminating the flow of effluents at outfalls would represent an improvement in water quality in the LANL region but locally could have a negative effect on some wetlands and wildlife species. None of the affected species are protected by any state or federal endangered species laws. The purpose of this report is to briefly discuss the different biological studies that have been done in the region of the project area. This report is written to give biological information and baseline data and the biota of the project area.

  3. Regional Scale High Resolution δ18O Prediction in Precipitation Using MODIS EVI

    Science.gov (United States)

    Huang, Cho-Ying; Wang, Chung-Ho; Lin, Shou-De; Lo, Yi-Chen; Huang, Bo-Wen; Hatch, Kent A.; Shiu, Hau-Jie; You, Cheng-Feng; Chang, Yuan-Mou; Shen, Sheng-Feng

    2012-01-01

    The natural variation in stable water isotope ratio data, also known as water isoscape, is a spatiotemporal fingerprint and a powerful natural tracer that has been widely applied in disciplines as diverse as hydrology, paleoclimatology, ecology and forensic investigation. Although much effort has been devoted to developing a predictive water isoscape model, it remains a central challenge for scientists to generate high accuracy, fine scale spatiotemporal water isoscape prediction. Here we develop a novel approach of using the MODIS-EVI (the Moderate Resolution Imagining Spectroradiometer-Enhanced Vegetation Index), to predict δ18O in precipitation at the regional scale. Using a structural equation model, we show that the EVI and precipitated δ18O are highly correlated and thus the EVI is a good predictor of precipitated δ18O. We then test the predictability of our EVI-δ18O model and demonstrate that our approach can provide high accuracy with fine spatial (250×250 m) and temporal (16 days) scale δ18O predictions (annual and monthly predictabilities [r] are 0.96 and 0.80, respectively). We conclude the merging of the EVI and δ18O in precipitation can greatly extend the spatial and temporal data availability and thus enhance the applicability for both the EVI and water isoscape. PMID:23029053

  4. High-resolution bent-crystal spectrometer for the ultra-soft x-ray region

    International Nuclear Information System (INIS)

    Beiersdorfer, P.; von Goeler, S.; Bitter, M.; Hill, K.W.; Hulse, R.A.; Walling, R.S.

    1988-10-01

    A multichannel vacuum Brag-crystal spectrometer has been developed for high-resolution measurements of the line emission from tokamak plasmas in the wavelength region between 4 and 25 /angstrom/. The spectrometer employs a bent crystal in Johann geometry and a microchannel-plate intensified photodiode array. The instrument is capable of measuring high-resolution spectra (λ/Δλ ∼ 3000) with fast time resolution (4 msec per spectrum) and good spatial resolution (3 cm). The spectral bandwidth is Δλ/λ 0 = 8/angstrom/. A simple tilt mechanism allows access to different wavelength intervals. In order to illustrate the utility of the new spectrometer, time- and space-resolved measurements of the n = 3 to n = 2 spectrum of selenium from the Princeton Large Torus tokamak plasmas are presented. The data are used to determine the plasma transport parameters and to infer the radial distribution of fluorinelike, neonlike, and sodiumlike ions of selenium in the plasma. The new ultra-soft x-ray spectrometer has thus enabled us to demonstrate the utility of high-resolution L-shell spectroscopy of neonlike ions as a fusion diagnostic. 43 refs., 23 figs

  5. Simulation of D and E region high-power microwave heating with HF ionospheric modification experiments

    International Nuclear Information System (INIS)

    Meltz, G.; Rush, C.M.; Violette, E.J.

    1981-01-01

    The microwave power beam from a Solar Power Satellite (SPS) is sufficiently intense to cause large changes in the properties of the lower ionosphere by ohmic heating of the plasma. Power is absorbed from the beam at a rate that is proportional to the ratio of the flux s and the square of an effective frequency f/sub e/. Throughout most of the lower ionosphere f/sub e/ = f -+ f/sub L/, where f is the wave frequency and f/sub L is a reduced electron gyrofrequency. It follows that SPS equivalent heating can be simulated at much lower power fluxes with HF radio waves. A detailed examination of the frequency scaling, based on fluid and kinetic theory estimates of the change in electron temperature and density, shows that the high-power HF facility at Platteville, CO, can simulate or exceed the ohmic effects of the SPS beam up to 90 km. This paper describes the results of a series of 5.2 and 9.9 MHz underdense heating experiments undertaken to study the effect of high-power microwaves on the lower ionosphere. A pulsed ionosonde probe, located nearly below the most intense portion of the high-power beam, was used to observe the changes in the D and lower E region. Both phase and amplitude measurements were recorded during CW and intermittent heating

  6. A survey of high-velocity H I in the Cetus region

    International Nuclear Information System (INIS)

    Cohen, R.J.

    1982-01-01

    The region 02sup(h) 16sup(m) 0 0 surrounding the Cohen and Davies complex of high-velocity clouds has been surveyed in the 21-cm line of H I using the Jodrell Bank MK II radio telescope (beamwidth 31 x 34 arcmin). The high-velocity cloud complex was sampled every 2sup(m) in right ascension and every 0 0 .5 in declination. The observations cover a velocity range of 2100 km s -1 with a resolution of 7.3 km s -1 and an rms noise level of 0.025 K. No HVCs were found outside the velocity range -400 to +100 km s -1 . The data are presented on microfiche as a set of contour maps showing 21-cm line temperature as a function of declination and radial velocity at constant values of right ascension. Discussion is centred on the very-high-velocity clouds at velocities of -360 to -190 km s -1 . It is concluded that they are probably debris from the tidal interaction between our Galaxy and the Magellanic Clouds. (author)

  7. Thermal SiO as a probe of high velocity motions in regions of star formation

    International Nuclear Information System (INIS)

    Downes, D.; Genzel, R.; Hjalmarson, A.; Nyman, L.A.; Roennaeng, B.

    1982-01-01

    New observations of the v = 0, J = = 2→1 line of SiO at 86.8 GHz show a close association of the thermal SiO emission and infrared and maser sources in regions of star formation. In addition to SiO emission with low velocity dispersion (Δν -1 ), we report the first detection of high velocity (''plateau'') emission toward W49 and W51. The low velocity SiO component may come from the core of the molecular cloud which contains the infrared and maser sources. The ''plateau'' may indicate mass clusters. In Orion KL, the positional centroid of the high velocity SiO emission (Vertical BarΔνVertical Bar> or =20 km s -1 ) is near that of the component we identify as the ''18 km s -1 flow''. However, the centriods of the blue- and redshifted wings are displaced from each other by a few arcseconds, to the NW and NE of the position of the 18 km s -1 component. The mass-loss rates of the high velocity flow and the 18 km s -1 flow are similar

  8. Automated Segmentation of High-Resolution Photospheric Images of Active Regions

    Science.gov (United States)

    Yang, Meng; Tian, Yu; Rao, Changhui

    2018-02-01

    Due to the development of ground-based, large-aperture solar telescopes with adaptive optics (AO) resulting in increasing resolving ability, more accurate sunspot identifications and characterizations are required. In this article, we have developed a set of automated segmentation methods for high-resolution solar photospheric images. Firstly, a local-intensity-clustering level-set method is applied to roughly separate solar granulation and sunspots. Then reinitialization-free level-set evolution is adopted to adjust the boundaries of the photospheric patch; an adaptive intensity threshold is used to discriminate between umbra and penumbra; light bridges are selected according to their regional properties from candidates produced by morphological operations. The proposed method is applied to the solar high-resolution TiO 705.7-nm images taken by the 151-element AO system and Ground-Layer Adaptive Optics prototype system at the 1-m New Vacuum Solar Telescope of the Yunnan Observatory. Experimental results show that the method achieves satisfactory robustness and efficiency with low computational cost on high-resolution images. The method could also be applied to full-disk images, and the calculated sunspot areas correlate well with the data given by the National Oceanic and Atmospheric Administration (NOAA).

  9. Enhanced electrochemomechanical activity of polyaniline films towards high pH region: contribution of Donnan effect

    International Nuclear Information System (INIS)

    Takashima, Wataru; Nakashima, Megumi; Pandey, Shyam S.; Kaneto, Keiichi

    2004-01-01

    Enhancement of electrochemomechanical deformation (ECMD) and expansion of ECMD activity towards high pH have been simultaneously achieved in the electrolytes equilibrated with HCl and NaCl solutions for polyaniline (PANI) film. The maximum deformation has been reached to 6.7% in the mixture of 3 M HCl and 3 M NaCl equilibrated at pH 3 at ambient temperature. By comparing the fact that the ECMD magnitude is 3.2% in 1 M HCl equilibrated at pH 0.5, the simple judicious selection of electrolyte condition leads to the enhancement of ECMD magnitude by around two times. The concentration dependence on both electrical conductivity and absorption spectra elucidates the increase of protonation ratio as a function of electrolyte concentration. The results indicate that the high concentration retains both the electrochemical and ECMD activities in PANI film towards high pH region, which is the enhanced functionality of PANI supported by Donnan effect

  10. How sensitive are di-leptons from ρ mesons to the high baryon density region?

    International Nuclear Information System (INIS)

    Vogel, S.; Schmidt, K.; Santini, E.; Sturm, C.; Bleicher, M.; Petersen, H.; Aichelin, J.

    2008-01-01

    We show that the measurement of dileptons might provide only a restricted view into the most dense stages of heavy-ion reactions. Thus, possible studies of meson and baryon properties at high baryon densities, as, e.g., done at the GSI High Acceptance DiElectron Spectrometer (HADES) and envisioned for the Facility for Antiproton and Ion Research (FAIR) compressed baryonic matter experiments, might observe weaker effects than currently expected in certain approaches. We argue that the strong absorption of resonances in the high-baryon-density region of the heavy-ion collision masks information from the early hot and dense phase due to a strong increase of the total decay width because of collisional broadening. To obtain additional information, we also compare the currently used approaches to extract dileptons from transport simulations, i.e., shining, only vector mesons from final baryon resonance decays and instant emission of dileptons and find a strong sensitivity on the method employed in particular at FAIR and the CERN Super Proton Synchrotron energies. It is shown explicitly that a restriction to ρ meson (and therefore dilepton) production only in final-state baryon resonance decays provide a strong bias toward rather low baryon densities. The results presented are obtained from ultrarelativistic quantum molecular dynamics v2.3 calculations using the standard setup

  11. Nonrandom community assembly and high temporal turnover promote regional coexistence in tropics but not temperate zone.

    Science.gov (United States)

    Freestone, Amy L; Inouye, Brian D

    2015-01-01

    A persistent challenge for ecologists is understanding the ecological mechanisms that maintain global patterns of biodiversity, particularly the latitudinal diversity gradient of peak species richness in the tropics. Spatial and temporal variation in community composition contribute to these patterns of biodiversity, but how this variation and its underlying processes change across latitude remains unresolved. Using a model system of sessile marine invertebrates across 25 degrees of latitude, from the temperate zone to the tropics, we tested the prediction that spatial and temporal patterns of taxonomic richness and composition, and the community assembly processes underlying these patterns, will differ across latitude. Specifically, we predicted that high beta diversity (spatial variation in composition) and high temporal turnover contribute to the high species richness of the tropics. Using a standardized experimental approach that controls for several confounding factors that hinder interpretation of prior studies, we present results that support our predictions. In the temperate zone, communities were more similar across spatial scales from centimeters to tens of kilometers and temporal scales up to one year than at lower latitudes. Since the patterns at northern latitudes were congruent with a null model, stochastic assembly processes are implicated. In contrast, the communities in the tropics were a dynamic spatial and temporal mosaic, with low similarity even across small spatial scales and high temporal turnover at both local and regional scales. Unlike the temperate zone, deterministic community assembly processes such as predation likely contributed to the high beta diversity in the tropics. Our results suggest that community assembly processes and temporal dynamics vary across latitude and help structure and maintain latitudinal patterns of diversity.

  12. High-fat diet-induced brain region-specific phenotypic spectrum of CNS resident microglia.

    Science.gov (United States)

    Baufeld, Caroline; Osterloh, Anja; Prokop, Stefan; Miller, Kelly R; Heppner, Frank L

    2016-09-01

    Diets high in fat (HFD) are known to cause an immune response in the periphery as well as the central nervous system. In peripheral adipose tissue, this immune response is primarily mediated by macrophages that are recruited to the tissue. Similarly, reactivity of microglia, the innate immune cells of the brain, has been shown to occur in the hypothalamus of mice fed a high-fat diet. To characterize the nature of the microglial response to diets high in fat in a temporal fashion, we studied the phenotypic spectrum of hypothalamic microglia of mice fed high-fat diet for 3 days and 8 weeks by assessing their tissue reaction and inflammatory signature. While we observed a significant increase in Iba1+ myeloid cells and a reaction of GFAP+ astrocytes in the hypothalamus after 8 weeks of HFD feeding, we found the hypothalamic myeloid cell reaction to be limited to endogenous microglia and not mediated by infiltrating myeloid cells. Moreover, obese humans were found to present with signs of hypothalamic gliosis and exacerbated microglia dystrophy, suggesting a targeted microglia response to diet in humans as well. Notably, the glial reaction occurring in the mouse hypothalamus was not accompanied by an increase in pro-inflammatory cytokines, but rather by an anti-inflammatory reaction. Gene expression analyses of isolated microglia not only confirmed this observation, but also revealed a downregulation of microglia genes important for sensing signals in the microenvironment. Finally, we demonstrate that long-term exposure of microglia to HFD in vivo does not impair the cell's ability to respond to additional stimuli, like lipopolysaccharide. Taken together, our findings support the notion that microglia react to diets high in fat in a region-specific manner in rodents as well as in humans; however, this response changes over time as it is not exclusively pro-inflammatory nor does exposure to HFD prime microglia in the hypothalamus.

  13. High-Performance Region-of-Interest Image Error Concealment with Hiding Technique

    Directory of Open Access Journals (Sweden)

    Shih-Chang Hsia

    2010-01-01

    Full Text Available Recently region-of-interest (ROI based image coding is a popular topic. Since ROI area contains much more important information for an image, it must be prevented from error decoding while suffering from channel lost or unexpected attack. This paper presents an efficient error concealment method to recover ROI information with a hiding technique. Based on the progressive transformation, the low-frequency components of ROI are encoded to disperse its information into the high-frequency bank of original image. The capability of protection is carried out with extracting the ROI coefficients from the damaged image without increasing extra information. Simulation results show that the proposed method can efficiently reconstruct the ROI image when ROI bit-stream occurs errors, and the measurement of PSNR result outperforms the conventional error concealment techniques by 2 to 5 dB.

  14. Typical disturbances of the daytime equatorial F region observed with a high-resolution HF radar

    Directory of Open Access Journals (Sweden)

    E. Blanc

    1998-06-01

    Full Text Available HF radar measurements were performed near the magnetic equator in Africa (Korhogo 9°24'63''N–5°37'38''W during the International Equatorial Electrojet Year (1993–1994. The HF radar is a high-resolution zenithal radar. It gives ionograms, Doppler spectra and echo parameters at several frequencies simultaneously. This paper presents a comparative study of the daytime ionospheric structures observed during 3 days selected as representative of different magnetic conditions, given by magnetometer measurements. Broad Doppler spectra, large echo width, and amplitude fluctuations revealed small-scale instability processes up to the F-region peak. The height variations measured at different altitudes showed gravity waves and larger-scale disturbances related to solar daytime influence and equatorial electric fields. The possibility of retrieving the ionospheric electric fields from these Doppler or height variation measurements in the presence of the other possible equatorial ionospheric disturbances is discussed.

  15. Landslide hazard and land management in high-density urban areas of Campania region, Italy

    Directory of Open Access Journals (Sweden)

    D. Di Martire

    2012-04-01

    Full Text Available Results deriving from a research focused on the interplay between landslides and urban development are presented here, with reference to two densely populated settings located in the Campania region, Italy: the city of Naples and the island of Ischia. Both areas suffer adverse consequences from various types of landslides since at least 2000 yr. Our study evidences that, despite the long history of slope instabilities, the urban evolution, often illegal, disregarded the high landslide propensity of the hillsides; thus, unsafe lands have been occupied, even in recent years, when proper and strict rules have been enacted to downgrade the landslide risk. It is finally argued that future guidelines should not be entirely based upon physical countermeasures against mass movements. On the contrary, national and local authorities should enforce the territorial control, obliging citizens to respect the existing regulations and emphasizing the role of alternative, non-structural solutions.

  16. Improvement of the sensitivity of CdTe detectors in the high energy regions

    Energy Technology Data Exchange (ETDEWEB)

    Nishizawa, Hiroshi; Ikegami, Kazunori; Takashima, Kazuo; Usami, Teruo [Mitsubishi Electric Corp., Tokyo (Japan); Yamamoto, Takayoshi

    1996-07-01

    In order to improve the efficiency of the full energy peak in the high energy regions, we had previously suggested a multi-layered structure of CdTe elements and have since confirmed the sensitivity improvement of the full energy peak. And furthermore, we have suggested a new type structure of multi-layered elements in this paper and we confirmed that the efficiency of the full energy peak became higher and that more proper energy spectra were obtained by our current experiment than by the detector with the conventional structure. This paper describes a simulation and experiment to improve the efficiency of the full energy peak and to obtain the more proper energy spectra of {sup 137}Cs (662keV) and {sup 60}Co (1.17 and 1.33MeV) using the new structure of CdTe detector. (J.P.N.)

