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Sample records for international multicentre observational

  1. Loss to follow-up in an international, multicentre observational study

    DEFF Research Database (Denmark)

    Mocroft, A; Kirk, O; Aldins, P

    2008-01-01

    OBJECTIVE: The aim of this work was to assess loss to follow-up (LTFU) in EuroSIDA, an international multicentre observational cohort study. METHODS: LTFU was defined as no follow-up visit, CD4 cell count measurement or viral load measurement after 1 January 2006. Poisson regression was used...

  2. Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study.

    Science.gov (United States)

    2018-01-13

    Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy). The primary aim of this study is to determine the contemporary negative appendicectomy rate. The study's secondary aims are to determine the rate of laparoscopy for appendicitis and to validate the Appendicitis Inflammatory Response (AIR) and Alvarado prediction scores. This multicentre, international prospective observational study will include all patients referred to surgical specialists with either RIF pain or suspected appendicitis. Consecutive patients presenting within 2-week long data collection periods will be included. Centres will be invited to participate in up to four data collection periods between February and August 2017. Data will be captured using a secure online data management system. A centre survey will profile local policy and service delivery for management of RIF pain. Research ethics are not required for this study in the UK, as determined using the National Research Ethics Service decision tool. This study will be registered as a clinical audit in participating UK centres. National leads in countries outside the UK will oversee appropriate registration and study approval, which may include completing full ethical review. The study will be disseminated by trainee-led research collaboratives and through social media. Peer-reviewed publications will be published under corporate authorship including 'RIFT Study Group' and 'West Midlands Research Collaborative'. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  3. Multicentre observational study of the Gatekeeper for faecal incontinence.

    Science.gov (United States)

    Ratto, C; Buntzen, S; Aigner, F; Altomare, D F; Heydari, A; Donisi, L; Lundby, L; Parello, A

    2016-02-01

    A variety of therapeutic approaches are available for faecal incontinence. Implantation of Gatekeeper prostheses is a new promising option. The primary endpoint of this prospective observational multicentre study was to assess the clinical efficacy of Gatekeeper implantation in patients with faecal incontinence. Secondary endpoints included the assessment of patients' quality of life, and the feasibility and safety of implantation. Patients with faecal incontinence, with either intact sphincters or internal anal sphincter lesions extending for less than 60° of the anal circumference, were selected. Intersphincteric implantation of six prostheses was performed. At baseline, and 1, 3 and 12 months after implantation, the number of faecal incontinence episodes, Cleveland Clinic Faecal Incontinence, Vaizey and American Medical Systems, Faecal Incontinence Quality of Life Scale and Short Form 36 Health Survey scores were recorded. Endoanal ultrasonography was performed at baseline and follow-up. Fifty-four patients were implanted. After Gatekeeper implantation, incontinence to gas, liquid and solid stool improved significantly, soiling was reduced, and ability to defer defaecation enhanced. All faecal incontinence severity scores were significantly reduced, and patients' quality of life improved. At 12 months, 30 patients (56 per cent) showed at least 75 per cent improvement in all faecal incontinence parameters, and seven (13 per cent) became fully continent. In three patients a single prosthesis was extruded during surgery, but was replaced immediately. After implantation, prosthesis dislodgement occurred in three patients; no replacement was required. Anal implantation of the Gatekeeper in patients with faecal incontinence was effective and safe. Clinical benefits were sustained at 1-year follow-up. © 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  4. Perinatal complications in patients with unisutural craniosynostosis: An international multicentre retrospective cohort study

    NARCIS (Netherlands)

    Cornelissen, Martijn J.; Softeland, Madiha; Apon, Inge; Ladfors, Lars; Mathijssen, Irene M. J.; Cohen-Overbeek, Titia E.; Bonsel, Gouke J.; Kolby, Lars

    2017-01-01

    Purpose Craniosynostosis may lead to hampered fetal head molding and birth complications. To study the interaction between single suture craniosynostosis and delivery complications, an international, multicentre, retrospective cohort study was performed. Materials and methods All infants born

  5. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study

    Science.gov (United States)

    Preisler, Jessica; Kopeika, Julia; Ismail, Laure; Vathanan, Veluppillai; Farren, Jessica; Abdallah, Yazan; Battacharjee, Parijat; Van Holsbeke, Caroline; Bottomley, Cecilia; Gould, Deborah; Johnson, Susanne; Stalder, Catriona; Van Calster, Ben; Hamilton, Judith; Timmerman, Dirk

    2015-01-01

    Objectives To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty. Secondary aims were to examine the influence of gestational age on interpretation of mean gestational sac diameter and crown-rump length values, determine the optimal intervals between scans and findings on repeat scans that definitively diagnose pregnancy failure.) Design Prospective multicentre observational trial. Setting Seven hospital based early pregnancy assessment units in the United Kingdom. Participants 2845 women with intrauterine pregnancies of unknown viability included if transvaginal ultrasonography showed an intrauterine pregnancy of uncertain viability. In three hospitals this was initially defined as an empty gestational sac <20 mm mean diameter with or without a visible yolk sac but no embryo, or an embryo with crown-rump length <6 mm with no heartbeat. Following amended guidance in December 2011 this definition changed to a gestational sac size <25 mm or embryo crown-rump length <7 mm. At one unit the definition was extended throughout to include a mean gestational sac diameter <30 mm or embryo crown-rump length <8 mm. Main outcome measures Mean gestational sac diameter, crown-rump length, and presence or absence of embryo heart activity at initial and repeat transvaginal ultrasonography around 7-14 days later. The final outcome was pregnancy viability at 11-14 weeks’ gestation. Results The following indicated a miscarriage at initial scan: mean gestational sac diameter ≥25 mm with an empty sac (364/364 specificity: 100%, 95% confidence interval 99.0% to 100%), embryo with crown-rump length ≥7 mm without visible embryo heart activity (110/110 specificity: 100%, 96.7% to 100%), mean gestational sac diameter ≥18 mm for gestational sacs without an embryo presenting after 70 days’ gestation (907/907 specificity: 100%, 99.6% to

  6. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); A. van Kampen (A.); Yee, A. (Albert); A.C. de Vries (Alexander); de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar); Romero, A.W. (Amanda W.); Rangan, A. (Amar); Oatt, A. (Amber); Sanghavi, A. (Amir); Foley, A.L. (Amy L.); Karlsten, A. (Anders); Dolenc, A. (Andrea); Bucknill, A. (Andrew); Chia, A. (Andrew); Evans, A. (Andrew); Gong, A. (Andrew); Schmidt, A.H. (Andrew H.); Marcantonio, A.J. (Andrew J.); Jennings, A. (Andrew); Ward, A. (Angela); Khanna, A. (Angshuman); Rai, A. (Anil); Smits, A.B. (Anke B.); Horan, A.D. (Annamarie D.); Brekke, A.C. (Anne Christine); Flynn, A. (Annette); Duraikannan, A. (Aravin); Stødle, A. (Are); van Vugt, A.B. (Arie B.); Luther, A. (Arlene); Zurcher, A.W. (Arthur W.); Jain, A. (Arvind); Amundsen, A. (Asgeir); Moaveni, A. (Ash); Carr, A. (Ashley); Sharma, A. (Ateet); Hill, A.D. (Austin D.); Trommer, A. (Axel); Rai, B.S. (B. Sachidananda); Hileman, B. (Barbara); Schreurs, B. (Bart); Verhoeven, B. (Bart); Barden, B.B. (Benjamin B.); Flatøy, B. (Bernhard); B.I. Cleffken (Berry); Bøe, B. (Berthe); Perey, B. (Bertrand); Hanusch, B.C. (Birgit C.); Weening, B. (Brad); B. Fioole (Bram); Rijbroek, B. (Bram); Crist, B.D. (Brett D.); Halliday, B. (Brett); Peterson, B. (Brett); Mullis, B. (Brian); Richardson, C.G. (C. Glen); Clark, C. (Callum); Sagebien, C.A. (Carlos A.); C. van der Pol (Carmen); Bowler, C. (Carol); Humphrey, C.A. (Catherine A.); Coady, C. (Catherine); Koppert, C.L. (Cees L.); Coles, C. (Chad); Tannoury, C. (Chadi); DePaolo, C.J. (Charles J.); Gayton, C. (Chris); Herriott, C. (Chris); Reeves, C. (Christina); Tieszer, C. (Christina); Dobb, C. (Christine); Anderson, C.G. (Christopher G.); Sage, C. (Claire); Cuento, C. (Claudine); Jones, C.B. (Clifford B.); Bosman, C.H.R. (Coks H.R.); Linehan, C. (Colleen); C.P. van der Hart (Cor P.); Henderson, C. (Corey); Lewis, C.G. (Courtland G.); Davis, C.A. (Craig A.); Donohue, C. (Craig); Mauffrey, C. (Cyril); Sundaresh, D.C. (D. C.); Farrell, D.J. (Dana J.); Whelan, D.B. (Daniel B.); Horwitz, D. (Daniel); Stinner, D. (Daniel); Viskontas, D. (Darius); Roffey, D.M. (Darren M.); Alexander, D. (David); Karges, D.E. (David E.); Hak, D. (David); Johnston, D. (David); Love, D. (David); Wright, D.M. (David M.); Zamorano, D.P. (David P.); Goetz, D.R. (David R.); Sanders, D. (David); Stephen, D. (David); Yen, D. (David); Bardana, D. (Davide); Olakkengil, D.J. (Davy J); Lawson, D. (Deanna); Maddock, D. (Deborah); Sietsema, D.L. (Debra L.); Pourmand, D. (Deeba); D. den Hartog (Dennis); Donegan, D. (Derek); D. Heels-Ansdell (Diane); Nam, D. (Diane); Inman, D. (Dominic); Boyer, D. (Dory); Li, D. (Doug); Gibula, D. (Douglas); Price, D.M. (Dustin M.); Watson, D.J. (Dylan J.); Hammerberg, E.M. (E. Mark); Tan, E.T.C.H. (Edward T.C.H.); E.J.R. de Graaf (Eelco); Vesterhus, E.B. (Elise Berg); Roper, E. (Elizabeth); Edwards, E. (Elton); E.H. Schemitsch (Emil); E.R. Hammacher (Eric); Henderson, E.R. (Eric R.); Whatley, E. (Erica); Torres, E.T. (Erick T.); Vermeulen, E.G.J. (Erik G.J.); Finn, E. (Erin); E.M.M. van Lieshout (Esther); Wai, E.K. (Eugene K.); Bannister, E.R. (Evan R.); Kile, E. (Evelyn); Theunissen, E.B.M. (Evert B.M.); Ritchie, E.D. (Ewan D.); Khan, F. (Farah); Moola, F. (Farhad); Howells, F. (Fiona); F. de Nies (Frank); F.H.W.M. van der Heijden (Frank); de Meulemeester, F.R.A.J. (Frank R.A.J.); F. Frihagen (Frede); Nilsen, F. (Fredrik); Schmidt, G.B. (G. Ben); Albers, G.H.R. (G.H. Robert); Gudger, G.K. (Garland K.); Johnson, G. (Garth); Gruen, G. (Gary); Zohman, G. (Gary); Sharma, G. (Gaurav); Wood, G. (Gavin); G.W.M. Tetteroo (Geert); Hjorthaug, G. (Geir); Jomaas, G. (Geir); Donald, G. (Geoff); Rieser, G.R. (Geoffrey Ryan); Reardon, G. (Gerald); Slobogean, G.P. (Gerard P.); G.R. Roukema (Gert); Visser, G.A. (Gijs A.); Moatshe, G. (Gilbert); Horner, G. (Gillian); Rose, G. (Glynis); Guyatt, G. (Gordon); Chuter, G. (Graham); Etherington, G. (Greg); Rocca, G.J.D. (Gregory J. Della); Ekås, G. (Guri); Dobbin, G. (Gwendolyn); Lemke, H.M. (H. Michael); Curry, H. (Hamish); H. Boxma (Han); Gissel, H. (Hannah); Kreder, H. (Hans); Kuiken, H. (Hans); H.L.F. Brom; Pape, H.-C. (Hans-Christoph); H.M. van der Vis (Harm); Bedi, H. (Harvinder); Vallier, H.A. (Heather A.); Brien, H. (Heather); Silva, H. (Heather); Newman, H. (Heike); H. Viveiros (Helena); van der Hoeven, H. (Henk); Ahn, H. (Henry); Johal, H. (Herman); H. Rijna; Stockmann, H. (Heyn); Josaputra, H.A. (Hong A.); Carlisle, H. (Hope); van der Brand, I. (Igor); I. Dawson (Imro); Tarkin, I. (Ivan); Wong, I. (Ivan); Parr, J.A. (J. Andrew); Trenholm, J.A. (J. Andrew); J.C. Goslings (Carel); Amirault, J.D. (J. David); Broderick, J.S. (J. Scott); Snellen, J.P. (Jaap P.); Zijl, J.A.C. (Jacco A.C.); Ahn, J. (Jaimo); Ficke, J. (James); Irrgang, J. (James); Powell, J. (James); Ringler, J.R. (James R.); Shaer, J. (James); Monica, J.T. (James T.); J. Biert (Jan); Bosma, J. (Jan); Brattgjerd, J.E. (Jan Egil); J.P.M. Frölke (Jan Paul); J.C. Wille (Jan); Rajakumar, J. (Janakiraman); Walker, J.E. (Jane E.); Baker, J.K. (Janell K.); Ertl, J.P. (Janos P.); de Vries, J.P.P.M. (Jean Paul P.M.); Gardeniers, J.W.M. (Jean W.M.); May, J. (Jedediah); Yach, J. (Jeff); Hidy, J.T. (Jennifer T.); Westberg, J.R. (Jerald R.); Hall, J.A. (Jeremy A.); van Mulken, J. (Jeroen); McBeth, J.C. (Jessica Cooper); Hoogendoorn, J. (Jochem); Hoffman, J.M. (Jodi M.); Cherian, J.J. (Joe Joseph); Tanksley, J.A. (John A.); Clarke-Jenssen, J. (John); Adams, J.D. (John D.); Esterhai, J. (John); Tilzey, J.F. (John F.); Murnaghan, J. (John); Ketz, J.P. (John P.); Garfi, J.S. (John S.); Schwappach, J. (John); Gorczyca, J.T. (John T.); Wyrick, J. (John); Rydinge, J. (Jonas); Foret, J.L. (Jonathan L.); Gross, J.M. (Jonathan M.); Keeve, J.P. (Jonathan P.); Meijer, J. (Joost); J.J. Scheepers (Joris J.); Baele, J. (Joseph); O'Neil, J. (Joseph); Cass, J.R. (Joseph R.); Hsu, J.R. (Joseph R.); Dumais, J. (Jules); Lee, J. (Julia); Switzer, J.A. (Julie A.); Agel, J. (Julie); Richards, J.E. (Justin E.); Langan, J.W. (Justin W.); Turckan, K. (Kahn); Pecorella, K. (Kaili); Rai, K. (Kamal); Aurang, K. (Kamran); Shively, K. (Karl); K.J.P. van Wessem; Moon, K. (Karyn); Eke, K. (Kate); Erwin, K. (Katie); Milner, K. (Katrine); K.J. Ponsen (Kees-jan); Mills, K. (Kelli); Apostle, K. (Kelly); Johnston, K. (Kelly); Trask, K. (Kelly); Strohecker, K. (Kent); Stringfellow, K. (Kenya); Kruse, K.K. (Kevin K.); Tetsworth, K. (Kevin); Mitchell, K. (Khalis); Browner, K. (Kieran); Hemlock, K. (Kim); Carcary, K. (Kimberly); Jørgen Haug, K. (Knut); Noble, K. (Krista); Robbins, K. (Kristin); Payton, K. (Krystal); Jeray, K.J. (Kyle J.); Rubino, L.J. (L. Joseph); Nastoff, L.A. (Lauren A.); Leffler, L.C. (Lauren C.); L.P. Stassen (Laurents); O'Malley, L.K. (Lawrence K.); Specht, L.M. (Lawrence M.); L. Thabane (Lehana); Geeraedts, L.M.G. (Leo M.G.); Shell, L.E. (Leslie E.); Anderson, L.K. (Linda K.); Eickhoff, L.S. (Linda S.); Lyle, L. (Lindsey); Pilling, L. (Lindsey); Buckingham, L. (Lisa); Cannada, L.K. (Lisa K.); Wild, L.M. (Lisa M.); Dulaney-Cripe, L. (Liz); L.M.S.J. Poelhekke; Govaert, L. (Lonneke); Ton, L. (Lu); Kottam, L. (Lucksy); L.P.H. Leenen (Luke); Clipper, L. (Lydia); Jackson, L.T. (Lyle T.); Hampton, L. (Lynne); de Waal Malefijt, M.C. (Maarten C.); M.P. Simons; M. van der Elst (Maarten); M.W.G.A. Bronkhorst (Maarten); Bhatia, M. (Mahesh); M.F. Swiontkowski (Marc ); Lobo, M.J. (Margaret J.); Swinton, M. (Marilyn); Pirpiris, M. (Marinis); Molund, M. (Marius); Gichuru, M. (Mark); Glazebrook, M. (Mark); Harrison, M. (Mark); Jenkins, M. (Mark); MacLeod, M. (Mark); M.R. de Vries (Mark); Butler, M.S. (Mark S.); Nousiainen, M. (Markku); van ‘t Riet, M. (Martijne); Tynan, M.C. (Martin C.); Campo, M. (Martin); M.G. Eversdijk (Martin); M.J. Heetveld (Martin); Richardson, M. (Martin); Breslin, M. (Mary); Fan, M. (Mary); Edison, M. (Matt); Napierala, M. (Matthew); Knobe, M. (Matthias); Russ, M. (Matthias); Zomar, M. (Mauri); de Brauw, M. (Maurits); Esser, M. (Max); Hurley, M. (Meghan); Peters, M.E. (Melissa E.); Lorenzo, M. (Melissa); Li, M. (Mengnai); Archdeacon, M. (Michael); Biddulph, M. (Michael); Charlton, M. (Michael); McDonald, M.D. (Michael D.); McKee, M.D. (Michael D.); Dunbar, M. (Michael); Torchia, M.E. (Michael E.); Gross, M. (Michael); Hewitt, M. (Michael); Holt, M. (Michael); Prayson, M.J. (Michael J.); M.J.R. Edwards (Michael); Beckish, M.L. (Michael L.); Brennan, M.L. (Michael L.); Dohm, M.P. (Michael P.); Kain, M.S.H. (Michael S.H.); Vogt, M. (Michelle); Yu, M. (Michelle); M.H.J. Verhofstad (Michiel); Segers, M.J.M. (Michiel J.M.); M.J.M. Segers (Michiel); Siroen, M.P.C. (Michiel P.C.); M.R. Reed (Mike); Vicente, M.R. (Milena R.); M.M.M. Bruijninckx (Milko); Trivedi, M. (Mittal); M. Bhandari (Mohit); Moore, M.M. (Molly M.); Kunz, M. (Monica); Smedsrud, M. (Morten); Palla, N. (Naveen); Jain, N. (Neeraj); Out, N.J.M. (Nico J.M.); Simunovic, N. (Nicole); Simunovic, N. (Nicole); N.W.L. Schep (Niels); Müller, O. (Oliver); Guicherit, O.R. (Onno R.); O.J.F. van Waes (Oscar); Wang, O. (Otis); P. Doornebosch (Pascal); Seuffert, P. (Patricia); Hesketh, P.J. (Patrick J.); Weinrauch, P. (Patrick); Duffy, P. (Paul); Keller, P. (Paul); Lafferty, P.M. (Paul M.); Pincus, P. (Paul); P. Tornetta III (Paul); Zalzal, P. (Paul); McKay, P. (Paula); Cole, P.A. (Peter A.); de Rooij, P.D. (Peter D.); Hull, P. (Peter); Go, P.M.N.Y.M. (Peter M.N.Y.M.); P. Patka (Peter); Siska, P. (Peter); Weingarten, P. (Peter); Kregor, P. (Philip); Stahel, P. (Philip); Stull, P. (Philip); P. Wittich (Philippe); P.A.R. Rijcke (Piet); P.P. Oprel (Pim); Devereaux, P.J. (P. J.); Zhou, Q. (Qi); Lee Murphy, R. (R.); Alosky, R. (Rachel); Clarkson, R. (Rachel); Moon, R. (Raely); Logishetty, R. (Rajanikanth); Nanda, R. (Rajesh); Sullivan, R.J. (Raymond J.); Snider, R.G. (Rebecca G.); Buckley, R.E. (Richard E.); Iorio, R. (Richard); Farrugia, R.J. (Richard J); Jenkinson, R. (Richard); Laughlin, R. (Richard); R.P.R. Groenendijk (Richard); Gurich, R.W. (Richard W.); Worman, R. (Ripley); Silvis, R. (Rob); R. Haverlag (Robert); Teasdall, R.J. (Robert J.); Korley, R. (Robert); McCormack, R. (Robert); Probe, R. (Robert); Cantu, R.V. (Robert V.); Huff, R.B. (Roger B.); R.K.J. Simmermacher; Peters, R. (Rolf); Pfeifer, R. (Roman); Liem, R. (Ronald); Wessel, R.N. (Ronald N.); Verhagen, R. (Ronald); Vuylsteke, R. (Ronald); Leighton, R. (Ross); McKercher, R. (Ross); R.W. Poolman (Rudolf); Miller, R. (Russell); Bicknell, R. (Ryan); Finnan, R. (Ryan); Khan, R.M. (Ryan M.); Mehta, S. (Samir); Vang, S. (Sandy); Singh, S. (Sanjay); Anand, S. (Sanjeev); Anderson, S.A. (Sarah A.); Dawson, S.A. (Sarah A.); Marston, S.B. (Scott B.); Porter, S.E. (Scott E.); Watson, S.T. (Scott T.); S. Festen (Sebastiaan); Lieberman, S. (Shane); Puloski, S. (Shannon); Bielby, S.A. (Shea A.); Sprague, S. (Sheila); Hess, S. (Shelley); MacDonald, S. (Shelley); Evans, S. (Simone); Bzovsky, S. (Sofia); Hasselund, S. (Sondre); Lewis, S. (Sophie); Ugland, S. (Stein); Caminiti, S. (Stephanie); Tanner, S.L. (Stephanie L.); S.M. Zielinski (Stephanie); Shepard, S. (Stephanie); Sems, S.A. (Stephen A.); Walter, S.D. (Stephen D.); Doig, S. (Stephen); Finley, S.H. (Stephen H.); Kates, S. (Stephen); Lindenbaum, S. (Stephen); Kingwell, S.P. (Stephen P.); Csongvay, S. (Steve); Papp, S. (Steve); Buijk, S.E. (Steven E.); S. Rhemrev (Steven); Hollenbeck, S.M. (Steven M.); van Gaalen, S.M. (Steven M.); Yang, S. (Steven); Weinerman, S. (Stuart); Subash, (); Lambert, S. (Sue); Liew, S. (Susan); S.A.G. Meylaerts (Sven); Blokhuis, T.J. (Taco J.); de Vries Reilingh, T.S. (Tammo S.); Lona, T. (Tarjei); Scott, T. (Taryn); Swenson, T.K. (Teresa K.); Endres, T.J. (Terrence J.); Axelrod, T. (Terry); van Egmond, T. (Teun); Pace, T.B. (Thomas B.); Kibsgård, T. (Thomas); Schaller, T.M. (Thomas M.); Ly, T.V. (Thuan V.); Miller, T.J. (Timothy J.); Weber, T. (Timothy); Le, T. (Toan); Oliver, T.M. (Todd M.); T.M. Karsten (Thomas); Borch, T. (Tor); Hoseth, T.M. (Tor Magne); Nicolaisen, T. (Tor); Ianssen, T. (Torben); Rutherford, T. (Tori); Nanney, T. (Tracy); Gervais, T. (Trevor); Stone, T. (Trevor); Schrickel, T. (Tyson); Scrabeck, T. (Tyson); Ganguly, U. (Utsav); Naumetz, V. (V.); Frizzell, V. (Valda); Wadey, V. (Veronica); Jones, V. (Vicki); Avram, V. (Victoria); Mishra, V. (Vimlesh); Yadav, V. (Vineet); Arora, V. (Vinod); Tyagi, V. (Vivek); Borsella, V. (Vivian); W.J. Willems (Jaap); Hoffman, W.H. (W. H.); Gofton, W.T. (Wade T.); Lackey, W.G. (Wesley G.); Ghent, W. (Wesley); Obremskey, W. (William); Oxner, W. (William); Cross, W.W. (William W.); Murtha, Y.M. (Yvonne M.); Murdoch, Z. (Zoe)