  17. High Sequence Variations in Mitochondrial DNA Control Region among Worldwide Populations of Flathead Mullet Mugil cephalus

    Directory of Open Access Journals (Sweden)

    Brian Wade Jamandre

    2014-01-01

    Full Text Available The sequence and structure of the complete mtDNA control region (CR of M. cephalus from African, Pacific, and Atlantic populations are presented in this study to assess its usefulness in phylogeographic studies of this species. The mtDNA CR sequence variations among M. cephalus populations largely exceeded intraspecific polymorphisms that are generally observed in other vertebrates. The length of CR sequence varied among M. cephalus populations due to the presence of indels and variable number of tandem repeats at the 3′ hypervariable domain. The high evolutionary rate of the CR in this species probably originated from these mutations. However, no excessive homoplasic mutations were noticed. Finally, the star shaped tree inferred from the CR polymorphism stresses a rapid radiation worldwide, in this species. The CR still appears as a good marker for phylogeographic investigations and additional worldwide samples are warranted to further investigate the genetic structure and evolution in M. cephalus.

  18. Sensitivity Analysis of Expected Wind Extremes over the Northwestern Sahara and High Atlas Region.

    Science.gov (United States)

    Garcia-Bustamante, E.; González-Rouco, F. J.; Navarro, J.

    2017-12-01

    A robust statistical framework in the scientific literature allows for the estimation of probabilities of occurrence of severe wind speeds and wind gusts, but does not prevent however from large uncertainties associated with the particular numerical estimates. An analysis of such uncertainties is thus required. A large portion of this uncertainty arises from the fact that historical observations are inherently shorter that the timescales of interest for the analysis of return periods. Additional uncertainties stem from the different choices of probability distributions and other aspects related to methodological issues or physical processes involved. The present study is focused on historical observations over the Ouarzazate Valley (Morocco) and in a high-resolution regional simulation of the wind in the area of interest. The aim is to provide extreme wind speed and wind gust return values and confidence ranges based on a systematic sampling of the uncertainty space for return periods up to 120 years.

  19. Establishment of extracorporeal circulation of artificial liver support system in high altitude region

    Directory of Open Access Journals (Sweden)

    Ming-sen ZHANG

    2011-01-01

    Full Text Available Objective To establish extracorporeal circulation in big animal suitable for the research on artificial liver support system in high altitude region.Methods Under the anesthesia of ketamine hydrochloride/diazepam IV,cannulation of common carotid artery/external jugular vein(n=3 and inferior vena cava via the left external jugular vein/right external jugular vein(n=3,was respectively performed on six healthy Chang-Bai piglets adapted to native environment(altitude 3700m.One day after that,the extracorporeal circulation was performed at a progressively elevated blood current velocity,and the general condition of the animals,blood pressure,HR,bleeding tendoncy of the experimental pigs and coagulation in the cannulae were observed.Results On the premise that the hemodynamics was not influenced,the highest blood current velocity was 133.33±28.87ml/min,the lowest heparin maintaining speed amounted to 138.67±12.22mg/h,and the bleeding tendency and blood coagulation in the cannula was significant in the group of common carotid artery/external jugular vein intubation.While the highest blood current velocity was 400ml/min,the lowest heparin maintaining speed was 26.67±9.24mg/h,no bleeding tendency or obvious cannular blood coagulation were observed in the group of cannulation of inferior vena cava via the left external jugular vein/right external jugular vein.These untoward results were significantly less or slight than that of the former group(P < 0.01.Conclusion It is suitable to perform research of artificial liver support system on piglets in high altitude region by establishing extracorporeal circulation by the way of inferior vena cava with cannulation passing through the left external jugular vein/right external jugular vein with the blood current velocity of 400ml/min.

  20. CHEMICAL EVOLUTION IN HIGH-MASS STAR-FORMING REGIONS: RESULTS FROM THE MALT90 SURVEY

    Energy Technology Data Exchange (ETDEWEB)

    Hoq, Sadia; Jackson, James M.; Foster, Jonathan B.; Sanhueza, Patricio; Claysmith, Christopher [Institute for Astrophysical Research, Boston University, Boston, MA 02215 (United States); Guzmán, Andrés [Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138 (United States); Whitaker, J. Scott [Physics Department, Boston University, Boston, MA 02215 (United States); Rathborne, Jill M. [Australia Telescope National Facility, CSIRO Astronomy and Space Science, Epping, NSW (Australia); Vasyunina, Tatiana; Vasyunin, Anton, E-mail: shoq@bu.edu, E-mail: jackson@bu.edu, E-mail: patricio@bu.edu, E-mail: claysmit@bu.edu, E-mail: jonathan.b.foster@yale.edu, E-mail: aguzmanf@cfa.harvard.edu, E-mail: scott@bu.edu, E-mail: rathborne@csiro.au, E-mail: tv3h@virginia.edu, E-mail: aiv3f@virginia.edu [Department of Chemistry, University of Virginia, Charlottesville, VA 22904 (United States)

    2013-11-10

    The chemical changes of high-mass star-forming regions provide a potential method for classifying their evolutionary stages and, ultimately, ages. In this study, we search for correlations between molecular abundances and the evolutionary stages of dense molecular clumps associated with high-mass star formation. We use the molecular line maps from Year 1 of the Millimetre Astronomy Legacy Team 90 GHz (MALT90) Survey. The survey mapped several hundred individual star-forming clumps chosen from the ATLASGAL survey to span the complete range of evolution, from prestellar to protostellar to H II regions. The evolutionary stage of each clump is classified using the Spitzer GLIMPSE/MIPSGAL mid-IR surveys. Where possible, we determine the dust temperatures and H{sub 2} column densities for each clump from Herschel/Hi-GAL continuum data. From MALT90 data, we measure the integrated intensities of the N{sub 2}H{sup +}, HCO{sup +}, HCN and HNC (1-0) lines, and derive the column densities and abundances of N{sub 2}H{sup +} and HCO{sup +}. The Herschel dust temperatures increase as a function of the IR-based Spitzer evolutionary classification scheme, with the youngest clumps being the coldest, which gives confidence that this classification method provides a reliable way to assign evolutionary stages to clumps. Both N{sub 2}H{sup +} and HCO{sup +} abundances increase as a function of evolutionary stage, whereas the N{sub 2}H{sup +} (1-0) to HCO{sup +} (1-0) integrated intensity ratios show no discernable trend. The HCN (1-0) to HNC(1-0) integrated intensity ratios show marginal evidence of an increase as the clumps evolve.

  1. Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2011-02-01

    Full Text Available Background: Highly active antiretroviral therapy (HAART can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia.Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale  (HIVASES, Beck Depression Inventory (BDI-II and Interpersonal Support Evaluation List (ISEL was adapted to assess self-efficacy, depression level and social support, respectively.Results: We found that 96% (n=53 of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply  forget’.Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia. (Med J Indones 2011; 20:50-5Keywords: adherence, depression, HAART, HIV, self-efficacy, social support

  2. Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida: A nonconcurrent prospective study.

    Science.gov (United States)

    Dahlin, Arielle A; Parsons, Chase C; Barengo, Noël C; Ruiz, Juan Gabriel; Ward-Peterson, Melissa; Zevallos, Juan Carlos

    2017-07-01

    Stroke remains one of the leading causes of death in the United States. Current evidence identified electrocardiographic abnormalities and cardiac arrhythmias in 50% of patients with an acute stroke. The purpose of this study was to assess whether the presence of ventricular arrhythmia (VA) in adult patients hospitalized in Florida with acute stroke increased the risk of in-hospital mortality.Secondary data analysis of 215,150 patients with ischemic and hemorrhagic stroke hospitalized in the state of Florida collected by the Florida Agency for Healthcare Administration from 2008 to 2012. The main outcome for this study was in-hospital mortality. The main exposure of this study was defined as the presence of VA. VA included the ICD-9 CM codes: paroxysmal ventricular tachycardia (427.1), ventricular fibrillation (427.41), ventricular flutter (427.42), ventricular fibrillation and flutter (427.4), and other - includes premature ventricular beats, contractions, or systoles (427.69). Differences in demographic and clinical characteristics and hospital outcomes were assessed between patients who developed versus did not develop VA during hospitalization (χ and t tests). Binary logistic regression was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals (CIs) between VA and in-hospital mortality.VA was associated with an increased risk of in-hospital mortality after adjusting for all covariates (odds ratio [OR]: 1.75; 95% CI: 1.6-1.2). There was an increased in-hospital mortality in women compared to men (OR: 1.1; 95% CI: 1.1-1.14), age greater than 85 years (OR: 3.9, 95% CI: 3.5-4.3), African Americans compared to Whites (OR: 1.1; 95% CI: 1.04-1.2), diagnosis of congestive heart failure (OR: 2.1; 95% CI: 2.0-2.3), and atrial arrhythmias (OR: 2.1, 95% CI: 2.0-2.2). Patients with hemorrhagic stroke had increased odds of in-hospital mortality (OR: 9.0; 95% CI: 8.6-9.4) compared to ischemic stroke.Identifying VAs in stroke patients may help in

  3. Crack Growth Behavior in the Threshold Region for High Cycle Fatigue Loading

    Science.gov (United States)

    Forman, R. G.; Zanganeh, M.

    2014-01-01

    This paper describes the results of a research program conducted to improve the understanding of fatigue crack growth rate behavior in the threshold growth rate region and to answer a question on the validity of threshold region test data. The validity question relates to the view held by some experimentalists that using the ASTM load shedding test method does not produce valid threshold test results and material properties. The question involves the fanning behavior observed in threshold region of da/dN plots for some materials in which the low R-ratio data fans out from the high R-ratio data. This fanning behavior or elevation of threshold values in the low R-ratio tests is generally assumed to be caused by an increase in crack closure in the low R-ratio tests. Also, the increase in crack closure is assumed by some experimentalists to result from using the ASTM load shedding test procedure. The belief is that this procedure induces load history effects which cause remote closure from plasticity and/or roughness changes in the surface morphology. However, experimental studies performed by the authors have shown that the increase in crack closure is a result of extensive crack tip bifurcations that can occur in some materials, particularly in aluminum alloys, when the crack tip cyclic yield zone size becomes less than the grain size of the alloy. This behavior is related to the high stacking fault energy (SFE) property of aluminum alloys which results in easier slip characteristics. Therefore, the fanning behavior which occurs in aluminum alloys is a function of intrinsic dislocation property of the alloy, and therefore, the fanned data does represent the true threshold properties of the material. However, for the corrosion sensitive steel alloys tested in laboratory air, the occurrence of fanning results from fretting corrosion at the crack tips, and these results should not be considered to be representative of valid threshold properties because the fanning is

  4. High-dose regions versus likelihood of cure after prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Merrick, Gregory; Sutlief, Steven; True, Laurence; Butler, Wayne

    2005-01-01

    Purpose: To analyze the effect of high-dose regions on biochemical cancer control rates after prostate brachytherapy. Methods and Materials: Patients with 1997 American Joint Committee on Cancer clinical Stage T1c-T2a prostate carcinoma (Gleason grade 5-6, prostate-specific antigen level 4-10 ng/mL) were randomized to implantation with 125 I (144 Gy) vs. 103 Pd (125 Gy, National Institute of Standards and Technology 1999). Isotope implantation was performed by standard techniques, using a modified peripheral loading pattern. Of the 313 patients entered in the protocol, 270 were included in this analysis. The 125 I source strength ranged from 0.4 to 0.89 mCi (median, 0.55 mCi), and the 103 Pd source strength ranged from 1.3 to 1.6 mCi (median, 1.5 mCi). CT was performed within 4 h after implantation. The dosimetric parameters analyzed included the percentage of the postimplant prostate volume covered by the 100%, 150%, 200%, and 300% prescription dose (V 100 , V 150 , V 200 , and V 300 , respectively). The median time to the last follow-up for patients without failure was 2.7 years. Freedom from biochemical failure was defined as a serum prostate-specific antigen level of ≤0.5 ng/mL at last follow-up. Patients were censored at last follow-up if their serum prostate-specific antigen level was still decreasing. Results: The mean V 100 , V 150 , V 200 , and V 300 value was 90% (±8%), 63% (±14), 35% (±13%), and 14% (±7%), respectively. Patients with a V 100 of ≥90% had a 3-year freedom from biochemical failure rate of 96% vs. 87% for those with a V 100 of 100 of ≥90% were analyzed, no relationship was found between higher dose regions and the likelihood of cancer control. This lack of effect on biochemical control was apparent for both isotopes. Conclusion: High-dose regions do not appear to affect cancer control rates, as long as >90% of the prostate volume is covered by the prescription dose

  5. Quadrupole moments of high spin states in the trans lead region

    International Nuclear Information System (INIS)

    Neyens, G.; Hardeman, F.; Nouwen, R.; S'heeren, G.; Van Den Bergh, M.; Cousement, R.

    1990-01-01

    The last few years, a lot of attention has been paid to the trans lead region. A reason for this has to be found in the fact that 208 Pb is a double magic core: both its proton and neutron shell are closed. This means that all nuclei in the lead region can be described well by the shell model, using a spherical 208 Pb core (spherical symmetric potential) and some valence particles or holes around it. The question is whether this model is also correct for high spin states. In this region, isomers with high angular momenta can only be created by alignment of all the spins of the valence particles and holes. And in some cases, alignment is not enough: core excitations are necessary to build up the large spin value of the isomeric state (e.g. the 63/2-isomer in 211 Rn. This means that a neutron pair from the closed N = 126 shell is broken up and one or both neutrons are excited to a level with higher energy and spin. The alignment of the valence-particle-spins causes an increase of the interactions between the valence particles (holes) on one hand, and between the valence particles (holes) and the hard core on the other hand. The latter interaction can cause a deformation of the core. The two interactions are taken into account in two different models: The SERI model (Spherical shell model with Empirical Residual Interactions) and the DIPM (Deformed Independent Particle Model). This paper reports that the effect of alignment of the spins of the valence particles in an isomeric state has been taken into account in the shell model by using residual interactions between the valence particles. These interactions are introduced in the theory in an empirical way or are calculated. Another model, the DIPM, takes into account the effect of alignment in a natural way: it starts from a deformed core (e.g. an axial symmetric potential) in which the valence particles are moving independently from each other)

  6. Integrated Studies of a Regional Ozone Pollution Synthetically Affected by Subtropical High and Typhoon System in the Yangtze River Delta Region, China

    Science.gov (United States)

    Xie, M.; Shu, L.

    2017-12-01

    Severe high ozone (O3) episodes usually have close relations to synoptic systems. A regional continuous O3 pollution episode was detected over the Yangtze River Delta (YRD) region in China during August 7-12, 2013, in which the O3 concentrations in more than half of the cities exceeded the national air quality standard. By means of the observational analysis and the WRF/CMAQ numerical simulation, the characteristics and the essential impact factors of the typical regional O3 pollution are investigated. The observational analysis shows that the atmospheric subsidence dominated by Western Pacific subtropical high plays a crucial role in the formation of high-level O3. In addition, when the YRD cities at the front of Typhoon Utor, the periphery circulation of typhoon system can enhance the downward airflows and cause more serious air pollution. But when the typhoon system weakens the subtropical high, the prevailing southeasterly surface wind leads to the mitigation of the O3 pollution. The Integrated Process Rate (IPR) analysis incorporated in CMAQ is applied to further illustrate the combined influence of subtropical high and typhoon system in this O3 episode. The results show that the vertical diffusion (VDIF) and the gas-phase chemistry (CHEM) are two major contributors to O3 formation. On August 10-11, the cities close to the sea are apparently affected by the typhoon system, with the contribution of VDIF increasing to 28.45 ppb/h in Shanghai and 19.76 ppb/h in Hangzhou. When the YRD region is under the control of the typhoon system, the contribution values of all individual processes decrease to a low level in all cities. These results provide an insight for the O3 pollution synthetically impacted by the Western Pacific subtropical high and the tropical cyclone system.

  7. National survey of crystalline rocks and recommendations of regions to be explored for high-level radioactive waste repository sites

    International Nuclear Information System (INIS)

    Smedes, H.W.

    1983-04-01

    A reconnaissance of the geological literature on large regions of exposed crystalline rocks in the United States provides the basis for evaluating if any of those regions warrant further exploration toward identifying potential sites for development of a high-level radioactive waste repository. The reconnaissance does not serve as a detailed evaluation of regions or of any smaller subunits within the regions. Site performance criteria were selected and applied insofar as a national data base exists, and guidelines were adopted that relate the data to those criteria. The criteria include consideration of size, vertical movements, faulting, earthquakes, seismically induced ground motion, Quaternary volcanic rocks, mineral deposits, high-temperature convective ground-water systems, hydraulic gradients, and erosion. Brief summaries of each major region of exposed crystalline rock, and national maps of relevant data provided the means for applying the guidelines and for recommending regions for further study. It is concluded that there is a reasonable likelihood that geologically suitable repository sites exist in each of the major regions of crystalline rocks. The recommendation is made that further studies first be conducted of the Lake Superior, Northern Appalachian and Adirondack, and the Southern Appalachian Regions. It is believed that those regions could be explored more effectively and suitable sites probably could be found, characterized, verified, and licensed more readily there than in the other regions

  8. National survey of crystalline rocks and recommendations of regions to be explored for high-level radioactive waste repository sites

    Energy Technology Data Exchange (ETDEWEB)

    Smedes, H.W.

    1983-04-01

    A reconnaissance of the geological literature on large regions of exposed crystalline rocks in the United States provides the basis for evaluating if any of those regions warrant further exploration toward identifying potential sites for development of a high-level radioactive waste repository. The reconnaissance does not serve as a detailed evaluation of regions or of any smaller subunits within the regions. Site performance criteria were selected and applied insofar as a national data base exists, and guidelines were adopted that relate the data to those criteria. The criteria include consideration of size, vertical movements, faulting, earthquakes, seismically induced ground motion, Quaternary volcanic rocks, mineral deposits, high-temperature convective ground-water systems, hydraulic gradients, and erosion. Brief summaries of each major region of exposed crystalline rock, and national maps of relevant data provided the means for applying the guidelines and for recommending regions for further study. It is concluded that there is a reasonable likelihood that geologically suitable repository sites exist in each of the major regions of crystalline rocks. The recommendation is made that further studies first be conducted of the Lake Superior, Northern Appalachian and Adirondack, and the Southern Appalachian Regions. It is believed that those regions could be explored more effectively and suitable sites probably could be found, characterized, verified, and licensed more readily there than in the other regions.

  9. Highly accurate potential calculations for cylindrically symmetric geometries using multi-region FDM: A review

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, David, E-mail: dej@kingcon.com [IJL Research Center, Newark, VT 05871 (United States)

    2011-07-21

    This paper is a review of multi-region FDM, a numerical technique for accurately determining electrostatic potentials in cylindrically symmetric geometries. Multi-region FDM can be thought of as the union of various individual elements: a single region FDM process: a method for algorithmic development; a method for auto creating a multi-region structure; the process for the relaxation of multi-region structures. Each element will be briefly described along with its integration into the multi-region relaxation process itself.

  10. Incidence and care of environmental dermatoses in the high-altitude region of Ladakh, India

    Directory of Open Access Journals (Sweden)

    G K Singh

    2013-01-01

    Full Text Available Background : Low humidity, high-velocity wind, excessive ultraviolet (UV exposure, and extreme cold temperature are the main causes of various types of environmental dermatoses in high altitudes. Materials and Methods: A retrospective study was carried out in patients visiting the lone dermatology department in Ladakh between July 2009 and June 2010. The aim was to identify the common environmental dermatoses in high altitudes so that they can be treated easily or prevented. The patients were divided into three demographic groups, namely, lowlanders, Ladakhis (native highlanders, and tourists. Data was analyzed in a tabulated fashion. Results: A total of 1,567 patients with skin ailments were seen, of whom 965 were lowlanders, 512 native Ladakhis, and 90 were tourists. The skin disorders due to UV rays, dry skin, and papular urticaria were common among all groups. The frequency of melasma ( n = 42; 49.4%, chronic actinic dermatitis (CAD ( n = 18; 81.81% of total CAD cases, and actinic cheilitis ( n = 3; 100% was much higher among the native Ladakhis. The frequency of cold-related injuries was much lesser among Ladakhis ( n = 1; 1.19% than lowlanders ( n = 70; 83.33% and tourists ( n = 13; 15.47% ( P < 0.05. Conclusion: Dryness of skin, tanning, acute or chronic sunburn, polymorphic light reaction, CAD, insect bite reactions, chilblain, and frostbite are common environmental dermatoses of high altitudes. Avoidance of frequent application of soap, application of adequate and suitable emollient, use of effective sunscreen, and wearing of protective clothing are important guidelines for skin care in this region.

  11. Human Papillomavirus Cervical Infection and Associated Risk Factors in a Region of Argentina With a High Incidence of Cervical Carcinoma

    Directory of Open Access Journals (Sweden)

    S. A. Tonon

    1999-01-01

    Full Text Available Objective: To assess the prevalence and potential risk factors associated with human papillomavirus (HPV cervical infection among women residing in a region of northeastern Argentina with a high incidence of cervical cancer.

  12. Analysis of bubble pressure in the rim region of high burnup PWR fuel

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Yang Hyun; Lee, Byung Ho; Sohn, Dong Seong [Korea Atomic Energy Research Institute, Taejeon (Korea)

    2000-02-01

    Bubble pressure in the rim region of high burnup PWR UO{sub 2} fuel has been modeled based on measured rim width, porosity and bubble density. Using the assumption that excessive bubble pressure in the rim is inversely proportional to its radius, proportionality constant is derived as a function of average pellet burnup and bubble radius. This approach is possible because the integration of the number of Xe atoms retained in the rim bubbles, which can be calculated as a function of bubble radius, over the bubble radius gives the total number of Xe atoms in the rim bubbles. Here the total number of Xe atoms in the rim bubbles can be derived from the measured Xe depletion fraction in the matrix and the calculated rim thickness. Then the rim bubble pressure is obtained as a function of fuel burnup and bubble size from the proportionality constant. Therefore, the present model can provide some useful information that would be required to analyze the behavior of high burnup PWR UO{sub 2} fuel under both normal and transient operating conditions. 28 refs., 9 figs. (Author)

  13. Mechanical versus kinematical shortening reconstructions of the Zagros High Folded Zone (Kurdistan region of Iraq)

    Science.gov (United States)

    Frehner, Marcel; Reif, Daniel; Grasemann, Bernhard

    2012-06-01

    This paper compares kinematical and mechanical techniques for the palinspastic reconstruction of folded cross sections in collision orogens. The studied area and the reconstructed NE-SW trending, 55.5 km long cross section is located in the High Folded Zone of the Zagros fold-and-thrust belt in the Kurdistan region of Iraq. The present-day geometry of the cross section has been constructed from field as well as remote sensing data. In a first step, the structures and the stratigraphy are simplified and summarized in eight units trying to identify the main geometric and mechanical parameters. In a second step, the shortening is kinematically estimated using the dip domain method to 11%-15%. Then the same cross section is used in a numerical finite element model to perform dynamical unfolding simulations taking various rheological parameters into account. The main factor allowing for an efficient dynamic unfolding is the presence of interfacial slip conditions between the mechanically strong units. Other factors, such as Newtonian versus power law viscous rheology or the presence of a basement, affect the numerical simulations much less strongly. If interfacial slip is accounted for, fold amplitudes are reduced efficiently during the dynamical unfolding simulations, while welded layer interfaces lead to unrealistic shortening estimates. It is suggested that interfacial slip and decoupling of the deformation along detachment horizons is an important mechanical parameter that controlled the folding processes in the Zagros High Folded Zone.

  14. Evaluation of machine learning algorithms for prediction of regions of high Reynolds averaged Navier Stokes uncertainty

    Science.gov (United States)

    Ling, J.; Templeton, J.

    2015-08-01

    Reynolds Averaged Navier Stokes (RANS) models are widely used in industry to predict fluid flows, despite their acknowledged deficiencies. Not only do RANS models often produce inaccurate flow predictions, but there are very limited diagnostics available to assess RANS accuracy for a given flow configuration. If experimental or higher fidelity simulation results are not available for RANS validation, there is no reliable method to evaluate RANS accuracy. This paper explores the potential of utilizing machine learning algorithms to identify regions of high RANS uncertainty. Three different machine learning algorithms were evaluated: support vector machines, Adaboost decision trees, and random forests. The algorithms were trained on a database of canonical flow configurations for which validated direct numerical simulation or large eddy simulation results were available, and were used to classify RANS results on a point-by-point basis as having either high or low uncertainty, based on the breakdown of specific RANS modeling assumptions. Classifiers were developed for three different basic RANS eddy viscosity model assumptions: the isotropy of the eddy viscosity, the linearity of the Boussinesq hypothesis, and the non-negativity of the eddy viscosity. It is shown that these classifiers are able to generalize to flows substantially different from those on which they were trained. Feature selection techniques, model evaluation, and extrapolation detection are discussed in the context of turbulence modeling applications.

  15. [High blood pressure and obesity in indigenous Ashaninkas of Junin region, Peru].

    Science.gov (United States)

    Romero, Candice; Zavaleta, Carol; Cabrera, Lilia; Gilman, Robert H; Miranda, J Jaime

    2014-01-01

    In order to determine the prevalence of high blood pressure and obesity in indigenous Ashaninkas, with limited contact with Western culture, a cross-sectional study was conducted in 2008 in five Ashaninka communities of the Junin region in the jungle of Peru. Individuals aged 35 or older were included. 76 subjects were evaluated (average age 47.4 years old, 52.6 % women) corresponding to 43.2% of the eligible population. The prevalence of hypertension was 14.5% (CI 95%: 6.4-22.6) and the prevalence of obesity, according to body mass index, was 4% (CI 95%: 0-8.4). No differences were observed in gender or in blood pressure levels by age group. Compared with previous studies in non-indigenous people of the Peruvian jungle, the prevalence of high blood pressure was higher while the prevalence of obesity was lower. Our findings are a call to be aware of the situation of chronic non-communicable diseases in indigenous populations in the Peruvian Amazon.

  16. NMDA receptor antagonist-enhanced high frequency oscillations: are they generated broadly or regionally specific?

    Science.gov (United States)

    Olszewski, Maciej; Dolowa, Wioleta; Matulewicz, Pawel; Kasicki, Stefan; Hunt, Mark J

    2013-12-01

    Systemic administration of NMDA receptor antagonists, used to model schizophrenia, increase the power of high-frequency oscillations (130-180Hz, HFO) in a variety of neuroanatomical and functionally distinct brain regions. However, it is unclear whether HFO are independently and locally generated or instead spread from a distant source. To address this issue, we used local infusion of tetrodotoxin (TTX) to distinct brain areas to determine how accurately HFO recorded after injection of NMDAR antagonists reflect the activity actually generated at the electrode tip. Changes in power were evaluated in local field potentials (LFPs) recorded from the nucleus accumbens (NAc), prefrontal cortex and caudate and in electrocorticograms (ECoGs) from visual and frontal areas. HFO recorded in frontal and visual cortices (ECoGs) or in the prefrontal cortex, caudate (LFPs) co-varied in power and frequency with observed changes in the NAc. TTX infusion to the NAc immediately and profoundly reduced the power of accumbal HFO which correlated with changes in HFO recorded in distant cortical sites. In contrast, TTX infusion to the prefrontal cortex did not change HFO power recorded locally, although gamma power was reduced. A very similar result was found after TTX infusion to the caudate. These findings raise the possibility that the NAc is an important neural generator. Our data also support existing studies challenging the idea that high frequencies recorded in LFPs are necessarily generated at the recording site. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

  17. High HPV vaccination uptake rates for adolescent girls after regional governmental funding in Shiki City, Japan.

    Science.gov (United States)

    Hayashi, Y; Shimizu, Y; Netsu, S; Hanley, S; Konno, R

    2012-08-10

    In Japan, the bivalent HPV vaccine was approved in October, 2009 and became available as a non-routine vaccine from December, 2009. While routine vaccinations are free, the cost and responsibility for non-routine vaccinations are left to the individual. In exceptional circumstances regional governments fund non-routine vaccinations. This was the case in Shiki City, Saitama Prefecture, where a high uptake rate for individual (non-school based) HPV vaccination was obtained. On January 20, 2010, the mayor of Shiki City announced to the media his decision to vaccinate adolescent girls in Shiki City against HPV. A project team for HPV vaccination was set up in the city's Health Promotion Center. To gain mutual consent for HPV vaccination, senior health professionals, city officials, the head of the board of education, school principals and health-care teachers met several times. The cohort to be vaccinated was 1254 girls aged 12-15 years. Individual notifications were mailed to each girl on April 23, 2010, along with information about the HPV vaccine. As of April 10th, 2011, the uptake rate for girls aged 15 years old was 90.7% for the 1st dose. The vaccine registry is managed by the health care system of the city. The success of the HPV vaccination program and high uptake rates in Shiki City is a good model for the nationwide HPV vaccination program that started in February, 2011. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. GPS scintillations and total electron content climatology in the southern low, middle and high latitude regions

    Directory of Open Access Journals (Sweden)

    Luca Spogli

    2013-06-01

    Full Text Available In recent years, several groups have installed high-frequency sampling receivers in the southern middle and high latitude regions, to monitor ionospheric scintillations and the total electron content (TEC changes. Taking advantage of the archive of continuous and systematic observations of the ionosphere on L-band by means of signals from the Global Positioning System (GPS, we present the first attempt at ionospheric scintillation and TEC mapping from Latin America to Antarctica. The climatology of the area considered is derived through Ground-Based Scintillation Climatology, a method that can identify ionospheric sectors in which scintillations are more likely to occur. This study also introduces the novel ionospheric scintillation 'hot-spot' analysis. This analysis first identifies the crucial areas of the ionosphere in terms of enhanced probability of scintillation occurrence, and then it studies the seasonal variation of the main scintillation and TEC-related parameters. The results produced by this sophisticated analysis give significant indications of the spatial/ temporal recurrences of plasma irregularities, which contributes to the extending of current knowledge of the mechanisms that cause scintillations, and consequently to the development of efficient tools to forecast space-weather-related ionospheric events.

  19. Monazite behaviours during high-temperature metamorphism: a case study from Dinggye region, Tibetan Himalaya

    Science.gov (United States)

    Wang, Jia-Min; Wu, Fu-Yuan; Rubatto, Daniela; Liu, Shi-Ran; Zhang, Jin-Jiang

    2017-04-01

    Monazite is a key accessory mineral for metamorphic geochronology, but its growth mechanisms during melt-bearing high-temperature metamorphism is not well understood. Therefore, the petrology, pressure-temperature and timing of metamorphism have been investigated in pelitic and psammitic granulites from the Greater Himalayan Crystalline Complex (GHC) in Dinggye, southern Tibet. These rocks underwent an isothermal decompression process from pressure conditions of >10 kbar to armour effect of matrix crystals (biotite and quartz). Most monazite grains formed at the M3-stage (21-19 Ma) through either dissolution-reprecipitation or recrystallization that was related to biotite dehydration melting reaction. These monazite grains record HREE and Y signatures in local equilibrium with different reactions involving either garnet breakdown or peritectic garnet growth. Another peak of monazite growth occurs during melt crystallization ( 15 Ma), and these monazites are unzoned and have homogeneous compositions. Our results documented the widespread recrystallization to account for monazite growth during high-temperature metamorphism and related melting reactions that trigger monazite recrystallization. In a regional sense, our P-T-t data along with published data indicate that the pre-M1 eclogite-facies metamorphism occurred at 39-30 Ma in the Dinggye Himalaya. Our results are in favour of a steady exhumation of the GHC rocks since Oligocene that was contributed by partial melting. Key words: U-Th-Pb geochronology, Monazite, Recrystallization, Pelitic granulite, Himalaya

  20. Integrated studies of a regional ozone pollution synthetically affected by subtropical high and typhoon system in the Yangtze River Delta region, China

    Directory of Open Access Journals (Sweden)

    L. Shu

    2016-12-01

    Full Text Available Severe high ozone (O3 episodes usually have close relations to synoptic systems. A regional continuous O3 pollution episode was detected over the Yangtze River Delta (YRD region in China during 7–12 August 2013, in which the O3 concentrations in more than half of the cities exceeded the national air quality standard. The maximum hourly concentration of O3 reached 167.1 ppb. By means of the observational analysis and the numerical simulation, the characteristics and the essential impact factors of the typical regional O3 pollution are comprehensively investigated. The observational analysis shows that the atmospheric subsidence dominated by the western Pacific subtropical high plays a crucial role in the formation of high-level O3. The favorable weather conditions, such as extremely high temperature, low relative humidity and weak wind speed, caused by the abnormally strong subtropical high are responsible for the trapping and the chemical production of O3 in the boundary layer. In addition, when the YRD cities are at the front of Typhoon Utor, the periphery circulation of typhoon system can enhance the downward airflows and cause worse air quality. However, when the typhoon system weakens the subtropical high, the prevailing southeasterly surface wind leads to the mitigation of the O3 pollution. The integrated process rate (IPR analysis incorporated in the Community Multi-scale Air Quality (CMAQ model is applied to further illustrate the combined influence of subtropical high and typhoon system in this O3 episode. The results show that the vertical diffusion (VDIF and the gas-phase chemistry (CHEM are two major contributors to O3 formation. During the episode, the contributions of VDIF and CHEM to O3 maintain the high values over the YRD region. On 10–12 August, the cities close to the sea are apparently affected by the typhoon system, with the contribution of VDIF increasing to 28.45 ppb h−1 in Shanghai and 19.76 ppb h−1 in

  1. The Success Rate of Pediatric In-Hospital Cardiopulmonary Resuscitation in Ahvaz Training Hospitals

    Directory of Open Access Journals (Sweden)

    Shideh Assar

    2016-01-01

    Full Text Available Research Objective. This study determined the outcome of cardiopulmonary resuscitation (CPR after in-hospital cardiac arrest and factors influencing it in two training hospitals in Ahvaz. Method. Patients hospitalized in the pediatric wards and exposed to CPR during hospital stay were included in the study (September 2013 to May 2014. The primary outcome of CPR was assumed to be the return of spontaneous circulation (ROSC and the secondary outcome was assumed to be survival to discharge. The neurological outcome of survivors was assessed using the Pediatric Cerebral Performance Category (PCPC method. Results. Of the 279 study participants, 138 patients (49.4% showed ROSC, 81 patients (29% survived for 24 hours after the CPR, and 33 patients (11.8% survived to discharge. Of the surviving patients, 16 (48.5% had favorable neurological outcome. The resuscitation during holidays resulted in fewer ROSC. Multivariate analysis showed that longer CPR duration, CPR by junior residents, growth deficiency, and prearrest vasoactive drug infusion were associated with decreased survival to discharge (p<0.05. Infants and patients with respiratory disease had higher survival rates. Conclusion. The rate of successful CPR in our study was lower than rates reported by developed countries. However, factors influencing the outcome of CPR were similar. These results reflect the necessity of paying more attention to pediatric CPR training, postresuscitation conditions, and expansion of intensive care facilities.

  2. A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions.

    Science.gov (United States)

    Fabbian, Fabio; De Giorgi, Alfredo; Maietti, Elisa; Gallerani, Massimo; Pala, Marco; Cappadona, Rosaria; Manfredini, Roberto; Fedeli, Ugo

    2017-05-01

    In-hospital mortality (IHM) is an indicator of the quality of care provided. The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson Comorbidity indexes. Our aim was to obtain new measures based on internal medicine ICD codes for the original EI, to detect risk for IHM. This single-center retrospective study included hospital admissions for any cause in the department of internal medicine between January 1, 2000, and December 31, 2013, recorded in the hospital database. The EI was calculated for evaluation of comorbidity, then we added age, gender and diagnosis of ischemic heart disease. IHM was our outcome. Only predictors positively associated with IHM were taken into consideration and the Sullivan's method was applied in order to modify the parameter estimates of the regression model into an index. We analyzed 75,586 admissions (53.4% females) and mean age was 72.7±16.3years. IHM was 7.9% and mean score was 12.1±7.6. The points assigned to each condition ranged from 0 to 16, and the possible range of the score varied between 0 and 89. In our population the score ranged from 0 to 54, and it was higher in the deceased group. Receiver operating characteristic curve of the new score was 0.721 (95% CI 0.714-0.727, pInternal Medicine. Published by Elsevier B.V. All rights reserved.