    2017-01-01

    textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled

  7. Fracture fixation in the operative management of hip fractures (FAITH) : an international, multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Nauth, Aaron; Creek, Aaron T.; Zellar, Abby; Lawendy, Abdel Rahman; Dowrick, Adam; Gupta, Ajay; Dadi, Akhil; van Kampen, Albert; Yee, Albert; de Vries, Alexander C.; de Mol van Otterloo, Alexander; Garibaldi, Alisha; Liew, Allen; McIntyre, Allison W.; Prasad, Amal Shankar; Romero, Amanda W.; Rangan, Amar; Oatt, Amber; Sanghavi, Amir; Foley, Amy L.; Karlsten, Anders; Dolenc, Andrea; Bucknill, Andrew; Chia, Andrew; Evans, Andrew; Gong, Andrew; Schmidt, Andrew H.; Marcantonio, Andrew J.; Jennings, Andrew; Ward, Angela; Khanna, Angshuman; Rai, Anil; Smits, Anke B; Horan, Annamarie D.; Brekke, Anne Christine; Flynn, Annette; Duraikannan, Aravin; Stødle, Are; van Vugt, Arie B.; Luther, Arlene; Zurcher, Arthur W.; Jain, Arvind; Amundsen, Asgeir; Moaveni, Ash; Carr, Ashley; Sharma, Ateet; Hill, Austin D.; Trommer, Axel; Rai, B. Sachidananda; Hileman, Barbara; Schreurs, Bart; Verhoeven, Bart A N; Barden, Benjamin B.; Flatøy, Bernhard; Cleffken, Berry I.; Bøe, Berthe; Perey, Bertrand; Hanusch, Birgit C.; Weening, Brad; Fioole, Bram; Rijbroek, Bram; Crist, Brett D.; Halliday, Brett; Peterson, Brett; Mullis, Brian; Richardson, C. Glen; Clark, Callum; Sagebien, Carlos A.; van der Pol, Carmen C.; Bowler, Carol; Humphrey, Catherine A.; Coady, Catherine; Koppert, Cees L.; Coles, Chad; Tannoury, Chadi; DePaolo, Charles J.; Gayton, Chris; Herriott, Chris; Reeves, Christina; Tieszer, Christina; Dobb, Christine; Anderson, Christopher G.; Sage, Claire; Cuento, Claudine; Jones, Clifford B.; Bosman, Coks H.R.; Linehan, Colleen; van der Hart, Cor P.; Henderson, Corey; Lewis, Courtland G.; Davis, Craig A.; Donohue, Craig; Mauffrey, Cyril; Sundaresh, D. C.; Farrell, Dana J.; Whelan, Daniel B.; Horwitz, Daniel; Stinner, Daniel; Viskontas, Darius; Roffey, Darren M.; Alexander, David; Karges, David E.; Hak, David; Johnston, David; Love, David; Wright, David M.; Zamorano, David P.; Goetz, David R.; Sanders, David; Stephen, David; Yen, David; Bardana, Davide; Olakkengil, Davy J.; Lawson, Deanna; Maddock, Deborah; Sietsema, Debra L.; Pourmand, Deeba; Den Hartog, Dennis; Donegan, Derek; Heels-Ansdell, Diane; Nam, Diane; Inman, Dominic; Boyer, Dory; Li, Doug; Gibula, Douglas; Price, Dustin M.; Watson, Dylan J.; Hammerberg, E. Mark; Tan, Edward C T H; de Graaf, Eelco J.R.; Vesterhus, Elise Berg; Roper, Elizabeth; Edwards, Elton; Schemitsch, Emil H.; Hammacher, Eric R.; Henderson, Eric R.; Whatley, Erica; Torres, Erick T.; Vermeulen, Erik G.J.; Finn, Erin; Van Lieshout, Esther M M; Wai, Eugene K.; Bannister, Evan R.; Kile, Evelyn; Theunissen, Evert B.M.; Ritchie, Ewan D.; Khan, Farah; Moola, Farhad; Howells, Fiona; de Nies, Frank; van der Heijden, Frank H.W.M.; de Meulemeester, Frank R.A.J.; Frihagen, Frede; Nilsen, Fredrik; Schmidt, G. Ben; Albers, G. H.Robert; Gudger, Garland K.; Johnson, Garth; Gruen, Gary; Zohman, Gary; Sharma, Gaurav; Wood, Gavin; Tetteroo, Geert W.M.; Hjorthaug, Geir; Jomaas, Geir; Donald, Geoff; Rieser, Geoffrey Ryan; Reardon, Gerald; Slobogean, Gerard P.; Roukema, Gert R.; Visser, Gijs A.; Moatshe, Gilbert; Horner, Gillian; Rose, Glynis; Guyatt, Gordon; Chuter, Graham; Etherington, Greg; Rocca, Gregory J.Della; Ekås, Guri; Dobbin, Gwendolyn; Lemke, H. Michael; Curry, Hamish; Boxma, Han; Gissel, Hannah; Kreder, Hans; Kuiken, Hans; Brom, Hans L.F.; Pape, Hans Christoph; van der Vis, Harm M.; Bedi, Harvinder; Vallier, Heather A.; Brien, Heather; Silva, Heather; Newman, Heike; Viveiros, Helena; van der Hoeven, Henk; Ahn, Henry; Johal, Herman; Rijna, Herman; Stockmann, Heyn; Josaputra, Hong A.; Carlisle, Hope; van der Brand, Igor; Dawson, Imro; Tarkin, Ivan; Wong, Ivan; Parr, J. Andrew; Trenholm, J. Andrew; Goslings, J Carel; Amirault, J. David; Broderick, J. Scott; Snellen, Jaap P.; Zijl, Jacco A.C.; Ahn, Jaimo; Ficke, James; Irrgang, James; Powell, James; Ringler, James R.; Shaer, James; Monica, James T.; Biert, Jan; Bosma, Jan; Brattgjerd, Jan Egil; Frölke, Jan Paul M.; Wille, Jan; Rajakumar, Janakiraman; Walker, Jane E.; Baker, Janell K.; Ertl, Janos P.; De Vries, Jean-Paul P. M.; Gardeniers, Jean W.M.; May, Jedediah; Yach, Jeff; Hidy, Jennifer T.; Westberg, Jerald R.; Hall, Jeremy A.; van Mulken, Jeroen; McBeth, Jessica Cooper; Hoogendoorn, Jochem M; Hoffman, Jodi M.; Cherian, Joe Joseph; Tanksley, John A.; Clarke-Jenssen, John; Adams, John D.; Esterhai, John; Tilzey, John F.; Murnaghan, John; Ketz, John P.; Garfi, John S.; Schwappach, John; Gorczyca, John T.; Wyrick, John; Rydinge, Jonas; Foret, Jonathan L.; Gross, Jonathan M.; Keeve, Jonathan P.; Meijer, Joost; Scheepers, Joris J.G.; Baele, Joseph; O'Neil, Joseph; Cass, Joseph R.; Hsu, Joseph R.; Dumais, Jules; Lee, Julia; Switzer, Julie A.; Agel, Julie; Richards, Justin E.; Langan, Justin W.; Turckan, Kahn; Pecorella, Kaili; Rai, Kamal; Aurang, Kamran; Shively, Karl; van Wessem, Karlijn; Moon, Karyn; Eke, Kate; Erwin, Katie; Milner, Katrine; Ponsen, Kees Jan; Mills, Kelli; Apostle, Kelly; Johnston, Kelly; Trask, Kelly; Strohecker, Kent; Stringfellow, Kenya; Kruse, Kevin K.; Tetsworth, Kevin; Mitchell, Khalis; Browner, Kieran; Hemlock, Kim; Carcary, Kimberly; Jørgen Haug, Knut; Noble, Krista; Robbins, Kristin; Payton, Krystal; Jeray, Kyle J.; Rubino, L. Joseph; Nastoff, Lauren A.; Leffler, Lauren C.; Stassen, Laurents P.S.; O'Malley, Lawrence K.; Specht, Lawrence M.; Thabane, Lehana; Geeraedts, Leo M.G.; Shell, Leslie E.; Anderson, Linda K.; Eickhoff, Linda S.; Lyle, Lindsey; Pilling, Lindsey; Buckingham, Lisa; Cannada, Lisa K.; Wild, Lisa M.; Dulaney-Cripe, Liz; Poelhekke, Lodewijk M.S.J.; Govaert, Lonneke; Ton, Lu; Kottam, Lucksy; Leenen, Luke P.H.; Clipper, Lydia; Jackson, Lyle T.; Hampton, Lynne; de Waal Malefijt, Maarten C.; Simons, Maarten P.; van der Elst, Maarten; Bronkhorst, Maarten W.G.A.; Bhatia, Mahesh; Swiontkowski, Marc; Lobo, Margaret J.; Swinton, Marilyn; Pirpiris, Marinis; Molund, Marius; Gichuru, Mark; Glazebrook, Mark; Harrison, Mark; Jenkins, Mark; MacLeod, Mark; de Vries, Mark R.; Butler, Mark S.; Nousiainen, Markku; van ‘t Riet, Martijne; Tynan, Martin C.; Campo, Martin; Eversdijk, Martin G.; Heetveld, Martin J.; Richardson, Martin; Breslin, Mary; Fan, Mary; Edison, Matt; Napierala, Matthew; Knobe, Matthias; Russ, Matthias; Zomar, Mauri; de Brauw, Maurits; Esser, Max; Hurley, Meghan; Peters, Melissa E.; Lorenzo, Melissa; Li, Mengnai; Archdeacon, Michael; Biddulph, Michael; Charlton, Michael R; McDonald, Michael D.; McKee, Michael D.; Dunbar, Michael; Torchia, Michael E.; Gross, Michael; Hewitt, Michael; Holt, Michael; Prayson, Michael J.; Edwards, Michael J R; Beckish, Michael L.; Brennan, Michael L.; Dohm, Michael P.; Kain, Michael S.H.; Vogt, Michelle; Yu, Michelle; Verhofstad, Michiel H J; Segers, Michiel J M; Segers, Michiel J M; Siroen, Michiel P.C.; Reed, Mike; Vicente, Milena R.; Bruijninckx, Milko M.M.; Trivedi, Mittal; Bhandari, Mohit; Moore, Molly M.; Kunz, Monica; Smedsrud, Morten; Palla, Naveen; Jain, Neeraj; Out, Nico J.M.; Simunovic, Nicole; Simunovic, Nicole; Schep, Niels W. L.; Müller, Oliver; Guicherit, Onno R.; Van Waes, Oscar J.F.; Wang, Otis; Doornebosch, Pascal G.; Seuffert, Patricia; Hesketh, Patrick J.; Weinrauch, Patrick; Duffy, Paul; Keller, Paul; Lafferty, Paul M.; Pincus, Paul; Tornetta, Paul; Zalzal, Paul; McKay, Paula; Cole, Peter A.; de Rooij, Peter D.; Hull, Peter; Go, Peter M.N.Y.M.; Patka, Peter; Siska, Peter; Weingarten, Peter; Kregor, Philip; Stahel, Philip; Stull, Philip; Wittich, Philippe; de Rijcke, Piet A.R.; Oprel, Pim; Devereaux, P. J.; Zhou, Qi; Lee Murphy, R.; Alosky, Rachel; Clarkson, Rachel; Moon, Raely; Logishetty, Rajanikanth; Nanda, Rajesh; Sullivan, Raymond J.; Snider, Rebecca G.; Buckley, Richard E.; Iorio, Richard; Farrugia, Richard J.; Jenkinson, Richard; Laughlin, Richard; Groenendijk, Richard P R; Gurich, Richard W.; Worman, Ripley; Silvis, Rob; Haverlag, Robert; Teasdall, Robert J.; Korley, Robert; McCormack, Robert; Probe, Robert; Cantu, Robert V.; Huff, Roger B.; Simmermacher, Rogier K J; Peters, Rolf; Pfeifer, Roman; Liem, Ronald; Wessel, Ronald N.; Verhagen, Ronald; Vuylsteke, Ronald J C L M; Leighton, Ross; McKercher, Ross; Poolman, Rudolf W; Miller, Russell; Bicknell, Ryan; Finnan, Ryan; Khan, Ryan M.; Mehta, Samir; Vang, Sandy; Singh, Sanjay; Anand, Sanjeev; Anderson, Sarah A.; Dawson, Sarah A.; Marston, Scott B.; Porter, Scott E.; Watson, Scott T.; Festen, Sebastiaan; Lieberman, Shane; Puloski, Shannon; Bielby, Shea A.; Sprague, Sheila; Hess, Shelley; MacDonald, Shelley; Evans, Simone; Bzovsky, Sofia; Hasselund, Sondre; Lewis, Sophie; Ugland, Stein; Caminiti, Stephanie; Tanner, Stephanie L.; Zielinski, Stephanie M.; Shepard, Stephanie; Sems, Stephen A.; Walter, Stephen D.; Doig, Stephen; Finley, Stephen H.; Kates, Stephen; Lindenbaum, Stephen; Kingwell, Stephen P.; Csongvay, Steve; Papp, Steve; Buijk, Steven E.; Rhemrev, Steven J.; Hollenbeck, Steven M.; van Gaalen, Steven M.; Yang, Steven; Weinerman, Stuart; Lambert, Sue; Liew, Susan; Meylaerts, Sven A.G.; Blokhuis, Taco J.; de Vries Reilingh, Tammo S.; Lona, Tarjei; Scott, Taryn; Swenson, Teresa K.; Endres, Terrence J.; Axelrod, Terry; van Egmond, Teun; Pace, Thomas B.; Kibsgård, Thomas; Schaller, Thomas M.; Ly, Thuan V.; Miller, Timothy J.; Weber, Timothy; Le, Toan; Oliver, Todd M.; Karsten, Tom M.; Borch, Tor; Hoseth, Tor Magne; Nicolaisen, Tor; Ianssen, Torben; Rutherford, Tori; Nanney, Tracy; Gervais, Trevor; Stone, Trevor; Schrickel, Tyson; Scrabeck, Tyson; Ganguly, Utsav; Naumetz, V.; Frizzell, Valda; Wadey, Veronica; Jones, Vicki; Avram, Victoria; Mishra, Vimlesh; Yadav, Vineet; Arora, Vinod; Tyagi, Vivek; Borsella, Vivian; Willems, W. Jaap; Hoffman, W. H.; Gofton, Wade T.; Lackey, Wesley G.; Ghent, Wesley; Obremskey, William; Oxner, William; Cross, William W.; Murtha, Yvonne M.; Murdoch, Zoe

    2017-01-01

    Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we

  8. Evaluation of the preliminary auditory profile test battery in an international multi-centre study

    NARCIS (Netherlands)

    van Esch, T.E.M.; Kollmeier, B.; Vormann, M.; Lijzenga, J.; Houtgast, T.; Hallgren, M.; Larsby, B.; Athalye, S.P.; Lutman, M.E.; Dreschler, W.A.

    2013-01-01

    Objective: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported

  9. Evaluation of the preliminary auditory profile test battery in an international multi-centre study

    NARCIS (Netherlands)

    van Esch, Thamar E. M.; Kollmeier, Birger; Vormann, Matthias; Lyzenga, Johannes; Houtgast, Tammo; Hällgren, Mathias; Larsby, Birgitta; Athalye, Sheetal P.; Lutman, Mark E.; Dreschler, Wouter A.

    2013-01-01

    This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported disability

  10. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

    OpenAIRE

    Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); Kampen, A.; Yee, A. (Albert); Vries, Alexander; de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar)

    2017-01-01

    textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a...

  11. i-gel™ supraglottic airway in clinical practice: a prospective observational multicentre study

    OpenAIRE

    Theiler, L.; Gutzmann, M.; Kleine-Brueggeney, M.; Urwyler, N.; Kaempfen, B.; Greif, R.

    2017-01-01

    Background The i-gel™ supraglottic airway device has been studied in randomized controlled studies, but it has not been evaluated in a large prospective patient cohort. Therefore, we performed this prospective multicentre observational study to evaluate success rates, airway leak pressure, risk factors for i-gel failure, and adverse events. Methods With Ethics Committee approval and waiver of patients' consent, data about anaesthesia providers, patient characteristics, and the performance of ...

  12. Necrotizing soft tissue infections - a multicentre, prospective observational study (INFECT)

    NARCIS (Netherlands)

    Madsen, M.B.; Skrede, S.; Bruun, T.; Arnell, P.; Rosén, A.; Nekludov, M.; Karlsson, Y.; Bergey, F.; Saccenti, E.; Martins dos Santos, V.A.P.; Perner, A.; Norrby-Teglund, A.; Hyldegaard, O.

    2018-01-01

    Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating

  13. Necrotizing soft tissue infections - a multicentre, prospective observational study (INFECT)

    DEFF Research Database (Denmark)

    Madsen, M. B.; Skrede, S.; Bruun, T.

    2018-01-01

    Indicator for Necrotizing Fasciitis (LRINEC) score and 90-day mortality; 90-day mortality in patients with and without acute kidney injury (AKI) and LRINEC score of six and above or below six; and association between affected body part at arrival and microbiological findings. Exploratory outcomes include......Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating...... univariate analyses of baseline characteristics associations with 90-day mortality. The statistical analyses will be conducted in accordance with the predefined statistical analysis plan. Conclusion: Necrotizing soft tissue infections result in severe morbidity and mortality. The INFECT study...

  14. Results from a multicentre international registry of familial Mediterranean fever

    DEFF Research Database (Denmark)

    Ozen, Seza; Demirkaya, Erkan; Amaryan, Gayane

    2014-01-01

    BACKGROUND AND AIM: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. We analyse the impact of ethnic, environmental and genetic factors on the severity of disease presentation in a large international registry. METHODS: Demographic, genetic....../year and more frequent arthritis, pericarditis, chest pain, abdominal pain and vomiting compared to the other two groups. Multivariate analysis showed that the variables independently associated with severity of disease presentation were country of residence, presence of M694V mutation and positive family...

  15. Prescribing patterns in dementia: a multicentre observational study in a German network of CAM physicians

    Directory of Open Access Journals (Sweden)

    Vollmar Horst C

    2011-08-01

    Full Text Available Abstract Background Dementia is a major and increasing health problem worldwide. This study aims to investigate dementia treatment strategies among physicians specialised in complementary and alternative medicine (CAM by analysing prescribing patterns and comparing them to current treatment guidelines in Germany. Methods Twenty-two primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients had at least one diagnosis of dementia according to the 10th revision of the International Classification of Diseases during the study period. Multiple logistic regression was used to determine factors associated with a prescription of any anti-dementia drug including Ginkgo biloba. Results During the 5-year study period (2004-2008, 577 patients with dementia were included (median age: 81 years (IQR: 74-87; 69% female. Dementia was classified as unspecified dementia (57.2%, vascular dementia (25.1%, dementia in Alzheimer's disease (10.4%, and dementia in Parkinson's disease (7.3%. The prevalence of anti-dementia drugs was 25.6%. The phytopharmaceutical Ginkgo biloba was the most frequently prescribed anti-dementia drug overall (67.6% of all followed by cholinesterase inhibitors (17.6%. The adjusted odds ratio (AOR for receiving any anti-dementia drug was greater than 1 for neurologists (AOR = 2.34; CI: 1.59-3.47, the diagnosis of Alzheimer's disease (AOR = 3.28; CI: 1.96-5.50, neuroleptic therapy (AOR = 1.87; CI: 1.22-2.88, co-morbidities hypertension (AOR = 2.03; CI: 1.41-2.90, and heart failure (AOR = 4.85; CI: 3.42-6.88. The chance for a prescription of any anti-dementia drug decreased with the diagnosis of vascular dementia (AOR = 0.64; CI: 0.43-0.95 and diabetes mellitus (AOR = 0.55; CI: 0.36-0.86. The prescription of Ginkgo biloba was associated with sex (female: AOR = 0.41; CI: 0.19-0.89, patient age (AOR = 1

  16. Bulletin of International Simultaneous Observations

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The publication of the Bulletin of International Simultaneous Observations, began July 1, 1875, with daily maps added in 1877. It was published for distribution...

  17. Managing acute alcohol withdrawal with Homoeopathy: A prospective, observational, multicentre exploratory study

    Directory of Open Access Journals (Sweden)

    Debadatta Nayak

    2014-01-01

    Full Text Available Background: Alcohol dependence is a common social problem which may be associated with other risk factors and co-morbidities. Abrupt cessation of alcohol intake may provoke an acute alcohol withdrawal phase with varying degrees of signs and symptoms. In conventional medical system, specific pharmacological interventions are used for management of Acute Alcohol Withdrawal (AAW. There exists a need to explore safe and holistic treatment of AAW. The present work reports the results of a prospective, observational, exploratory, multicentre trial (2008-2011 to assess the role of Homoeopathy in AAW. Materials and Methods: Individualised Homoeopathy was given to 112 patients reporting with AAW. The clinical assessment was done for 05 days using Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar. Post-withdrawal phase, quality of life of patients was assessed at end of 01 st , 03 rd and 06 th month using World Health Organisation quality of life (WHOQOL- BREF. Results and Analysis: There was a significant decrease in CIWA-Ar mean scores and increase in quality of life score (P < 0.001. The most common remedies used were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica and Pulsatilla. Conclusion: The results of current observational pilot study suggest the promising use of Homoeopathy in the management of acute alcohol withdrawal. Further studies with large sample size and rigorous design are warranted.

  18. Evaluation of the preliminary auditory profile test battery in an international multi-centre study.

    Science.gov (United States)

    van Esch, Thamar E M; Kollmeier, Birger; Vormann, Matthias; Lyzenga, Johannes; Houtgast, Tammo; Hällgren, Mathias; Larsby, Birgitta; Athalye, Sheetal P; Lutman, Mark E; Dreschler, Wouter A

    2013-05-01

    This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported disability and handicap, and cognition. Clinical applicability and comparability across different centres are investigated. Headphone tests were conducted in five centres divided over four countries. Effects of test-retest, ear, and centre were investigated. Results for normally-hearing (NH) and hearing-impaired (HI) listeners are presented. Thirty NH listeners aged 19-39 years, and 72 HI listeners aged 22-91 years with a broad range of hearing losses were included. Test-retest reliability was generally good and there were very few right/left ear effects. Results of all tests were comparable across centres for NH listeners after baseline correction to account for necessary differences between test materials. For HI listeners, results were comparable across centres for the language-independent tests. The auditory profile forms a clinical test battery that is applicable in four different languages. Even after baseline correction, differences between test materials have to be taken into account when interpreting results of language-dependent tests in HI listeners.

  19. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study.

    NARCIS (Netherlands)

    Boogaard, M.W. van den; Pickkers, P.; Slooter, A.J.; Kuiper, M.A.; Spronk, P.E.; Voort, P.H. van der; Hoeven, J.G. van der; Donders, R.; Achterberg, T. van; Schoonhoven, L.

    2012-01-01

    OBJECTIVES: To develop and validate a delirium prediction model for adult intensive care patients and determine its additional value compared with prediction by caregivers. DESIGN: Observational multicentre study. SETTING: Five intensive care units in the Netherlands (two university hospitals and

  20. Homeopathy in chronic sinusitis: a prospective multi-centric observational study.

    Science.gov (United States)

    Nayak, Chaturbhuja; Singh, Vikram; Singh, V P; Oberai, Praveen; Roja, Varanasi; Shitanshu, Shashi Shekhar; Sinha, M N; Deewan, Deepti; Lakhera, B C; Ramteke, Sunil; Kaushik, Subhash; Sarkar, Sarabjit; Mandal, N R; Mohanan, P G; Singh, J R; Biswas, Sabyasachi; Mathew, Georgekutty

    2012-04-01

    The primary objective was to ascertain the therapeutic usefulness of homeopathic medicine in the management of chronic sinusitis (CS). Multicentre observational study at Institutes and Units of the Central Council for Research in Homoeopathy, India. Symptoms were assessed using the chronic sinusitis assessment score (CSAS). 17 pre-defined homeopathic medicines were shortlisted for prescription on the basis of repertorisation for the pathological symptoms of CS. Regimes and adjustment of regimes in the event of a change of symptoms were pre-defined. The follow-up period was for 6 months. Statistical analysis was done using SPSS version 16. 628 patients suffering from CS confirmed on X-ray were enrolled from eight Institutes and Units of the Central Council for Research in Homoeopathy. All 550 patients with at least one follow-up assessment were analyzed. There was a statistically significant reduction in CSAS (P = 0.0001, Friedman test) after 3 and 6 months of treatment. Radiological appearances also improved. A total of 13 out of 17 pre-defined medicines were prescribed in 550 patients, Sil. (55.2% of 210), Calc. (62.5% of 98), Lyc. (69% of 55), Phos. (66.7% of 45) and Kali iod. (65% of 40) were found to be most useful having marked improvement. 4/17 medicines were never prescribed. No complications were observed during treatment. Homeopathic treatment may be effective for CS patients. Controlled trials are required for further validation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: A multicentre observational study.

    Science.gov (United States)

    Deloge, Elsa; Amour, Julien; Provenchère, Sophie; Rozec, Bertrand; Scherrer, Bruno; Ouattara, Alexandre

    2017-05-01

    Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. A multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases. Four tertiary care teaching hospitals (Haut-Lévêque Hospital in Bordeaux, Pitié-Salpêtrière Hospital and Bichat-Claude Bernard Hospital in Paris, and Laennec Hospital in Nantes). We included data of 2496 isolated on-pump CABG surgery patients who received either aprotinin between November 2003 and May 2008 (n = 1267) or TXA between November 2007 and November 2013 (n = 1229). The primary outcome was total blood loss within 24 h after operation. Secondary outcomes were transfusion of blood products, reoperation for bleeding, renal replacement therapy, ICU length of stay and in-hospital mortality. Adjusted mean (SEM) 24-h blood loss after surgery [483 (11) vs. 634 (11) ml, P < 0.0001] and the proportion of patients requiring intraoperative blood product transfusion (32.7 vs. 46.5%, P = 0.01) were lower in aprotinin-treated patients. No difference was observed with regard to reoperations for bleeding, renal replacement therapy and in-hospital mortality. However, patients receiving aprotinin had a significantly shorter adjusted ICU length of stay. In patients undergoing isolated CABG, aprotinin was more effective than TXA in reducing postoperative blood loss, and no safety concerns were identified. The benefits of aprotinin should be considered when evaluating the risk of major blood loss and transfusion in patients scheduled for isolated CABG surgery.

  2. The effectiveness of 2-implant overdentures - a pragmatic international multicentre study.

    LENUS (Irish Health Repository)

    Rashid, F

    2011-03-01

    The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a \\'real world\\' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post-treatment, they rated their satisfaction with their mandibular prostheses on 100-mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6-month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.

  3. Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn's disease: a multicentre observational study.

    Science.gov (United States)

    de Barcelos, I F; Kotze, P G; Spinelli, A; Suzuki, Y; Teixeira, F V; de Albuquerque, I C; Saad-Hossne, R; da Silva Kotze, L M; Yamamoto, T

    2017-01-01

    Early endoscopic recurrence is frequently observed in patients following resection for Crohn's disease (CD). However, factors affecting the incidence of an early postoperative endoscopic recurrence (EPER) have not been fully determined. The aim of this study was to evaluate risk factors for EPER after ileocolonic resection for CD. This was a retrospective, international multicentre study, in which 127 patients with a first ileocolonoscopy conducted between 6 and 12 months after ileocolonic resection for CD were included. Endoscopic recurrence was defined as a Rutgeerts score of ≥ i2. The following variables were investigated as potential risk factors for EPER: gender, age at surgery, location and behaviour of CD, smoking, concomitant perianal lesions, preoperative use of steroids, immunomodulators and biologics, previous resection, blood transfusion, surgical procedure (open vs laparoscopic approach), length of resected bowel, type of anastomosis (side-to-side vs end-to-end), postoperative complications, granuloma and postoperative biological therapy. Variables related to the patient, disease and surgical procedure were investigated as potential risk factors for EPER, with univariate and multivariate (logistic regression) analyses. 43/127 (34%) patients had EPER at the time of the first postoperative ileocolonoscopy. In univariate analysis, only preoperative steroid use was significantly associated with a higher rate of EPER [21/45 patients (47%) on steroids and 22/82 patients (27%) without steroids (P = 0.04)]. In multivariate analysis, only preoperative steroid use was a significant independent risk factor for EPER (odds ratio 3.28, 95% confidence interval: 1.30-8.28; P = 0.01). This study found that only preoperative steroid use was a significant risk factor for EPER after ileocolonic resection for CD. Prospective studies are necessary to evaluate precisely the impact of perioperative medications on EPER rates. Colorectal Disease © 2016 The Association

  4. [Thrombosis during thrombopoietin receptor agonist treatment for immune thrombocytopenia. A French multicentric observational study].

    Science.gov (United States)

    Weber, E; Moulis, G; Mahévas, M; Guy, C; Lioger, B; Durieu, I; Hunault, M; Ramanantsoa, M; Royer, B; Default, A; Pérault-Pochat, M-C; Moachon, L; Bernard, N; Bardy, G; Jonville-Bera, A-P; Geniaux, H; Godeau, B; Cathébras, P

    2017-03-01

    Thrombopoietin-receptor agonists (TPO-RA) are marketed for immune thrombocytopenia (ITP). They have been associated to thrombosis occurrence in randomized controlled trials. However, the characteristics of these thromboses in the real-life practice as well as their management are poorly known. The objectives of this study were to determine the risk factors, circumstances and management of thrombosis occurring during exposure to TPO-RA in ITP. We carried out a multicentre retrospective study in France. Moreover, all cases reported to the French pharmacovigilance system were also analyzed. Overall, 41 thrombosis (13 arterial) in 36 ITP patients (14 males and 22 females, mean age: 59 years) were recorded between January 2009 and October 2015. Twenty patients were treated with romiplostim, 15 with eltrombopag and 1 was treated by both medications. Thirty-three (92%) of the patients had another risk factor for thrombosis. Ten (28%) had an history of thrombosis and 13 (36%) received immunoglobulin in the month preceding the thrombotic event. Three had antiphospholipid antibodies; congenital low-risk thrombophilia was found in 4 cases; 18 patients (50%) were splenectomized. Median platelet count at the time of thrombosis was 172G/l (1-1049G/l). In 22 patients (56%), a good prognosis was associated with the thrombosis and was not linked with TPO-RA withdrawal. Bleeding events occurred in 14% of the patients treated with antiplatelet or anticoagulant drug, including 5% serious events (1 death of intracranial haemorrhage, 1 death of haemorrhagic shock). The thrombotic risk may be carefully assessed before starting TPO-RA in ITP patients. The impact of antiphospholipid antibodies and of congenital thrombophilia remains to be defined. Thrombosis evolution seems independent of TPO-RA management. Bleeding manifestations seem rare. Poor prognosis was mainly due to ischemic sequelae. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI

  5. Cost-of-illness of epilepsy in Italy. Data from a multicentre observational study (Episcreen).

    Science.gov (United States)

    Berto, P; Tinuper, P; Viaggi, S

    2000-02-01

    To investigate the impact of epilepsy in Italy on healthcare resources, producing an average cost per patient per year of follow-up. The Episcreen Project is a multicentre longitudinal Italian observational study; its methodology, organisational network and case report form have been reported in detail elsewhere. Using a subset of patients with epilepsy from this project, we conducted a retrospective cost-of-illness analysis based on clinical records. The analysis was performed from the societal (community) perspective, including both direct and indirect costs. Hospital admissions, day-hospital visits, specialist visits, instrumental examinations, drugs and productivity losses because of visits and hospitalisation were analysed. Each cost variable was valued in 1996 Italian liras (L) using published national tariffs (except for drugs for which published prices were used). A sensitivity analysis was conducted on indirect costs to test the robustness of the assumption that 1 working day lost for each day hospital visit would produce a change of 0.3% in the weight of indirect costs. Patients analysed in this study were registered in the Episcreen database as at 21 November 1996. They were diagnosed with epilepsy at the last visit, had at least 1 follow-up visit (i.e. at least 1 visit after the enrolment visit), and had at least 12 months of follow-up. The average cost per patient per year was L2,726,116 ($US1767). The average cost per patient was higher for children than for adults [L3,629,997 ($US2353) and L2,362,134 ($US1531), respectively), and for newly diagnosed patients for whom the first diagnosis of epilepsy was addressed at the first Episcreen visit [adults: old referrals L1,304,353 ($US845), new referrals L6,901,374 ($US4473); children: old referrals L2,810,504 ($US1822), new referrals L7,814,400 ($US5065)]. Direct costs represented 87.6% of total costs. The major cost driver was hospitalisation (63.7%), followed by drugs (10.5%), day-hospital visits (4

  6. An international multicentre study on the allergenic activity of air-oxidized R-limonene

    DEFF Research Database (Denmark)

    Bråred Christensson, Johanna; Andersen, Klaus; Bruze, Magnus

    2013-01-01

    Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies, giving 2-3...