  3. In-hospital Breastfeeding and Intention to Return to Work Influence Mothers' Breastfeeding Intentions.

    Science.gov (United States)

    Thomas-Jackson, Shera C; Bentley, Gail E; Keyton, Kristina; Reifman, Alan; Boylan, Mallory; Hart, Sybil L

    2016-11-01

    Research continues to demonstrate that formula feeding is associated with numerous long-term negative outcomes for a mother and her infant. However, many women cease breastfeeding sooner than intended and recommended. Breastfeeding has been found to be related to demographics, maternal mood, and returning to work outside the home. This study aimed to shed light on the woman's perception of the effect of working on intended breastfeeding duration. This study used intentions to return to work and in-hospital breastfeeding to predict breastfeeding intentions. Women (N = 160) were surveyed during the first 48 hours postdelivery of healthy, full-term infants. Survey instruments included demographics (socioeconomic status, maternal age, education, and marital status), depression, fetal attachment, current exclusive breastfeeding status, as well as breastfeeding and return-to-work intentions for the next year. A path analysis was used to explore relationships and predictors of breastfeeding intentions. The model had a good fit and breastfeeding intentions were predicted by exclusive breastfeeding in the hospital (β = 0.21, P work (β = -0.18, P work influence how long a mother intends to breastfeed. Attention to these areas can be provided immediately postpartum to support exclusive breastfeeding and provide informational support on continuing to breastfeed/express milk upon return to work if the mother intends to return to work.

  4. Improving treatment times for patients with in-hospital stroke using a standardized protocol.

    Science.gov (United States)

    Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun-Ichi; Nagata, Izumi

    2017-10-15

    Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016). Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, pvs. 26.5min, pvs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Transition from in-hospital ventilation to home ventilation: process description and quality indicators

    Directory of Open Access Journals (Sweden)

    Kastrup, Marc

    2017-12-01

    Full Text Available The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process.This project describes an ideal sequence of processes (process chain, based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment.The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions.

  6. Evaluation of the in-hospital hemovigilance by introduction of the information technology-based system.

    Science.gov (United States)

    Fujihara, Harumi; Yamada, Chiaki; Furumaki, Hiroaki; Nagai, Seiya; Shibata, Hiroki; Ishizuka, Keiko; Watanabe, Hiroko; Kaneko, Makoto; Adachi, Miwa; Takeshita, Akihiro

    2015-12-01

    Hemovigilance is an important aspect of transfusion medicine. However, the frequency of the adverse reactions often varies using different reporters. Recently, we have employed a new information technology (IT)-based in-hospital hemovigilance system. Here, we evaluated changes in practice after implementation of an IT-based reporting system. We compared the rate of frequency and details of blood transfusion-related adverse reactions 3 years before and after introduction of the IT-based reporting system. Contents and severity of the adverse reactions were reported in a paper-based reporting system, but input by selecting items in an IT-based reporting system. The details of adverse reactions are immediately sent to the blood transfusion unit online. After we introduced the IT-based reporting system, the reported rate of transfusion-related adverse reactions increased approximately 10-fold from 0.20% to 2.18% (p introduction of an IT-based reporting system. © 2015 AABB.

  7. Predictors of In-Hospital Mortality for Stroke in Douala, Cameroon

    Directory of Open Access Journals (Sweden)

    N. Y. Mapoure

    2014-01-01

    Full Text Available Background. The objective of this study was to describe complications in hospitalized patients for stroke and to determine the predictive factors of intrahospital mortality from stroke at the Douala General Hospital (DGH in Cameroon. Patients and Methods. A prospective cross-sectional study was carried out from January 1, 2010 to December 31, 2012, at the DGH. All the patients who were aged more than 15 years with established diagnosis of stroke were included. A univariate analysis was done to look for factors associated with the risk of death, whilst the predictive factors of death were determined in a multivariate analysis following Cox regression model. Results. Of the 325 patients included patients, 68.1% were males and the mean age was 58.66 ± 13.6 years. Ischaemic stroke accounted for 52% of the cases. Sepsis was the leading complications present in 99 (30.12% cases. Independent predicting factors of in-hospital mortality were Glasgow Coma Scale lower than 8 (HR = 2.17 95% CI 4.86–36.8; P=0.0001, hyperglycaemia at admission (HR = 3.61 95% CI 1.38–9.44; P=0.009, and hemorrhagic stroke (HR = 5.65 95% CI 1.77–18; P=0.003. Conclusion. The clinician should systematically diagnose and treat infectious states and hyperglycaemia in stroke.

  8. Thermal-hydraulic Analysis of High-temperature Cover Gas Region in STELLA-2

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Youngchul; Son, Seok-Kwon; Yoon, Jung; Eoh, Jaehyuk; Jeong, Ji-Young [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2016-10-15

    The first phase of the program was focused on the key sodium component tests, and the second one has been concentrated on the sodium thermal-hydraulic integral effect test (STELLA-2). Based on its platform, simulation of the PGSFR transient will be made to evaluate plant dynamic behaviors as well as to demonstrate decay heat removal performance. Therefore, most design features of PGSFR have been modeled in STELLA-2 as closely as possible. The similarities of temperature and pressure between the model (STELLA-2) and the prototype (PGSFR) have been well preserved to reflect thermal-hydraulic behavior with natural convection as well as heat transfer between structure and sodium coolant inside the model reactor vessel (RV). For this reason, structural integrity of the entire test section should be confirmed as in the prototype. In particular, since the model reactor head in STELLA-2 supports key components and internal structures, its structural integrity exposed to high-temperature cover gas region should be confirmed. In order to reduce thermal radiation heat transfer from the hot sodium pool during normal operation, a dedicated insulation layer has been installed at the downward surface of the model reactor head to prevent direct heat flux from the sodium free surface at 545 .deg. C. Three-dimensional conjugate heat transfer analyses for the full-shape geometry of the upper part of the model reactor vessel in STELLA-2 have been carried out. Based on the results, steady-state temperature distributions in the cover gas region and the model reactor head itself have been obtained and the design requirement in temperature of the model reactor head has been newly proposed to be 350 .deg. C. For any elevated temperature conditions in STELLA-2, it was confirmed that the model reactor head generally satisfied the requirement. The CFD database constructed from this study will be used to optimize geometric parameters such as thicknesses and/or types of the insulator.

  9. HIGH-VELOCITY LINE FORMING REGIONS IN THE TYPE Ia SUPERNOVA 2009ig

    International Nuclear Information System (INIS)

    Marion, G. H.; Foley, Ryan J.; Challis, Peter; Kirshner, Robert P.; Vinko, Jozsef; Wheeler, J. Craig; Silverman, Jeffrey M.; Hsiao, Eric Y.; Brown, Peter J.; Filippenko, Alexei V.; Garnavich, Peter; Landsman, Wayne B.; Parrent, Jerod T.; Pritchard, Tyler A.; Roming, Peter W. A.; Wang, Xiaofeng

    2013-01-01

    We report measurements and analysis of high-velocity (HVF) (>20,000 km s –1 ) and photospheric absorption features in a series of spectra of the Type Ia supernova (SN) 2009ig obtained between –14 days and +13 days with respect to the time of maximum B-band luminosity (B-max). We identify lines of Si II, Si III, S II, Ca II, and Fe II that produce both HVF and photospheric-velocity (PVF) absorption features. SN 2009ig is unusual for the large number of lines with detectable HVF in the spectra, but the light-curve parameters correspond to a slightly overluminous but unexceptional SN Ia (M B = –19.46 mag and Δm 15 (B) = 0.90 mag). Similarly, the Si II λ6355 velocity at the time of B-max is greater than 'normal' for an SN Ia, but it is not extreme (v Si = 13,400 km s –1 ). The –14 days and –13 days spectra clearly resolve HVF from Si II λ6355 as separate absorptions from a detached line forming region. At these very early phases, detached HVF are prevalent in all lines. From –12 days to –6 days, HVF and PVF are detected simultaneously, and the two line forming regions maintain a constant separation of about 8000 km s –1 . After –6 days all absorption features are PVF. The observations of SN 2009ig provide a complete picture of the transition from HVF to PVF. Most SNe Ia show evidence for HVF from multiple lines in spectra obtained before –10 days, and we compare the spectra of SN 2009ig to observations of other SNe. We show that each of the unusual line profiles for Si II λ6355 found in early-time spectra of SNe Ia correlate to a specific phase in a common development sequence from HVF to PVF

  10. Ethnophytotherapeutical research in the high Molise region (Central-Southern Italy

    Directory of Open Access Journals (Sweden)

    Lucchese Fernando

    2008-03-01

    Full Text Available Abstract Background In the years 2003–2005 research was carried out concerning ethno-medicine in the high Molise (central- southern Italy, a region that has been the object of very little investigation from the ethnobotanical point of view. Upper Molise is a continuation of the mountain profiles of the Abruzzi Appenines: a series of hills, steep slopes and deep fluvial valleys making communications difficult. Primordial traditions (e.g. harvest feasts are typical of the region. Methods Field data were collected through open interviews in the field. These were conducted on both an individual and group level, fresh plants gathered from surrounding areas being displayed. In other cases, individual interviews were conducted by accompanying the person involved to the places where they perform their activities (for example, in the woods with woodcutters, kitchen gardens and fields with housewives, pastures with shepherds, etc.. In total 54 individuals were interviewed. Results Data of 70 taxa belonging to 39 families were gathered. Among the species, 64 are used in human therapy, 5 as insect repellents, 11 in veterinary medicine, 1 to keep eggs and cheeses and 4 for magic purposes. The most important findings in ethno-medicine relate to the lichen Lobaria pulmonaria (L. Hoffm. (wounds and to some vascular plant species: Asplenium trichomanes L. and Ceterach officinarum Willd. (to regularize menstruation, Cyclamen hederifolium (chilblains, Centaurium erythraea Rafn. and Pulmonaria apennina Cristof. & Puppi (bruises, while in the ethno-veterinary field, we have Valeriana officinalis L. (wounds sustained by mules. Also worthy of note, given the isolation of the area, is the number of plants used to protect foodstuffs from parasites, among which Allium sativum L. and Capsicum frutescens L. Conclusion The research revealed a deep-rooted and widespread habit of husbanding the family's resources. Whilst isolation and snowfalls contributed to the widespread

  11. High-resolution aeromagnetic survey of the Mono Basin-Long Valley Caldera region, California

    Science.gov (United States)

    Ponce, D. A.; Mangan, M.; McPhee, D.

    2013-12-01

    A new high-resolution aeromagnetic survey of the Mono Basin-Long Valley Caldera region greatly enhances previous magnetic interpretations that were based on older, low-resolution, and regional aeromagnetic data sets and provides new insights into volcano-tectonic processes. The surveyed area covers a 8,750 km2 NNW-trending swath situated between the Sierra Nevada to the west and the Basin and Range Province to the east. The surveyed area includes the volcanic centers of Mono Lake, Mono-Inyo Craters, Mammoth Mountain, Devils Postpile, and Long Valley Caldera. The NW-trending eastern Sierra frontal fault zone crosses through the study area, including the active Mono Lake, Silver Lake, Hartley Springs, Laurel Creek, and Hilton Creek faults. Over 6,000 line-kilometers of aeromagnetic data were collected at a constant terrain clearance of 150 m, a flight-line spacing of 400 m, and a tie-line spacing of 4 km. Data were collected via helicopter with an attached stinger housing a magnetic sensor using a Scintrex CS-3 cesium magnetometer. In the northern part of the survey area, data improve the magnetic resolution of the individual domes and coulees along Mono Craters and a circular shaped magnetic anomaly that coincides with a poorly defined ring fracture mapped by Kistler (1966). Here, aeromagnetic data combined with other geophysical data suggests that Mono Craters may have preferentially followed a pre-existing plutonic basement feature that may have controlled the sickle shape of the volcanic chain. In the northeastern part of the survey, aeromagnetic data reveal a linear magnetic anomaly that correlates with and extends a mapped fault. In the southern part of the survey, in the Sierra Nevada block just south of Long Valley Caldera, aeromagnetic anomalies correlate with NNW-trending Sierran frontal faults rather than to linear NNE-trends observed in recent seismicity over the last 30 years. These data provide an important framework for the further analysis of the

  12. Air-sea exchange over Black Sea estimated from high resolution regional climate simulations

    Science.gov (United States)

    Velea, Liliana; Bojariu, Roxana; Cica, Roxana

    2013-04-01

    Black Sea is an important influencing factor for the climate of bordering countries, showing cyclogenetic activity (Trigo et al, 1999) and influencing Mediterranean cyclones passing over. As for other seas, standard observations of the atmosphere are limited in time and space and available observation-based estimations of air-sea exchange terms present quite large ranges of uncertainty. The reanalysis datasets (e.g. ERA produced by ECMWF) provide promising validation estimates of climatic characteristics against the ones in available climatic data (Schrum et al, 2001), while cannot reproduce some local features due to relatively coarse horizontal resolution. Detailed and realistic information on smaller-scale processes are foreseen to be provided by regional climate models, due to continuous improvements of physical parameterizations and numerical solutions and thus affording simulations at high spatial resolution. The aim of the study is to assess the potential of three regional climate models in reproducing known climatological characteristics of air-sea exchange over Black Sea, as well as to explore the added value of the model compared to the input (reanalysis) data. We employ results of long-term (1961-2000) simulations performed within ENSEMBLE project (http://ensemblesrt3.dmi.dk/) using models ETHZ-CLM, CNRM-ALADIN, METO-HadCM, for which the integration domain covers the whole area of interest. The analysis is performed for the entire basin for several variables entering the heat and water budget terms and available as direct output from the models, at seasonal and annual scale. A comparison with independent data (ERA-INTERIM) and findings from other studies (e.g. Schrum et al, 2001) is also presented. References: Schrum, C., Staneva, J., Stanev, E. and Ozsoy, E., 2001: Air-sea exchange in the Black Sea estimated from atmospheric analysis for the period 1979-1993, J. Marine Systems, 31, 3-19 Trigo, I. F., T. D. Davies, and G. R. Bigg (1999): Objective

  13. Air pollution exposure, cause-specific deaths and hospitalizations in a highly polluted Italian region.

    Science.gov (United States)

    Carugno, Michele; Consonni, Dario; Randi, Giorgia; Catelan, Dolores; Grisotto, Laura; Bertazzi, Pier Alberto; Biggeri, Annibale; Baccini, Michela

    2016-05-01

    The Lombardy region in northern Italy ranks among the most air polluted areas of Europe. Previous studies showed air pollution short-term effects on all-cause mortality. We examine here the effects of particulate matter with aerodynamic diameter ≤10µm (PM10) and nitrogen dioxide (NO2) exposure on deaths and hospitalizations from specific causes, including cardiac, cerebrovascular and respiratory diseases. We considered air pollution, mortality and hospitalization data for a non-opportunistic sample of 18 highly polluted and most densely populated areas of the region in the years 2003-2006. We obtained area-specific effect estimates for PM10 and NO2 from a Poisson regression model on the daily number of total deaths or cause-specific hospitalizations and then combined them in a Bayesian random-effects meta-analysis. For cause-specific mortality, we applied a case-crossover analysis. Age- and season-specific analyses were also performed. Effect estimates were expressed as percent variation in mortality or hospitalizations associated with a 10µg/m(3) increase in PM10 or NO2 concentration. Natural mortality was positively associated with both pollutants (0.30%, 90% Credibility Interval [CrI]: -0.31; 0.78 for PM10; 0.70%, 90%CrI: 0.10; 1.27 for NO2). Cardiovascular deaths showed a higher percent variation in association with NO2 (1.12%, 90% Confidence Interval [CI]: 0.14; 2.11), while the percent variation for respiratory mortality was highest in association with PM10 (1.64%, 90%CI: 0.35; 2.93). The effect of both pollutants was more evident in the summer season. Air pollution was also associated to hospitalizations, the highest variations being 0.77% (90%CrI: 0.22; 1.43) for PM10 and respiratory diseases, and 1.70% (90%CrI: 0.39; 2.84) for NO2 and cerebrovascular diseases. The effect of PM10 on respiratory hospital admissions appeared to increase with age. For both pollutants, effects on cerebrovascular hospitalizations were more evident in subjects aged less than

  14. [Efficacy of noninvasive ventilation on in-hospital mortality in patients with acute cardiogenic pulmonary edema: a meta-analysis].

    Science.gov (United States)

    Sun, Tongwen; Wan, Youdong; Kan, Quancheng; Yang, Fei; Yao, Haimu; Guan, Fangxia; Zhang, Jinying; Li, Ling

    2014-02-01

    To evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema (ACPE) . We searched PubMed, Embase, Wanfang, CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE, which were reported from January 1980 to December 2012. Meta-analysis was performed with software of RevMan 5.1. According to inclusive criteria and exclusion criteria, 35 randomized controlled trials with 3 204 patients were enrolled for analyses. Meta-analysis of the trials showed that continuous positive airway pressure (CPAP) reduced in-hospital mortality by 43% (RR = 0.57, 95%CI 0.43-0.75, P management strategies for these patients.

  15. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement

    DEFF Research Database (Denmark)

    Aadal, Lena; Angel, Sanne; Langhorn, Leanne

    2017-01-01

    RATIONALE: In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of everyday life and to provide emotional as well as practical support in relation...... and the actual contribution from nurses. AIM: This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. METHODOLOGICAL DESIGN: A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus...... and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. CONCLUSION: Nurses experience their roles and functions addressing relatives after stroke as crucial...

  16. Regional and local meteorology influences high-resolution tropospheric ozone concentration in the Los Angeles Basin

    Science.gov (United States)

    Koutzoukis, S.; Jenerette, D.; Chandler, M.; Wang, J.; Ge, C.; Ripplinger, J.

    2017-12-01

    Urban air quality and climate directly affect resident health. The Los Angeles (LA) Basin is a highly populated metropolitan area, with widespread point sources of ozone (O3) precursors (NOx , Volatile Organic Compounds, CO) from fossil fuel combustion. The LA basin exists on a coast-to-mountain gradient, with increasing temperatures towards the Transverse Ranges, which rise to 1700m. Frequently not compliant with 8-hour O3 standards, the LA and South Coast Air Basins are designated as severe and extreme non-attainment areas. Summer weather in the LA basin is characterized by a persistent high pressure system, creating an inversion that traps air pollutants, including O3 precursors, coupled with physical geography that blocks prevailing upper atmosphere air flow. These interactions make neighborhood-level O3 levels more variable than common regional models. Over the summer of 2017, we investigated the importance of local meteorology, wind patterns and air temperature, in transporting and mixing ozone precursors from point sources along the coast-to-mountain gradient. We deployed a network of six EPA federal equivalent method ozone and meteorological sensors in three campaigns in the LA basin along the coast-to-mountain transect. Each campaign, we collaborated with citizen scientists to deploy three sensor stations in two, 4 km2 quadrats, for a total of six high-resolution 4 km2 pixels. O3 concentrations vary greatly along the transect. At the coastal sites, daily O3 ranges from 0ppm to 60ppm and the range increases at the inland sites, to 100ppm. At all sites, there was a positive relationship between wind speed, air temperature, and O3 concentration, with increasing correlation inland. The Pearson correlation coefficient between wind speed and O3 concentration doubles from the coast to inland, and triples between air temperature and O3. The site-specific relationships between O3 and wind direction and temperature vary, suggesting neighborhood-effects from local

  17. Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988-2011.

    Science.gov (United States)

    Rosenbaum, Benjamin P; Kelly, Michael L; Kshettry, Varun R; Weil, Robert J

    2014-11-01

    Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality can help guide hospital initiatives and resource allocation. We investigated the categories of neurologic and neurosurgical conditions associated with in-hospital deaths that account for the highest YPLL and their trends over time. Using the Nationwide Inpatient Sample (NIS), we calculated YPLL for patients hospitalized in the USA from 1988 to 2011. Hospitalizations were categorized by related neurologic principal diagnoses. An estimated 2,355,673 in-hospital deaths accounted for an estimated 25,598,566 YPLL. The traumatic brain injury (TBI) category accounted for the highest annual mean YPLL at 361,748 (33.9% of total neurologic YPLL). Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain damage completed the group of five diagnoses with the highest YPLL. TBI accounted for 12.1% of all inflation adjusted neurologic hospital charges and 22.4% of inflation adjusted charges among neurologic deaths. The in-hospital mortality rate has been stable or decreasing for all of these diagnoses except TBI, which rose from 5.1% in 1988 to 7.8% in 2011. Using YPLL, we provide a framework to compare the burden of premature in-hospital mortality on patients with neurologic disorders, which may prove useful for informing decisions related to allocation of health resources or research funding. Considering premature mortality alone, increased efforts should be focused on TBI, particularly in and related to the hospital setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Predicting in-hospital death during acute presentation with pulmonary embolism to facilitate early discharge and outpatient management.

    Directory of Open Access Journals (Sweden)

    Jerrett K Lau

    Full Text Available Pulmonary embolism continues to be a significant cause of death. The aim was to derive and validate a risk prediction model for in-hospital death after acute pulmonary embolism to identify low risk patients suitable for outpatient management.A confirmed acute pulmonary embolism database of 1,426 consecutive patients admitted to a tertiary-center (2000-2012 was analyzed, with odd and even years as derivation and validation cohorts respectively. Risk stratification for in-hospital death was performed using multivariable logistic-regression modelling. Models were compared using receiver-operating characteristic-curve and decision curve analyses.In-hospital mortality was 3.6% in the derivation cohort (n = 693. Adding day-1 sodium and bicarbonate to simplified Pulmonary Embolism Severity Index (sPESI significantly increased the C-statistic for predicting in-hospital death (0.71 to 0.86, P = 0.001. The validation cohort yielded similar results (n = 733, C-statistic 0.85. The new model was associated with a net reclassification improvement of 0.613, and an integrated discrimination improvement of 0.067. The new model also increased the C-statistic for predicting 30-day mortality compared to sPESI alone (0.74 to 0.83, P = 0.002. Decision curve analysis demonstrated superior clinical benefit with the use of the new model to guide admission for pulmonary embolism, resulting in 43 fewer admissions per 100 presentations based on a risk threshold for admission of 2%.A risk model incorporating sodium, bicarbonate, and the sPESI provides accurate risk prediction of acute in-hospital mortality after pulmonary embolism. Our novel model identifies patients with pulmonary embolism who are at low risk and who may be suitable for outpatient management.

  19. In-hospital Mortality due to Respiratory Diseases in the Provincial Hospital of Cienfuegos. 2010-2014

    OpenAIRE

    Liuva Leyva Rodríguez; Orlando Morera Álvarez; Daylin Madruga Jiménez; Heidy Caridad Cordero Cabrera; Reinaldo José Pino Blanco

    2016-01-01

    Background: in-hospital mortality is a health indicator commonly used as a measure of quality of care. Respiratory diseases are a major cause of deaths in hospitals. Objective: to describe mortality from respiratory diseases at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Methods: a descriptive study of all patients over 18 years old who died from respiratory diseases in the hospital of Cienfuegos from 2010 to 2014 was conducted. The variables analyzed were: age,...

  20. The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

    2013-06-01

    This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. High spatial and spectral resolution measurements of Jupiter's auroral regions using Gemini-North-TEXES

    Science.gov (United States)

    Sinclair, J. A.; Orton, G. S.; Greathouse, T. K.; Lacy, J.; Giles, R.; Fletcher, L. N.; Vogt, M.; Irwin, P. G.

    2017-12-01

    Jupiter exhibits auroral emission at a multitude of wavelengths. Auroral emission at X-ray, ultraviolet and near-infrared wavelengths demonstrate the precipitation of ion and electrons in Jupiter's upper atmosphere, at altitudes exceeding 250 km above the 1-bar level. Enhanced mid-infrared emission of CH4, C2H2, C2H4 and further hydrocarbons is also observed coincident with Jupiter's auroral regions. Retrieval analyses of infrared spectra from IRTF-TEXES (Texas Echelon Cross Echelle Spectrograph on NASA's Infrared Telescope Facility) indicate strong heating at the 1-mbar level and evidence of ion-neutral chemistry, which enriches the abundances of unsaturated hydrocarbons (Sinclair et al., 2017b, doi:10.1002/2017GL073529, Sinclair et al., 2017c (under review)). The extent to which these phenomena in the stratosphere are correlated and coupled physically with the shorter-wavelength auroral emission originating from higher altitudes has been a challenge due to the limited spatial resolution available on the IRTF. Smaller-scale features observed in the near-infrared and ultraviolet emission, such as the main `oval', transient `swirls' and dusk-active regions within the main oval (e.g. Stallard et al., 2014, doi:10.1016/j/Icarus.2015.12.044, Nichols et al., 2017, doi: 10.1002/2017GL073029) are potentially being blurred in the mid-infrared by the diffraction-limited resolution (0.7") of IRTF's 3-metre primary aperture. However, on March 17-19th 2017, we obtained spectral measurements of H2 S(1), CH4, C2H2, C2H4 and C2H6 emission of Jupiter's high latitudes using TEXES on Gemini-North, which has a 8-metre primary aperture. This rare opportunity combines the superior spectral resolving power of TEXES and the high spatial resolution provided by Gemini-North's 8-metre aperture. We will perform a retrieval analyses to determine the 3D distributions of temperature, C2H2, C2H4 and C2H6. The morphology will be compared with near-contemporaneous measurements of H3+ emission from

  2. An integrated approach for estimation of methane emissions from wetlands and lakes in high latitude regions

    Science.gov (United States)

    Chiu, C.; Bowling, L. C.; Podest, E.; Bohn, T. J.; Lettenmaier, D. P.; Schroeder, R.; McDonald, K. C.

    2009-04-01

    In recent years, there has been increasing evidence of significant alteration in the extent of lakes and wetlands in high latitude regions due in part to thawing permafrost, as well as other changes governing surface and subsurface hydrology. Methane is a 23 times more efficient greenhouse gas than carbon dioxide; changes in surface water extent, and the associated subsurface anaerobic conditions, are important controls on methane emissions in high latitude regions. Methane emissions from wetlands vary substantially in both time and space, and are influenced by plant growth, soil organic matter decomposition, methanogenesis, and methane oxidation controlled by soil temperature, water table level and net primary productivity (NPP). The understanding of spatial and temporal heterogeneity of surface saturation, thermal regime and carbon substrate in northern Eurasian wetlands from point measurements are limited. In order to better estimate the magnitude and variability of methane emissions from northern lakes and wetlands, we present an integrated assessment approach based on remote sensing image classification, land surface modeling and process-based ecosystem modeling. Wetlands classifications based on L-band JERS-1 SAR (100m) and ALOS PALSAR (~30m) are used together with topographic information to parameterize a lake and wetland algorithm in the Variable Infiltration Capacity (VIC) land surface model at 25 km resolution. The enhanced VIC algorithm allows subsurface moisture exchange between surface water and wetlands and includes a sub-grid parameterization of water table position within the wetland area using a generalized topographic index. Average methane emissions are simulated by using the Walter and Heimann methane emission model based on temporally and spatially varying soil temperature, net primary productivity and water table generated from the modified VIC model. Our five preliminary study areas include the Z. Dvina, Upper Volga, Yeloguy, Syum, and Chaya

  3. Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients.

    Science.gov (United States)

    Kim, Hee Yeon; Kim, Chang Wook; Choi, Jong Young; Lee, Chang Don; Lee, Sae Hwan; Kim, Moon Young; Jang, Byoung Kuk; Wo, Hyun Young

    2016-01-01

    Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade.

  4. Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study.

    Science.gov (United States)

    Sirch, Linda; Salvador, Linda; Palese, Alvisa

    2017-06-01

    Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication. The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach. Four themes have emerged: (a) experiencing a common vulnerability: the need for reciprocal understanding and sensitivity, (b) being outside the comfort zone: feeling discriminated against once again, (c) perceiving a lack of consonance between care and needs and (d) developing a sense of progressively disempowerment. The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level. © 2016 Nordic College of Caring Science.

  5. Recognized Obstructive Sleep Apnea is Associated With Improved In-Hospital Outcomes After ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Mohananey, Divyanshu; Villablanca, Pedro A; Gupta, Tanush; Agrawal, Sahil; Faulx, Michael; Menon, Venugopal; Kapadia, Samir R; Griffin, Brian P; Ellis, Stephen G; Desai, Milind Y

    2017-07-20

    Obstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions such as coronary artery disease, myocardial infarction, systemic hypertension, pulmonary hypertension, and stroke. However, the association of OSA with outcomes in patients hospitalized for ST-elevation myocardial infarction remains controversial. We used the nation-wide inpatient sample between 2003 and 2011 to identify patients with a primary discharge diagnosis of ST-elevation myocardial infarction and then used the International Classification of Diseases, Clinical Modification code 327.23 to identify a group of patients with OSA. The primary outcome of interest was in-hospital mortality, and secondary outcomes were in-hospital cardiac arrest, length of stay and hospital charges. Our cohort included 1 850 625 patients with ST-elevation myocardial infarction, of which 1.3% (24 623) had documented OSA. OSA patients were younger and more likely to be male, smokers, and have chronic pulmonary disease, depression, hypertension, known history of coronary artery disease, dyslipidemia, obesity, and renal failure ( P ST-elevation myocardial infarction patients with recognized OSA had significantly decreased mortality compared with patients without OSA. Although patients with OSA had longer hospital stays and incurred greater hospital charges, there was no difference in incidence of in-hospital cardiac arrest. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  6. Spatial Planning and High-tech Development A comparative study of Eindhoven city-region, the Netherlands and Hsinchu City-region, Taiwan

    Directory of Open Access Journals (Sweden)

    Wei-Ju Huang

    2013-08-01

    Full Text Available High-tech development—which lies at the very heart of the processes of economic growth—has been recognised by many developed and developing countries as a strategic instrument to enhance and sustain their competitiveness in the global economic network. Although the concept of high-tech development differs between countries, many share the underlying assumption that the core of high-tech development is to create a sound environment where innovation thrives. This ideology implies a definite spatial dimension. As a result, various spatial strategies have been formulated and implemented to support high-tech development. This has had intentional and unintentional effects on the economy, society and space. Numerous studies have been devoted to exploring, analysing and theorising this global phenomenon. However, there has been less attention given to the role spatial planning may play in the process of high-tech development and to the factors that shape the spatial planning approaches to high-tech development in a particular place. The major objectives of this research are to advance the knowledge of the role of spatial planning in the process of high-tech development, and to establish an analytical framework that helps reveal the major institutional factors that shape spatial planning mechanisms for dealing with the spatial issues of high-tech development in different places. This contributes to the field of high-tech spatial policies transfer and lesson-drawing. In order to explore the major factors that shape the practices of spatial planning in hightech development, a comparative approach is applied in this research. The Eindhoven city-region in the Netherlands and the Hsinchu city-region in Taiwan are selected as case study areas. Both city-regions can be recognised as success stories of high-tech development not only on a national scale but also on a global scale, despite the fact that they apply different approaches. In the Eindhoven city-region

  7. Using High Energy Precipitation for Magnetic Mapping in the Nightside Transition Region During Dynamic Events

    Science.gov (United States)

    Spanswick, E.

    2017-12-01

    Identifying the magnetic footprint of a satellite can be done using the in situ observations together with some ionospheric or low-altitude satellite observation to argue that the two measurements were made on the same field line. Nishimura et al. [2011], e.g., correlated a time series of chorus wave power near the magnetic equator with the time series of intensities of every pixel of a is roughly magnetically conjugate ASI. Often, the pattern of correlation shows a well-defined peak at the location of the satellite's magnetic footprint. Their results cannot be replicated during dynamic events (e.g., substorms), because the required auroral forms do not occur at such times. It would be important if we could make mappings with such confidence during active times. The Transition Region Explorer (TREx), which is presently being implemented, is a new ground-based facility that will remote sense electron precipitation across 3 hours of MLT and 12 degrees of magnetic latitude spanning the auroral zone in western Canada. TREx includes the world's first imaging riometers array with a contiguous field of view large enough to seamlessly track the spatio-temporal evolution of high energy electron precipitation at mesoscales. Two studies motivated the TREx riometers array. First, Baker et al. [1981] demonstrated riometer absorption is an excellent proxy for the electron energy flux integrated from 30 keV to 200keV keV at the magnetic equator on the flux tube corresponding to the location of that riometers. Second, Spanswick et al. [2007] showed the correlation between the riometers absorption and the integrated electron energy flux near the magnetic equator peaked when the satellite was nearest to conjugate to the riometers. Here we present observations using CANOPUS single beam riometers and CRRES MEB to illustrate how the relative closeness of the footpoint of an equatorial spacecraft can be assessed using high energy precipitation. As well, we present the capabilities of

  8. Species distribution modeling in regions of high need and limited data: waterfowl of China

    Science.gov (United States)

    Prosser, Diann J.; Ding, Changqing; Erwin, R. Michael; Mundkur, Taej; Sullivan, Jeffery D.; Ellis, Erle C.

    2018-01-01

    BackgroundA number of conservation and societal issues require understanding how species are distributed on the landscape, yet ecologists are often faced with a lack of data to develop models at the resolution and extent desired, resulting in inefficient use of conservation resources. Such a situation presented itself in our attempt to develop waterfowl distribution models as part of a multi-disciplinary team targeting the control of the highly pathogenic H5N1 avian influenza virus in China.MethodsFaced with limited data, we built species distribution models using a habitat suitability approach for China’s breeding and non-breeding (hereafter, wintering) waterfowl. An extensive review of the literature was used to determine model parameters for habitat modeling. Habitat relationships were implemented in GIS using land cover covariates. Wintering models were validated using waterfowl census data, while breeding models, though developed for many species, were only validated for the one species with sufficient telemetry data available.ResultsWe developed suitability models for 42 waterfowl species (30 breeding and 39 wintering) at 1 km resolution for the extent of China, along with cumulative and genus level species richness maps. Breeding season models showed highest waterfowl suitability in wetlands of the high-elevation west-central plateau and northeastern China. Wintering waterfowl suitability was highest in the lowland regions of southeastern China. Validation measures indicated strong performance in predicting species presence. Comparing our model outputs to China’s protected areas indicated that breeding habitat was generally better covered than wintering habitat, and identified locations for which additional research and protection should be prioritized.ConclusionsThese suitability models are the first available for many of China’s waterfowl species, and have direct utility to conservation and habitat planning and prioritizing management of critically

  9. Region-scale groundwater flow modelling of generic high level waste disposal sites

    International Nuclear Information System (INIS)

    Metcalfe, D.