  7. Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study

    Science.gov (United States)

    Filion, Kristian B; Platt, Robert W; Dahl, Matthew; Dormuth, Colin R; Clemens, Kristin K; Durand, Madeleine; Juurlink, David N; Targownik, Laura E; Turin, Tanvir C; Paterson, J Michael; Ernst, Pierre

    2016-01-01

    Objective To determine whether the use of incretin based drugs compared with sulfonylureas is associated with an increased risk of incident pancreatic cancer in people with type 2 diabetes. Design Population based cohort. Setting Large, international, multicentre study combining the health records from six participating sites in Canada, the United States, and the United Kingdom. Participants A cohort of 972 384 patients initiating antidiabetic drugs between 1 January 2007 and 30 June 2013, with follow-up until 30 June 2014. Main outcome measures Within each cohort we conducted nested case-control analyses, where incident cases of pancreatic cancer were matched with up to 20 controls on sex, age, cohort entry date, duration of treated diabetes, and duration of follow-up. Hazard ratios and 95% confidence intervals for incident pancreatic cancer were estimated, comparing use of incretin based drugs with use of sulfonylureas, with drug use lagged by one year for latency purposes. Secondary analyses assessed whether the risk varied by class (dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists) or by duration of use (cumulative duration of use and time since treatment initiation). Site specific hazard ratios were pooled using random effects models. Results During 2 024 441 person years of follow-up (median follow-up ranging from 1.3 to 2.8 years; maximum 8 years), 1221 patients were newly diagnosed as having pancreatic cancer (incidence rate 0.60 per 1000 person years). Compared with sulfonylureas, incretin based drugs were not associated with an increased risk of pancreatic cancer (pooled adjusted hazard ratio 1.02, 95% confidence interval 0.84 to 1.23). Similarly, the risk did not vary by class and evidence of a duration-response relation was lacking. Conclusions In this large, population based study the use of incretin based drugs was not associated with an increased risk of pancreatic cancer compared with sulfonylureas

  8. Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies.

    Science.gov (United States)

    O'Keeffe, Linda M; Kearney, Patricia M; McCarthy, Fergus P; Khashan, Ali S; Greene, Richard A; North, Robyn A; Poston, Lucilla; McCowan, Lesley M E; Baker, Philip N; Dekker, Gus A; Walker, James J; Taylor, Rennae; Kenny, Louise C

    2015-07-06

    To compare the prevalence and predictors of alcohol use in multiple cohorts. Cross-cohort comparison of retrospective and prospective studies. Population-based studies in Ireland, the UK, Australia and New Zealand. 17,244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Assessment Monitoring System Ireland (PRAMS Ireland)), and one multicentre prospective international cohort, Screening for Pregnancy Endpoints (SCOPE) study. Prevalence of alcohol use pre-pregnancy and during pregnancy across cohorts. Sociodemographic factors associated with alcohol consumption in each cohort. Alcohol consumption during pregnancy in Ireland ranged from 20% in GUI to 80% in SCOPE, and from 40% to 80% in Australia, New Zealand and the UK. Levels of exposure also varied substantially among drinkers in each cohort ranging from 70% consuming more than 1-2 units/week in the first trimester in SCOPE Ireland, to 46% and 15% in the retrospective studies. Smoking during pregnancy was the most consistent predictor of gestational alcohol use in all three cohorts, and smokers were 17% more likely to drink during pregnancy in SCOPE, relative risk (RR)=1.17 (95% CI 1.12 to 1.22), 50% more likely to drink during pregnancy in GUI, RR=1.50 (95% CI 1.36 to 1.65), and 42% more likely to drink in PRAMS, RR=1.42 (95% CI 1.18 to 1.70). Our data suggest that alcohol use during pregnancy is prevalent and socially pervasive in the UK, Ireland, New Zealand and Australia. New policy and interventions are required to reduce alcohol prevalence both prior to and during pregnancy. Further research on biological markers and conventions for measuring alcohol use in pregnancy is required to improve the validity and reliability of prevalence estimates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Multicentre observational study of the natural history of left-sided acute diverticulitis.

    Science.gov (United States)

    Binda, G A; Arezzo, A; Serventi, A; Bonelli, L; Facchini, M; Prandi, M; Carraro, P S; Reitano, M C; Clerico, G; Garibotto, L; Aloesio, R; Sganzaroli, A; Zanoni, M; Zanandrea, G; Pellegrini, F; Mancini, S; Amato, A; Barisone, P; Bottini, C; Altomare, D F; Milito, G

    2012-02-01

    The natural history of acute diverticulitis (AD) is still unclear. This study investigated the recurrence rate, and the risks of emergency surgery, associated stoma and death following initial medical or surgical treatment of AD. The Italian Study Group on Complicated Diverticulosis conducted a 4-year multicentre retrospective and prospective database analysis of patients admitted to hospital for medical or surgical treatment of AD and then followed for a minimum of 9 years. The persistence of symptoms, recurrent episodes of AD, new hospital admissions, medical or surgical treatment, and their outcome were recorded during follow-up. Of 1046 patients enrolled at 17 centres, 743 were eligible for the study (407 recruited retrospectively and 336 prospectively); 242 patients (32·6 per cent) underwent emergency surgery at accrual. After a mean follow-up of 10·7 years, rates of recurrence (17·2 versus 5·8 per cent; P recurrence. There was no association between any of the investigated parameters and subsequent emergency surgery. The risk of stoma formation was below 1 per cent and disease-related mortality was zero in this group. The disease-related mortality rate was 0·6 per cent among patients who had surgical treatment. Long-term risks of recurrent AD or emergency surgery were limited and colectomy did not fully protect against recurrence. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  10. A comparison of functional outcome in patients sustaining major trauma: a multicentre, prospective, international study.

    Directory of Open Access Journals (Sweden)

    Timothy H Rainer

    Full Text Available OBJECTIVES: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. SUMMARY BACKGROUND DATA: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR. METHODS: Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE functional outcome and risk-adjusted Short-Form 12 (SF-12 health status at 6 and 12 months after injury. RESULTS: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17, and at 12 months was 0.83 (95% CI: 0.60, 1.12. Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6 and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4 compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8 or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5. CONCLUSION: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

  11. A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills.

    Science.gov (United States)

    Flowerdew, Lynsey; Gaunt, Arran; Spedding, Jessica; Bhargava, Ajay; Brown, Ruth; Vincent, Charles; Woloshynowych, Maria

    2013-06-01

    To evaluate a new tool to assess emergency physicians' non-technical skills. This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error. 96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's ρ for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (ptechnical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.

  12. Metabolic syndrome and social deprivation: results of a French observational multicentre survey.

    Science.gov (United States)

    Blanquet, Marie; Debost-Legrand, Anne; Gerbaud, Laurent; de La Celle, Catherine; Brigand, Alain; Mioche, Laurence; Sass, Catherine; Hazart, Juliette; Aw, Alhassane

    2016-02-01

    Deprivation, a process that prevents people to assume their social responsibilities, is a main cause of inequalities in health. Metabolic syndrome has a growing prevalence in France. To assess the association between deprivation and the metabolic syndrome and to identify the most relevant waist circumference cut-off point. A cross-sectional multicentre study was carried out of data extracted from health examination centres of two French areas in 2008. The harmonized definition of the metabolic syndrome contained five criteria with two thresholds for waist circumference. Deprivation was calculated by the Evaluation of Deprivation and Inequalities in Health Examination Centres score (EPICES). Eligible patients were at least 16 years old. The methodology of time to event analysis was used on patients having two criteria to identify the most relevant waist circumference threshold, taking waist circumference as event and computing it as a continuous variable. The median corresponded to the waist circumference threshold for which half of the patients switched from two to three criteria and so metabolic syndrome. Of the 32374 persons included in the study, 39.4% were socially deprived. The prevalence of the metabolic syndrome varied from 16.3% to 22.2% in the overall sample depending on the published waist circumference thresholds chosen. Deprivation was an independent factor associated with the metabolic syndrome. The cut-off point for waist circumference was between 95 and 99 cm for men and 88 and 97 cm for women. Deprivation is associated with a higher prevalence of the metabolic syndrome. The most relevant threshold for waist circumference could be 94 cm for men and 88 cm for women. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Assessment of data quality in an international multi-centre randomised trial of coronary artery surgery

    Directory of Open Access Journals (Sweden)

    Bochenek Andrzej

    2011-09-01

    Full Text Available Abstract Background ART is a multi-centre randomised trial of cardiac surgery which provided a unique opportunity to evaluate the data from a large number of centres from a variety of countries. We attempted to assess data quality, including recruitment rates, timeliness and completeness of the data obtained from the centres in different socio-economic strata. Methods The analysis was based on the 2-page CRF completed at the 6 week follow-up. CRF pages were categorised into "clean" (no edit query and "dirty" (any incomplete, inconsistent or illegible data. The timelines were assessed on the basis of the time interval from the visit and receipt of complete CRF. Data quality was defined as the number of data queries (in percent and time delay (in days between visit and receipt of correct data. Analyses were stratified according to the World Bank definitions into: "Developing" countries (Poland, Brazil and India and "Developed" (Italy, UK, Austria and Australia. Results There were 18 centres in the "Developed" and 10 centres in the "Developing" countries. The rate of enrolment did not differ significantly by economic level ("Developing":4.1 persons/month, "Developed":3.7 persons/month. The time interval for the receipt of data was longer for "Developing" countries (median:37 days compared to "Developed" ones (median:11 days (p Conclusions In this study we showed that data quality was comparable between centres from "Developed" and "Developing" countries. Data was received in a less timely fashion from Developing countries and appropriate systems should be instigated to minimize any delays. Close attention should be paid to the training of centres and to the central management of data quality. Trial registration ISRCTN46552265

  14. International astronomical remote present observation on IRC.

    Science.gov (United States)

    Ji, Kaifan; Cao, Wenda; Song, Qian

    On March 6 - 7, 1997, an international astronomical remote present observation (RPO) was made on Internet Relay Chat (IRC) for the first time. Seven groups in four countries, China, United States, Canada and Great Britain, used the 1 meter telescope of Yunnan observatory together by the way of remote present observation. Within minutes, images were "On-line" by FTP, and every one was able to get them by anonymous ftp and discuss them on IRC from different widely separated sites.

  15. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial.

    Science.gov (United States)

    1975-07-12

    The efficacy of low-dose heparin in preventing fatal postoperative pulmonary embolism has been investigated in a multicentre prospective randomised trial. 4121 patients over the age of forty years undergoing a variety of elective major surgical procedures were included in the trial; 2076 of these were in the control group and 2045 patients received heparin. The two groups were well matched for age, sex, weight, blood-group, and other factors which could predispose to the development of venous thromboembolism. 180 (4-4 %) patients died during the postoperative period, 100 in the control and 80 in the heparin group: 72% of deaths in the control and 66% in the heparin group had necropsy examination. 16 patients in the control group and 2 in the heparin group were found at necropsy to have died due to acute massive pulmonary embolism (P smaller than 0-005). In addition, emboli found at necropsy in 6 patients in the control group and 3 in the heparin group were considered either contributory to death or an incidental finding since death in these patients was attributed to other causes. Taking all pulmonary emboli together, the findings were again significant (P smaller than 0-005). Of 1292 patients in whom the 125-I-fibrinogen test was performed to detect deep-vein thrombosis (D.V.T.) 667 were in the control group and 625 in the heparin group. The frequency of isotopic D.V.T. was reduced from 24-6% in the control group 7-7% in the heparin group (P smaller 0-005). In 30 patients D.V.T. was detected at necropsy; 24 in the control and 6 in the heparin group (P smaller 0-005). 32 patients in the control group and 11 in the heparin group developed clinically diagnosed D.V.T. which was confirmed by venography (P smaller than 0-005). In addition, 24 patients in the control and 8 in the heparin group were treated for clinically suspected pulmonary emoblism. The difference in the number of patients requiring treatment for D.V.T. and/or pulmonary embolism in the two groups was

  16. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Galicia].

    Science.gov (United States)

    Pato-Pato, A; Midaglia, L; Costa-Arpin, E; Rodriguez-Regal, A; Puy-Nunez, A; Rodriguez-Rodriguez, M; Lopez-Real, A; Llaneza-Gonzalez, M A; Garcia-Estevez, D A; Moreno-Carretero, M J; Escriche-Jaime, D; Aguado-Valcarcel, M L; Munoz, D; Prieto, J M; Lorenzo-Gonzalez, J R; Amigo-Jorrin, M C

    2016-09-05

    The effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) have been proven in clinical trials. Yet, due to their limitations, it is important to know how it behaves under everyday clinical practice conditions. Hence, the aim of this study is to evaluate the effectiveness and safety of fingolimod after 12 months' usage in clinical practice in Galicia. We conducted a retrospective, multi-centre study (n = 8) of patients with RRMS who were treated with one or more doses of fingolimod, 0.5 mg/day. Effectiveness was assessed -annualised relapse rate (ARR), changes in the score on the Expanded Disability Status Scale (EDSS), percentage of patients free from relapses, free from progression of disability and free from activity in resonance- for the total number of patients and according to previous treatment. Safety was assessed based on the percentage of patients who withdrew and presented adverse side effects. After 12 months' use, fingolimod reduced the ARR by 87% (1.7 to 0.23; p < 0.0001) and, consequently, 81% of patients were free from relapses. The score was reduced by 9%. In all, 91% of patients were free from progression of disability and 72% were free from resonance activity. No signs of disease activity were found in 43% of the patients. Most of the benefits of fingolimod differed depending on previous treatment. About a third of the patients reported adverse side effects, but only 2% of them withdrew for this reason. In clinical practice, most of the results on the effectiveness of the clinical trials conducted with fingolimod were observed during the first 12 months of treatment. A better safety profile was observed than that reported in the clinical trials.

  17. Safety of transcranial Doppler 'bubble study' for identification of right to left shunts: an international multicentre study.

    Science.gov (United States)

    Tsivgoulis, Georgios; Stamboulis, Elefterios; Sharma, Vijay K; Heliopoulos, Ioannis; Voumvourakis, Konstantinos; Teoh, Hock Luen; Vadikolias, Konstantinos; Triantafyllou, Nikos; Chan, Bernard P L; Vasdekis, Spyros N; Piperidou, Charitomeni

    2011-11-01

    A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of TCD-BS. 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCD-BS within 1 week of ictus. RLS was identified in 151 cases (30%). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67%). It was positive in 99 patients (98%). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0% (95% CI by the adjusted Wald 0-0.6%). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n=23), tetralogy of Fallot (n=1), intracardiac thrombus (n=2), ventricular septal defect (n=3) and atrial myxoma (n=1). TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.

  18. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation

    DEFF Research Database (Denmark)

    Wild, J B; Stather, P W; Biancari, F

    2013-01-01

    OBJECTIVES: Currently most abdominal aortic aneurysm screening programmes discharge patients with aortic diameter of less than 30 mm. However, sub-aneurysmal aortic dilatation (25 mm-29 mm) does not represent a normal aortic diameter. This observational study aimed to determine the outcomes of pa...

  19. Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases

    OpenAIRE

    Martín-Hernández, Elena; Aldámiz-Echevarría, Luis; Castejón-Ponce, Esperanza; Pedrón-Giner, Consuelo; Couce, María Luz; Serrano-Nieto, Juliana; Pintos-Morell, Guillem; Bélanger-Quintana, Amaya; Martínez-Pardo, Mercedes; García-Silva, María Teresa; Quijada-Fraile, Pilar; Vitoria-Miñana, Isidro; Dalmau, Jaime; Lama-More, Rosa A; Bueno-Delgado, María Amor

    2014-01-01

    Background Advances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain. Methods Observational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish populatio...

  20. Nurse compliance with a protocol for safe injectable medication administration: comparison of two multicentre observational studies

    Science.gov (United States)

    Schutijser, Bernadette; Jongerden, Irene; Spreeuwenberg, Peter; Wagner, Cordula; de Bruijne, Martine

    2018-01-01

    Objectives Medication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance. Methods In this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model. Results A total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings ‘hand hygiene’ and ‘check by a second nurse’ remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model. Conclusions Compliance with ‘hand hygiene’ and ‘check by a second nurse’ needs to be further improved in order to increase complete protocol compliance. To do

  1. Age in antiretroviral therapy programmes in South Africa: a retrospective, multicentre, observational cohort study.

    Science.gov (United States)

    Cornell, Morna; Johnson, Leigh F; Schomaker, Michael; Tanser, Frank; Maskew, Mhairi; Wood, Robin; Prozesky, Hans; Giddy, Janet; Stinson, Kathryn; Egger, Matthias; Boulle, Andrew; Myer, Landon

    2015-09-01

    As access to antiretroviral therapy (ART) expands, increasing numbers of older patients will start treatment and need specialised long-term care. However, the effect of age in ART programmes in resource-constrained settings is poorly understood. The HIV epidemic is ageing rapidly and South Africa has one of the highest HIV population prevalences worldwide. We explored the effect of age on mortality of patients on ART in South Africa and whether this effect is mediated by baseline immunological status. In this retrospective cohort analysis, we studied HIV-positive patients aged 16-80 years who started ART for the first time in six large South African cohorts of the International Epidemiologic Databases to Evaluate AIDS-Southern Africa collaboration, in KwaZulu-Natal, Gauteng, and Western Cape (two primary care clinics, three hospitals, and a large rural cohort). The primary outcome was mortality. We ascertained patients' vital status through linkage to the National Population Register. We used inverse probability weighting to correct mortality for loss to follow-up. We estimated mortality using Cox's proportional hazards and competing risks regression. We tested the interaction between baseline CD4 cell count and age. Between Jan 1, 2004, and Dec 31, 2013, 84,078 eligible adults started ART. Of these, we followed up 83,566 patients for 174,640 patient-years. 8% (1817 of 23,258) of patients aged 16-29 years died compared with 19% (93 of 492) of patients aged 65 years or older. The age adjusted mortality hazard ratio was 2·52 (95% CI 2·01-3·17) for people aged 65 years or older compared with those 16-29 years of age. In patients starting ART with a CD4 count of less than 50 cells per μL, the adjusted mortality hazard ratio was 2·52 (2·04-3·11) for people aged 50 years or older compared with those 16-39 years old. Mortality was highest in patients with CD4 counts of less than 50 cells per μL, and 15% (1103 of 7295) of all patients aged 50 years or older

  2. Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study.

    Science.gov (United States)

    Kelly, Jennifer; Wright, David; Wood, John

    2011-12-01

    The aim of this study was to describe the interventions used by nurses when administering oral medicines to patients with and without dysphagia, to quantify the appropriateness of these interventions and the medicine administration error rate. The administration of medicines to patients with dysphagia is complex and potentially more error prone because of the need to match the medication's formulation to the swallowing ability of the patient. Data was collected on the preparation and administration of oral medicines to patients with and without dysphagia, including those with enteral feeding tubes, using undisguised direct observation of 65 nurse-led medicine administration rounds on stroke and care-of-the-elderly wards at four acute general hospitals in East of England between 1 March and 30 June 2008. Of the 2129 medicine administrations observed, 817 involved an error, and of these 313 involved patients with dysphagia. Excluding time errors, the normalized frequency of medicine administration errors for patients with dysphagia was 21.1% compared with 5.9% for patients without. Using a mixed effects model and excluding time errors, there is a higher risk of errors for patients with dysphagia (excluding patients with enteral tubes) compared with those without (P < 0.001) and a further increase in risk of error for patients with enteral tubes compared with dysphagic patients without tubes (P < 0.001). The increased medicine administration error rate in patients with dysphagia requires healthcare professionals to take extra care when prescribing, dispensing and administering medicines to this group. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  3. GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

    OpenAIRE

    Dellagrammaticas Demosthenes; Torgerson David; Gough Moira; Banning Adrian P; Rothwell Peter M; Lewis Steff C; Colam Bridget; Horrocks Michael; Bodenham Andrew; Gough Michael J; Leigh-Brown Anne; Liapis Christos; Warlow Charles

    2008-01-01

    Abstract Background Patients who have severe narrowing at or near the origin of the internal carotid artery as a result of atherosclerosis have a high risk of ischaemic stroke ipsilateral to the arterial lesion. Previous trials have shown that carotid endarterectomy improves long-term outcomes, particularly when performed soon after a prior transient ischaemic attack or mild ischaemic stroke. However, complications may occur during or soon after surgery, the most serious of which is stroke, w...

  4. The international seismological observing period in Africa

    Science.gov (United States)

    Engdahl, E.R.; Bergman, Eric A.

    1992-01-01

    The International Seismological Observing Period (ISOP) is a specific time interval designated for enhanced international cooperation in the collection and dissemination of observatory measurements from the global seismographic network. The primary purpose of the ISOP is to strengthen the international infrastructure that supports current seismological practice and increase the cooperation among nations that operate seismological observatories. Measurements, reported by the existing global network and compiled by agencies such as the International Seismological Centre (ISC), are providing new information about earthquakes and the structure of the Earth of fundamental importance to the Earth sciences. However, these data represent but a small fraction of the information contained in the seismograms. One of the goals of the ISOP is to collect improved sets of data. In particular, the measurement and reporting of later-arriving phases, during a fixed ISOP period, from earthquakes selected for detailed observation by the cooperating stations will be encouraged. The use of advanced, digital instrumentation provides an unprecedented opportunity for enhancing the methods of seismogram interpretation and seismic parameter extraction, by the implementation of digital processing methods at seismic observatories worldwide. It must be ensured that this new information will be available to the entire seismological community. It is believed that this purpose is best served with an ISOP that promotes increased on-site processing at digital stations in Africa and elsewhere. Improvements in seismology require truly international cooperation and the educational aspects of seismological practice form one of the goals of the ISOP. Thus, workshops will be needed in Africa to train analysts in ISOP procedures and to introduce them to modern techniques and applications of the data. Participants will, thus, benefit from theoretical results and practical experience that are of direct

  5. A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study.

    Science.gov (United States)

    Snoeker, Barbara Am; Zwinderman, Aeilko H; Lucas, Cees; Lindeboom, Robert

    2015-08-01

    In primary care, meniscal tears are difficult to detect. A quick and easy clinical prediction rule based on patient history and a single meniscal test may help physicians to identify high-risk patients for referral for magnetic resonance imaging (MRI). The study objective was to develop and internally validate a clinical prediction rule (CPR) for the detection of meniscal tears in primary care. In a cross-sectional multicentre study, 121 participants from primary care were included if they were aged 18-65 years with knee complaints that existed for meniscal tear. One diagnostic physical meniscal test and 14 clinical variables were considered to be predictors of MRI outcome. Using known predictors for the presence of meniscal tears, a 'quick and easy' CPR was derived. The final CPR included the variables sex, age, weight-bearing during trauma, performing sports, effusion, warmth, discolouration, and Deep Squat test. The final model had an AUC of 0.76 (95% CI = 0.72 to 0.80). A cut-point of 150 points yielded an overall sensitivity of 86.1% and a specificity of 45.5%. For this cut-point, the positive predictive value was 55.0%, and the negative predictive value was 81.1%. A scoring system was provided including the corresponding predicted probabilities for a meniscal tear. The CPR improved the detection of meniscal tears in primary care. Further evaluation of the CPR in new primary care patients is needed, however, to assess its usefulness. © British Journal of General Practice 2015.

  6. Age in antiretroviral therapy programmes in South Africa: a multi-centre observational cohort study

    Science.gov (United States)

    Cornell, Morna; Johnson, Leigh F; Schomaker, Michael; Tanser, Frank; Maskew, Mhairi; Wood, Robin; Prozesky, Hans; Giddy, Janet; Stinson, Kathryn; Egger, Matthias; Boulle, Andrew; Myer, Landon

    2015-01-01

    Background As access to antiretroviral therapy (ART) expands, increasing numbers of older patients will start treatment and require specialised long-term care. However the impact of age in ART programs in resource-constrained settings is poorly understood. South Africa has the second largest population of older (≥50 years) people in sub-Saharan Africa. The HIV epidemic is also ageing rapidly and the country has one of the highest HIV population prevalences worldwide. This study explored the effect of age on mortality on ART in South Africa and whether this effect was mediated by baseline immunologic status. Methods IeDEA-SA is a regional collaboration which combines routine observational data from large ART programmes across Southern Africa. This study was a retrospective cohort analysis of adults starting ART from 2004-2013 in six large South African cohorts: two primary care clinics, three hospitals and a large rural cohort. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), immunologic and virologic responses. Patients' vital status was ascertained through linkage to the National Population Register. Inverse probability weighting was used to correct mortality for LTF. Mortality was estimated using Cox's proportional hazards and competing risks regression. The interaction between baseline CD4+ cell count and age was tested. Immunologic responses were graphed by age and duration on ART. Findings 83 566 patients were followed for 174 640 patient-years. Patients were predominantly female, especially in the younger age groups: 81% (18 819/23 258) of patients 16-29 years and 66% (12 812/19 372) of those aged 30-34. Mortality increased with age in a dose response, mediated by baseline immunologic status. Patients with CD4 counts <50 cells/μL were a particularly high risk group, comprising 14% of all older patients starting ART. The percentage of older patients enrolling increased with successive calendar years from 6% (290/4 999) in

  7. Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases.

    Science.gov (United States)

    Martín-Hernández, Elena; Aldámiz-Echevarría, Luis; Castejón-Ponce, Esperanza; Pedrón-Giner, Consuelo; Couce, María Luz; Serrano-Nieto, Juliana; Pintos-Morell, Guillem; Bélanger-Quintana, Amaya; Martínez-Pardo, Mercedes; García-Silva, María Teresa; Quijada-Fraile, Pilar; Vitoria-Miñana, Isidro; Dalmau, Jaime; Lama-More, Rosa A; Bueno-Delgado, María Amor; Del Toro-Riera, Mirella; García-Jiménez, Inmaculada; Sierra-Córcoles, Concepción; Ruiz-Pons, Mónica; Peña-Quintana, Luis J; Vives-Piñera, Inmaculada; Moráis, Ana; Balmaseda-Serrano, Elena; Meavilla, Silvia; Sanjurjo-Crespo, Pablo; Pérez-Cerdá, Celia

    2014-11-30

    Advances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain. Observational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish population. Heterozygous mothers of patients with OTC deficiency were only included if they were on treatment due to being symptomatic or having biochemistry abnormalities. 104 patients from 98 families were included. Ornithine transcarbamylase deficiency was the most frequent condition (64.4%) (61.2% female) followed by type 1 citrullinemia (21.1%) and argininosuccinic aciduria (9.6%). Only 13 patients (12.5%) were diagnosed in a pre-symptomatic state. 63% of the cases presented with type intoxication encephalopathy. The median ammonia level at onset was 298 μmol/L (169-615). The genotype of 75 patients is known, with 18 new mutations having been described. During the data collection period four patients died, three of them in the early days of life. The median current age is 9.96 years (5.29-18), with 25 patients over 18 years of age. Anthropometric data, expressed as median and z-score for the Spanish population is shown. 52.5% of the cases present neurological sequelae, which have been linked to the type of disease, neonatal onset, hepatic failure at diagnosis and ammonia values at diagnosis. 93 patients are following a protein restrictive diet, 0.84 g/kg/day (0.67-1.10), 50 are receiving essential amino acid supplements, 0.25 g/kg/day (0.20-0.45), 58 arginine, 156 mg/kg/day (109-305) and 45 citrulline, 150 mg/kg/day (105-199). 65 patients are being treated with drugs: 4 with sodium benzoate, 50 with sodium phenylbutyrate, 10 with both drugs and 1 with carglumic acid. Studies like this make it

  8. Oxygen therapy multicentric study--a nationwide audit to oxygen therapy procedures in internal medicine wards.

    Science.gov (United States)

    Neves, J T; Lobão, M J

    2012-01-01

    Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it isn't provided accordingly with the best of care. The goal of this work is to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS) in its consensus statement "BTS guideline for emergency oxygen use in adult patients". Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring. Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93,4%. Most prescriptions were by a fixed dose (82,4%), but only 11,6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors. Oxygen was administered to only 77,0% of the patients with fixed dose prescriptions. FiO(2) or flow rate and the delivery device were the same as prescribed in 70,9 and 89,2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO(2) range, 82,7% were on the prescribed SatO(2) objective range. Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO(2) range are still a minority. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  9. Early versus Late Application of Subthalamic deep brain Stimulation to Parkinson's disease patients with motor complications (ELASS): protocol of a multicentre, prospective and observational study.

    Science.gov (United States)

    Jiang, Lulu; Poon, Wai Sang; Moro, Elena; Xian, Wenbiao; Yang, Chao; Zhu, Xian Lun; Gu, Jing; Cai, Xiaodong; Liu, Jinlong; Mok, Vincent; Liu, Yanmei; Xu, Shaohua; Guo, Qiyu; Chen, Wanru; Chen, Ling

    2017-11-16

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical treatment for Parkinson's disease (PD). However, there is currently no consensus on the best timing for this surgery. The aim of our study is to compare the therapeutic efficacy of bilateral STN DBS in patients with PD with early and late motor complications. 200 patients with PD will be enrolled in this multicentre, prospective, observational study, and will be followed up for 4 years. Patients with PD who meet the criteria for STN DBS surgery will be allocated to either the early stimulation group or the late stimulation group based on the duration of their motor complications. The primary outcome will be changes in quality of life from baseline to 4 years, measured using the 39-item Parkinson's Disease Questionnaire Summary Index. The secondary outcomes include changes in motor function measured using Movement Disorder Society-revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, self-reported experiences of daily living measured using MDS-UPDRS Part I B and Part II, good 'on' time recorded by the patients using a diary and safety profile of both groups. The study received ethical approval from the Medical Ethical Committee of the First Affiliated Hospital, Sun Yat-sen University. The results of this study will be published in peer-reviewed journals and presented at international conferences. NCT01922388; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Harmonizing national growth references for multi-centre surveys, drug monitoring and international postmarketing surveillance.

    Science.gov (United States)

    Hermanussen, M; Assmann, C; Wöhling, H; Zabransky, M

    2012-01-01

    National European growth references differ. We aimed to convert (harmonize) currently used charts into a single unified interchangeable LMS format for each European nation. Nine currently used national European growth references from Belgium (2009), France (1979), Poland (2001), Sweden (2002), Switzerland (1989), the UK (1990), Italy (2006) and Germany (1979 and 1997) were harmonized and compared with the international WHO child growth standards and WHO growth reference data for 5-19 years. European growth charts can be harmonized. The approach appears useful as height, and body mass index (BMI) is inappropriately represented by WHO references. European height references exhibit warping when plotted against the WHO reference. The French appears too short, the other Europeans too tall. Also, the BMI is not appropriately represented by the WHO references. Harmonizing references is a novel, convenient and cost-effective approach for converting historic and/or incomplete local or national growth reference charts into a unified interchangeable LMS format. Harmonizing facilitates producing growth references 'on demand', for limited regional purposes, for ethnically, socio-economically or politically defined minorities, but also for matching geographically different groups of children and adolescents for international growth and registry studies. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

  11. Collecting core data in severely injured patients using a consensus trauma template: an international multicentre study

    DEFF Research Database (Denmark)

    Ringdal, Kjetil G; Lossius, Hans Morten; Jones, J Mary

    2011-01-01

    ABSTRACT: INTRODUCTION: No worldwide, standardised definitions exist for documenting, reporting, and comparing data from severely injured trauma patients. This study evaluated the feasibility of collecting the data variables of the international consensus-derived Utstein Trauma Template. METHODS......: Trauma centres from three different continents were invited to submit Utstein Trauma Template core data during a defined period, for up to 50 consecutive trauma patients. Directly admitted patients with a New Injury Severity Score (NISS) equal to or above 16 were included. Main outcome variables were...... was 27 (IQR 20-38), and blunt trauma predominated (91.1%). Of the 36 Utstein variables, 13 (36%) were collected by all participating centres. Eleven (46%) centres applied definitions of the survival outcome variable that were different from those of the template. Seventeen (71%) centres used...

  12. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome.

    Science.gov (United States)

    Sorensen, Janice; Kondrup, Jens; Prokopowicz, Jacek; Schiesser, Marc; Krähenbühl, Lukas; Meier, Rémy; Liberda, Martin

    2008-06-01

    The aim of the study was to implement nutritional risk screening (NRS-2002) and to assess the association between nutritional risk and clinical outcome. NRS-2002 was implemented in 26 hospital departments (surgery, internal medicine, oncology, intensive care, gastroenterology and geriatrics) in Austria, the Czech Republic, Egypt, Germany, Hungary, Lebanon, Libya, Poland, Romania, Slovakia, Spain and Switzerland. Being a prospective cohort study, randomly selected adult patients were included at admission and followed during their hospitalisation. Data were collected on the nutritional risk screening, complications, mortality, length of stay and discharge. The correlation between risk status and clinical outcome was assessed and adjusted for confounders (age, speciality, diagnoses, comorbidity, surgery, cancer and region) by multivariate regression analysis. Of the 5051 study patients, 32.6% were defined as 'at-risk' by NRS-2002. 'At-risk' patients had more complications, higher mortality and longer lengths of stay than 'not at-risk' patients and these variables were significantly related to components of NRS-2002, also when adjusted for confounders. Components of NRS-2002 are independent predictors of poor clinical outcome.

  13. [Effectivity and satisfaction with the treatment for dyslipidemia with pitavastatin. Multicentric, descriptive, post authorised and observational study (REINA study)].

    Science.gov (United States)

    Rodríguez Arroyo, Luis Alberto; Díaz Rodríguez, Angel; Pintó Sala, Xavier; Coca Payeras, Antonio; Rius Tarruella, Joan

    2014-01-01

    Evaluating the therapeutical adherence as well as the patient' satisfaction with the treatment should be considered to optimize lipidic control. The REINA Study evaluates the grade of satisfaction in dyslipidemic patients treated with pitavastatin. The current study was observational, descriptive, transversal and multi-centric with patients from our country only. The following data were collected in each case: Morisky-Green test and TSQM-9 for patients older than 18 years old, with dyslipidemia treated with pitavastatin in the last 12 weeks. We studied 6,489 patients (60.0% males) from Primary Health (52.7%) and Specialised Health (47.3%), with age (mean) = 60.9 ± 11.2 years by aleatory sampling. 72.3% of patients achieved an adequate control with 2mg/day of pitavastatin. General satisfaction with the treatment was 73.20 points (95% CI: 58.17-87.23). Patients who followed the treatment (65%) showed better data of satisfaction with the drug (77.70 [95% CI: 65.20-90.20]), of global satisfaction (75.00 [95% CI: 61.50-88.50]) and their satisfaction with the drug efficiency was higher (72.50 [95% CI: 57.70-87.30]) than in the patients who did not finish the treatment (72.70 [95% CI: 59.30-85.74]; 68.5 [95% CI: 53.20-83.80] and 67.80 [95% CI: 53.70-81.90], respectively), P < .0001, without any difference between the two primary care systems. The validation of the satisfaction is a crucial indicator in the evaluation of the services offered in health. Patients with the highest grade of satisfaction present better therapeutical adherence, and such a relation is bidirectional. The individuals who are satisfied and who followed the treatment obtained better clinical results. Pitavastatin is an effective therapeutic alternative for patients with dyslipidemia. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  14. FGFR2 amplification has prognostic significance in gastric cancer: results from a large international multicentre study.

    Science.gov (United States)

    Su, X; Zhan, P; Gavine, P R; Morgan, S; Womack, C; Ni, X; Shen, D; Bang, Y-J; Im, S-A; Ho Kim, W; Jung, E-J; Grabsch, H I; Kilgour, E

    2014-02-18

    In preclinical gastric cancer (GC) models, FGFR2 amplification was associated with increased tumour cell proliferation and survival, and drugs targeting this pathway are now in clinical trials. FGFR2 FISH was performed on 961 GCs from the United Kingdom, China and Korea, and the relationship with clinicopathological data and overlap with HER2 amplification were analysed. The prevalence of FGFR2 amplification was similar between the three cohorts (UK 7.4%, China 4.6% and Korea 4.2%), and intratumoral heterogeneity was observed in 24% of FGFR2 amplified cases. FGFR2 amplification was associated with lymph node metastases (P<0.0001). FGFR2 amplification and polysomy were associated with poor overall survival (OS) in the Korean (OS: 1.83 vs 6.17 years, P=0.0073) and UK (OS: 0.45 vs 1.9 years, P<0.0001) cohorts, and FGFR2 amplification was an independent marker of poor survival in the UK cohort (P=0.0002). Co-amplification of FGFR2 and HER2 was rare, and when high-level amplifications did co-occur these were detected in distinct areas of the tumour. A similar incidence of FGFR2 amplification was found in Asian and UK GCs and was associated with lymphatic invasion and poor prognosis. This study also shows that HER2 and FGFR2 amplifications are mostly exclusive.

  15. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study.

    Science.gov (United States)

    Penaloza, Andrea; Soulié, Caroline; Moumneh, Thomas; Delmez, Quentin; Ghuysen, Alexandre; El Kouri, Dominique; Brice, Christian; Marjanovic, Nicolas S; Bouget, Jacques; Moustafa, Fares; Trinh-Duc, Albert; Le Gall, Catherine; Imsaad, Lionel; Chrétien, Jean-Marie; Gable, Béatrice; Girard, Philippe; Sanchez, Olivier; Schmidt, Jeannot; Le Gal, Grégoire; Meyer, Guy; Delvau, Nicolas; Roy, Pierre-Marie

    2017-12-01

    The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium. We included consecutive patients aged 18 years or older with suspected pulmonary embolism. Patients were excluded if they had already been hospitalised for more than 2 days, had curative anticoagulant therapy in progress for more than 48 h, or had a diagnosis of thromboembolic disease documented before admission to emergency department. Physicians completed a standardised case report form comprising implicit clinical probability assessment (low, moderate, or high) and a list of risk factors including criteria of the PERC rule. They were asked to follow international recommendations for diagnostic strategy, masked to PERC assessment. The primary endpoint was the proportion of patients with low implicit clinical probability and negative PERC who had venous thromboembolic events, diagnosed during initial diagnostic work-up or during 3-month follow-up, as externally adjudicated by an independent committee masked to the PERC and clinical probability assessment. The upper limit of the 95% CI around the 3-month thromboembolic risk was set at 3%. We did all analyses by intention to treat, including all patients with complete follow-up. This trial is registered with ClinicalTrials.gov, number NCT02360540. Between May 1, 2015, and April 30, 2016, 1773 consecutive patients with suspected pulmonary embolism were prospectively assessed for inclusion, of whom 1757 were included. 1052 (60%) patients were classed as having low clinical probability

  16. 32 CFR 700.705 - Observance of international law.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Observance of international law. 700.705 Section... Other Commanders Titles and Duties of Commanders § 700.705 Observance of international law. At all times, commanders shall observe, and require their commands to observe, the principles of international law. Where...

  17. Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study.

    Science.gov (United States)

    Habiba, Samer; Nygaard, Øystein P; Brox, Jens I; Hellum, Christian; Austevoll, Ivar M; Solberg, Tore K

    2017-06-01

    There are no previous studies evaluating risk factors for surgical site infections (SSIs) and the effectiveness of prophylactic antibiotic treatment (PAT), specifically for patients operated on for lumbar disc herniation. This observational multicentre study comprises a cohort of 1,772 consecutive patients operated on for lumbar disc herniation without laminectomy or fusion at 23 different surgical units in Norway. The patients were interviewed about SSIs according to a standardised questionnaire at 3 months' follow-up. Three months after surgery, 2.3% of the patients had an SSI. Only no PAT (OR = 5.3, 95% CI = 2.2-12.7, pdisc herniation. Senior surgeons assisting inexperienced colleagues to avoid prolonged duration of surgery could also reduce the occurrence of SSI.

  18. Automatic segmentation of male pelvic anatomy on computed tomography images: a comparison with multiple observers in the context of a multicentre clinical trial

    International Nuclear Information System (INIS)

    Geraghty, John P; Grogan, Garry; Ebert, Martin A

    2013-01-01

    This study investigates the variation in segmentation of several pelvic anatomical structures on computed tomography (CT) between multiple observers and a commercial automatic segmentation method, in the context of quality assurance and evaluation during a multicentre clinical trial. CT scans of two prostate cancer patients (‘benchmarking cases’), one high risk (HR) and one intermediate risk (IR), were sent to multiple radiotherapy centres for segmentation of prostate, rectum and bladder structures according to the TROG 03.04 “RADAR” trial protocol definitions. The same structures were automatically segmented using iPlan software for the same two patients, allowing structures defined by automatic segmentation to be quantitatively compared with those defined by multiple observers. A sample of twenty trial patient datasets were also used to automatically generate anatomical structures for quantitative comparison with structures defined by individual observers for the same datasets. There was considerable agreement amongst all observers and automatic segmentation of the benchmarking cases for bladder (mean spatial variations < 0.4 cm across the majority of image slices). Although there was some variation in interpretation of the superior-inferior (cranio-caudal) extent of rectum, human-observer contours were typically within a mean 0.6 cm of automatically-defined contours. Prostate structures were more consistent for the HR case than the IR case with all human observers segmenting a prostate with considerably more volume (mean +113.3%) than that automatically segmented. Similar results were seen across the twenty sample datasets, with disagreement between iPlan and observers dominant at the prostatic apex and superior part of the rectum, which is consistent with observations made during quality assurance reviews during the trial. This study has demonstrated quantitative analysis for comparison of multi-observer segmentation studies. For automatic segmentation

  19. Validation of the German version of the patient activation measure 13 (PAM13-D in an international multicentre study of primary care patients.

    Directory of Open Access Journals (Sweden)

    Katja Brenk-Franz

    Full Text Available The patients' active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D in German-speaking primary care patients. This international cross-sectional multicentre study enrolled consecutively patients from primary care practices in three German-speaking countries: Germany, Austria, and Switzerland. Patients completed the PAM13-D questionnaire. General Self-Efficacy scale (GSE was used to assess convergent validity. Furthermore Cronbach's alpha was performed to assess internal consistency. Exploratory factor analysis was used to evaluate the underlying factor structure of the items. We included 508 patients from 16 primary care practices in the final analysis. Results were internally consistent, with a Cronbach's alpha of 0.84. Factor analysis revealed one major underlying factor. The mean values of the PAM13-D correlated significantly (r = 0.43 with those of the GSE. The German PAM13 is a reliable and valid measure of patient activation. Thus, it may be useful in primary care clinical practice and research.

  20. Observations of an internal tide beam in the Tasman Sea

    Science.gov (United States)

    Waterhouse, A. F.; Kelly, S. M.; MacKinnon, J. A.; Nash, J. D.; Johnston, S.; Zhao, Z.; Rainville, L.; Simmons, H. L.; Brazhnikov, D.; Rudnick, D. L.

    2016-02-01

    Internal-tide energy can propagate away from generation regions in the form of low-mode internal tides. The ultimate fate of this energy is unknown and has a large impact on the global geography of turbulent mixing rates. Previous studies of low-mode internal tide propagation have observed regions where the internal tide was diffuse and exhibited complex interference patterns. As a result, direct comparisons of observed energy-flux divergence and dissipation rates have been inconclusive. A well-defined beam of internal tide energy originates from the Macquarie Ridge southwest of New Zealand and propagates across the Tasman Sea towards Tasmania, dominating the internal wave field found in the region. Numerical simulations have shown that the internal tide focuses into a "beam" as it propagates northwest across the Tasman Sea before it eventually impinges on the Tasmanian continental slope. During January-February 2015, field observations mapped the structure and variability of this internal-tide beam in the deep ocean before it reached the continental slope using moored, ship-based and glider observations. In-situ observations from the Tasman Sea captured synoptic measurements of incident internal-tide energy flux that are comparable to those inferred from altimetric estimates. As the region is known to have a strong mesoscale which can bias altimetric estimates, comparisons made here can document the extent of this bias. Estimates on how variability of the internal beam as it crosses through an active mesoscale are made using both observational and numerical results.

  1. The impact of virus infections on pneumonia mortality is complex in adults: a prospective multicentre observational study.

    Science.gov (United States)

    Katsurada, Naoko; Suzuki, Motoi; Aoshima, Masahiro; Yaegashi, Makito; Ishifuji, Tomoko; Asoh, Norichika; Hamashige, Naohisa; Abe, Masahiko; Ariyoshi, Koya; Morimoto, Konosuke

    2017-12-06

    Various viruses are known to be associated with pneumonia. However, the impact of viral infections on adult pneumonia mortality remains unclear. This study aimed to clarify the effect of virus infection on pneumonia mortality among adults stratified by virus type and patient comorbidities. This multicentre prospective study enrolled pneumonia patients aged ≥15 years from September 2011 to August 2014. Sputum samples were tested by in-house multiplex polymerase chain reaction assays to identify 13 respiratory viruses. Viral infection status and its effect on in-hospital mortality were examined by age group and comorbidity status. A total of 2617 patients were enrolled in the study and 77.8% was aged ≥65 years. 574 (21.9%) did not have comorbidities, 790 (30.2%) had chronic respiratory disease, and 1253 (47.9%) had other comorbidities. Viruses were detected in 605 (23.1%) patients. Human rhinovirus (9.8%) was the most frequently identified virus, followed by influenza A (3.9%) and respiratory syncytial virus (3.9%). Respiratory syncytial virus was more frequently identified in patients with chronic respiratory disease (4.7%) than those with other comorbidities (4.2%) and without comorbidities (2.1%) (p = 0.037). The frequencies of other viruses were almost identical between the three groups. Virus detection overall was not associated with increased mortality (adjusted risk ratio (ARR) 0.76, 95% CI 0.53-1.09). However, influenza virus A and B were associated with three-fold higher mortality in patients with chronic respiratory disease but not with other comorbidities (ARR 3.38, 95% CI 1.54-7.42). Intriguingly, paramyxoviruses were associated with dramatically lower mortality in patients with other comorbidities (ARR 0.10, 95% CI 0.01-0.70) but not with chronic respiratory disease. These effects were not affected by age group. The impact of virus infections on pneumonia mortality varies by virus type and comorbidity status in adults.

  2. Evaluation of internal noise methods for Hotelling observer models

    International Nuclear Information System (INIS)

    Zhang Yani; Pham, Binh T.; Eckstein, Miguel P.

    2007-01-01

    The inclusion of internal noise in model observers is a common method to allow for quantitative comparisons between human and model observer performance in visual detection tasks. In this article, we studied two different strategies for inserting internal noise into Hotelling model observers. In the first strategy, internal noise was added to the output of individual channels: (a) Independent nonuniform channel noise, (b) independent uniform channel noise. In the second strategy, internal noise was added to the decision variable arising from the combination of channel responses. The standard deviation of the zero mean internal noise was either constant or proportional to: (a) the decision variable's standard deviation due to the external noise, (b) the decision variable's variance caused by the external noise, (c) the decision variable magnitude on a trial to trial basis. We tested three model observers: square window Hotelling observer (HO), channelized Hotelling observer (CHO), and Laguerre-Gauss Hotelling observer (LGHO) using a four alternative forced choice (4AFC) signal known exactly but variable task with a simulated signal embedded in real x-ray coronary angiogram backgrounds. The results showed that the internal noise method that led to the best prediction of human performance differed across the studied model observers. The CHO model best predicted human observer performance with the channel internal noise. The HO and LGHO best predicted human observer performance with the decision variable internal noise. The present results might guide researchers with the choice of methods to include internal noise into Hotelling model observers when evaluating and optimizing medical image quality

  3. Ibrutinib for patients with rituximab-refractory Waldenström's macroglobulinaemia (iNNOVATE): an open-label substudy of an international, multicentre, phase 3 trial.

    Science.gov (United States)

    Dimopoulos, Meletios A; Trotman, Judith; Tedeschi, Alessandra; Matous, Jeffrey V; Macdonald, David; Tam, Constantine; Tournilhac, Olivier; Ma, Shuo; Oriol, Albert; Heffner, Leonard T; Shustik, Chaim; García-Sanz, Ramón; Cornell, Robert F; de Larrea, Carlos Fernández; Castillo, Jorge J; Granell, Miquel; Kyrtsonis, Marie-Christine; Leblond, Veronique; Symeonidis, Argiris; Kastritis, Efstathios; Singh, Priyanka; Li, Jianling; Graef, Thorsten; Bilotti, Elizabeth; Treon, Steven; Buske, Christian

    2017-02-01

    In the era of widespread rituximab use for Waldenström's macroglobulinaemia, new treatment options for patients with rituximab-refractory disease are an important clinical need. Ibrutinib has induced durable responses in previously treated patients with Waldenström's macroglobulinaemia. We assessed the efficacy and safety of ibrutinib in a population with rituximab-refractory disease. This multicentre, open-label substudy was done at 19 sites in seven countries in adults aged 18 years and older with confirmed Waldenström's macroglobulinaemia, refractory to rituximab and requiring treatment. Disease refractory to the last rituximab-containing therapy was defined as either relapse less than 12 months since last dose of rituximab or failure to achieve at least a minor response. Key exclusion criteria included: CNS involvement, a stroke or intracranial haemorrhage less than 12 months before enrolment, clinically significant cardiovascular disease, hepatitis B or hepatitis C viral infection, and a known bleeding disorder. Patients received oral ibrutinib 420 mg once daily until progression or unacceptable toxicity. The substudy was not prospectively powered for statistical comparisons, and as such, all the analyses are descriptive in nature. This study objectives were the proportion of patients with an overall response, progression-free survival, overall survival, haematological improvement measured by haemoglobin, time to next treatment, and patient-reported outcomes according to the Functional Assessment of Cancer Therapy-Anemia (FACT-An) and the Euro Qol 5 Dimension Questionnaire (EQ-5D-5L). All analyses were per protocol. The study is registered at ClinicalTrials.gov, number NCT02165397, and follow-up is ongoing but enrolment is complete. Between Aug 18, 2014, and Feb 18, 2015, 31 patients were enrolled. Median age was 67 years (IQR 58-74); 13 (42%) of 31 patients had high-risk disease per the International Prognostic Scoring System Waldenstr

  4. [A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions].

    Science.gov (United States)

    Sicras-Mainar, A; Navarro-Artieda, R; Ruiz-Torrejón, A; Saez, M; Coll-de Tuero, G; Sánchez, L

    To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of Pbladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. The effects of a randomised multi-centre trial and international accreditation on availability and quality of clinical guidelines

    DEFF Research Database (Denmark)

    Juul, AB; Gluud, C; Wetterslev, J

    2005-01-01

    To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation.......To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation....

  6. Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey.

    Science.gov (United States)

    Esposito, Ciro; Masieri, Lorenzo; Steyaert, Henri; Escolino, Maria; Cerchione, Raffaele; La Manna, Angela; Cini, Chiara; Lendvay, Thomas S

    2018-03-01

    This multicentric international retrospective study aimed to report the outcome of robot-assisted extravesical ureteral reimplantation (REVUR) in patients with unilateral vesico-ureteral reflux (VUR). The medical records of 55 patients (35 girls, 20 boys) underwent REVUR in four international centers of pediatric robotic surgery for primary unilateral VUR were retrospectively reviewed. Patients' average age was 4.9 years. The preoperative grade of reflux was III in 12.7%, IV in 47.3% and V in 40%. Twenty-six patients (47.3%) presented a loss of renal function preoperatively and 10 (18.1%) had a duplex system. Average robot docking time was 16.2 min (range 5-30). Average total operative time was 92.2 min (range 50-170). No conversions or intra-operative complications were recorded. All patients had a bladder Foley catheter for 24 h post-operatively. Average hospital stay was 2 days (range 1-3). Average follow-up length was 28 months (range 9-60). We recorded three (5.4%) postoperative complications: 1 small urinoma resolved spontaneously (II Clavien) and 2 persistent reflux, only one requiring redo-surgery using endoscopic injection (IIIb Clavien). REVUR is a safe and effective technique for treatment of primary unilateral VUR. The procedure is easy and fast to perform thanks to the 6° of freedom of robotic arms. The learning curve is short and it is useful to begin the robotics experience with a surgeon expert in robotic surgery as proctor on the 2nd robot console. The high cost and the diameter of instruments remain the main challenges of robotics applications in pediatric urology.

  7. Internal-time observable of classical relativistic systems

    International Nuclear Information System (INIS)

    Ben-Ya'acov, Uri

    2006-01-01

    The relativistic framework with its symmetries offers a natural definition for the internal time of classical (non-quantum) physical systems as a Lorentz-invariant observable. The internal-time observable, measuring the system's aging or internal evolution, is identified with the proper time of the system derived from its centre-of-mass (CM) coordinate. For its definition as an observable it is required that the system be symmetric not only under Lorentz-Poincare transformations but also under uniform scaling, with the associated existence of a dilatation function D, and yet that D be a varying-not conserved-quantity. Two alternative definitions are discussed, and it is found that in order to maintain simultaneity of the CM time with the events that define it, it is necessary to split the dilatation function into a CM part and an internal part

  8. Impact of the Tohoku earthquake and tsunami on pneumonia hospitalisations and mortality among adults in northern Miyagi, Japan: a multicentre observational study

    Science.gov (United States)

    Daito, Hisayoshi; Suzuki, Motoi; Shiihara, Jun; Kilgore, Paul E; Ohtomo, Hitoshi; Morimoto, Konosuke; Ishida, Masayuki; Kamigaki, Taro; Oshitani, Hitoshi; Hashizume, Masahiro; Endo, Wataru; Hagiwara, Koichi; Ariyoshi, Koya; Okinaga, Shoji

    2013-01-01

    Background On 11 March 2011, the Tohoku earthquake and tsunami struck off the coast of northeastern Japan. Within 3 weeks, an increased number of pneumonia admissions and deaths occurred in local hospitals. Methods A multicentre survey was conducted at three hospitals in Kesennuma City (population 74 000), northern Miyagi Prefecture. All adults aged ≥18 years hospitalised between March 2010 and June 2011 with community-acquired pneumonia were identified using hospital databases and medical records. Segmented regression analyses were used to quantify changes in the incidence of pneumonia. Results A total of 550 pneumonia hospitalisations were identified, including 325 during the pre-disaster period and 225 cases during the post-disaster period. The majority (90%) of the post-disaster pneumonia patients were aged ≥65 years, and only eight cases (3.6%) were associated with near-drowning in the tsunami waters. The clinical pattern and causative pathogens were almost identical among the pre-disaster and post-disaster pneumonia patients. A marked increase in the incidence of pneumonia was observed during the 3-month period following the disaster; the weekly incidence rates of pneumonia hospitalisations and pneumonia-associated deaths increased by 5.7 times (95% CI 3.9 to 8.4) and 8.9 times (95% CI 4.4 to 17.8), respectively. The increases were largest among residents in nursing homes followed by those in evacuation shelters. Conclusions A substantial increase in the pneumonia burden was observed among adults after the Tohoku earthquake and tsunami. Although the exact cause remains unresolved, multiple factors including population aging and stressful living conditions likely contributed to this pneumonia outbreak. PMID:23422213

  9. Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study.