    1996-02-01

    Regional-scale groundwater flow modelling analyses are performed on generic high level waste (HLW) disposal sites to assess the extent to which a large crystalline rock mass such as a pluton or batholith can be expected to contain and isolate HLW in terms of hydraulic considerations, for a variety of geologic and hydrogeologic conditions. The two-dimensional cross-sectional conceptual models of generic HLW disposal sites are evaluated using SWIFT III, which is a finite-difference flow and transport code. All steps leading to the final results and conclusions are incorporated in this report. The available data and information on geological and hydrogeologic conditions in plutons and batholiths are summarized. The generic conceptual models developed from this information are defined in terms of the finite difference grid, the geologic and hydrogeologic properties and the hydrologic boundary conditions used. The modelled results are described with contour maps showing the modelled head fields, groundwater flow paths and travel times and groundwater flux rates within the modelled systems. The results of the modelling analyses are used to develop general conclusions on the scales and patterns of groundwater flow in granitic plutons and batholiths. The conclusions focus on geologic and hydrogeologic characteristics that can result in favourable conditions, in terms of hydraulic considerations, for a HLW repository. (author) 43 refs., 9 tabs., 40 figs

  10. Cyberbullying, school bullying, and psychological distress: a regional census of high school students.

    Science.gov (United States)

    Schneider, Shari Kessel; O'Donnell, Lydia; Stueve, Ann; Coulter, Robert W S

    2012-01-01

    Using data from a regional census of high school students, we have documented the prevalence of cyberbullying and school bullying victimization and their associations with psychological distress. In the fall of 2008, 20,406 ninth- through twelfth-grade students in MetroWest Massachusetts completed surveys assessing their bullying victimization and psychological distress, including depressive symptoms, self-injury, and suicidality. A total of 15.8% of students reported cyberbullying and 25.9% reported school bullying in the past 12 months. A majority (59.7%) of cyberbullying victims were also school bullying victims; 36.3% of school bullying victims were also cyberbullying victims. Victimization was higher among nonheterosexually identified youths. Victims report lower school performance and school attachment. Controlled analyses indicated that distress was highest among victims of both cyberbullying and school bullying (adjusted odds ratios [AORs] were from 4.38 for depressive symptoms to 5.35 for suicide attempts requiring medical treatment). Victims of either form of bullying alone also reported elevated levels of distress. Our findings confirm the need for prevention efforts that address both forms of bullying and their relation to school performance and mental health.

  11. Nitrogen mineralization in a high altitude ecosystem in the mediterranean phytogeographical region of Turkey.

    Science.gov (United States)

    Guleryuz, Gurcan; Gucel, Salih; Ozturk, Munir

    2010-07-01

    Interrelations exist in the terrestrial ecosystems between the plant type and characteristics of nutrient uptake. Annual net nitrogen mineralization in soils of different plant communities in the high altitude zone of Spil mountain located in the Mediterranean phytogeographical region of Turkey was investigated throughout one year by field incubation method. Seasonal fluctuations resulting from field incubation were markedly higher in autumn and spring than summer. These are mainly associated with the changes in soil moisture being at minimum in the Mediterranean summer. A significant correlation was developed between the net Nitrate (kg NO3(-)-N ha week(-1)) production and soil water content (p<0.05; r = 0.316 in soil of 0-5 cm; r = 0.312 in soil of 5-15 cm). The results showed that the annual productivity of nitrogen mineralization shows different values depending on communities. Annual net ammonium (NH4(+)-N) production in the soils of each community was negatively estimated. However annual net nitrate (NO3(-)-N) production (0-15 cm) was higher in grassland (27.8 kg ha y(-1)) and shrub (25.0 kg ha y(-1)) than forest (12.4 kg ha y(-1)) community. While annual net N(min) values were close to each other in grassland (14.5 kg ha y(-1)) and shrub (14.1 kg ha y(-1)), but negative in forest community (-3.6 kg ha y(-1)). The reasons for these differences are discussed.

  12. The simulation of medicanes in a high-resolution regional climate model

    Energy Technology Data Exchange (ETDEWEB)

    Cavicchia, Leone [Centro Euro-Mediterraneo per i Cambiamenti Climatici, Bologna (Italy); Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Geesthacht (Germany); Ca' Foscari University, Venice (Italy); Storch, Hans von [Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Geesthacht (Germany); University of Hamburg, Meteorological Institute, Hamburg (Germany)

    2012-11-15

    Medicanes, strong mesoscale cyclones with tropical-like features, develop occasionally over the Mediterranean Sea. Due to the scarcity of observations over sea and the coarse resolution of the long-term reanalysis datasets, it is difficult to study systematically the multidecadal statistics of sub-synoptic medicanes. Our goal is to assess the long-term variability and trends of medicanes, obtaining a long-term climatology through dynamical downscaling of the NCEP/NCAR reanalysis data. In this paper, we examine the robustness of this method and investigate the value added for the study of medicanes. To do so, we performed several climate mode simulations with a high resolution regional atmospheric model (CCLM) for a number of test cases described in the literature. We find that the medicanes are formed in the simulations, with deeper pressures and stronger winds than in the driving global NCEP reanalysis. The tracks are adequately reproduced. We conclude that our methodology is suitable for constructing multi-decadal statistics and scenarios of current and possible future medicane activities. (orig.)

  13. Forecasting high-priority infectious disease surveillance regions: a socioeconomic model.

    Science.gov (United States)

    Chan, Emily H; Scales, David A; Brewer, Timothy F; Madoff, Lawrence C; Pollack, Marjorie P; Hoen, Anne G; Choden, Tenzin; Brownstein, John S

    2013-02-01

    Few researchers have assessed the relationships between socioeconomic inequality and infectious disease outbreaks at the population level globally. We use a socioeconomic model to forecast national annual rates of infectious disease outbreaks. We constructed a multivariate mixed-effects Poisson model of the number of times a given country was the origin of an outbreak in a given year. The dataset included 389 outbreaks of international concern reported in the World Health Organization's Disease Outbreak News from 1996 to 2008. The initial full model included 9 socioeconomic variables related to education, poverty, population health, urbanization, health infrastructure, gender equality, communication, transportation, and democracy, and 1 composite index. Population, latitude, and elevation were included as potential confounders. The initial model was pared down to a final model by a backwards elimination procedure. The dependent and independent variables were lagged by 2 years to allow for forecasting future rates. Among the socioeconomic variables tested, the final model included child measles immunization rate and telephone line density. The Democratic Republic of Congo, China, and Brazil were predicted to be at the highest risk for outbreaks in 2010, and Colombia and Indonesia were predicted to have the highest percentage of increase in their risk compared to their average over 1996-2008. Understanding socioeconomic factors could help improve the understanding of outbreak risk. The inclusion of the measles immunization variable suggests that there is a fundamental basis in ensuring adequate public health capacity. Increased vigilance and expanding public health capacity should be prioritized in the projected high-risk regions.

  14. Origin and Distribution of PAHs in Ambient Particulate Samples at High Mountain Region in Southern China

    Directory of Open Access Journals (Sweden)

    Peng-hui Li

    2015-01-01

    Full Text Available To understand the deposition and transport of PAHs in southern China, a measurement campaign was conducted at a high-elevation site (the summit of Mount Heng, 1269 m A.S.L. from April 4 to May 31, 2009, and a total of 39 total suspended particulate samples were collected for measurement of PAH concentrations. The observed particulate-bound PAHs concentrations ranged from 1.63 to 29.83 ng/m3, with a mean concentration of 6.03 ng/m3. BbF, FLA, and PYR were the predominant compounds. Good correlations were found between individual PAHs and meteorological parameters such as atmospheric pressure, relative humidity, and ambient temperature. The backward trajectory analysis suggested that particulate samples measured at the Mount Heng region were predominantly associated with the air masses from southern China, while the air masses transported over northern and northwestern China had relative higher PAHs concentrations. Based on the diagnostic ratios and factor analysis, vehicular emission, coal combustion, industry emission, and unburned fossil fuels were suggested to be the PAHs sources at Mount Heng site. However, the reactivity and degradation of individual PAHs could influence the results of PAH source profiles, which deserves further investigations in the future.

  15. Highly restricted deletion of the SNORD116 region is implicated in Prader–Willi Syndrome

    Science.gov (United States)

    Bieth, Eric; Eddiry, Sanaa; Gaston, Véronique; Lorenzini, Françoise; Buffet, Alexandre; Conte Auriol, Françoise; Molinas, Catherine; Cailley, Dorothée; Rooryck, Caroline; Arveiler, Benoit; Cavaillé, Jérome; Salles, Jean Pierre; Tauber, Maïthé

    2015-01-01

    The SNORD116 locus lies in the 15q11-13 region of paternally expressed genes implicated in Prader–Willi Syndrome (PWS), a complex disease accompanied by obesity and severe neurobehavioural disturbances. Cases of PWS patients with a deletion encompassing the SNORD116 gene cluster, but preserving the expression of flanking genes, have been described. We report a 23-year-old woman who presented clinical criteria of PWS, including the behavioural and nutritional features, obesity, developmental delay and endocrine dysfunctions with hyperghrelinemia. We found a paternally transmitted highly restricted deletion of the SNORD116 gene cluster, the shortest described to date (118 kb). This deletion was also present in the father. This finding in a human case strongly supports the current hypothesis that lack of the paternal SNORD116 gene cluster has a determinant role in the pathogenesis of PWS. Moreover, targeted analysis of the SNORD116 gene cluster, complementary to SNRPN methylation analysis, should be carried out in subjects with a phenotype suggestive of PWS. PMID:24916642

  16. Highly restricted deletion of the SNORD116 region is implicated in Prader-Willi Syndrome.

    Science.gov (United States)

    Bieth, Eric; Eddiry, Sanaa; Gaston, Véronique; Lorenzini, Françoise; Buffet, Alexandre; Conte Auriol, Françoise; Molinas, Catherine; Cailley, Dorothée; Rooryck, Caroline; Arveiler, Benoit; Cavaillé, Jérome; Salles, Jean Pierre; Tauber, Maïthé

    2015-02-01

    The SNORD116 locus lies in the 15q11-13 region of paternally expressed genes implicated in Prader-Willi Syndrome (PWS), a complex disease accompanied by obesity and severe neurobehavioural disturbances. Cases of PWS patients with a deletion encompassing the SNORD116 gene cluster, but preserving the expression of flanking genes, have been described. We report a 23-year-old woman who presented clinical criteria of PWS, including the behavioural and nutritional features, obesity, developmental delay and endocrine dysfunctions with hyperghrelinemia. We found a paternally transmitted highly restricted deletion of the SNORD116 gene cluster, the shortest described to date (118 kb). This deletion was also present in the father. This finding in a human case strongly supports the current hypothesis that lack of the paternal SNORD116 gene cluster has a determinant role in the pathogenesis of PWS. Moreover, targeted analysis of the SNORD116 gene cluster, complementary to SNRPN methylation analysis, should be carried out in subjects with a phenotype suggestive of PWS.

  17. Comparison of excitation mechanisms in the analytical regions of a high-power two-jet plasma

    International Nuclear Information System (INIS)

    Zaksas, Natalia P.

    2015-01-01

    Excitation mechanisms in the analytical regions of a high-power two-jet plasma were investigated. A new plasmatron recently developed was applied in this work. The Boltzmann population of excited levels of Fe atoms and ions was observed in both analytical regions, before and after the jet confluence, as well as in the jet confluence, which proves excitation of atoms and ions by electron impact. The disturbance of local thermodynamic equilibrium in all regions of the plasma flow was deduced on the basis of considerable difference in Fe atomic and ionic excitation temperatures. Such a difference is most likely to be caused by contribution of metastable argon to atom ionization. The region before the jet confluence has the greatest difference in Fe atomic and ionic excitation temperatures and is more non-equilibrium than the region after the confluence due to comparatively low electron and high metastable argon concentrations. Low electron concentration in this region provides lower background emission than in the region after the jet confluence, which leads to better detection limits for the majority of elements. - Highlights: • Excitation mechanisms were investigated in the analytical regions of a high-power TJP. • Boltzmann population of excited levels of Fe atoms and ions takes place in all regions of the plasma flow. • The considerable difference in Fe atomic and ionic excitation temperatures occurs. • Penning ionization by metastable argon results in disturbance of LTE in the plasma. • The region before the jet confluence is more non-equilibrium than after that

  18. The Effect of Land Cover/Land Use Changes on the Regional Climate of the USA High Plains

    Directory of Open Access Journals (Sweden)

    Denis Mutiibwa

    2014-08-01

    Full Text Available We present the detection of the signatures of land use/land cover (LULC changes on the regional climate of the US High Plains. We used the normalized difference vegetation index (NDVI as a proxy of LULC changes and atmospheric CO2 concentrations as a proxy of greenhouse gases. An enhanced signal processing procedure was developed to detect the signatures of LULC changes by integrating autoregression and moving average (ARMA modeling and optimal fingerprinting technique. The results, which are representative of the average spatial signatures of climate response to LULC change forcing on the regional climate of the High Plains during the 26 years of the study period (1981–2006, show a significant cooling effect on the regional temperatures during the summer season. The cooling effect was attributed to probable evaporative cooling originating from the increasing extensive irrigation in the region. The external forcing of atmospheric CO2 was included in the study to suppress the radiative warming effect of greenhouse gases, thus, enhancing the LULC change signal. The results show that the greenhouse gas radiative warming effect in the region is significant, but weak, compared to the LULC change signal. The study demonstrates the regional climatic impact of anthropogenic induced atmospheric-biosphere interaction attributed to LULC change, which is an additional and important climate forcing in addition to greenhouse gas radiative forcing in High Plains region.

  19. Tuberculosis during pregnancy in the United States: Racial/ethnic disparities in pregnancy complications and in-hospital death.

    Science.gov (United States)

    Dennis, Erika M; Hao, Yun; Tamambang, Mabella; Roshan, Tasha N; Gatlin, Knubian J; Bghigh, Hanane; Ogunyemi, Oladimeji T; Diallo, Fatoumata; Spooner, Kiara K; Salemi, Jason L; Olaleye, Omonike A; Khan, Kashif Z; Aliyu, Muktar H; Salihu, Hamisu M

    2018-01-01

    Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US. This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories. The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease. TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial

  20. Gender differences in in-hospital mortality and mechanisms of death after the first acute myocardial infarction

    International Nuclear Information System (INIS)

    Fabijanic, D.; Culic, V.; Bozic, I; Miric, D.; Stipic, S.S.; Radic, M.; Vucinovic, Z.

    2006-01-01

    There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjusting for age and other prognostic factors. Therefore, we investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI. The data was obtained from a chart review of 3382 consecutive patients, 1184 (35%) women (69.7+-10.9 years) and 2198 (65%) men (63.5+-11.8 years) with first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression. Unadjusted in-hospital mortalty was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other base-line differences (Hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy)decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications-refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01). Our result demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women, and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-related differences in

  1. CUTLASS HF radar observations of high-velocity E-region echoes

    Directory of Open Access Journals (Sweden)

    M. V. Uspensky

    Full Text Available A short event of high-velocity E-region echo observations by the Pykkvibaer HF radar is analysed to study echo parameters and the echo relation to the Farley-Buneman plasma instability. The echoes were detected in several beams aligned closely to the magnetic L-shell direction. Two echo groups were identified: one group corresponded to the classical type 1 echoes with velocities close to the nominal ion-acoustic speed of 400 ms1 , while the other group had significantly larger velocities, of the order of 700 ms1 . The mutual relationship between the echo power, Doppler velocity, spectral width and elevation angles for these two groups was studied. Plotting of echo parameters versus slant range showed that all ~700 ms1 echoes originated from larger heights and distances of 500–700 km, while all ~400 ms1 echoes came from lower heights and from farther distances; 700–1000 km. We argue that both observed groups of echoes occurred due to the Farley-Buneman plasma instability excited by strong ( ~70 mVm1 and uniformly distributed electric fields. We show that the echo velocities for the two groups were different because the echoes were received from different heights. Such a separation of echo heights occurred due to the differing amounts of ionospheric refraction at short and large ranges. Thus, the ionospheric refraction and related altitude modulation of ionospheric parameters are the most important factors to consider, when various characteristics of E-region decametre irregularities are derived from HF radar measurements.

    Key words. Ionosphere (ionospheric irregularities; plasma waves and instabilities; polar ionosphere

  2. Experimental investigation on feasibility of two-region-designed pebble-bed high-temperature gas-cooled reactor

    International Nuclear Information System (INIS)

    Yang Xingtuan; Hu Wenping; Jiang Shengyao

    2009-01-01

    Phenomenological experiments were performed on a 2-dimensional scaled model of the two-region designed pebble-bed high-temperature gas-cooled reactor core consisting of the distinct fuel pebble region and graphite pebble region. Issues with respect to the feasibility of the two-region design, including the establishment of the two-region arrangement, the mixing zone between the two regions, and the stagnant zone existence, were investigated. Three equilibrium conditions were proposed to evaluate the stable two-region arrangement formation. The general characteristics of the flow of the pebble bed were analyzed on basis of the observed phenomenon. It was found that a stable two-region arrangement was formed under the experimental conditions: the pebbles' motion was to some extent random but also confined by the neighbors of pebbles so that the mixing zone is constrained to a reasonable size. Guide plates utilized to improve mixing are proved to be effective without noticeable effect on the two-region arrangement features. Stagnant zones were observed under the experimental conditions and they were expected to be avoided by improving the design of the experimental setup. (author)

  3. Highly syntenic regions in the genomes of soybean, Medicago truncatula, and Arabidopsis thaliana

    Directory of Open Access Journals (Sweden)

    Roe Bruce A

    2005-08-01

    Full Text Available Abstract Background Recent genome sequencing enables mega-base scale comparisons between related genomes. Comparisons between animals, plants, fungi, and bacteria demonstrate extensive synteny tempered by rearrangements. Within the legume plant family, glimpses of synteny have also been observed. Characterizing syntenic relationships in legumes is important in transferring knowledge from model legumes to crops that are important sources of protein, fixed nitrogen, and health-promoting compounds. Results We have uncovered two large soybean regions exhibiting synteny with M. truncatula and with a network of segmentally duplicated regions in Arabidopsis. In all, syntenic regions comprise over 500 predicted genes spanning 3 Mb. Up to 75% of soybean genes are colinear with M. truncatula, including one region in which 33 of 35 soybean predicted genes with database support are colinear to M. truncatula. In some regions, 60% of soybean genes share colinearity with a network of A. thaliana duplications. One region is especially interesting because this 500 kbp segment of soybean is syntenic to two paralogous regions in M. truncatula on different chromosomes. Phylogenetic analysis of individual genes within these regions demonstrates that one is orthologous to the soybean region, with which it also shows substantially denser synteny and significantly lower levels of synonymous nucleotide substitutions. The other M. truncatula region is inferred to be paralogous, presumably resulting from a duplication event preceding speciation. Conclusion The presence of well-defined M. truncatula segments showing orthologous and paralogous relationships with soybean allows us to explore the evolution of contiguous genomic regions in the context of ancient genome duplication and speciation events.