    Science.gov (United States)

    Congdon, Nathan; Yan, Xixi; Lansingh, Van; Sisay, Alemayehu; Müller, Andreas; Chan, Ving; Jin, Ling; Meltzer, Mirjam E; Karumanchi, Sasipriya M; Guan, Chunhong; Vuong, Quy; Rivera, Nelson; McCleod-Omawale, Joan; He, Mingguang

    2013-07-01

    Poor follow-up after cataract surgery in developing countries makes assessment of operative quality uncertain. We aimed to assess two strategies to measure visual outcome: recording the visual acuity of all patients 3 or fewer days postoperatively (early postoperative assessment), and recording that of only those patients who returned for the final follow-up examination after 40 or more days without additional prompting. Each of 40 centres in ten countries in Asia, Africa, and Latin America recruited 40-120 consecutive surgical cataract patients. Operative-eye best-corrected visual acuity and uncorrected visual acuity were recorded before surgery, 3 or fewer days postoperatively, and 40 or more days postoperatively. Clinics logged whether each patient had returned for the final follow-up examination without additional prompting, had to be actively encouraged to return, or had to be examined at home. Visual outcome for each centre was defined as the proportion of patients with uncorrected visual acuity of 6/18 or better minus the proportion with uncorrected visual acuity of 6/60 or worse, and was calculated for each participating hospital with results from the early assessment of all patients and the late assessment of only those returning unprompted, with results from the final follow-up assessment for all patients used as the standard. Of 3708 participants, 3441 (93%) had final follow-up vision data recorded 40 or more days after surgery, 1831 of whom (51% of the 3581 total participants for whom mode of follow-up was recorded) had returned to the clinic without additional prompting. Visual outcome by hospital from early postoperative and final follow-up assessment for all patients were highly correlated (Spearman's rs=0·74, pFred Hollows Foundation, Helen Keller International, International Association for the Prevention of Blindness Latin American Office, Aravind Eye Care System. Copyright © 2013 Congdon et al. Open Access article distributed under the terms of

  10. Medicine administration errors and their severity in secondary care older persons' ward: a multi-centre observational study.

    Science.gov (United States)

    Kelly, Jennifer; Wright, David

    2012-07-01

    To assess the severity of medicine administration errors to older patients. Severity of medicine administration errors has been determined in a variety of settings but not in care-of-older-person wards, which this study aims to do. Undisguised observational study. Sixty-two nurses were observed administering oral medicines to 625 patients. Data were collected on the preparation and administration of oral medicines. Thirty-five cases of error were selected and analysed for their severity. In the 65 drug rounds observed 2129 potential drug administrations were made to 625 patients, of which 817 doses (38.4%) were given incorrectly (95% CI = 36.3-40.4). The overall mean harm score of the 35 incidents analysed was 4.1 (range 1.1-8.6, SD 1.8) on a scale of 0-10. The number and severity of MAEs observed is high compared with previous studies. There is a need to decrease the number and severity of MAEs, by increasing nurse awareness and error reporting. © 2011 Blackwell Publishing Ltd.

  11. MRI of the wrist in juvenile idiopathic arthritis: proposal of a paediatric synovitis score by a consensus of an international working group. Results of a multicentre reliability study

    International Nuclear Information System (INIS)

    Damasio, Maria Beatrice; Mattiuz, Chiara; Magnano, GianMichele; Malattia, Clara; Martini, Alberto; Tanturri de Horatio, Laura; Barbuti, Domenico; Toma, Paolo; Pistorio, Angela; Bracaglia, Claudia; Boavida, Peter; Ording, Lil Sophie Mueller; Juhan, Karen Lambot; Rosendahl, Karen

    2012-01-01

    MRI is a sensitive tool for the evaluation of synovitis in juvenile idiopathic arthritis (JIA). The purpose of this study was to introduce a novel MRI-based score for synovitis in children and to examine its inter- and intraobserver variability in a multi-centre study. Wrist MRI was performed in 76 children with JIA. On postcontrast 3-D spoiled gradient-echo and fat-suppressed T2-weighted spin-echo images, joint recesses were scored for the degree of synovial enhancement, effusion and overall inflammation independently by two paediatric radiologists. Total-enhancement and inflammation-synovitis scores were calculated. Interobserver agreement was poor to moderate for enhancement and inflammation in all recesses, except in the radioulnar and radiocarpal joints. Intraobserver agreement was good to excellent. For enhancement and inflammation scores, mean differences (95 % CI) between observers were -1.18 (-4.79 to 2.42) and -2.11 (-6.06 to 1.83). Intraobserver variability (reader 1) was 0 (-1.65 to 1.65) and 0.02 (-1.39 to 1.44). Intraobserver agreement was good. Except for the radioulnar and radiocarpal joints, interobserver agreement was not acceptable. Therefore, the proposed scoring system requires further refinement. (orig.)

  12. Annals of the international geophysical year ionospheric drift observations

    CERN Document Server

    Rawer, K; Beloussov, V V; Beynon, W J G

    2013-01-01

    Annals of the International Geophysical Year, Volume 33: Results of Ionospheric Drift Observations describes the systematic changes in individual ionospheric observations during the International Geophysical Year (IGY). This book is composed of four chapters, and begins with a presentation of the general data on stations and the lists of publications concerning drift work during IGY/IGC. The next chapter contains the results obtained mainly by intercomparison of the time shift between fadings observed on three antenna separated by a distance of roughly a wavelength. These data are followed by

  13. Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study.

    Science.gov (United States)

    Culine, S; Chambrier, C; Tadmouri, A; Senesse, P; Seys, P; Radji, A; Rotarski, M; Balian, A; Dufour, P

    2014-07-01

    Malnutrition is a predictor of poor outcomes in patients with cancer. Little is known about the benefit of nutritional support in these patients. The purpose of this study was to assess the impact of home parenteral nutrition (HPN) on quality of life (Qol) in cancer patients. We performed an observational prospective study to determine the impact of HPN on Qol in a population of patients with heterogeneous cancer. Physicians, patients and family members had to complete a questionnaire before HPN administration and 28 days after the course of HPN. Qol was evaluated using the self-administered questionnaire FACT-G. We included 767 patients with cancer of whom 437 ended the study. Mean patient age was 63±11.4 years and 60.5% were men. Primary gastrointestinal cancer was reported in 50% of patients and 65.3% were presenting metastases. Malnutrition was reported in 98.3%. After 28 days of HPN intake, significant improvement was observed in the Qol (49.95±5.82 vs. 48.35±5.01 at baseline, pnutrition risk index had also improved significantly. Most patients (78%) had perceived a positive impact of the HPN. A significant improvement in patient's well-being was perceived also by family members and physicians. Our data suggest that preventing and correcting malnutrition using HPN in patients with cancer might have a significant benefit on their well-being. Randomized controlled studies are required to confirm this finding.

  14. Impact of harmful use of alcohol on the sedation of critical patients on mechanical ventilation: A multicentre prospective, observational study in 8 Spanish intensive care units.

    Science.gov (United States)

    Sandiumenge, A; Torrado, H; Muñoz, T; Alonso, M Á; Jiménez, M J; Alonso, J; Pardo, C; Chamorro, C

    2016-05-01

    To evaluate the impact of a history of harmful use of alcohol (HUA) on sedoanalgesia practices and outcomes in patients on mechanical ventilation (MV). A prospective, observational multicentre study was made of all adults consecutively admitted during 30 days to 8 Spanish ICUs. Patients on MV >24h were followed-up on until discharge from the ICU or death. Data on HUA, smoking, the use of illegal (IP) and medically prescribed psychotropics (MPP), sedoanalgesia practices and their related complications (sedative failure [SF] and sedative withdrawal [SW]), as well as outcome, were prospectively recorded. A total of 23.4% (119/509) of the admitted patients received MV >24h; 68.9% were males; age 57.0 (17.9) years; APACHE II score 18.8 (7.2); with a medical cause of admission in 53.9%. Half of them consumed at least one psychotropic agent (smoking 27.7%, HUA 25.2%; MPP 9.2%; and IP 7.6%). HUA patients more frequently required PS (86.7% vs. 64%; p2 sedatives (56.7% vs. 28.1%; p<0.02). HUA was associated to an eightfold (p<0.001) and fourfold (p<0.02) increase in SF and SW, respectively. In turn, the duration of MV and the stay in the ICU was increased by 151h (p<0.02) and 4.4 days (p<0.02), respectively, when compared with the non-HUA group. No differences were found in terms of mortality. HUA may be associated to a higher risk of SF and WS, and can prolong MV and the duration of stay in the ICU in critical patients. Early identification could allow the implementation of specific sedation strategies aimed at preventing these complications. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  15. Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013.

    Science.gov (United States)

    Wiingreen, Rikke; Greisen, Gorm; Ebbesen, Finn; Petersen, Jesper Padkær; Zachariassen, Gitte; Henriksen, Tine Brink; Mølholm Hansen, Bo

    2017-01-01

    In recent years, early nasal continuous positive airway pressure (nCPAP) as respiratory support for preterm infants is being advocated as an alternative to prophylactic surfactant and treatment with mechanical ventilation. A number of infants treated with early nCPAP do not need treatment with surfactant, but few studies provide data on this. Since the 1990s, the first approach to respiratory support to preterm infants in Denmark has been early nCPAP combined with surfactant administration by the INSURE method by which the infant is intubated and surfactant administration is followed by rapid extubation to nCPAP if possible. To investigate how often surfactant was administered in preterm infants with a gestational age below 34 weeks treated with early nCPAP as a first approach to respiratory support. An observational multicentre study including all inborn infants with a gestational age below 34 weeks admitted to 1 of the 4 level 3 neonatal intensive care units in Denmark in the period from 2000 to 2013. A total of 6,628 infants were included in this study. We found that surfactant was administered in 1,056 of 1,799 (59%; 95% CI: 57-61%), in 821 of 2,864 (29%; 95% CI: 27-31%), and in 132 of 1,796 (7%; 95% CI: 6-8%) of the infants with a gestational age from 24 to 27, 28 to 31, and 32 to 33 weeks and 6 days, respectively. A large proportion of preterm infants treated with early nCPAP as the first approach to respiratory support was never treated with surfactant. © 2017 S. Karger AG, Basel.

  16. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study.

    Science.gov (United States)

    van den Boogaard, M; Pickkers, P; Slooter, A J C; Kuiper, M A; Spronk, P E; van der Voort, P H J; van der Hoeven, J G; Donders, R; van Achterberg, T; Schoonhoven, L

    2012-02-09

    To develop and validate a delirium prediction model for adult intensive care patients and determine its additional value compared with prediction by caregivers. Observational multicentre study. Five intensive care units in the Netherlands (two university hospitals and three university affiliated teaching hospitals). 3056 intensive care patients aged 18 years or over. Development of delirium (defined as at least one positive delirium screening) during patients' stay in intensive care. The model was developed using 1613 consecutive intensive care patients in one hospital and temporally validated using 549 patients from the same hospital. For external validation, data were collected from 894 patients in four other hospitals. The prediction (PRE-DELIRIC) model contains 10 risk factors-age, APACHE-II score, admission group, coma, infection, metabolic acidosis, use of sedatives and morphine, urea concentration, and urgent admission. The model had an area under the receiver operating characteristics curve of 0.87 (95% confidence interval 0.85 to 0.89) and 0.86 after bootstrapping. Temporal validation and external validation resulted in areas under the curve of 0.89 (0.86 to 0.92) and 0.84 (0.82 to 0.87). The pooled area under the receiver operating characteristics curve (n=3056) was 0.85 (0.84 to 0.87). The area under the curve for nurses' and physicians' predictions (n=124) was significantly lower at 0.59 (0.49 to 0.70) for both. The PRE-DELIRIC model for intensive care patients consists of 10 risk factors that are readily available within 24 hours after intensive care admission and has a high predictive value. Clinical prediction by nurses and physicians performed significantly worse. The model allows for early prediction of delirium and initiation of preventive measures. Trial registration Clinical trials NCT00604773 (development study) and NCT00961389 (validation study).

  17. Occupational status as a determinant of mental health inequities in French young people: is fairness needed? Results of a cross-sectional multicentre observational survey.

    Science.gov (United States)

    Blanquet, Marie; Labbe-Lobertreau, Emilie; Sass, Catherine; Berger, Dominique; Gerbaud, Laurent

    2017-08-08

    Employment conditions are associated with health inequities. In 2013, French young people had the highest unemployment rate and among those who worked as salaried workers most of them had temporary job. The purpose of the study was to assess mental health state of French young people through the prism of their occupational status and to measure whether occupational status is a determinant of health inequities. A cross-sectional multicentre observational survey was performed in June and July 2010 in 115 French Local Social Centres and 74 Health Examination Centres, who were available to participate. The survey was based on an anonymous self-administrated questionnaire delivered by social workers or healthcare professionals to young people age from 16 to 25 years old. The questionnaire was composed of 54 items. Several health outcomes were measured: self-perceived health, mental health, addictions and to be victim of violence. The association of occupational status and mental health was assessed by adjusting results on age and gender and by introducing other explanatory variables such as social deprivation. A total of 4282 young people completed the questionnaire, a response rate of 83%, 1866 men and 2378 women, sex-ratio 0.79. French young people having a non-working occupational status or a non-permanent working status were more exposed to poor self-perceived health, poor mental health, addictions and violence. To be at school particularly secondary school was a protective factor for addiction. Occupational status of French young people was a determinant of mental health inequities. Young people not at work and not studying reported greater vulnerability and should be targeted therefore by appropriate and specific social and medical services.

  18. Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals.

    Science.gov (United States)

    Ismail, S; Siddiqui, S; Shafiq, F; Ishaq, M; Khan, S

    2014-08-01

    Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin. A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (Ptransfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses.

    Science.gov (United States)

    Bellandi, Tommaso; Cerri, Alessandro; Carreras, Giulia; Walter, Scott; Mengozzi, Cipriana; Albolino, Sara; Mastrominico, Eleonora; Renzetti, Fernando; Tartaglia, Riccardo; Westbrook, Johanna

    2018-01-01

    The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

  20. Treatment effect and safety of EPs 7630-solution in acute bronchitis in childhood: report of a multicentre observational study.

    Science.gov (United States)

    Haidvogl, M; Heger, M

    2007-01-01

    An open post-marketing surveillance study was conducted to examine the treatment effect and safety of EPs 7630-solution in the treatment of acute bronchitis in children. This study included a total of 742 children (aged between 0 and 12 years) with acute bronchitis (83.4%) or acute exacerbations of chronic bronchitis (14.3%), who were treated with different doses of the herbal drug for up to 14 days. Five bronchitis specific symptoms (BSS) were summed up to give an overall measure of disease severity. Non-specific disease symptoms (loss of appetite, diarrhoea, headache, vomiting, and fever) were also recorded, together with adverse events and overall ratings of efficacy and tolerability. The overall BSS score decreased during treatment from 6.0+/-3.0 points at baseline to 2.7+/-2.5 points after 7 days and to 1.4+/-2.1 points after 14 days. Remission or improvement in at least 80% of patients was recorded for all the individual component symptoms. The proportion of patients suffering from non-specific symptoms also substantially improved during treatment. For example, loss of appetite was present in 65.8% of patients at study begin, but only in 27.6% at the time point of last observation visit. In 88.3% of cases, the responsible physician rated the treatment as successful. Adverse events were minor and transitory. In conclusion, EPs 7630-solution was shown to be a safe and an effective treatment option for acute bronchitis or acute exacerbations of chronic bronchitis in children.

  1. Remission in early, aggressive rheumatoid arthritis: a multicentre prospective observational Italian study ARPA (Artrite Reumatoide Precoce Aggressiva).

    Science.gov (United States)

    Ceccarelli, Fulvia; Perricone, Carlo; Trotta, Francesco; Cuomo, Giovanna; Pellerito, Raffaele; Bagnato, Gianfilippo; Salaffi, Fausto; Caporali, Roberto; Cutolo, Maurizio; Galeazzi, Mauro; Fiocco, Ugo; Lapadula, Giovanni; Bombardieri, Stefano; Bianchi, Girolamo; Gorla, Roberto; Giardina, Anna Rita; Gallo, Gaia; Giardino, Angela Maria; Valesini, Guido

    2013-01-01

    To provide a survey of disease activity in patients treated with standard care in Italian clinical practice. This was an observational prospective cohort study in patients with early, aggressive rheumatoid arthritis (RA; duration ≤2 years but ≥6 weeks; DAS28 >3.2) naïve to anti-tumour necrosis factor (TNF) therapy who were treated with disease-modifying anti-rheumatic drugs (DMARDs) and/or biologics according to standard practice at 15 Italian ARPA (Artrite Reumatoide Precoce Aggressiva) centres. Patients were evaluated at baseline and after 6, 12 and 24 months. The primary endpoint was the proportion of patients achieving remission, as defined by disease activity score in 28 joints (DAS28) <2.6, after 1 year. Among the 152 patients enrolled, 92 were evaluable after 1 year and 77 after 2 years for DAS28. At baseline, patients had a mean DAS28 of 6.1±1.0. At 12 months, 62.6% of patients were treated with DMARDs (in monotherapy or in combination), and 37.4% with anti-TNFs (in monotherapy or in association with DMARDs). At 24 months, 35.1% were receiving anti-TNF therapy. The rate of DAS28 remission rates at 12 months and 24 months were 28.3% (95% confidence interval [CI] 19.1-37.5) and 41.6% (95% confidence interval [CI] 30.6-52.6), respectively. The remission rate was lower at 12 months compared with previous large randomised clinical trials for early, aggressive RA, but significantly improved at 24 months. These results suggest that patients in real-world clinical settings in Italy may experience a delay in receiving the best possible care.

  2. A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale.

    Science.gov (United States)

    Walker, Stephen L; Sales, Anna M; Butlin, C Ruth; Shah, Mahesh; Maghanoy, Armi; Lambert, Saba M; Darlong, Joydeepa; Rozario, Benjamin Jewel; Pai, Vivek V; Balagon, Marivic; Doni, Shimelis N; Hagge, Deanna A; Nery, José A C; Neupane, Kapil D; Baral, Suwash; Sangma, Biliom A; Alembo, Digafe T; Yetaye, Abeba M; Hassan, Belaynesh A; Shelemo, Mohammed B; Nicholls, Peter G; Lockwood, Diana N J

    2017-07-01

    We wished to validate our recently devised 16-item ENLIST ENL Severity Scale, a clinical tool for measuring the severity of the serious leprosy associated complication of erythema nodosum leprosum (ENL). We also wished to assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical change in patients with ENL. Participants, recruited from seven centres in six leprosy endemic countries, were assessed using the ENLIST ENL Severity Scale by two researchers, one of whom categorised the severity of ENL. At a subsequent visit a further assessment using the scale was made and both participant and physician rated the change in ENL using the subjective categories of "Much better", "somewhat better", "somewhat worse" and "much worse" compared with "No change" or "about the same". 447 participants were assessed with the ENLIST ENL Severity Scale. The Cronbach alpha of the scale and each item was calculated to determine the internal consistency of the scale. The ENLIST ENL Severity Scale had good internal consistency and this improved following removal of six items to give a Cronbach's alpha of 0.77. The cut off between mild ENL and more severe disease was 9 determined using ROC curves. The minimal important difference of the scale was determined to be 5 using both participant and physician ratings of change. The 10-item ENLIST ENL Severity Scale is the first valid, reliable and responsive measure of ENL severity and improves our ability to assess and compare patients and their treatments in this severe and difficult to manage complication of leprosy. The ENLIST ENL Severity Scale will assist physicians in the monitoring and treatment of patients with ENL. The ENLIST ENL Severity Scale is easy to apply and will be useful as an outcome measure in treatment studies and enable the standardisation of other clinical and laboratory ENL research.

  3. Three-dimensional printed models for surgical planning of complex congenital heart defects: an international multicentre study.

    Science.gov (United States)

    Valverde, Israel; Gomez-Ciriza, Gorka; Hussain, Tarique; Suarez-Mejias, Cristina; Velasco-Forte, Maria N; Byrne, Nicholas; Ordoñez, Antonio; Gonzalez-Calle, Antonio; Anderson, David; Hazekamp, Mark G; Roest, Arno A W; Rivas-Gonzalez, Jose; Uribe, Sergio; El-Rassi, Issam; Simpson, John; Miller, Owen; Ruiz, Enrique; Zabala, Ignacio; Mendez, Ana; Manso, Begoña; Gallego, Pastora; Prada, Freddy; Cantinotti, Massimiliano; Ait-Ali, Lamia; Merino, Carlos; Parry, Andrew; Poirier, Nancy; Greil, Gerald; Razavi, Reza; Gomez-Cia, Tomas; Hosseinpour, Amir-Reza

    2017-12-01

    To evaluate the impact of 3D printed models (3D models) on surgical planning in complex congenital heart disease (CHD). A prospective case-crossover study involving 10 international centres and 40 patients with complex CHD (median age 3 years, range 1 month-34 years) was conducted. Magnetic resonance imaging and computed tomography were used to acquire and segment the 3D cardiovascular anatomy. Models were fabricated by fused deposition modelling of polyurethane filament, and dimensions were compared with medical images. Decisions after the evaluation of routine clinical images were compared with those after inspection of the 3D model and intraoperative findings. Subjective satisfaction questionnaire was provided. 3D models accurately replicate anatomy with a mean bias of -0.27 ± 0.73 mm. Ninety-six percent of the surgeons agree or strongly agree that 3D models provided better understanding of CHD morphology and improved surgical planning. 3D models changed the surgical decision in 19 of the 40 cases. Consideration of a 3D model refined the planned biventricular repair, achieving an improved surgical correction in 8 cases. In 4 cases initially considered for conservative management or univentricular palliation, inspection of the 3D model enabled successful biventricular repair. 3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. Oxygen therapy multicentric study—A nationwide audit to oxygen therapy procedures in Internal Medicine wards

    Directory of Open Access Journals (Sweden)

    J.T. Neves

    2012-03-01

    Full Text Available Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it is not provided accordingly with the best of care. The goal of this work was to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS in its consensus statement “BTS guideline for emergency oxygen use in adult patients”.Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring.Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93.4%. Most prescriptions were by a fixed dose (82.4%, but only 11.6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors.Oxygen was administered to only 77.0% of the patients with fixed dose prescriptions. FiO2 or flow rate and the delivery device were the same as prescribed in 70.9 and 89.2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO2 range, 82.7% were on the prescribed SatO2 objective range.Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO2 range are still a minority. Resumo: A oxigenoterapia é um tratamento comum e importante nas enfermarias de Medicina Interna. Contudo, vários estudos demonstram que não é praticada de acordo com os melhores cuidados. O objetivo deste trabalho foi o de avaliar os procedimentos de oxigenoterapia nas enfermarias de Medicina Interna portuguesas, comparando-os com os crit

  5. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study.

    Science.gov (United States)

    Praz, Fabien; Spargias, Konstantinos; Chrissoheris, Michael; Büllesfeld, Lutz; Nickenig, Georg; Deuschl, Florian; Schueler, Robert; Fam, Neil P; Moss, Robert; Makar, Moody; Boone, Robert; Edwards, Jeremy; Moschovitis, Aris; Kar, Saibal; Webb, John; Schäfer, Ulrich; Feldman, Ted; Windecker, Stephan

    2017-08-19

    Severe mitral regurgitation is associated with impaired prognosis if left untreated. Using the devices currently available, transcatheter mitral valve repair (TMVr) remains challenging in complex anatomical situations. We report the procedural and 30-day results of the first-in-man study of the Edwards PASCAL TMVr system. In this multicentre, prospective, observational, first-in-man study, we collected data from seven tertiary care hospitals in five countries that had a compassionate use programme in which patients underwent transcatheter mitral valve repair using the Edwards PASCAL TMVr system. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation deemed at high risk or inoperable. Safety and efficacy of the procedure were prospectively assessed at device implantation, discharge, and 30 days after device implantation. The key study endpoints were technical success assessed at the end of the procedure and device success 30 days after implantation using the Mitral Valve Academic Research Consortium definitions. Between Sept 1, 2016, and March 31, 2017, 23 patients (median age 75 years [IQR 61-82]) had treatment for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the Edwards PASCAL TMVr system. At baseline, the median EuroScore II score was 7·1% (IQR 3·6-12·8) and the median Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair was 4·8% (2·1-9·0) and 6·8% (2·9-10·1) for mitral valve replacement. 22 (96%) of 23 patients were New York Heart Association (NYHA) class III or IV at baseline. The implantation of at least one device was successful in all patients, resulting in procedural residual mitral regurgitation of grade 2+ or less in 22 (96%) patients. Six (26%) of 23 patients had two implants. Periprocedural complications occurred in two (9%) of 23 patients (one minor bleeding event and one transient ischaemic attack). Despite the anatomical

  6. Multicentric lupus vulgaris

    Directory of Open Access Journals (Sweden)

    Ramachandra S

    1995-01-01

    Full Text Available A 60 year old female patient presented with disseminated tuberculosis. She had multicentric lupus vulgaris and her joints, bones, lymph nodes and lungs were also affected. Haematogenous dissemination was because of her poor health.

  7. Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves' orbitopathy (MINGO): a randomised, observer-masked, multicentre trial.

    Science.gov (United States)

    Kahaly, George J; Riedl, Michaela; König, Jochem; Pitz, Susanne; Ponto, Katharina; Diana, Tanja; Kampmann, Elena; Kolbe, Elisa; Eckstein, Anja; Moeller, Lars C; Führer, Dagmar; Salvi, Mario; Curro, Nicola; Campi, Irene; Covelli, Danila; Leo, Marenza; Marinò, Michele; Menconi, Francesca; Marcocci, Claudio; Bartalena, Luigi; Perros, Petros; Wiersinga, Wilmar M

    2018-04-01

    European guidelines recommend intravenous methylprednisolone as first-line treatment for active and severe Graves' orbitopathy; however, it is common for patients to have no response or have relapse after discontinuation of treatment. We aimed to compare the efficacy and safety of add-on mycophenolate to methylprednisolone in comparison with methylprednisolone alone in patients with moderate-to-severe Graves' orbitopathy. MINGO was an observer-masked, multicentre, block-randomised, centre-stratified trial done in two centres in Germany and two in Italy. Patients with active moderate-to-severe Graves' orbitopathy were randomly assigned to receive intravenous methylprednisolone (500 mg once per week for 6 weeks followed by 250 mg per week for 6 weeks) either alone or with mycophenolate (one 360 mg tablet twice per day for 24 weeks). The prespecified primary endpoints were rate of response (reduction of at least two parameters of a composite ophthalmic index [eyelid swelling, clinical activity score, proptosis, lid width, diplopia, and eye muscle motility] without deterioration in any other parameter) at 12 weeks and rate of relapse (a worsening of symptoms that occurred after a response) at 24 and 36 weeks. Rates of response at week 24 and sustained response at week 36 were added as post-hoc outcomes. Prespecified primary outcomes and post-hoc outcomes were assessed in the modified intention-to-treat population (defined as all patients assigned to treatment who received at least one infusion of methylprednisolone, when outcome data were available), and safety was assessed in all patients who received at least one dose of study drug. This trial is registered with the EU Clinical Trials Register, EUDRACT number 2008-002123-93. 164 patients were enrolled and randomised between Nov 29, 2009, and July 31, 2015. 81 were randomly assigned to receive methylprednisolone alone and 83 to receive methylprednisolone with mycophenolate. In the intention-to-treat population at 12

  8. Effectiveness and tolerability of fixed-dose combination enalapril plus nitrendipine in hypertensive patients: results of the 3-month observational, post-marketing, multicentre, prospective CENIT study.

    Science.gov (United States)

    Sierra, Alejandro de la; Roca-Cusachs, Alejandro; Redón, Josep; Marín, Rafael; Luque, Manuel; Figuera, Mariano de la; Garcia-Garcia, Margarida; Falkon, Liliana

    2009-01-01

    Monotherapy with any class of antihypertensive drug effectively controls blood pressure (BP) in only about 50% of patients. Consequently, the majority of patients with hypertension require combined therapy with two or more medications. This study aimed to evaluate the effectiveness (systolic BP [SBP]/diastolic BP [DBP] control) and tolerability of the fixed-dose combination enalapril/nitrendipine 10 mg/20 mg administered as a single daily dose in hypertensive patients. This was a post-authorization, multicentre, prospective, observational study conducted in primary care with a 3-month follow-up. Patients throughout Spain with uncontrolled hypertension (> or =140/90 mmHg for patients without diabetes mellitus, or > or =130/85 mmHg for patients with diabetes) on monotherapy or with any combination other than enalapril + nitrendipine, or who were unable to tolerate their previous antihypertensive therapy, were recruited. Change from previous to study treatment was according to usual clinical practice. BP was measured once after 5 minutes of rest in the sitting position. Therapeutic response was defined as follows: 'controlled' meant controlled BP ( or =20 mmHg and in DBP of > or =10 mmHg. The main laboratory test parameters were documented at baseline and after 3 months. Patients aged >65 years, with diabetes, with isolated systolic hypertension (ISH; SBP > or =140 mmHg for patients without diabetes, SBP > or =130 mmHg for patients with diabetes) and who were obese (body mass index [BMI] > or =30 kg/m2) were analysed separately. Of 6537 patients included, 5010 and 6354 patients were assessed in effectiveness and tolerability analyses, respectively. In the tolerability analysis population, there were 3023 men (47.6%) and 3321 women (52.4%). The mean (+/- SD) age of the tolerability analysis group was 62.8 (+/- 10.7) years. A total of 71.1% of the patients presented at least one clinical cardiovascular risk factor other than hypertension, with the most frequent being

  9. Determining Surgical Complications in the Overweight (DISCOVER): a multicentre observational cohort study to evaluate the role of obesity as a risk factor for postoperative complications in general surgery.

    Science.gov (United States)

    Nepogodiev, Dmitri; Chapman, Stephen J; Glasbey, James; Kelly, Michael; Khatri, Chetan; Drake, Thomas M; Kong, Chia Yew; Mitchell, Harriet; Harrison, Ewen M; Fitzgerald, J Edward; Bhangu, Aneel

    2015-07-20

    Obesity is increasingly prevalent among patients undergoing surgery. Conflicting evidence exists regarding the impact of obesity on postoperative complications. This multicentre study aims to determine whether obesity is associated with increased postoperative complications following general surgery. This prospective, multicentre cohort study will be performed utilising a collaborative methodology. Consecutive adults undergoing open or laparoscopic, elective or emergency, gastrointestinal, bariatric or hepatobiliary surgery will be included. Day case patients will be excluded. The primary end point will be the overall 30-day major complication rate (Clavien-Dindo grade III-V complications). Data will be collected to risk-adjust outcomes for potential confounding factors, such as preoperative cardiac risk. This study will be disseminated through structured medical student networks using established collaborative methodology. The study will be powered to detect a two-percentage point increase in the major postoperative complication rate in obese versus non-obese patients. Following appropriate assessment, an exemption from full ethics committee review has been received, and the study will be registered as a clinical audit or service evaluation at each participating hospital. Dissemination will take place through national and local research collaborative networks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Erlotinib and bevacizumab in patients with advanced non-small-cell lung cancer and activating EGFR mutations (BELIEF): an international, multicentre, single-arm, phase 2 trial.

    Science.gov (United States)

    Rosell, Rafael; Dafni, Urania; Felip, Enriqueta; Curioni-Fontecedro, Alessandra; Gautschi, Oliver; Peters, Solange; Massutí, Bartomeu; Palmero, Ramon; Aix, Santiago Ponce; Carcereny, Enric; Früh, Martin; Pless, Miklos; Popat, Sanjay; Kotsakis, Athanasios; Cuffe, Sinead; Bidoli, Paolo; Favaretto, Adolfo; Froesch, Patrizia; Reguart, Noemí; Puente, Javier; Coate, Linda; Barlesi, Fabrice; Rauch, Daniel; Thomas, Michael; Camps, Carlos; Gómez-Codina, Jose; Majem, Margarita; Porta, Rut; Shah, Riyaz; Hanrahan, Emer; Kammler, Roswitha; Ruepp, Barbara; Rabaglio, Manuela; Kassapian, Marie; Karachaliou, Niki; Tam, Rachel; Shames, David S; Molina-Vila, Miguel A; Stahel, Rolf A

    2017-05-01

    The tyrosine kinase inhibitor erlotinib improves the outcomes of patients with advanced non-small-cell lung carcinoma (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations. The coexistence of the T790M resistance mutation with another EGFR mutation in treatment-naive patients has been associated with a shorter progression-free survival to EGFR inhibition than in the absence of the T790M mutation. To test this hypothesis clinically, we developed a proof-of-concept study, in which patients with EGFR-mutant NSCLC were treated with the combination of erlotinib and bevacizumab, stratified by the presence of the pretreatment T790M mutation. BELIEF was an international, multicentre, single-arm, phase 2 trial done at 29 centres in eight European countries. Eligible patients were aged 18 years or older and had treatment-naive, pathologically confirmed stage IIIB or stage IV lung adenocarcinoma with a confirmed, activating EGFR mutation (exon 19 deletion or L858R mutation). Patients received oral erlotinib 150 mg per day and intravenous bevacizumab 15 mg/kg every 21 days and were tested centrally for the pretreatment T790M resistance mutation with a peptide nucleic acid probe-based real-time PCR. The primary endpoint was progression-free survival. The primary efficacy analysis was done in the intention-to-treat population and was stratified into two parallel substudies according to the centrally confirmed pretreatment T790M mutation status of enrolled patients (T790M positive or negative). The safety analysis was done in all patients that have received at least one dose of trial treatment. This trial was registered with ClinicalTrials.gov, number NCT01562028. Between June 11, 2012, and Oct 28, 2014, 109 patients were enrolled and included in the efficacy analysis. 37 patients were T790M mutation positive and 72 negative. The overall median progression-free survival was 13·2 months (95% CI 10·3-15·5), with a 12 month progression-free survival of 55% (95% CI

  11. World-Wide Outreach through International Observe the Moon Night

    Science.gov (United States)

    Buxner, S.; Jones, A. P.; Bleacher, L.; Shaner, A. J.; Day, B. H.; Wenger, M.; Joseph, E.; Canipe, M.

    2016-12-01

    International Observe the Moon Night (InOMN) is an annual worldwide public event that encourages observation, appreciation, and understanding of our Moon and its connection to NASA planetary science and exploration. Everyone on Earth is invited to join the celebration by hosting or attending an InOMN event - and uniting on one day each year to look at and learn about the Moon together. Events are hosted by a variety of institutions including astronomy clubs, observatories, schools, and universities, museums, planetaria, schools, universities, observatories, parks, private businesses and private homes. Events hosts are supported with event flyers, information sheets, Moon maps for observing, activities to use during events, presentations, certificates of participation, and evaluation materials to be used by hosts. 2016 is the seventh year of worldwide participation in InOMN which will be held on October 8th. In the last six years, over 3,000 events were registered worldwide from almost 100 different countries and almost all 50 states and the District of Columbia in the United States. Evaluation of InOMN is conducted by an external evaluation group and includes analysis of event registrations, facilitator surveys, and visitor surveys. Evaluation results demonstrate that InOMN events are successful in raising visitors' awareness of lunar science and exploration, providing audiences with information about lunar science and exploration, and inspiring visitors to want to learn more about the Moon. Additionally, preliminary analysis of social media has shown that there is a virtual network of individuals connecting about InOMN. A large fraction of events have been held by institutions for more than one year showing sustained interest in participation. During this presentation, we will present data for all seven years of InOMN including lessons learned through supporting and evaluating a worldwide event. InOMN is sponsored by NASA's Lunar Reconnaissance Orbiter, NASA

  12. Influence of quality of care and individual patient characteristics on quality of life and return to work in survivors of the acute respiratory distress syndrome: protocol for a prospective, observational, multi-centre patient cohort study (DACAPO).

    Science.gov (United States)

    Brandstetter, Susanne; Dodoo-Schittko, Frank; Blecha, Sebastian; Sebök, Philipp; Thomann-Hackner, Kathrin; Quintel, Michael; Weber-Carstens, Steffen; Bein, Thomas; Apfelbacher, Christian

    2015-12-17

    Health-related quality of life (HRQoL) and return to work are important outcomes in critical care medicine, reaching beyond mortality. Little is known on factors predictive of HRQoL and return to work in critical illness, including the acute respiratory distress syndrome (ARDS), and no evidence exists on the role of quality of care (QoC) for outcomes in survivors of ARDS. It is the aim of the DACAPO study ("Surviving ARDS: the influence of QoC and individual patient characteristics on quality of life") to investigate the role of QoC and individual patient characteristics on quality of life and return to work. A prospective, observational, multi-centre patient cohort study will be performed in Germany, using hospitals from the "ARDS Network Germany" as the main recruiting centres. It is envisaged to recruit 2400 patients into the DACAPO study and to analyse a study population of 1500 survivors. They will be followed up until 12 months after discharge from hospital. QoC will be assessed as process quality, structural quality and volume at the institutional level. The main outcomes (HRQoL and return to work) will be assessed by self-report questionnaires. Further data collection includes general medical and ARDS-related characteristics of patients as well as sociodemographic and psycho-social parameters. Multilevel hierarchical modelling will be performed to analyse the effects of QoC and individual patient characteristics on outcomes, taking the cluster structure of the data into account. By obtaining comprehensive data at patient and hospital level using a prospective multi-centre design, the DACAPO-study is the first study investigating the influence of QoC on individual outcomes of ARDS survivors.

  13. Experimental observation of internal water curing of concrete

    DEFF Research Database (Denmark)

    Lura, Pietro; Jensen, Ole Mejlhede

    2007-01-01

    Internal water curing has a significant effect on concrete. In addition to affecting hydration and moisture distribution, it influences most concrete properties, such as strength, shrinkage, cracking, and durability. The following paper is an overview of experimental methods to study internal water...... curing of concrete and its consequences. The special techniques needed to study internal water curing are dealt with along with the consequences of this process. Examples of applications are given and new measuring techniques that may potentially be applied to this field are addressed....

  14. International Halley watch amateur observers' manual for scientific comet studies. Part 1: Methods

    Science.gov (United States)

    Edberg, S. J.

    1983-01-01

    The International Halley Watch is described as well as comets and observing techniques. Information on periodic Comet Halley's apparition for its 1986 perihelion passage is provided. Instructions are given for observation projects valuable to the International Halley Watch in six areas of study: (1) visual observations; (2) photography; (3) astrometry; (4) spectroscopic observations; (5) photoelectric photometry; and (6) meteor observations.

  15. Committee on Earth Observation Satellites (CEOS) International Directory Portal

    Data.gov (United States)

    National Aeronautics and Space Administration — The CEOS IDN is an international effort developed to assist researchers in locating information on available datasets and services. The directory is sponsored as a...

  16. Atypical multicentric reticulohistiocytosis

    Directory of Open Access Journals (Sweden)

    Mittal R

    1998-01-01

    Full Text Available A 38-year-old male had arthritis since 8 years and erythematous papules, plaques, cutaneous and subcutaneous nodules over face, ears, trunk, and extensors of arms since 2 years, Histopathologically, presence of multiple foreign body giant cells confirmed the clinical diagnosis of multicentric reticulohistiocytosis. Unusual associations were: tapered fingers with depressed scars on their tips, low ESR - (5mm 1st hour. Raynaud′s phenomenon and exaggeration of lesions after methotrexate.

  17. Association of glycerol and paraffin in the treatment of ichthyosis in children: an international, multicentric, randomized, controlled, double-blind study.

    Science.gov (United States)

    Blanchet-Bardon, C; Tadini, G; Machado Matos, M; Delarue, A

    2012-08-01

    Efficacy and tolerance should be considered in topical treatments of chronicle affections with impaired skin barrier function such as ichthyosis. To demonstrate the efficacy of Dexeryl in reducing severity of ichthyosis. A prospective, multicentre, randomized, placebo controlled study was performed with patients under 18 years suffering from a non-bullous form of ichthyosis. A double-blind period using Dexeryl (an emollient cream containing glycerol 15% and paraffin 10%) or placebo (its vehicle) during 4 weeks followed by an open label period with all patients treated by Dexeryl for 8 weeks. Improvement of ichthyosis was assessed by cutaneous xerosis evolution (SRRC score): the percentage of patients with 50% reduction of the SRRC score at D28 was the primary criterion. The assessment of pruritus [visual analogue scale (VAS)], global evaluation and safety were secondary. The percentage of patients with at least 50% reduction of SRRC score at D28 was significantly higher in Dexeryl group (60.3%) vs. vehicle group (43.5%; P = 0.008). Reduction of pruritus on VAS was significantly higher at D28 with Dexeryl (-2.16) compared to that in placebo (-1.49), P ichthyosis and was well tolerated. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

  18. Observations on the robustness of internal wave attractors to perturbations

    Science.gov (United States)

    Hazewinkel, Jeroen; Tsimitri, Chrysanthi; Maas, Leo R. M.; Dalziel, Stuart B.

    2010-10-01

    Previously, internal wave attractors have been studied in the laboratory in idealized situations. Here, we present a series of experiments in which these conditions are modified. Modifications are made by varying the forcing frequency, by using a nonuniform stratification, by introducing finite amplitude perturbations to the trapezoidal domain, and by using a parabolic domain. All these new experiments reveal the persistence of internal wave attractors that remain reasonably well predictable by means of ray tracing. We conclude that the occurrence of wave attractors is likely to be more general than has previously been thought. The fundamental response of the confined, continuously stratified fluids studied in this paper to a sustained forcing has to be described in terms of internal wave attractors.

  19. A 2-Year, Phase IV, Multicentre, Observational Study of Ranibizumab 0.5 mg in Patients with Neovascular Age-Related Macular Degeneration in Routine Clinical Practice: The EPICOHORT Study

    Directory of Open Access Journals (Sweden)

    Sergio Pagliarini

    2014-01-01

    Full Text Available Purpose. To assess the safety profile of ranibizumab 0.5 mg in patients with neovascular age-related macular degeneration (nAMD in routine clinical practice. Methods. This 2-year, multicentre, observational study was conducted to capture real-world early practice and outcomes across Europe, shortly after European licensing of ranibizumab for nAMD. Being observational in nature, the study did not impose diagnostic/therapeutic interventions/visit schedule. Patients were to be treated as per the EU summary of product characteristics (SmPC in effect during the study. Key outcome measures were incidence of selected adverse events (AEs, treatment exposure, bilateral treatment, compliance to the EU SmPC, and best-corrected visual acuity (BCVA over 2 years. Results. 755 of 770 patients received treatment. Ranibizumab was generally well tolerated with low incidence of selected AEs (0%–1.9%. Patients received 6.2 (mean injections and 133 patients received bilateral treatment over 2 years. Protocol deviation to treatment compliance was reported in majority of patients. The observed decline in mean BCVA (Month 12, +1.5; Month 24, –1.3 letters may be associated with undertreatment as suggested by BCVA subgroup analysis. Conclusion. The EPICOHORT study conducted in routine clinical practice reinforces the well-established safety profile of ranibizumab in nAMD. In early European practice it appeared that the nAMD patients were undertreated.

  20. International Observe the Moon Night: Providing Opportunities for the Public to Engage in Lunar Observation

    Science.gov (United States)

    Hsu, B. C.; Bleacher, L.; Day, B. H.; Daou, D.; Jones, A. P.; Mitchell, B.; Shaner, A. J.; Shipp, S. S.

    2010-12-01

    International Observe the Moon Night (InOMN) is designed to engage lunar science and education communities, our partner networks, amateur astronomers, space enthusiasts, and the general public in annual lunar observation campaigns that share the excitement of lunar science and exploration. InOMN enables the public to maintain its curiosity about the Moon and gain a better understanding of the Moon's formation, its evolution, and its place in the sky. For 2010, members of the public were encouraged to host their own InOMN events. InOMN hosts such as astronomy clubs, museums, schools, or other groups could find helpful resources and share information about InOMN events they organized on the InOMN website (http://observethemoonnight.org). Images, feedback, and lessons learned from the 2010 InOMN event will be shared in order to encourage increased planning and hosting of InOMN events in 2011. From various interpretations of the lunar “face,” early pictograms of the Moon’s phases, or to the use of the lunar cycle for festivals or harvests, the Moon has an undeniable influence on human civilization. We have chosen the 2011 InOMN theme to provide an opportunity for individuals to share their personal or cultural connections to the Moon. For 2011, the InOMN website will include a ‘lunar bulletin board’ where InOMN participants can post pictures and share stories of what the Moon means to them. The 2011 InOMN contest will encourage people to submit their works of art, poems, short stories, or music about the Moon all centered around the theme “What does the Moon mean to you?” As with the winners of previous contests, winning entries will be incorporated into the following year’s InOMN advertisements and events.

  1. The internal migration between public and faith-based health providers: a cross-sectional, retrospective and multicentre study from southern Tanzania.

    Science.gov (United States)

    Tabatabai, Patrik; Prytherch, Helen; Baumgarten, Inge; Kisanga, Oberlin M E; Schmidt-Ehry, Bergis; Marx, Michael

    2013-07-01

    To assess the magnitude, direction and underlying dynamics of internal health worker migration between public and faith-based health providers from a hospital perspective. Two complementary tools were implemented in 10 public and six faith-based hospitals in southern Tanzania. A hospital questionnaire assessed magnitude and direction of staff migration between January 2006 and June 2009. Interviews with 42 public and 20 faith-based maternity nurses evaluated differences in staff perspectives and motives for the observed migration patterns. The predominant direction of staff movement was from the faith-based to the public sector: 69.1% (n = 105/152) of hospital staff exits and 60.6% (n = 60/99) of hospital staff gains. Nurses were the largest group among the migrating health workforce. Faith-based hospitals lost 59.3% (n = 86/145) of nurses and 90.6% (n = 77/85) of registered nurses to the public sector, whereby public hospitals reported 13.5% (n = 59/436) of nurses and 24.4% (n = 41/168) of registered nurses being former faith-based employees. Interviews revealed significantly inferior staff perspectives among faith-based respondents than their public colleagues. Main differences were identified regarding career development and training, management support, employee engagement and workload. This study revealed considerable internal health worker migration from the faith-based to the public sector. Staff retention and motivation within faith-based hospitals are not restricted to financial considerations, and salary gaps can no longer uniquely explain this movement pattern. The consequences for the catchment area of faith-based hospitals are potentially severe and erode cooperation potential between the public and private health sector.

  2. OBSERVATIONS ON LEVELS OF INTERNAL PARASITES IN FREE ...

    African Journals Online (AJOL)

    Since wild animals have assumed greater importance as a natural resource in developing countries, it has become imperative that more be known of the natural mechanisms which control the size and density of their populations. Under natural conditions internal parasites are rarely pathogenic in wild mammals and birds.

  3. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial.

    Science.gov (United States)

    van den Hout, Lieke; Tibboel, Dick; Vijfhuize, Sanne; te Beest, Harma; Hop, Wim; Reiss, Irwin

    2011-11-02

    Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO) to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. This trial is designed as a multicentre trial in which 400 infants (200 in each arm) will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. Netherlands Trial Register (NTR): NTR1310.

  4. The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van den Hout Lieke

    2011-11-01

    Full Text Available Abstract Background Congenital diaphragmatic hernia (CDH is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. Methods/design This trial is designed as a multicentre trial in which 400 infants (200 in each arm will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. Discussion To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. Trial registration Netherlands Trial Register (NTR: NTR1310

  5. Non-Stationary Internal Tides Observed with Satellite Altimetry

    Science.gov (United States)

    Ray, Richard D.; Zaron, E. D.

    2011-01-01

    Temporal variability of the internal tide is inferred from a 17-year combined record of Topex/Poseidon and Jason satellite altimeters. A global sampling of along-track sea-surface height wavenumber spectra finds that non-stationary variance is generally 25% or less of the average variance at wavenumbers characteristic of mode-l tidal internal waves. With some exceptions the non-stationary variance does not exceed 0.25 sq cm. The mode-2 signal, where detectable, contains a larger fraction of non-stationary variance, typically 50% or more. Temporal subsetting of the data reveals interannual variability barely significant compared with tidal estimation error from 3-year records. Comparison of summer vs. winter conditions shows only one region of noteworthy seasonal changes, the northern South China Sea. Implications for the anticipated SWOT altimeter mission are briefly discussed.

  6. Observing and modeling nonlinear dynamics in an internal combustion engine

    International Nuclear Information System (INIS)

    Daw, C.S.; Kennel, M.B.; Finney, C.E.; Connolly, F.T.

    1998-01-01

    We propose a low-dimensional, physically motivated, nonlinear map as a model for cyclic combustion variation in spark-ignited internal combustion engines. A key feature is the interaction between stochastic, small-scale fluctuations in engine parameters and nonlinear deterministic coupling between successive engine cycles. Residual cylinder gas from each cycle alters the in-cylinder fuel-air ratio and thus the combustion efficiency in succeeding cycles. The model close-quote s simplicity allows rapid simulation of thousands of engine cycles, permitting statistical studies of cyclic-variation patterns and providing physical insight into this technologically important phenomenon. Using symbol statistics to characterize the noisy dynamics, we find good quantitative matches between our model and experimental time-series measurements. copyright 1998 The American Physical Society

  7. Asymptomatic population reference values for three knee patient-reported outcomes measures: evaluation of an electronic data collection system and implications for future international, multi-centre cohort studies.

    Science.gov (United States)

    McLean, James M; Brumby-Rendell, Oscar; Lisle, Ryan; Brazier, Jacob; Dunn, Kieran; Gill, Tiffany; Hill, Catherine L; Mandziak, Daniel; Leith, Jordan

    2018-05-01

    The aim was to assess whether the Knee Society Score, Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were comparable in asymptomatic, healthy, individuals of different age, gender and ethnicity, across two remote continents. The purpose of this study was to establish normal population values for these scores using an electronic data collection system. There is no difference in clinical knee scores in an asymptomatic population when comparing age, gender and ethnicity, across two remote continents. 312 Australian and 314 Canadian citizens, aged 18-94 years, with no active knee pain, injury or pathology in the ipsilateral knee corresponding to their dominant arm, were evaluated. A knee examination was performed and participants completed an electronically administered questionnaire covering the subjective components of the knee scores. The cohorts were age- and gender-matched. Chi-square tests, Fisher's exact test and Poisson regression models were used where appropriate, to investigate the association between knee scores, age, gender, ethnicity and nationality. There was a significant inverse relationship between age and all assessment tools. OKS recorded a significant difference between gender with females scoring on average 1% lower score. There was no significant difference between international cohorts when comparing all assessment tools. An electronic, multi-centre data collection system can be effectively utilized to assess remote international cohorts. Differences in gender, age, ethnicity and nationality should be taken into consideration when using knee scores to compare to pathological patient scores. This study has established an electronic, normal control group for future studies using the Knee society, Oxford, and KOOS knee scores. Diagnostic Level II.

  8. A multicentre evaluation of emergency abdominal surgery in South ...

    African Journals Online (AJOL)

    Background. GlobalSurg-1 was a multicentre, international, prospective cohort study conducted to address the global lack of surgical outcomes data. Six South African (SA) hospitals participated in the landmark surgical outcomes study. In this subsequent study, we collated the data from these six local participants and ...

  9. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

    2015-01-01

    to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference...... to the original source....

  10. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

    2015-01-01

    to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference...

  11. Earth observation space programmes, SAFISY activities, strategies of international organisations, legal aspects. Volume 3

    International Nuclear Information System (INIS)

    1992-01-01

    This volume is separated in four sessions. First part is on earth observation space programmes (international earth observation projects and international collaboration, the ERS-1, SPOT and PRIRODA programmes, the first ESA earth observation polar platform and its payload, the future earth observation remote sensing techniques and concepts). The second part is on SAFISY activities (ISY programmes, education and applications, demonstrations and outreach projects). The third part is on programme and strategies of international organisations with respect to earth observation from space. The fourth part is on legal aspects of the use of satellite remote sensing data in Europe. (A.B.). refs., figs., tabs

  12. Validation of earth observations using international space station

    Science.gov (United States)

    Gebelein, Jennifer; Estes, John E.

    1999-01-01

    Accurate, up-to-date (science quality) land cover maps do not exist for most areas of the world. They do not exist at global scales; nor do they exist at continental, national, or local scales. This is equally true of both developed and developing nations. Land cover patterns on the surface of the Earth change. Some changes are rapid, such as urban sprawl. Other changes are slower such as the meandering of river channels consuming agricultural lands. Researchers at the University of California, Santa Barbara are working with colleagues at the University of Maryland, College Park; the United States Geological Survey, Earth Resource Observation System Data Center; and, the National Aeronautics and Space Administration (NASA) Johnson Space Center. We are proposing to test the capability of astronaut acquired photography to document and validate land cover change. Funding for the pilot phase of this project has been approved and research is underway to select appropriate sites in the Southern United States. The overall objects of this effort are: 1. Evaluate the potential of astronaut acquired data for the validation of land cover maps; 2. Determine to what extent astronaut acquired photography can assist in the identification of specific types of land cover change and the immediate local causes of such change; 3. Test the potential of astronauts to acquire photography to provide data concerning scientifically interesting and/or culturally significant ephemeral events; and, 4. Assist in the design for an upgraded Window Observational Rack Facility (WORF). The goal of this effort is to demonstrate the utility of ISS for the collection of information of value to researchers interested in documenting important land cover changes at scales from local to global. Using ISS data from tropical and mid latitudes combined with information extracted from polar orbiting satellites primarily from mid to high latitudes, we believe we can improve our ability to detect, document and

  13. Is IL-6 an appropriate target to treat spondyloarthritis patients refractory to anti-TNF therapy? a multicentre retrospective observational study

    Science.gov (United States)

    2012-01-01

    Introduction The aim of this study was to evaluate, under real-life conditions, the safety and efficacy of tocilizumab in patients having failed anti-TNFα therapy for spondyloarthritis. Methods French rheumatologists and internal-medicine practitioners registered on the Club Rhumatismes et Inflammations website were asked to report on patients given tocilizumab (4 or 8 mg/kg) to treat active disease meeting Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral spondyloarthritis, after anti-TNFα treatment failure. Safety and efficacy after 3 and 6 months were assessed retrospectively using standardised questionnaires. Results Data were obtained for 21 patients, 13 with axial spondyloarthritis (46% men; median age, 42 years; disease duration, 11 years; HLA-B27-positive, 92.3%) and eight with peripheral spondyloarthritis (25% men; median age, 40 years; disease duration, 10 years; HLA-B27-positive, 62.5%). No patients with axial disease had at least a 20 mm decrease in the BASDAI, nor a BASDAI50 response or major ASAS-endorsed disease activity score improvements after 3 or 6 months; an ASAS-endorsed disease activity score clinically important improvement was noted at month 3 in five of 13 patients and at month 6 in one of four patients. A good DAS28 response was achieved in four patients with peripheral disease, including one in EULAR remission at month 3. Four patients were still taking tocilizumab at month 6, including one in EULAR remission and one with a good DAS28 response. Tocilizumab was well tolerated, with no serious adverse events. Initially elevated acute-phase reactants declined during tocilizumab therapy. Conclusion In patients having failed anti-TNFα therapy, tocilizumab decreased acute-phase reactants but failed to substantially improve axial spondyloarthritis and was inconsistently effective in peripheral spondyloarthritis. PMID:22404969

  14. The EMBARC European Bronchiectasis Registry: protocol for an international observational study

    Directory of Open Access Journals (Sweden)

    James D. Chalmers

    2016-01-01

    Full Text Available Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1 a clinical history consistent with bronchiectasis; and 2 computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1 bronchiectasis due to known cystic fibrosis; 2 age <18 years; and 3 patients who are unable or unwilling to provide informed consent. The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitudinal data on outcomes, treatment patterns and quality of life. Data from the registry will be available in the form of annual reports. and will be disseminated in conference presentations and peer-reviewed publications. The European Bronchiectasis Registry aims to make a major contribution to understanding the natural history of the disease, as well as guiding evidence-based decision making and facilitating large randomised controlled trials.

  15. Multi-centre observational study of transplacental transmission of influenza antibodies following vaccination with AS03(A)-adjuvanted H1N1 2009 vaccine.

    Science.gov (United States)

    Puleston, Richard; Bugg, George; Hoschler, Katja; Konje, Justin; Thornton, James; Stephenson, Iain; Myles, Puja; Enstone, Joanne; Augustine, Glenda; Davis, Yvette; Zambon, Maria; Nicholson, Karl; Nguyen-Van-Tam, Jonathan

    2013-01-01

    Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009-10 pandemic. In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres. Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre ≥1:40) was detected in 58 (75.3%, 95% CI 64.2-84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3-38.1) from unvaccinated women (Pcases for at least 16 weeks. Immunization of pregnant women with AS03(A)-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of new-born infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy.

  16. The prevalence of medical error related to end-of-life communication in Canadian hospitals: results of a multicentre observational study.