  4. Trigonometric parallaxes of high mass star forming regions: the structure and kinematics of the Milky Way

    Energy Technology Data Exchange (ETDEWEB)

    Reid, M. J.; Dame, T. M. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Menten, K. M.; Brunthaler, A.; Wu, Y.; Zhang, B.; Sanna, A.; Sato, M.; Choi, Y. K.; Immer, K. [Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn (Germany); Zheng, X. W. [Department of Astronomy, Nanjing University Nanjing 210093 (China); Xu, Y. [Purple Mountain Observatory, Chinese Academy of Sciences, Nanjing 210008 (China); Hachisuka, K. [Shanghai Astronomical Observatory, 80 Nandan Rd., Shanghai (China); Moscadelli, L. [Arcetri Observatory, Firenze (Italy); Rygl, K. L. J. [European Space Agency (ESA-ESTEC), Keplerlaan 1, P.O. Box 299, 2200 AG, Noordwijk (Netherlands); Bartkiewicz, A. [Centre for Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Grudziadzka 5, 87-100 Torun (Poland)

    2014-03-10

    Over 100 trigonometric parallaxes and proper motions for masers associated with young, high-mass stars have been measured with the Bar and Spiral Structure Legacy Survey, a Very Long Baseline Array key science project, the European VLBI Network, and the Japanese VLBI Exploration of Radio Astrometry project. These measurements provide strong evidence for the existence of spiral arms in the Milky Way, accurately locating many arm segments and yielding spiral pitch angles ranging from about 7° to 20°. The widths of spiral arms increase with distance from the Galactic center. Fitting axially symmetric models of the Milky Way with the three-dimensional position and velocity information and conservative priors for the solar and average source peculiar motions, we estimate the distance to the Galactic center, R {sub 0}, to be 8.34 ± 0.16 kpc, a circular rotation speed at the Sun, Θ{sub 0}, to be 240 ± 8 km s{sup –1}, and a rotation curve that is nearly flat (i.e., a slope of –0.2 ± 0.4 km s{sup –1} kpc{sup –1}) between Galactocentric radii of ≈5 and 16 kpc. Assuming a 'universal' spiral galaxy form for the rotation curve, we estimate the thin disk scale length to be 2.44 ± 0.16 kpc. With this large data set, the parameters R {sub 0} and Θ{sub 0} are no longer highly correlated and are relatively insensitive to different forms of the rotation curve. If one adopts a theoretically motivated prior that high-mass star forming regions are in nearly circular Galactic orbits, we estimate a global solar motion component in the direction of Galactic rotation, V {sub ☉} = 14.6 ± 5.0 km s{sup –1}. While Θ{sub 0} and V {sub ☉} are significantly correlated, the sum of these parameters is well constrained, Θ{sub 0} + V {sub ☉} = 255.2 ± 5.1 km s{sup –1}, as is the angular speed of the Sun in its orbit about the Galactic center, (Θ{sub 0} + V {sub ☉})/R {sub 0} = 30.57 ± 0.43 km s{sup –1} kpc{sup –1}. These parameters improve the accuracy

  5. Probing topological relations between high-density and low-density regions of 2MASS with hexagon cells

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Yongfeng [American Physical Society, San Diego, CA (United States); Xiao, Weike, E-mail: yongfeng.wu@maine.edu [Department of Astronautics Engineering, Harbin Institute of Technology, P.O. Box 345, Heilongjiang Province 150001 (China)

    2014-02-01

    We introduced a new two-dimensional (2D) hexagon technique for probing the topological structure of the universe in which we mapped regions of the sky with high and low galaxy densities onto a 2D lattice of hexagonal unit cells. We defined filled cells as corresponding to high-density regions and empty cells as corresponding to low-density regions. The numbers of filled cells and empty cells were kept the same by controlling the size of the cells. By analyzing the six sides of each hexagon, we could obtain and compare the statistical topological properties of high-density and low-density regions of the universe in order to have a better understanding of the evolution of the universe. We applied this hexagonal method to Two Micron All Sky Survey data and discovered significant topological differences between the high-density and low-density regions. Both regions had significant (>5σ) topological shifts from both the binomial distribution and the random distribution.

  6. Avoiding unstable regions in the design space of EUV mirror systems comprising high-order aspheric surfaces

    NARCIS (Netherlands)

    Marinescu, O.; Bociort, F.; Braat, J.

    2004-01-01

    When Extreme Ultraviolet mirror systems having several high-order aspheric surfaces are optimized, the configurations often enter into highly unstable regions of the parameter space. Small changes of system parameters lead then to large changes in ray paths, and therefore optimization algorithms

  7. Current status of in-hospital donation coordinators in Japan: nationwide survey.

    Science.gov (United States)

    Konaka, S; Shimizu, S; Iizawa, M; Ohkawara, H; Kato, O; Ashikari, J; Fukushima, N

    2013-05-01

    When the Japanese Organ Transplantation Act was issued, the Japanese Organ Transplantation Network (JOT) was established in 1997. JOT lists recipients, assesses and manages organ donors, and educates publics and headquarters for organ donations. JOT procurement transplant coordinators (PTC) play roles in obtaining consent from relatives for organ donation, donor evaluation and management, organ recovery management, organ transport, and care of donor families during and after donation. Every prefecture has at least one PTC who is mainly working in public education and hospital development. They also help the JOT PTC at the time of organ procurement. Most prefectures commission hospital staff in the procurement hospital to be an in-hospital PTC (In-Hp PTC), who make their hospital staff aware of organ donation and support organ procurement. Although the Act was revised in 2010 with brain-dead organ donation increased from 13 to 44 cases yearly, the number was still extremely smaller than other developed countries. In these circumstances, In-Hp PTC may play greater roles to increase donation and smooth procurement procedures Our primary aim was to describe the current status of In-Hp PTC in Japan. Between December 15, 2011, and January 31, 2012, we invited 1889 In-Hp PTC to complete a letter survey using a self-designed questionnaire. In all, 56 In-Hp PTC (40%) completed and returned it. The occupation of the respondents was nurse (66%), physician (18%), or other (16%). Although 52% of respondents belonged to the hospital, which was designated for brain-death organ donation by the government, only 46% had any experience with a cadaveric donor. Only 2% were full-time In-Hp PTC. They mainly played a role in preparing their own manual for organ procurement (57%), providing in-hospital lectures (44%) or their own simulation exercise (29%), as well as coordinating donation cases. Although 77% had attended seminar about organ donation provided by JOT or the prefecture PTC

  8. Participatory design of probability-based decision support tools for in-hospital nurses.

    Science.gov (United States)

    Jeffery, Alvin D; Novak, Laurie L; Kennedy, Betsy; Dietrich, Mary S; Mion, Lorraine C

    2017-11-01

    To describe nurses' preferences for the design of a probability-based clinical decision support (PB-CDS) tool for in-hospital clinical deterioration. A convenience sample of bedside nurses, charge nurses, and rapid response nurses (n = 20) from adult and pediatric hospitals completed participatory design sessions with researchers in a simulation laboratory to elicit preferred design considerations for a PB-CDS tool. Following theme-based content analysis, we shared findings with user interface designers and created a low-fidelity prototype. Three major themes and several considerations for design elements of a PB-CDS tool surfaced from end users. Themes focused on "painting a picture" of the patient condition over time, promoting empowerment, and aligning probability information with what a nurse already believes about the patient. The most notable design element consideration included visualizing a temporal trend of the predicted probability of the outcome along with user-selected overlapping depictions of vital signs, laboratory values, and outcome-related treatments and interventions. Participants expressed that the prototype adequately operationalized requests from the design sessions. Participatory design served as a valuable method in taking the first step toward developing PB-CDS tools for nurses. This information about preferred design elements of tools that support, rather than interrupt, nurses' cognitive workflows can benefit future studies in this field as well as nurses' practice. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  9. In-hospital paediatric accidents: an integrative review of the literature.

    Science.gov (United States)

    Da Rin Della Mora, R; Bagnasco, A; Sasso, L

    2012-12-01

    Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5 years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and

  10. Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study.

    Science.gov (United States)

    Berg, Katherine M; Grossestreuer, Anne V; Uber, Amy; Patel, Parth V; Donnino, Michael W

    2017-10-01

    In-hospital cardiac arrest (IHCA) strikes over 200,000 people in the United States annually. Targeted temperature management (TTM) is considered beneficial in other settings, but there is no prospective data for IHCA. Recent work on TTM and IHCA found an association between TTM and worse outcome. However, the authors used intubation as a marker for coma to determine eligibility for TTM. The validity of this approach is unexplored. Retrospective, single center study of adult patients with IHCA occurring in an intensive care unit, intubated prior to or during the event, or immediately after ROSC. We evaluated the percentage of patients documented as comatose after arrest, defined as Glasgow Comas Score (GCS) <8 for the primary analysis. We also evaluated the difference in hospital survival in patients with GCS <8 versus ≥8. Two sensitivity analyses using different methods for defining coma using post-ROSC GCS were conducted. 29/102 (28%) intubated patients had a post-ROSC GCS≥8, and 22 (22%) were documented as following commands. Survival in patients with GCS≥8 vs.<8 was 62% (18/29) vs. 37% (27/73) in unadjusted analysis (p=0.02). The adjusted odds ratio for survival to hospital discharge was 3.81 (95%CI: 1.37-10.61, p=0.01). Results were similar in both sensitivity analyses. Intubation prior to or during IHCA was not a valid marker of coma after ROSC. Post-ROSC mental status was associated with hospital survival, and thus could be an important confounder when conducting observational studies on the association of TTM with outcomes in this patient population. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response.

    Science.gov (United States)

    Leary, Marion; Schweickert, William; Neefe, Stacie; Tsypenyuk, Boris; Falk, Scott Austin; Holena, Daniel N

    2016-07-01

    How nontechnical factors such as inadequate role definition and overcrowding affect outcomes of in-hospital cardiac arrest (IHCA) is unknown. Using a bundled intervention, we sought to improve providers' role definitions and decrease overcrowding during IHCA events. To determine if a bundled intervention consisting of a nurse/physician leadership dyad, visual cues for provider roles, and a "role check" would lead to reductions in crowding and improve perceptions of communication and team leadership. Baseline data on the number and type of IHCA providers were collected. Providers were asked to complete a postevent survey rating communication and leadership. A bundled intervention was then introduced. Data were then obtained for the subsequent IHCA events. Twenty ICHA events were captured before and 34 after the intervention. The number of physicians present at pulse checks 2 (median [interquartile range]: 6 [5-8] before vs 5 [3-6] after, P = .02) and 3 (7 [5-9] vs 4 [4-5], P = .004) decreased significantly after the intervention. The overall number of providers at the third pulse check (18 [14-22] before vs 14 [12-16] after, P = .04) also decreased after the intervention. On a 10-point Likert scale, ratings of communication (8 [7-8]) and physician leadership (8 [7-9]) did not differ significantly from before to after the intervention. Both the physician leads (90%) and patients' primary nurses (97%) were able to identify clear nurse leaders. A bundled intervention targeted at improving IHCA response led to a decrease in overcrowding at ICHA events without substantial changes in the perceptions of communication or physician leadership. ©2016 American Association of Critical-Care Nurses.

  12. Digitization of Electrocardiogram From Telemetry Prior to In-hospital Cardiac Arrest: A Pilot Study.

    Science.gov (United States)

    Attin, Mina; Wang, Lu; Soroushmehr, S M Reza; Lin, Chii-Dean; Lemus, Hector; Spadafore, Maxwell; Najarian, Kayvan

    2016-03-01

    Analyzing telemetry electrocardiogram (ECG) data over an extended period is often time-consuming because digital records are not widely available at hospitals. Investigating trends and patterns in the ECG data could lead to establishing predictors that would shorten response time to in-hospital cardiac arrest (I-HCA). This study was conducted to validate a novel method of digitizing paper ECG tracings from telemetry systems in order to facilitate the use of heart rate as a diagnostic feature prior to I-HCA. This multicenter study used telemetry to investigate full-disclosure ECG papers of 44 cardiovascular patients obtained within 1 hr of I-HCA with initial rhythms of pulseless electrical activity and asystole. Digital ECGs were available for seven of these patients. An algorithm to digitize the full-disclosure ECG papers was developed using the shortest path method. The heart rate was measured manually (averaging R-R intervals) for ECG papers and automatically for digitized and digital ECGs. Significant correlations were found between manual and automated measurements of digitized ECGs (p < .001) and between digitized and digital ECGs (p < .001). Bland-Altman methods showed bias = .001 s, SD = .0276 s, lower and upper 95% limits of agreement for digitized and digital ECGs = .055 and -.053 s, and percentage error = 0.22%. Root mean square (rms), percentage rms difference, and signal to noise ratio values were in acceptable ranges. The digitization method was validated. Digitized ECG provides an efficient and accurate way of measuring heart rate over an extended period of time. © The Author(s) 2015.

  13. The impact of early specialist management on outcomes of patients with in-hospital stroke.

    Science.gov (United States)

    Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit

    2014-01-01

    Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I.  = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

  14. Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

    Directory of Open Access Journals (Sweden)

    Engsig M

    2016-11-01

    Full Text Available Magaly Engsig,1 Helle Søholm,2 Fredrik Folke,3,4 Peter J Gadegaard,1 Julie Therese Wiis,5 Rune Molin,6 Thomas Mohr,1 Frederik N Engsig7 1Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Hellerup, 2Department of Cardiology, Copenhagen University Hospital, Herlev, 3Department of Cardiology, Copenhagen University Hospital, Hellerup, 4Pre-Hospital Emergency Medical Services, Capital Region of Denmark, Ballerup, 5Department of Intensive Care, Copenhagen University Hospital, Copenhagen, 6Department of Anaesthesiology, Copenhagen University Hospital, Hillerød, 7Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark Objective: The long-term survival of in-hospital cardiac arrest (IHCA patients treated with targeted temperature management (TTM is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA patients treated with TTM. Design, setting, and patients: Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. Measurements: Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological outcome assessed using the Pittsburgh cerebral performance category (CPC. Results: A total of 282 patients were included in this study; 233 (83% OHCA and 49 (17% IHCA. The IHCA group presented more often with asystole, received bystander cardiopulmonary resuscitation (CPR in all cases, and had shorter time to return of spontaneous circulation (ROSC. Survival to hospital discharge was 54% for OHCA and 53% for IHCA (adjusted odds ratio 0.98 [95% confidence interval {CI}; 0.43–2.24]. Age ≤60 years, bystander CPR, time to ROSC ≤10 min, and shockable rhythm at presentation were associated with survival to hospital discharge. Good neurologic outcome among survivors was achieved by 86

  15. The Value Chains of High-Technology Products as Factor of formation the Regional Comprehensive Economic Partnership

    Directory of Open Access Journals (Sweden)

    Irina A. Safronova

    2016-01-01

    Full Text Available This article analyzes the value chain of high-tech products in Asia and the role of this phenomenon in the further consolidation of trade blocs and alliances in the region. The presence of these chains and their gradual transition from a vertically integrated model to a system of horizontal linkages and interdependence leads to the formation of mechanisms of economic de-facto integration (so-called regionalization process. The East Asian region has demonstrated unprecedented high rates of economic growth in recent decades. The countries are actively developing mechanisms of multilateral cooperation, involving partners from across the Asia-Pacific region. Particular features of a new regional architecture of economic relations are becoming more tangible, and the essential element of this architecture is the intra-regional integration. The author presents an assessment of further developments of the Regional comprehensive economic partnership (RCEP using the structural-functional approach and analytical instruments of the international political economy, The creation of this trade block will help less advanced countries of ASEAN to accelerate economic growth and improve the conditions for integration into global value chains. For advanced economies, participation in the RCEP seems controversial, because production chains have well-established formats within the framework of ASEAN +. The political standoff between Washington and Beijing has an impact on dynamics of regional integration. The split among the East Asian countries was galvanized by the Trans-Pacific Partnership Project (TTP, because TPP has objectives that are very similar to those of RCEP (trade liberalization and economic integration. The author concludes that the extension of this partnership in the ASEAN countries can seriously complicate the operation RVEP and enhance the impact of political factors on economic cooperation. In this case, the value of production and supply chains

  16. Space weather effects on airline communications in the high latitude regions

    Science.gov (United States)

    Stocker, Alan; Siddle, Dave; Warrington, Mike; Honary, Farideh; Zaalov, Nikolay; Homam, Mariyam; Boteler, David; Danskin, Donald; de Franceschi, Georgiana; Ascaneus, Svend