    Science.gov (United States)

    Heyland, Daren K; Ilan, Roy; Jiang, Xuran; You, John J; Dodek, Peter

    2016-09-01

    In the hospital setting, inadequate engagement between healthcare professionals and seriously ill patients and their families regarding end-of-life decisions is common. This problem may lead to medical orders for life-sustaining treatments that are inconsistent with patient preferences. The prevalence of this patient safety problem has not been previously described. Using data from a multi-institutional audit, we quantified the mismatch between patients' and family members' expressed preferences for care and orders for life-sustaining treatments. We recruited seriously ill, elderly medical patients and/or their family members to participate in this audit. We considered it a medical error if a patient preferred not to be resuscitated and there were orders to undergo resuscitation (overtreatment), or if a patient preferred resuscitation (cardiopulmonary resuscitation, CPR) and there were orders not to be resuscitated (undertreatment). From 16 hospitals in Canada, 808 patients and 631 family members were included in this study. When comparing expressed preferences and documented orders for use of CPR, 37% of patients experienced a medical error. Very few patients (8, 2%) expressed a preference for CPR and had CPR withheld in their documented medical orders (Undertreatment). Of patients who preferred not to have CPR, 174 (35%) had orders to receive it (Overtreatment). There was considerable variability in overtreatment rates across sites (range: 14-82%). Patients who were frail were less likely to be overtreated; patients who did not have a participating family member were more likely to be overtreated. Medical errors related to the use of life-sustaining treatments are very common in internal medicine wards. Many patients are at risk of receiving inappropriate end-of-life care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Response to Interleukin-1 Inhibitors in 140 Italian Patients with Adult-Onset Still’s Disease: A Multicentre Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Serena Colafrancesco

    2017-06-01

    only in one case (1/4, 25%.Conclusion: This is the largest retrospective observational study evaluating the efficacy and safety of IL-1 inhibitors in AOSD patients. A good response was noted at 3 months after therapy onset in both the ANA- and CAN-groups. Skin reaction may nevertheless represent a non-negligible AE during ANA treatment.

  18. How do lay people assess the quality of physicians' communicative responses to patients' emotional cues and concerns? An international multicentre study based on videotaped medical consultations.

    NARCIS (Netherlands)

    Mazzi, M.A.; Bensing, J.; Rimondini, M.; Fletcher, I.; Vliet, L. van; Zimmermann, C.; Deveugele, M.

    2013-01-01

    Objective: To establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people. Methods: A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations.

  19. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years.

    Science.gov (United States)

    Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Gray, Bridget; Briggs, Andrew; Lall, Ranjit; Chesser, Tim Js; Pallister, Ian; Lamb, Sarah E; Willett, Keith

    2016-10-01

    Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. Trauma and orthopaedic departments of 24 NHS hospitals. Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle

  20. Tale of the Tape: International Teaching Assistant Noticing during Videotaped Classroom Observations

    Science.gov (United States)

    Williams, Gwendolyn M.; Case, Rod E.

    2015-01-01

    International teaching assistants face challenges in learning the norms for teaching in American universities. In order to address this learning curve this article describes a qualitative study of twenty international teaching assistants that examined how these participants viewed observations as part of their professional development. The study…

  1. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

    DEFF Research Database (Denmark)

    Froehlich, F; Harris, JK; Wietlisbach, V

    2006-01-01

    in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were...

  2. NCDC feed of Global Telecommunication System (GTS) marine observations in International Maritime Meteorological Archive (IMMA) Format

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The data contained here are surface marine observations from many different sources via the NCDC Global Telecommunication System (GTS) Marine in International...

  3. Chromoendoscopy versus autofluorescence imaging for neoplasia detection in patients with longstanding ulcerative colitis (FIND-UC): an international, multicentre, randomised controlled trial.

    Science.gov (United States)

    Vleugels, Jasper L A; Rutter, Matt D; Ragunath, Krish; Rees, Colin J; Ponsioen, Cyriel Y; Lahiff, Conor; Ket, Shara N; Wanders, Linda K; Samuel, Sunil; Butt, Faheem; Kuiper, Teaco; Travis, Simon P L; D'Haens, Geert; Wang, Lai M; van Eeden, Susanne; East, James E; Dekker, Evelien

    2018-03-19

    Patients with longstanding ulcerative colitis undergo regular dysplasia surveillance because they have an increased colorectal cancer risk. Autofluorescence imaging and chromoendoscopy improve dysplasia detection. The aim of this study was to determine whether autofluorescence imaging should be further studied as an alternative method for dysplasia surveillance in patients with longstanding ulcerative colitis. This prospective, international, randomised controlled trial included patients from an ulcerative colitis-dysplasia surveillance cohort from five centres in the Netherlands and the UK. Eligible patients were aged 18 years or older who were undergoing dysplasia surveillance after being diagnosed with extensive colitis (Montreal E3) at least 8 years before study start or with left-sided colitis (Montreal E2) at least 15 years before study start. Randomisation (1:1) was minimised for a previous personal history of histologically proven dysplasia and concomitant primary sclerosing cholangitis. The coprimary outcomes were the proportion of patients in whom at least one dysplastic lesion was detected and the mean number of dysplastic lesions per patient. The relative dysplasia detection rate, calculated as the ratio of the detection rates by autofluorescence imaging and chromoendoscopy, needed to be more than 0·67 (using an 80% CI) for both primary outcomes to support a subsequent large non-inferiority trial. Outcomes were analysed on a per-protocol basis. The trial is registered at the Netherlands Trial Register, number NTR4062. Between Aug 1, 2013, and March 10, 2017, 210 patients undergoing colonoscopy surveillance for longstanding ulcerative colitis were randomised for inspection with either autofluorescence imaging (n=105) or chromoendoscopy (n=105). Dysplasia was detected in 13 (12%) patients by autofluorescence imaging and in 20 patients (19%) by chromoendoscopy. The relative dysplasia detection rate of autofluorescence imaging versus chromoendoscopy for

  4. A large, multicentre, observational, post-marketing surveillance study of the 2:1 formulation of follitropin alfa and lutropin alfa in routine clinical practice for assisted reproductive technology.

    Science.gov (United States)

    Bühler, Klaus; Naether, Olaf G J; Bilger, Wilma

    2014-01-14

    Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) both have a role to play in follicular development during the natural menstrual cycle. LH supplementation during controlled ovarian stimulation (COS) for assisted reproductive technology (ART) is used for patients with hypogonadotropic hypogonadism. However, the use of exogenous LH in COS in normogonadotropic women undergoing ART is the subject of debate. The aim of this study was to investigate characteristics of infertile women who received the 2:1 formulation of follitropin alfa and lutropin alfa (indicated for stimulation of follicular development in women with severe LH and FSH deficiency) in German clinical practice. A 3-year, multicentre, open-label, observational/non-interventional, post-marketing surveillance study of women (21-45 years) undergoing ART. Primary endpoint: reason for prescribing the 2:1 formulation of follitropin alfa and lutropin alfa. Secondary variables included: COS duration/dose; oocytes retrieved; fertilization; clinical pregnancy; ovarian hyperstimulation syndrome (OHSS). In total, 2220 cycles were assessed; at least one reason for prescribing the 2:1 formulation was given in 1834/2220 (82.6%) cycles. Most common reasons were: poor ovarian response (POR) (39.4%), low baseline LH (17.8%), and age (13.8%). COS: mean dose of the 2:1 formulation on first day, 183.1/91.5 IU; mean duration, 10.8 days. In 2173/2220 (97.9%) cycles, human chorionic gonadotrophin was administered. Oocyte pick-up (OPU) was attempted in 2108/2220 (95.0%) cycles; mean (standard deviation) 8.0 (5.4) oocytes retrieved/OPU cycle. Fertilization (≥1 oocyte fertilized) rates: in vitro fertilization (IVF), 391/439 (89.1%) cycles; intracytoplasmic sperm injection (ICSI)/IVF + ICSI, 1524/1613 (94.5%) cycles. Clinical pregnancy rate: all cycles, 25.9%; embryo transfer cycles, 31.3%. OHSS: hospitalization for OHSS, 8 (0.36%) cycles, Grade 2, 60 (2.7%), and Grade 3, 1 (0.05%). In German routine clinical

  5. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib: an international, multicentre, prospective, randomised, placebo-controlled phase 3 trial (GRID)

    Science.gov (United States)

    Demetri, George D; Reichardt, Peter; Kang, Yoon-Koo; Blay, Jean-Yves; Rutkowski, Piotr; Gelderblom, Hans; Hohenberger, Peter; Leahy, Michael; von Mehren, Margaret; Joensuu, Heikki; Badalamenti, Giuseppe; Blackstein, Martin; Cesne, Axel Le; Schöffski, Patrick; Maki, Robert G; Bauer, Sebastian; Nguyen, Binh Bui; Xu, Jianming; Nishida, Toshirou; Chung, John; Kappeler, Christian; Kuss, Iris; Laurent, Dirk; Casali, Paolo

    2013-01-01

    Summary Background To date, only two agents, imatinib and sunitinib, have shown clinical benefit in patients with gastrointestinal stromal tumours (GISTs), but almost all metastatic GISTs eventually develop resistance to these agents, resulting in fatal disease progression. This phase 3 trial assessed efficacy and safety of regorafenib in patients with metastatic and/or unresectable GIST progressing after failure of at least imatinib and sunitinib. Methods Patients were randomised 2:1 to receive either regorafenib 160 mg orally daily or placebo, plus best supportive care in both arms, for the first 3 weeks of each 4-week cycle. The primary endpoint was progression-free survival (PFS). Upon disease progression, patients on placebo could cross over to regorafenib. Secondary endpoints included overall survival (OS), objective response rate, disease control rate (DCR: rate of durable stable disease lasting for ≥12 weeks plus complete or partial responses), and safety. This trial is registered at ClinicalTrials.gov (NCT01271712). Results From January to August 2011, 240 patients were screened at 57 centres in 17 countries, and 199 patients were randomised to receive regorafenib (n=133) or matching placebo (n=66). Median PFS per independent blinded central review was 4·8 months and 0·9 months, respectively (hazard ratio [HR] 0·27, 95% confidence interval [CI] 0·19–0·39; pregorafenib, resulting in no significant difference in OS between study arms (HR 0·77, 95% CI 0·42–1·41; p=0·199). A best response of partial response or stable disease was observed in 101/133 patients (75·9%) on regorafenib and 23/66 patients (34·8%) on placebo. DCR was 52·6% (70/133 patients) and 9·1% (6/66 patients), respectively. Drug-related adverse events were reported in 130 (98·5%) of 132 regorafenib patients and 45 (68·2%) of 66 placebo patients. The most common grade ≥3 regorafenib-related adverse events were hypertension (31/132, 23·5%), hand–foot skin reaction (26

  6. Misfire detection based on switched state observer of hybrid system in internal combustion engine

    Science.gov (United States)

    Zhang, Yu; Zhou, Tonglin; Zheng, Taixiong; Han, Weimin; Tan, Rui; Wang, Yanjun

    2017-04-01

    This paper proposes a novel switched state observer of hybrid system using Luenberger sliding mode observer to estimate crankshaft angular acceleration which is further applied to detect misfire fault. The output error of hybrid system of internal combustion engine (engine speed) and the designed observer (estimated speed) is taken as input of observer to estimate crankshaft acceleration. Convergence of hybrid system is proven through Lyapunov stability theory. The experimental results show that the presented estimated technique has a higher accuracy and can be effectively used to misfire detection compared with reduced-order observer and sliding mode observer.

  7. Mapping the Delivery of Societal Benefit through the International Arctic Observations Assessment Framework

    Science.gov (United States)

    Lev, S. M.; Gallo, J.

    2017-12-01

    The international Arctic scientific community has identified the need for a sustained and integrated portfolio of pan-Arctic Earth-observing systems. In 2017, an international effort was undertaken to develop the first ever Value Tree framework for identifying common research and operational objectives that rely on Earth observation data derived from Earth-observing systems, sensors, surveys, networks, models, and databases to deliver societal benefits in the Arctic. A Value Tree Analysis is a common tool used to support decision making processes and is useful for defining concepts, identifying objectives, and creating a hierarchical framework of objectives. A multi-level societal benefit area value tree establishes the connection from societal benefits to the set of observation inputs that contribute to delivering those benefits. A Value Tree that relies on expert domain knowledge from Arctic and non-Arctic nations, international researchers, Indigenous knowledge holders, and other experts to develop a framework to serve as a logical and interdependent decision support tool will be presented. Value tree examples that map the contribution of Earth observations in the Arctic to achieving societal benefits will be presented in the context of the 2017 International Arctic Observations Assessment Framework. These case studies will highlight specific observing products and capability groups where investment is needed to contribute to the development of a sustained portfolio of Arctic observing systems.

  8. Detailed Study of the Internal Structure of a Red-giant Star Observed with Kepler

    DEFF Research Database (Denmark)

    Di Mauro, M. P.; Ventura, R.; Cardini, D.

    2012-01-01

    We study the internal structure and evolutionary state of KIC 4351319, a red-giant star observed with the Kepler satellite. The use of 25 individual oscillation frequencies, together with the accurate atmospheric data provided by ground-based spectroscopic observations, allowed us to estimate the...

  9. Assessment of disabilities in stroke patients with apraxia : Internal consistency and inter-observer reliability

    NARCIS (Netherlands)

    van Heugten, CM; Dekker, J; Deelman, BG; Stehmann-Saris, JC; Kinebanian, A

    1999-01-01

    In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

  10. Assessment of disabilities in stroke patients with apraxia: internal consistency and inter-observer reliability.

    NARCIS (Netherlands)

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Stehmann-Saris, J.C.; Kinebanian, A.

    1999-01-01

    In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in

  11. Detailed Study of the Internal Structure of a Red-giant Star Observed with Kepler

    NARCIS (Netherlands)

    Di Mauro, M.P.; Ventura, R.; Cardini, D.; Catanzaro, G.; Barban, C.; Bedding, T.R.; Christensen-Dalsgaard, J.; De Ridder, J.; Hekker, S.; Huber, D.; Kallinger, T.; Kinemuchi, K.; Kjeldsen, H.; Miglio, A.; Montalbán, J.; Mosser, B.; Mullally, F.; Stello, D.; Still, M.; Uytterhoeven, K.

    2012-01-01

    We study the internal structure and evolutionary state of KIC 4351319, a red-giant star observed with the Kepler satellite. The use of 25 individual oscillation frequencies, together with the accurate atmospheric data provided by ground-based spectroscopic observations, allowed us to estimate the

  12. High-frequency internal waves near the Luzon Strait observed by underwater gliders

    Science.gov (United States)

    Rudnick, Daniel L.; Johnston, T. M. Shaun; Sherman, Jeffrey T.

    2013-02-01

    flow through the Luzon Strait produces large internal waves that propagate westward into the South China Sea and eastward into the Pacific. Underwater gliders gathered sustained observations of internal waves during seven overlapping missions from April 2007 through July 2008. A particular focus is the high-frequency internal waves, where the operational definition of high involves periods shorter than a glider profile taking 3-6 h. Internal wave vertical velocity is estimated from measurements of pressure and glider orientation through two methods: (1) use of a model of glider flight balancing buoyancy and drag along the glider path and (2) high-pass filtering of the observed glider vertical velocity. By combining high-frequency vertical velocities from glider flight with low-frequency estimates from isopycnal depth variations between dives, a spectrum covering five decades of frequency is constructed. A map of the standard deviation of vertical velocity over the survey area shows a decay from the Luzon Strait into the Pacific. The growth of high-frequency vertical velocity with propagation into the South China Sea is observed through two 2-week time series stations. The largest observed vertical velocities are greater than 0.2 m s-1 and are associated with displacements approaching 200 m. The high-frequency waves are observed at regular intervals of 1 day as they ride on diurnal tidal internal waves generated in the Strait.

  13. Measurement of spin observables using a storage ring with polarized beam and polarized internal gas target

    International Nuclear Information System (INIS)

    Lee, K.; Miller, M.A.; Smith, A.; Hansen, J.; Bloch, C.; van den Brand, J.F.J.; Bulten, H.J.; Ent, R.; Goodman, C.D.; Jacobs, W.W.; Jones, C.E.; Korsch, W.; Leuschner, M.; Lorenzon, W.; Marchlenski, D.; Meyer, H.O.; Milner, R.G.; Neal, J.S.; Pancella, P.V.; Pate, S.F.; Pitts, W.K.; von Przewoski, B.; Rinckel, T.; Sowinski, J.; Sperisen, F.; Sugarbaker, E.; Tschalaer, C.; Unal, O.; Zhou, Z.

    1993-01-01

    We report the first measurement of analyzing powers and spin correlation parameters using a storage ring with both beam and internal target polarized. Spin observables were measured for elastic scattering of 45 and 198 MeV protons from polarized 3 He nuclei in a new laser-pumped internal gas target at the Indiana University Cyclotron Facility Cooler Ring. Scattered protons and recoil 3 He nuclei were detected in coincidence with large acceptance plastic scintillators and silicon detectors. The internal-target technique demonstrated in this experiment has broad applicability to the measurement of spin-dependent scattering in nuclear and particle physics

  14. Observation of sound focusing and defocusing due to propagating nonlinear internal waves.

    Science.gov (United States)

    Luo, J; Badiey, M; Karjadi, E A; Katsnelson, B; Tskhoidze, A; Lynch, J F; Moum, J N

    2008-09-01

    Fluctuations of the low frequency sound field in the presence of an internal solitary wave packet during the Shallow Water '06 experiment are analyzed. Acoustic, environmental, and on-board ship radar image data were collected simultaneously before, during, and after a strong internal solitary wave packet passed through the acoustic track. Preliminary analysis of the acoustic wave temporal intensity fluctuations agrees with previously observed phenomena and the existing theory of the horizontal refraction mechanism, which causes focusing and defocusing when the acoustic track is nearly parallel to the front of the internal waves [J. Acoust. Soc. Am., 122(2), pp. 747-760 (2007)].

  15. The CONFINE (Comorbidities and Outcome iN patients with chronic heart Failure: a study in INternal mEdicine units study: a new epidemiologic observational study on heart failure in the internal medicine departments in Italy

    Directory of Open Access Journals (Sweden)

    P. Biagi

    2013-05-01

    Full Text Available BACKGROUND The burden of heart failure (HF is enormous and its prevalence increases sharply with age. It has been estimated that heart failure affects up to 3% of the general population and 10% of the elderly. It contributes to hospital admission for most of them, mainly elder adults (admitted in internal medicine units with more than one comorbidity, cognitive disorders, impairment and so on. Despite the increasing prevalence of heart failure, its exact incidence and prevalence remain largely unknown and probably underestimated due to a lack of accurate epidemiological data and difficulties associated with comorbidities and correct diagnosis: over 40% of recurrent hospitalization causes, either cardiac or extracardiac, cannot be determined due to the lack of data. AIM OF THE STUDY The objective of this study estimated the prevalence and the primary care burden associated with comorbidities in internal medicine units. METHOD The design: a longitudinal multicentric observational study using spot analysis three data sheets were filled in during the hospital stay according to three crucial moments: enrolment (“the index day”, admission and discharge. Will be analyzed the following primary outcomes: total and cardiovascular mortality, intensive unit care admission, recurrent cardiovascular disorders, length of stay, hospital readmission, changes in activities of daily living, need for care. Second outcomes: clinical, therapeutic, instrumental and laboratory changes during the admission process. Deep analysis of the following comorbidities will be also taken into account: acute and chronic kidney failure, anaemia, chronic obstructive pulmonary disease, muscle loss, nutritional status, cirrhosis of the liver, neoplasms, blood cell disorders, chronic inflammatory diseases. Further evalutation items: cognitive impairment, self-sufficiency and perception of quality life.

  16. Internal hydraulic control in the Little Belt, Denmark - observations of flow configurations and water mass formation

    Science.gov (United States)

    Holtegaard Nielsen, Morten; Vang, Torben; Chresten Lund-Hansen, Lars

    2017-12-01

    Internal hydraulic control, which occurs when stratified water masses are forced through an abrupt constriction, plays an enormous role in nature on both large and regional scales with respect to dynamics, circulation, and water mass formation. Despite a growing literature on this subject surprisingly few direct observations have been made that conclusively show the existence of and the circumstances related to internal hydraulic control in nature. In this study we present observations from the Little Belt, Denmark, one of three narrow straits connecting the Baltic Sea and the North Sea. The observations (comprised primarily of along-strait, detailed transects of salinity and temperature; continuous observations of flow velocity, salinity, and temperature at a permanent station; and numerous vertical profiles of salinity, temperature, fluorescence, and flow velocity in various locations) show that internal hydraulic control is a frequently occurring phenomenon in the Little Belt. The observations, which are limited to south-going flows of approximately two-layered water masses, show that internal hydraulic control may take either of two configurations, i.e. the lower or the upper layer being the active, accelerating one. This is connected to the depth of the pycnocline on the upstream side and the topography, which is both deepening and contracting toward the narrow part of the Little Belt. The existence of two possible flow configurations is known from theoretical and laboratory studies, but we believe that this has never been observed in nature and reported before. The water masses formed by the intense mixing, which is tightly connected with the presence of control, may be found far downstream of the point of control. The observations show that these particular water masses are associated with chlorophyll concentrations that are considerably higher than in adjacent water masses, showing that control has a considerable influence on the primary production and

  17. Doxorubicin plus evofosfamide versus doxorubicin alone in locally advanced, unresectable or metastatic soft-tissue sarcoma (TH CR-406/SARC021): an international, multicentre, open-label, randomised phase 3 trial.

    Science.gov (United States)

    Tap, William D; Papai, Zsuzsanna; Van Tine, Brian A; Attia, Steven; Ganjoo, Kristen N; Jones, Robin L; Schuetze, Scott; Reed, Damon; Chawla, Sant P; Riedel, Richard F; Krarup-Hansen, Anders; Toulmonde, Maud; Ray-Coquard, Isabelle; Hohenberger, Peter; Grignani, Giovanni; Cranmer, Lee D; Okuno, Scott; Agulnik, Mark; Read, William; Ryan, Christopher W; Alcindor, Thierry; Del Muro, Xavier F Garcia; Budd, G Thomas; Tawbi, Hussein; Pearce, Tillman; Kroll, Stew; Reinke, Denise K; Schöffski, Patrick

    2017-08-01

    Evofosfamide is a hypoxia-activated prodrug of bromo-isophosphoramide mustard. We aimed to assess the benefit of adding evofosfamide to doxorubicin as first-line therapy for advanced soft-tissue sarcomas. We did this international, open-label, randomised, phase 3, multicentre trial (TH CR-406/SARC021) at 81 academic or community investigational sites in 13 countries. Eligible patients were aged 15 years or older with a diagnosis of an advanced unresectable or metastatic soft-tissue sarcoma, of intermediate or high grade, for which no standard curative therapy was available, an Eastern Cooperative Oncology Group performance status of 0-1, and measurable disease by Response Evaluation Criteria in Solid Tumors version 1.1. Patients were randomly assigned (1:1) to receive doxorubicin alone (75 mg/m 2 via bolus injection administered over 5-20 min or continuous intravenous infusion for 6-96 h on day 1 of every 21-day cycle for up to six cycles) or doxorubicin (given via the same dose procedure) plus evofosfamide (300 mg/m 2 intravenously for 30-60 min on days 1 and 8 of every 21-day cycle for up to six cycles). After six cycles of treatment, patients in the single-drug doxorubicin group were followed up expectantly whereas patients with stable or responsive disease in the combination group were allowed to continue with evofosfamide monotherapy until documented disease progression. A web-based central randomisation with block sizes of two and four was stratified by extent of disease, doxorubicin administration method, and previous systemic therapy. Patients and investigators were not masked to treatment assignment. The primary endpoint was overall survival, analysed in the intention-to-treat population. Safety analyses were done in all patients who received any amount of study drug. This study was registered with ClinicalTrials.gov, number NCT01440088. Between Sept 26, 2011, and Jan 22, 2014, 640 patients were enrolled and randomly assigned to a treatment group (317 to

  18. Health-related quality-of-life results for pembrolizumab versus chemotherapy in advanced, PD-L1-positive NSCLC (KEYNOTE-024): a multicentre, international, randomised, open-label phase 3 trial.

    Science.gov (United States)

    Brahmer, Julie R; Rodríguez-Abreu, Delvys; Robinson, Andrew G; Hui, Rina; Csőszi, Tibor; Fülöp, Andrea; Gottfried, Maya; Peled, Nir; Tafreshi, Ali; Cuffe, Sinead; O'Brien, Mary; Rao, Suman; Hotta, Katsuyuki; Zhang, Jin; Lubiniecki, Gregory M; Deitz, Anne C; Rangwala, Reshma; Reck, Martin

    2017-12-01

    In the phase 3 KEYNOTE-024 trial, treatment with pembrolizumab conferred longer progression-free survival than did platinum-based therapy in patients with treatment-naive, advanced non-small-cell lung cancer (NSCLC) with a programmed cell death-ligand 1 (PD-L1) tumour proportion score of 50% or greater (PD-L1-positive). Here we report the prespecified exploratory endpoint of pembrolizumab versus chemotherapy on patient-reported outcomes (PROs). In this multicentre, international, randomised, open-label, phase 3 trial, we recruited patients with treatment-naive, stage IV NSCLC in 102 sites in 16 countries. Eligible patients had measurable disease (per RECIST version 1.1) and an Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. Patients were randomly assigned (1:1) via an interactive voice response system and integrated web response system to receive either pembrolizumab 200 mg every 3 weeks (35 cycles) or investigator-choice platinum-doublet chemotherapy (4-6 cycles or until documented disease progression or unacceptable toxicity). Randomisation was stratified according to geography, ECOG performance status, and histology. PROs were assessed at day 1 of cycles 1-3, every 9 weeks thereafter, at the treatment discontinuation visit, and at the 30-day safety assessment visit using the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 items (QLQ-C30), the EORTC Quality of Life Questionnaire Lung Cancer 13 items (QLQ-LC13), and the European Quality of Life 5 Dimensions-3 Level (EQ-5D-3L) questionnaire. The key exploratory PRO endpoints (analysed for all patients who received at least one dose of study treatment and completed at least one PRO instrument at at least one timepoint) were baseline-to-week-15 change in the QLQ-C30 global health status (GHS)/quality-of-life (QOL) score and time to deterioration of the composite of cough, chest pain, and dyspnoea in the QLQ-LC13. This study is

  19. Multicentric Castleman's disease & HIV infection.

    LENUS (Irish Health Repository)

    Cotter, A

    2009-10-01

    We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman\\'s Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.

  20. International Ultraviolet Explorer satellite observations of seven high-excitation planetary nebulae.

    Science.gov (United States)

    Aller, L H; Keyes, C D

    1980-03-01

    Observations of seven high-excitation planetary nebulae secured with the International Ultraviolet Explorer (IUE) satellite were combined with extensive ground-based data to obtain electron densities, gas kinetic temperatures, and ionic concentrations. We then employed a network of theoretical model nebulae to estimate the factors by which observed ionic concentrations must be multiplied to obtain elemental abundances. Comparison with a large sample of nebulae for which extensive ground-based observations have been obtained shows nitrogen to be markedly enhanced in some of these objects. Possibly most, if not all, high-excitation nebulae evolve from stars that have higher masses than progenitors of nebulae of low-to-moderate excitation.

  1. First Light Observations from the International Study of Astronomy Reasoning (ISTAR) Database

    Science.gov (United States)

    Tatge, Coty B.; Slater, Stephanie; Slater, Timothy F.; Bretones, Paulo S.; McKinnon, David; Schleigh, Sharon

    2016-01-01

    During the period between Fall 2014 and Summer 2015, the International Astronomical Union reorganized its structure to include the IAU Working Group on Theory and Methods in Astronomy Education. The initial goals of that working group are 1) promoting Astronomy Education Research (AER) by adopting the international collaboration model used by astronomy researchers, 2) fostering international astronomy education and AER capacity through the development of networks, training and shared resources, and 3) improving astronomy education by describing research based approaches to the teaching and learning of astronomy. In support of those efforts, the working group began a collaboration with the Center for Astronomy & Physics Education Research to develop the International Study of Astronomy Reasoning (ISTAR) Database, an online, searchable research tool, intended to catalog, characterize, and provide access to all known astronomy education research production, world-wide. Beginning in the Summer of 2015, a test of ISTAR's functionality began with a survey of a previously uncatalogued set of test objects: U.S.-based doctoral dissertations and masters. This target population was selected for its familiarity to the ISTAR developers, and for its small expected sample size (50-75 objects). First light observations indicated that the sample exceeded 300 dissertation objects. These objects were characterized across multiple variables, including: year of production, document source, type of resource, empirical methodology, context, informal setting type, research construct, type of research subject, scientific content, language, and nation of production. These initial observations provide motivation to extend this project to observe masters levels thesis, which are anticipated to be ten times more numerous as doctoral dissertations, other peer-reviewed contributions, contributions from the larger international community.