    2013-04-01

    In the polar regions, ground-based VHF facilities for air-traffic control are lacking (and non-existent on the Russian side of the pole) and satellite communication systems either not available or expensive to retrofit to current aircraft and hence there remains a need for HF communication systems. Unfortunately, at these latitudes space weather can significantly affect the propagation of HF radio signals and the forecasting techniques currently employed by the airline industry are somewhat crude. In this paper, a new project that aims to provide forecasting of HF propagation characteristics for use by civilian airlines operating over polar routes will be described and preliminary results presented. Previous work in this area [e.g. Stocker et al., 2007] has focussed on taking HF signal measurements (e.g. SNR, delay and Doppler spread, and direction of arrival) on a limited number of propagation paths and developing an ionospheric model that incorporates high latitude features (e.g. polar patches and arcs) which, when combined with raytracing, allows the broad characteristics of the observations to be reproduced [Warrington et al., 2012]. The new project will greatly extend this work and consists of a number of stages. Firstly, HF measurements from an extensive network of purpose built transmitters and receivers spanning the Arctic regions will be collected and analysed. In order to test a wide variety of scenarios, the propagation paths will have different characteristics, e.g. different lengths and covering different parts of the northern ionosphere (i.e. polar cap paths where both terminals are in the polar cap, trans-auroral paths, and sub-auroral paths) and observations will be taken at a range of HF frequencies for a period covering the current (so far weak) solar maximum and part of the declining phase. Simultaneously, high latitude absorption measurements utilising the Global Riometer Array (GLORIA) will be collected and analysed. Next, the observations of

  17. High Reflectance Nanoscale V/Sc Multilayer for Soft X-ray Water Window Region.

    Science.gov (United States)

    Huang, Qiushi; Yi, Qiang; Cao, Zhaodong; Qi, Runze; Loch, Rolf A; Jonnard, Philippe; Wu, Meiyi; Giglia, Angelo; Li, Wenbin; Louis, Eric; Bijkerk, Fred; Zhang, Zhong; Wang, Zhanshan

    2017-10-10

    V/Sc multilayer is experimentally demonstrated for the first time as a high reflectance mirror for the soft X-ray water window region. It primarily works at above the Sc-L edge (λ = 3.11 nm) under near normal incidence while a second peak appears at above the V-L edge (λ = 2.42 nm) under grazing incidence. The V/Sc multilayer fabricated with a d-spacing of 1.59 nm and 30 bilayers has a smaller interface width (σ = 0.27 and 0.32 nm) than the conventional used Cr/Sc (σ = 0.28 and 0.47 nm). For V/Sc multilayer with 30 bilayers, the introduction of B 4 C barrier layers has little improvement on the interface structure. As the number of bilayers increasing to 400, the growth morphology and microstructure of the V/Sc layers evolves with slightly increased crystallization. Nevertheless, the surface roughness remains to be 0.25 nm. A maximum soft X-ray reflectance of 18.4% is measured at λ = 3.129 nm at 9° off-normal incidence using the 400-bilayers V/Sc multilayer. According to the fitted model, an s-polarization reflectance of 5.2% can also be expected at λ = 2.425 nm under 40° incidence. Based on the promising experimental results, further improvement of the reflectance can be achieved by using a more stable deposition system, exploring different interface engineering methods and so on.

  18. Genes involved in complex adaptive processes tend to have highly conserved upstream regions in mammalian genomes

    Directory of Open Access Journals (Sweden)

    Kohane Isaac

    2005-11-01

    Full Text Available Abstract Background Recent advances in genome sequencing suggest a remarkable conservation in gene content of mammalian organisms. The similarity in gene repertoire present in different organisms has increased interest in studying regulatory mechanisms of gene expression aimed at elucidating the differences in phenotypes. In particular, a proximal promoter region contains a large number of regulatory elements that control the expression of its downstream gene. Although many studies have focused on identification of these elements, a broader picture on the complexity of transcriptional regulation of different biological processes has not been addressed in mammals. The regulatory complexity may strongly correlate with gene function, as different evolutionary forces must act on the regulatory systems under different biological conditions. We investigate this hypothesis by comparing the conservation of promoters upstream of genes classified in different functional categories. Results By conducting a rank correlation analysis between functional annotation and upstream sequence alignment scores obtained by human-mouse and human-dog comparison, we found a significantly greater conservation of the upstream sequence of genes involved in development, cell communication, neural functions and signaling processes than those involved in more basic processes shared with unicellular organisms such as metabolism and ribosomal function. This observation persists after controlling for G+C content. Considering conservation as a functional signature, we hypothesize a higher density of cis-regulatory elements upstream of genes participating in complex and adaptive processes. Conclusion We identified a class of functions that are associated with either high or low promoter conservation in mammals. We detected a significant tendency that points to complex and adaptive processes were associated with higher promoter conservation, despite the fact that they have emerged

  19. High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke.

    Directory of Open Access Journals (Sweden)

    Josep Puig

    Full Text Available Blood-brain barrier (BBB permeability has been proposed as a predictor of hemorrhagic transformation (HT after tissue plasminogen activator (tPA administration; however, the reliability of perfusion computed tomography (PCT permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT in predicting HT after intravenous tPA administration in patients with acute stroke.We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT.The study included 156 patients (50% male, median age 75.5 years. Thirty-seven (23,7% developed HT [12 (7,7%, parenchymal hematoma type 2 (PH-2]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77. HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045.HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.

  20. High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke

    Science.gov (United States)

    Puig, Josep; Blasco, Gerard; Daunis-i-Estadella, Pepus; van Eendendburg, Cecile; Carrillo-García, María; Aboud, Carlos; Hernández-Pérez, María; Serena, Joaquín; Biarnés, Carles; Nael, Kambiz; Liebeskind, David S.; Thomalla, Götz; Menon, Bijoy K.; Demchuk, Andrew; Wintermark, Max; Pedraza, Salvador

    2017-01-01

    Objective Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke. Methods We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT. Results The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045). Conclusions HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT. PMID:29182658

  1. Fe-based bulk metallic glasses with a larger supercooled liquid region and high ductility

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, K.Q. [School of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110178 (China)], E-mail: kqqiu@yahoo.com.cn; Pang, J.; Ren, Y.L.; Zhang, H.B. [School of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110178 (China); Ma, C.L.; Zhang, T. [School of Materials Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100083 (China)

    2008-12-20

    Bulk metallic glasses (BMGs) with compositions of Fe{sub 61.5-x}Co{sub 3}Mo{sub 14}C{sub 15}B{sub 6}Er{sub 0.5}M{sub x} (x = 2, 3; M = Ni, Nb) were fabricated by copper mold casting using raw industrial materials. The X-ray diffraction (XRD), differential scanning calorimetry (DSC), mechanical tester and scanning electron microscope (SEM) were employed to check the phase constituent, the thermal stability, the mechanical properties and the fracture surfaces of as-cast samples. The results indicate that the BMGs with diameters of 1.5-3 mm were fabricated for the alloys investigated. The largest supercooled liquid region (SLR) up to 76 K was found for Fe{sub 58.5}Co{sub 3}Mo{sub 14}C{sub 15}B{sub 6}Er{sub 0.5}Ni{sub 3} BMG. The BMGs with Ni addition exhibit not only high fracture strengths reaching 3770 MPa for x = 2 and 3980 MPa for x = 3 alloys, respectively, but also apparently plastic strains up to 0.67% and 0.93%, respectively. The fracture surfaces of the Fe{sub 61.5-x}Co{sub 3}Mo{sub 14}C{sub 15}B{sub 6}Er{sub 0.5}Ni{sub x} (x = 2, 3) alloys with plasticity show narrow ridges characteristic of venous patterns combining with tearing flow between the ridges. While the Nb containing alloys show not only a lower SLR below 60 K but also a lower stress below 2400 MPa, as well as almost no plastic strain before fracture.

  2. Alcoholic Liver Disease in the Asian–Pacific Region with High Prevalence of Chronic Viral Hepatitis

    Directory of Open Access Journals (Sweden)

    Sien-Sing Yang

    2016-09-01

    Full Text Available The hospitalized cases and mortality from alcoholic liver disease (ALD are increasing in Taiwan and worldwide. Meanwhile, the Asia–Pacific region also has a high prevalence of hepatitis B virus (HBV and hepatocellular carcinoma (HCC. The Taiwanese have the highest percentage of aldehyde dehydrogenase 2 (ALDH2 deficiency and the lowest amount of alcohol consumption. Based on the histological changes, ALD is clinically classified as steatosis, alcoholic hepatitis, alcoholic fibrosis, alcoholic cirrhosis, and alcoholic hepatitis on cirrhosis. Patients with overt alcoholic hepatitis often develop marked hepatomegaly, audible hepatic arterial bruit, mild leukocytosis, and mild fever. Patients having alcoholic cirrhosis had much more serious complications and mortality. It is clinically important to identify hepatic fibrosis and cirrhosis earlier for early management. Active assessments for esophageal varices and ascites may help the diagnosis of cirrhosis. Sonography is helpful for exanimating features of cirrhosis including portal hypertension, ascites, increased hepatic portal flow, and collaterals. Synergistic damage of viral hepatitis on ALD patients lead to rapid progression to cirrhosis and HCC. Distinct from the Western population, 30% of Taiwanese alcoholics had concomitant chronic HBV regardless of the different histologic categories. Patient groups with combined alcoholics and HBV had fewer platelet counts and much more cirrhosis with Ishak Stage 5–6 fibrosis. The annual incidences of HCC were significantly higher in alcoholic cirrhotic patients having concomitant HBV infection than those with only HBV infection or alcoholism alone. Antiviral nucleotide and nucleoside analogs therapy reduces the prevalence of HCC to a similar level to those ALD patients without active HBV.

  3. Evaluation of high intensity precipitation from 16 Regional climate models over a meso-scale catchment in the Midlands Regions of England

    Science.gov (United States)

    Wetterhall, F.; He, Y.; Cloke, H.; Pappenberger, F.; Freer, J.; Wilson, M.; McGregor, G.

    2009-04-01

    Local flooding events are often triggered by high-intensity rain-fall events, and it is important that these can be correctly modelled by Regional Climate Models (RCMs) if the results are to be used in climate impact assessment. In this study, daily precipitation from 16 RCMs was compared with observations over a meso-scale catchment in the Midlands Region of England. The RCM data was provided from the European research project ENSEMBLES and the precipitation data from the UK MetOffice. The RCMs were all driven by reanalysis data from the ERA40 dataset over the time period 1961-2000. The ENSEMBLES data is on the spatial scale of 25 x 25 km and it was disaggregated onto a 5 x 5 km grid over the catchment and compared with interpolated observational data with the same resolution. The mean precipitation was generally underestimated by the ENSEMBLES data, and the maximum and persistence of high intensity rainfall was even more underestimated. The inter-annual variability was not fully captured by the RCMs, and there was a systematic underestimation of precipitation during the autumn months. The spatial pattern in the modelled precipitation data was too smooth in comparison with the observed data, especially in the high altitudes in the western part of the catchment where the high precipitation usually occurs. The RCM outputs cannot reproduce the current high intensity precipitation events that are needed to sufficiently model extreme flood events. The results point out the discrepancy between climate model output and the high intensity precipitation input needs for hydrological impact modelling.

  4. Sectorial and regional determinants of firm dynamics in developing countries: evidence for low, medium and high tech manufacturing in Argentina

    OpenAIRE

    Calá, Carla Daniela

    2018-01-01

    We analyse the determinants of firm dynamics in developing countries using Argentina as an illustrative case. We explain firm entry and exit at the regional level, distinguishing three groups of manufacturing activities: low, medium and high tech. We find that both region -and sector- specific determinants explain firm dynamics, but the impact is not homogeneous across sectors. In particular, for low tech industries, there is a need for explanatory variables that proxy for the specificities o...

  5. A High-definition View Of The Circum-nuclear Regions In Nearby Seyferts With Chandra And HST

    Science.gov (United States)

    Wang, Junfeng; Fabbiano, G.; Elvis, M.; Risaliti, G.; Karovska, M.; Zezas, A.; Mundell, C. G.

    2011-09-01

    To improve our understanding of AGN feedback, it is crucial to evaluate the true role of outflows on galaxy evolution observationally. I will present new results from the CHandra survey of Extended Emission-line Regions in nearby Seyfert galaxies (CHEERS), which aims to examine feedback in action in much greater detail than at high redshift. Findings from Chandra studies of the circum-nuclear region in the archetypal Seyfert 1 galaxy NGC 4151 will be discussed in detail. Exploiting Chandra's highest possible resolution, we find evidence for X-ray emission from interaction between radio outflow and the optical narrow-line region clouds, in addition to the emission from photoionized gas.

  6. Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection.

    Science.gov (United States)

    Meijide, Héctor; Mena, Álvaro; Rodríguez-Osorio, Iria; Pértega, Sonia; Castro-Iglesias, Ángeles; Rodríguez-Martínez, Guillermo; Pedreira, José; Poveda, Eva

    2017-01-01

    New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection. A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993-2002 and 2003-2013) to be compared by conducting a comparative cross-sectional analysis. A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36±11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5-16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003-2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P<.001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly). Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y

  7. East Siberian Sea, an Arctic region of very high biogeochemical activity

    Directory of Open Access Journals (Sweden)

    L. G. Anderson

    2011-06-01

    Full Text Available Shelf seas are among the most active biogeochemical marine environments and the East Siberian Sea is a prime example. This sea is supplied by seawater from both the Atlantic and Pacific Oceans and has a substantial input of river runoff. All of these waters contribute chemical constituents, dissolved and particulate, but of different signatures. Sea ice formation during the winter season and melting in the summer has a major impact on physical as well as biogeochemical conditions. The internal circulation and water mass distribution is significantly influenced by the atmospheric pressure field. The western region is dominated by input of river runoff from the Laptev Sea and an extensive input of terrestrial organic matter. The microbial decay of this organic matter produces carbon dioxide (CO2 that oversaturates all waters from the surface to bottom relative to atmospheric level, even when primary production, inferred from low surface water nutrients, has occurred. The eastern surface waters were under-saturated with respect to CO2 illustrating the dominance of marine primary production. The drawdown of dissolved inorganic carbon equals a primary production of ~0.8 ± 2 mol C m−2, which when multiplied by half the area of the East Siberian Sea, ~500 000 km2, results in an annual primary production of 0.4 (± 1 × 1012 mol C or ~4 (± 10 × 1012 gC. Microbial decay occurs through much of the water column, but dominates at the sediment interface where the majority of organic matter ends up, thus more of the decay products are recycled to the bottom water. High nutrient concentrations and fugacity of CO2 and low oxygen and pH were observed in the bottom waters. Another signature of organic matter decomposition, methane (CH4, was observed in very high but variable concentrations. This is due to its seabed sources of glacial origin or modern production from

  8. Are Boreal Ovenbirds, Seiurus aurocapilla, More Prone to Move across Inhospitable Landscapes in Alberta's Boreal Mixedwood Forest than in Southern Québec's Temperate Deciduous Forest?

    Directory of Open Access Journals (Sweden)

    Marc Bélisle

    2007-12-01

    Full Text Available Population life-history traits such as the propensity to move across inhospitable landscapes should be shaped by exposure to landscape structure over evolutionary time. Thus, birds that recently evolved in landscapes fragmented by natural disturbances such as fire would be expected to show greater behavioral and morphological vagility relative to conspecifics that evolved under less patchy landscapes shaped by fewer and finer-scaled disturbances, i.e., the resilience hypothesis. These predictions are not new, but they remain largely untested, even for well-studied taxa such as neotropical migrant birds. We combined two experimental translocation, i.e., homing, studies to test whether Ovenbird, Seiurus aurocapilla, from the historically dynamic boreal mixedwood forest of north-central Alberta (n = 55 is more vagile than Ovenbird from historically less dynamic deciduous forest of southern Québec (n = 89. We found no regional difference in either wing loading or the response of homing Ovenbird to landscape structure. Nevertheless, this study presents a heuristic framework that can advance the understanding of boreal landscape dynamics as an evolutionary force.

  9. High incidence of diseases endemic to the Amazon region of Brazil, 2001-2006.

    Science.gov (United States)

    Penna, Gerson; Pinto, Luiz Felipe; Soranz, Daniel; Glatt, Ruth

    2009-04-01

    In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001-2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region.

  10. High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006

    Science.gov (United States)

    Pinto, Luiz Felipe; Soranz, Daniel; Glatt, Ruth

    2009-01-01

    In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001–2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region. PMID:19331758

  11. Scalability of regional climate change in Europe for high-end scenarios

    DEFF Research Database (Denmark)

    Christensen, O. B.; Yang, S.; Boberg, F.

    2015-01-01

    With the help of a simulation using the global circulation model (GCM) EC-Earth, downscaled over Europe with the regional model DMI-HIRHAM5 at a 25 km grid point distance, we investigated regional climate change corresponding to 6°C of global warming to investigate whether regional climate change...... are close to the RCP8.5 emission scenario. We investigated the extent to which pattern scaling holds, i.e. the approximation that the amplitude of any climate change will be approximately proportional to the amount of global warming. We address this question through a comparison of climate change results...... from downscaling simulations over the same integration domain, but for different driving and regional models and scenarios, mostly from the EU ENSEMBLES project. For almost all quantities investigated, pattern scaling seemed to apply to the 6° simulation. This indicates that the single 6° simulation...

  12. Regional Curve Development and Use in Stream Restoration and Hydrologic Assessment in High Gradient Headwater Streams

    Science.gov (United States)

    Introduction to Regional Curves including; regressions relating bankfull channelcharacteristics to drainage area, providing estimates of bankfull discharge and channel geometry, validating the selection of the bankfull channel as determined in the field

  13. Rainfall Characteristics and Regionalization in Peninsular Malaysia Based on a High Resolution Gridded Data Set

    Directory of Open Access Journals (Sweden)

    Chee Loong Wong

    2016-11-01

    Full Text Available Daily gridded rainfall data over Peninsular Malaysia are delineated using an objective clustering algorithm, with the objective of classifying rainfall grids into groups of homogeneous regions based on the similarity of the rainfall annual cycles. It has been demonstrated that Peninsular Malaysia can be statistically delineated into eight distinct rainfall regions. Thi