  2. Intermittent large amplitude internal waves observed in Port Susan, Puget Sound

    Science.gov (United States)

    Harris, J. C.; Decker, L.

    2017-07-01

    A previously unreported internal tidal bore, which evolves into solitary internal wave packets, was observed in Port Susan, Puget Sound, and the timing, speed, and amplitude of the waves were measured by CTD and visual observation. Acoustic Doppler current profiler (ADCP) measurements were attempted, but unsuccessful. The waves appear to be generated with the ebb flow along the tidal flats of the Stillaguamish River, and the speed and width of the resulting waves can be predicted from second-order KdV theory. Their eventual dissipation may contribute significantly to surface mixing locally, particularly in comparison with the local dissipation due to the tides. Visually the waves appear in fair weather as a strong foam front, which is less visible the farther they propagate.

  3. Seismic, satellite, and site observations of internal solitary waves in the NE South China Sea.

    Science.gov (United States)

    Tang, Qunshu; Wang, Caixia; Wang, Dongxiao; Pawlowicz, Rich

    2014-06-20

    Internal solitary waves (ISWs) in the NE South China Sea (SCS) are tidally generated at the Luzon Strait. Their propagation, evolution, and dissipation processes involve numerous issues still poorly understood. Here, a novel method of seismic oceanography capable of capturing oceanic finescale structures is used to study ISWs in the slope region of the NE SCS. Near-simultaneous observations of two ISWs were acquired using seismic and satellite imaging, and water column measurements. The vertical and horizontal length scales of the seismic observed ISWs are around 50 m and 1-2 km, respectively. Wave phase speeds calculated from seismic observations, satellite images, and water column data are consistent with each other. Observed waveforms and vertical velocities also correspond well with those estimated using KdV theory. These results suggest that the seismic method, a new option to oceanographers, can be further applied to resolve other important issues related to ISWs.

  4. Are power calculations useful? A multicentre neuroimaging study

    OpenAIRE

    Suckling, John; Henty, Julian; Ecker, Christine; Deoni, Sean C; Lombardo, Michael V; Baron-Cohen, Simon; Jezzard, Peter; Barnes, Anna; Chakrabarti, Bhismadev; Ooi, Cinly; Lai, Meng-Chuan; Williams, Steven C; Murphy, Declan GM; Bullmore, Edward

    2014-01-01

    There are now many reports of imaging experiments with small cohorts of typical participants that precede large-scale, often multicentre studies of psychiatric and neurological disorders. Data from these calibration experiments are sufficient to make estimates of statistical power and predictions of sample size and minimum observable effect sizes. In this technical note, we suggest how previously reported voxel-based power calculations can support decision making in the design, execution and ...

  5. Acoustic observations of internal tides and tidal currents in shallow water.

    Science.gov (United States)

    Turgut, Altan; Mignerey, Peter C; Goldstein, David J; Schindall, Jeffrey A

    2013-04-01

    Significant acoustic travel-time variability and frequency shifts of acoustic intensity level curves in broadband signal spectrograms were measured in the East China Sea during the summer of 2008. The broadband pulses (270-330 Hz) were transmitted from a fixed source and received at a bottomed horizontal array, located at the 33 km range. The acoustic intensity level curves of the received signals indicate regular frequency shifts that are well correlated with the measured internal tides. Similarly, regular travel-time shifts of the acoustic mode arrivals correlate well with the barotropic tides and can be explained by tidal currents along the acoustic propagation track. These observations indicate the potential of monitoring internal tides and tidal currents using low-frequency acoustic signals propagating at long ranges.

  6. US Voluntary Observing Ship (VOS) - International Maritime Meteorological Tape (IMMT) data from TurboWin+ E-Logbook Software

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The US Voluntary Observing Ships (VOS) report surface marine observations in both real-time (FM-13 ship format) and delayed-mode (International Maritime...

  7. Are power calculations useful? A multicentre neuroimaging study.

    Science.gov (United States)

    Suckling, John; Henty, Julian; Ecker, Christine; Deoni, Sean C; Lombardo, Michael V; Baron-Cohen, Simon; Jezzard, Peter; Barnes, Anna; Chakrabarti, Bhismadev; Ooi, Cinly; Lai, Meng-Chuan; Williams, Steven C; Murphy, Declan G M; Bullmore, Edward

    2014-08-01

    There are now many reports of imaging experiments with small cohorts of typical participants that precede large-scale, often multicentre studies of psychiatric and neurological disorders. Data from these calibration experiments are sufficient to make estimates of statistical power and predictions of sample size and minimum observable effect sizes. In this technical note, we suggest how previously reported voxel-based power calculations can support decision making in the design, execution and analysis of cross-sectional multicentre imaging studies. The choice of MRI acquisition sequence, distribution of recruitment across acquisition centres, and changes to the registration method applied during data analysis are considered as examples. The consequences of modification are explored in quantitative terms by assessing the impact on sample size for a fixed effect size and detectable effect size for a fixed sample size. The calibration experiment dataset used for illustration was a precursor to the now complete Medical Research Council Autism Imaging Multicentre Study (MRC-AIMS). Validation of the voxel-based power calculations is made by comparing the predicted values from the calibration experiment with those observed in MRC-AIMS. The effect of non-linear mappings during image registration to a standard stereotactic space on the prediction is explored with reference to the amount of local deformation. In summary, power calculations offer a validated, quantitative means of making informed choices on important factors that influence the outcome of studies that consume significant resources. Copyright © 2014 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc.

  8. Validation of stratospheric and mesospheric ozone observed by SMILES from International Space Station

    Directory of Open Access Journals (Sweden)

    Y. Kasai

    2013-09-01

    Full Text Available We observed ozone (O3 in the vertical region between 250 and 0.0005 hPa (~ 12–96 km using the Superconducting Submillimeter-Wave Limb-Emission Sounder (SMILES on the Japanese Experiment Module (JEM of the International Space Station (ISS between 12 October 2009 and 21 April 2010. The new 4 K superconducting heterodyne receiver technology of SMILES allowed us to obtain a one order of magnitude better signal-to-noise ratio for the O3 line observation compared to past spaceborne microwave instruments. The non-sun-synchronous orbit of the ISS allowed us to observe O3 at various local times. We assessed the quality of the vertical profiles of O3 in the 100–0.001 hPa (~ 16–90 km region for the SMILES NICT Level 2 product version 2.1.5. The evaluation is based on four components: error analysis; internal comparisons of observations targeting three different instrumental setups for the same O3 625.371 GHz transition; internal comparisons of two different retrieval algorithms; and external comparisons for various local times with ozonesonde, satellite and balloon observations (ENVISAT/MIPAS, SCISAT/ACE-FTS, Odin/OSIRIS, Odin/SMR, Aura/MLS, TELIS. SMILES O3 data have an estimated absolute accuracy of better than 0.3 ppmv (3% with a vertical resolution of 3–4 km over the 60 to 8 hPa range. The random error for a single measurement is better than the estimated systematic error, being less than 1, 2, and 7%, in the 40–1, 80–0.1, and 100–0.004 hPa pressure regions, respectively. SMILES O3 abundance was 10–20% lower than all other satellite measurements at 8–0.1 hPa due to an error arising from uncertainties of the tangent point information and the gain calibration for the intensity of the spectrum. SMILES O3 from observation frequency Band-B had better accuracy than that from Band-A. A two month period is required to accumulate measurements covering 24 h in local time of O3 profile. However such a dataset can also contain variation due to

  9. The Scintillation Prediction Observations Research Task (SPORT): an International Science Mission Using a Cubesat

    Science.gov (United States)

    Spann, James; Swenson, Charles; Durao, Otavio; Loures, Luis; Heelis, Rod; Bishop, Rebecca; Le, Guan; Abdu, Mangalathayil; Krause, Linda; Fry, Craig; hide

    2017-01-01

    The Scintillation Prediction Observations Research Task (SPORT) is a 6U CubeSat mission to address the compelling but difficult problem of understanding the preconditions leading to equatorial plasma bubbles. The scientific literature describes the preconditions in both the plasma drifts and the density profiles related to bubble formations that occur several hours later in the evening. Most of the scientific discovery has resulted from observations at a single site, within a single longitude sector, from Jicamarca, Peru. SPORT will provide a systematic study of the state of the pre-bubble conditions at all longitudes sectors to enhance understanding between geography and magnetic geometry. SPORT is an international partnership between National Aeronautics and Space Administration (NASA), the Brazilian National Institute for Space Research (INPE), and the Technical Aeronautics Institute under the Brazilian Air Force Command Department (DCTA/ITA), and encouraged by U.S. Southern Command. This talk will present an overview of the SPORT mission, observation strategy, and science objectives to improve predictions of ionospheric disturbances that affect radio propagation of telecommunication signals. The science goals will be accomplished by a unique combination of satellite observations from a nearly circular middle inclination orbit and the extensive operation of ground based observations from South America near the magnetic equator.

  10. A Vision for an International Multi-Sensor Snow Observing Mission

    Science.gov (United States)

    Kim, Edward

    2015-01-01

    Discussions within the international snow remote sensing community over the past two years have led to encouraging consensus regarding the broad outlines of a dedicated snow observing mission. The primary consensus - that since no single sensor type is satisfactory across all snow types and across all confounding factors, a multi-sensor approach is required - naturally leads to questions about the exact mix of sensors, required accuracies, and so on. In short, the natural next step is to collect such multi-sensor snow observations (with detailed ground truth) to enable trade studies of various possible mission concepts. Such trade studies must assess the strengths and limitations of heritage as well as newer measurement techniques with an eye toward natural sensitivity to desired parameters such as snow depth and/or snow water equivalent (SWE) in spite of confounding factors like clouds, lack of solar illumination, forest cover, and topography, measurement accuracy, temporal and spatial coverage, technological maturity, and cost.

  11. Internal waves in the Black Sea: satellite observations and in-situ measurements

    Science.gov (United States)

    Lavrova, Olga Yu.; Mityagina, Marina I.; Serebryany, Andrey N.; Sabinin, Konstantin D.; Kalashnikova, Nina A.; Krayushkin, Evgeny V.; Khymchenko, Ielizaveta

    2014-10-01

    Satellite radar (SAR) and visible band data from Envisat ASAR, ERS-2 SAR, Lansat-5,7,8 sensors were used to investigate internal waves (IWs) in the Black Sea. The three main areas of the Black Sea where surface manifestations of internal waves (SMIWs) were mostly observed are: the Danube Delta, Crimea Peninsula and the northeastern region near Novorossiysk. The main goal of our investigation was to define the mechanisms of IW generation in the non-tidal sea. In the first area, IWs are observed rather often due to surface intrusions of fresh waters of the Danube River. In contrast to usual soliton-like IW trains caused by river plumes, soliton trains near the Danuba Delta propagate in different directions and often subject to nonlinear interactions. The interrelation between location and orientation of IW trains and fresh water fronts is discussed. In the area off Crimea, in our opinion, IWs are generated mainly by upwelling relaxation and interaction between internal inertial waves and bottom topography features. SMIW in the northeastern part of the Black Sea are scarce, though IWs are regularly revealed by in-situ measurements. Field measurements were conducted in the northeastern part of the Black Sea from a small boat and from scientific sea platform near Crimea employing CTD probes, thermistor chain and Acoustic Doppler Current Profilers (ADCP). ADCP measurements allowed us to detect a number of IW trains. Their amplitudes were estimated to reach 5-8 m. Joint analysis of satellite SAR and subsatellite data gave an assessment of their typical wavelength at 90-100 m.

  12. Swift and Fermi Observations of X-Ray Flares: The Case of Late Internal Shock

    Science.gov (United States)

    Troja, E.; Piro, L.; Vasileiou, V.; Omodei, N.; Burgess, J. M.; Cutini, S.; Connaughton, V.; McEnery, J. E.

    2015-01-01

    Simultaneous Swift and Fermi observations of gamma-ray bursts (GRBs) offer a unique broadband view of their afterglow emission, spanning more than 10 decades in energy. We present the sample of X-ray flares observed by both Swift and Fermi during the first three years of Fermi operations. While bright in the X-ray band, X-ray flares are often undetected at lower (optical), and higher (MeV to GeV) energies. We show that this disfavors synchrotron self-Compton processes as the origin of the observed X-ray emission. We compare the broadband properties of X-ray flares with the standard late internal shock model, and find that in this scenario, X-ray flares can be produced by a late-time relativistic (gamma greater than 50) outflow at radii R approximately 10(exp 13) - 10(exp 14) cm. This conclusion holds only if the variability timescale is significantly shorter than the observed flare duration, and implies that X-ray flares can directly probe the activity of the GRB central engine.

  13. Authorship issues in multi-centre clinical trials: the importance of making an authorship contract.

    Science.gov (United States)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian; Vinther, Siri

    2015-02-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

  14. Optical Imaging Observation of the Geospace from the International Space Station by ISS-IMAP

    Science.gov (United States)

    Saito, A.; Sakanoi, T.; Yoshikawa, I.; Yamazaki, A.; Hozumi, Y.; Perwitasari, S.; Otsuka, Y.; Yamamoto, M.

    2017-12-01

    Optical imaging observation of the mesosphere, thermosphere, ionosphere, and plasmasphere was carried out from the International Space Station (ISS) with ISS-IMAP (Ionosphere, Mesosphere, upper Atmosphere, and Plasmasphere mapping) mission instruments. ISS-IMAP instruments was installed on the Exposed Facility of Japanese Experiment Module of the ISS in August, 2012, and removed in August, 2015. They are two imagers, Visible-light and Infrared Spectrum Imager (VISI) and Extreme UltraViolet Imager (EUVI). VISI made imaging observations of the airglow and aurora in the nadir direction. It had two slits perpendicular to the trajectory of ISS, and the movement of ISS made the two-dimensional observation whose field-of-view width is 600km at 100km altitude. It covered the wave length range from 500nm to 900nm. The airglow of 730nm (OH, Alt. 85km), 762nm (O2, Alt. 95km), and 630nm (O, Alt. 250km) were mainly observed besides the other airglow, such as 589nm (Na) and 557 (O). EUVI made imaging observation of the resonant scattering from ions. It had two telescopes, and observed the resonant scattering of He+ in 30.4nm, and O+ in 83.4nm in the limb direction. VISI captured the airglow structures whose wavelength from 80km to 500km. The concentric wave structures were frequently observed in the mesosphere and lower thermosphere region. They are strong evidence of the vertical coupling between the lower atmosphere and the upper atmosphere by vertical propagation of the atmospheric gravity waves. The other airglow structures, such as mesospheric bores, were also detected by ISS-IMAP/VISI. The meso-scale structures in the ionosphere, such as plasma bubbles, and traveling ionospheric disturbances were also observed. EUVI revealed the longitudinal structures of He+ in the top side of the ionosphere. It was attributed to the neutral wind in the thermosphere. In the presentation, the outline and results of the ISS-IMAP's VISI and EUVI observations will be discussed.

  15. The International Classification of Functioning, Disability and Health: a systematic review of observational studies

    Directory of Open Access Journals (Sweden)

    Luciana Castaneda

    2014-06-01

    Full Text Available Objective: To systematically review the use of the International Classification of Functioning, Disability and Health (ICF in observational studies. Methods: This study is a systematic review of articles that use the ICF in observational studies. We took into account the observational design papers available in databases such as PubMed, Lilacs and SciELO, published in English and Portuguese from January 2001 to June 2011. We excluded those in which the samples did not comprise individuals, those about children and adolescents, and qualitative methodology articles. After reading the abstracts of 265 identified articles, 65 met the inclusion criteria. Of these, 18 were excluded. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology adapted Checklist, with 15 items needed for observational studies, was applied to the 47 remaining articles. Any paper that met 12 of these criteria was included in this systematic review. Results: 29 articles were reviewed. Regarding the ICF application methodology, the checklist was used in 31% of the articles, the core set in 31% and the ICF categories in 31%. In the remaining 7%, it was not possible to define the applied methodology. In most papers (41%, qualifiers were used in their original format. As far as the area of knowledge is concerned, most of the studies were related to Rheumatology (24% and Orthopedics (21%. Regarding the study design, 83% of the articles used cross-sectional studies. Conclusion: Results indicate a wide scientific production related to ICF over the past 10 years. Different areas of knowledge are involved in the debate on the improvement of information on morbidity. However, there are only a few quantitative epidemiological studies involving the use of ICF. Future studies are needed to improve data related to functioning and disability.

  16. The International Classification of Functioning, Disability and Health: a systematic review of observational studies.

    Science.gov (United States)

    Castaneda, Luciana; Bergmann, Anke; Bahia, Ligia

    2014-01-01

    To systematically review the use of the International Classification of Functioning, Disability and Health (ICF) in observational studies. This study is a systematic review of articles that use the ICF in observational studies. We took into account the observational design papers available in databases such as PubMed, Lilacs and SciELO, published in English and Portuguese from January 2001 to June 2011. We excluded those in which the samples did not comprise individuals, those about children and adolescents, and qualitative methodology articles. After reading the abstracts of 265 identified articles, 65 met the inclusion criteria. Of these, 18 were excluded. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) adapted Checklist, with 15 items needed for observational studies, was applied to the 47 remaining articles. Any paper that met 12 of these criteria was included in this systematic review. 29 articles were reviewed. Regarding the ICF application methodology, the checklist was used in 31% of the articles, the core set in 31% and the ICF categories in 31%. In the remaining 7%, it was not possible to define the applied methodology. In most papers (41%), qualifiers were used in their original format. As far as the area of knowledge is concerned, most of the studies were related to Rheumatology (24%) and Orthopedics (21%). Regarding the study design, 83% of the articles used cross-sectional studies. Results indicate a wide scientific production related to ICF over the past 10 years. Different areas of knowledge are involved in the debate on the improvement of information on morbidity. However, there are only a few quantitative epidemiological studies involving the use of ICF. Future studies are needed to improve data related to functioning and disability.

  17. Measuring the quality of observational study data in an international HIV research network.

    Directory of Open Access Journals (Sweden)

    Stephany N Duda

    Full Text Available Observational studies of health conditions and outcomes often combine clinical care data from many sites without explicitly assessing the accuracy and completeness of these data. In order to improve the quality of data in an international multi-site observational cohort of HIV-infected patients, the authors conducted on-site, Good Clinical Practice-based audits of the clinical care datasets submitted by participating HIV clinics. Discrepancies between data submitted for research and data in the clinical records were categorized using the audit codes published by the European Organization for the Research and Treatment of Cancer. Five of seven sites had error rates >10% in key study variables, notably laboratory data, weight measurements, and antiretroviral medications. All sites had significant discrepancies in medication start and stop dates. Clinical care data, particularly antiretroviral regimens and associated dates, are prone to substantial error. Verifying data against source documents through audits will improve the quality of databases and research and can be a technique for retraining staff responsible for clinical data collection. The authors recommend that all participants in observational cohorts use data audits to assess and improve the quality of data and to guide future data collection and abstraction efforts at the point of care.

  18. Transformation of internal solitary waves at the "deep" and "shallow" shelf: satellite observations and laboratory experiment

    Directory of Open Access Journals (Sweden)

    O. D. Shishkina

    2013-10-01

    Full Text Available An interaction of internal solitary waves with the shelf edge in the time periods related to the presence of a pronounced seasonal pycnocline in the Red Sea and in the Alboran Sea is analysed via satellite photos and SAR images. Laboratory data on transformation of a solitary wave of depression while passing along the transverse bottom step were obtained in a tank with a two-layer stratified fluid. The certain difference between two characteristic types of hydrophysical phenomena was revealed both in the field observations and in experiments. The hydrological conditions for these two processes were named the "deep" and the "shallow" shelf respectively. The first one provides the generation of the secondary periodic short internal waves – "runaway" edge waves – due to change in the polarity of a part of a soliton approaching the shelf normally. Another one causes a periodic shear flow in the upper quasi-homogeneous water layer with the period of incident solitary wave. The strength of the revealed mechanisms depends on the thickness of the water layer between the pycnocline and the shelf bottom as well as on the amplitude of the incident solitary wave.

  19. Positron spectra from internal pair conversion observed in 238U + 181Ta collisions

    CERN Document Server

    Heinz, S.; Heine, F.; Joeres, O.; Kienle, P.; Konig, I.; Konig, W.; Kozhuharov, C.; Leinberger, U.; Rhein, M.; Schroter, A.; Tsertos, Haralabos

    2000-01-01

    We present new results from measurements and simulations of positron spectra, originating from 238U + 181Ta collisions at beam energies close to the Coulomb barrier. The measurements were performed using an improved experimental setup at the double-Orange spectrometer of GSI. Particular emphasis is put on the signature of positrons from Internal-Pair-Conversion (IPC) processes in the measured e+ energy spectra, following the de-excitation of electromagnetic transitions in the moving Ta-like nucleus. It is shown by Monte Carlo simulations that, for the chosen current sweeping procedure used in the present experiments, positron emission from discrete IPC transitions can lead to rather narrow line structures in the measured energy spectra. The measured positron spectra do not show evidence for line structures within the statistical accuracy achieved, although expected from the intensities of the observed $\\gamma$ transitions (E$_{\\gamma}~1250-1600$ keV) and theoretical conversion coefficients. This is due to the...

  20. Internal gravity waves in Titan's atmosphere observed by Voyager radio occultation

    Science.gov (United States)

    Hinson, D. P.; Tyler, G. L.

    1983-01-01

    The radio scintillations caused by scattering from small-scale irregularities in Titan's neutral atmosphere during a radio occultation of Voyager 1 by Titan are investigated. Intensity and frequency fluctuations occurred on time scales from about 0.1 to 1.0 sec at 3.6 and 13 cm wavelengths whenever the radio path passed within 90 km of the surface, indicating the presence of variations in refractivity on length scales from a few hundred meters to a few kilometers. Above 25 km, the altitude profile of intensity scintillations closely agrees with the predictions of a simple theory based on the characteristics of internal gravity waves propagating with little or no attenuation through the vertical stratification in Titan's atmosphere. These observations support a hypothesis of stratospheric gravity waves, possibly driven by a cloud-free convective region in the lowest few kilometers of the stratosphere.

  1. Internal DNA modes below 25 cm-1: a resonance Raman spectroscopy observation.

    Science.gov (United States)

    Lisy, V; Miskovsky, P; Brutovsky, B; Chinsky, L

    1997-02-01

    The first resonance Raman scattering observation of the low-frequency (LF) region (below 40 up to 12 cm-1) of DNA motions is presented. Since the concentration of the studied DNA solution was very low (1 mg/ml), the spectra features reflect internal vibrations of the macromolecule. The decomposition of the spectra into Lorentzians clearly indicate three intrahelical DNA modes: the corresponding peaks are located at the frequencies 16, 19, and 23 (+/- 1) cm-1. This result is in agreement with our quasi-continuity model of the LF B-form DNA dynamics (V. Lisy, P. Miskovsky and P. Schreiber, J. Biomol. Struct. Dyn. 13, 707 (1996)). The fit of the experimental frequencies to the theory, using the Genetic Algorithms approach, allowed us to make some conclusions about the model force constants which could be found by independent conformational energy calculations. Possible positions of five lowest-frequency DNA peaks, predicted by the model, are discussed.

  2. International Observe the Moon Night: Using Public Outreach Events to Tell Your Story to the Public

    Science.gov (United States)

    Hsu, B. C.; International Observe the Moon Night Coordinating Committee

    2011-12-01

    From various interpretations of the lunar "face," early pictograms of the Moon's phases, or to the use of the lunar cycle for festivals or harvests, the Moon has an undeniable influence on human civilization. International Observe the Moon Night (InOMN) capitalizes on the human connection to the Moon by engaging the public in annual lunar observation campaigns that share the excitement of lunar science and exploration. In 2010 (InOMN's inaugural year), over 500,000 people attended events in 53 countries around the world. About 68% of InOMN hosts - astronomy clubs, museums, schools, or other groups - used the resources on the InOMN website (http://observethemoonnight.org). The InOMN website provided supporting materials for InOMN event hosts in the form of downloadable advertising materials, Moon maps, suggestions for hands-on educational activities, and links to lunar science content. InOMN event participants shared their experiences with the world using the Web and social media, event hosts shared their experiences with evaluation data, and amateur astronomers and photographers shared their images of the Moon through the lunar photography contest. The overwhelming response from InOMN in 2010 represents an untapped potential for infusing cutting edge lunar science and exploration into a large-scale public outreach event.

  3. Observational study: microgravity testing of a phase-change reference on the International Space Station.

    Science.gov (United States)

    Topham, T Shane; Bingham, Gail E; Latvakoski, Harri; Podolski, Igor; Sychev, Vladimir S; Burdakin, Andre

    2015-01-01

    Orbital sensors to monitor global climate change during the next decade require low-drift rates for onboard thermometry, which is currently unattainable without on-orbit recalibration. Phase-change materials (PCMs), such as those that make up the ITS-90 standard, are seen as the most reliable references on the ground and could be good candidates for orbital recalibration. Space Dynamics Lab (SDL) has been developing miniaturized phase-change references capable of deployment on an orbital blackbody for nearly a decade. Improvement of orbital temperature measurements for long duration earth observing and remote sensing. To determine whether and how microgravity will affect the phase transitions, SDL conducted experiments with ITS-90 standard material (gallium, Ga) on the International Space Station (ISS) and compared the phase-change temperature with earth-based measurements. The miniature on-orbit thermal reference (MOTR) experiment launched to the ISS in November 2013 on Soyuz TMA-11M with the Expedition 38 crew and returned to Kazakhstan in March 2014 on the Soyuz TMA-10 spacecraft. MOTR tested melts and freezes of Ga using repeated 6-h cycles. Melt cycles obtained on the ground before and after launch were compared with those obtained on the ISS. To within a few mK uncertainty, no significant difference between the melt temperature of Ga at 1 g and in microgravity was observed.

  4. Community-level antibiotic access and use (ABACUS in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Heiman F.L. Wertheim

    2017-07-01

    Full Text Available In many low- and middle-income countries (LMICs, a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe, which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries, which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and

  5. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2).

    Science.gov (United States)

    Schönenberger, Silvia; Niesen, Wolf-Dirk; Fuhrer, Hannah; Bauza, Colleen; Klose, Christina; Kieser, Meinhard; Suarez, José I; Seder, David B; Bösel, Julian

    2016-04-01

    Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial. Patients with acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage who are so severely affected that two weeks of ventilation are presumed necessary based on a prediction score are eligible. It is intended to enroll 190 patients per group (n = 380). Patients are randomized to either percutaneous tracheostomy within the first five days after intubation or to ongoing orotracheal intubation with consecutive weaning and extubation and, if the latter failed, to percutaneous tracheostomy from day 10 after intubation. The primary endpoint is functional outcome defined by the modified Rankin Scale (mRS, 0-4 (favorable) vs. 5 + 6 (unfavorable)) after six months; secondary endpoints are mortality and cause of mortality during intensive care unit-stay and within six months from admission, intensive care unit-length of stay, duration of sedation, duration of ventilation and weaning, timing and reasons for withdrawal of life support measures, relevant intracranial pressure rises before and after tracheostomy. The necessity and optimal timing of tracheostomy in ventilated stroke patients need to be identified. SETPOINT2 should clarify whether benefits in functional outcome can be achieved by early tracheostomy in these patients. © 2016 World Stroke Organization.

  6. Magnetosheath jets: MMS observations of internal structures and jet interactions with ambient plasma

    Science.gov (United States)

    Plaschke, F.; Karlsson, T.; Hietala, H.; Archer, M. O.; Voros, Z.; Nakamura, R.; Magnes, W.; Baumjohann, W.; Torbert, R. B.; Russell, C. T.; Giles, B. L.

    2017-12-01

    The dayside magnetosheath downstream of the quasi-parallel bow shock is commonly permeated by high-speed jets. Under low IMF cone angle conditions, large scale jets alone (with cross-sectional diameters of over 2 Earth radii) have been found to impact the subsolar magnetopause once every 6 minutes - smaller scale jets occurring much more frequently. The consequences of jet impacts on the magnetopause can be significant: they may trigger local reconnection and waves, alter radiation belt electron drift paths, disturb the geomagnetic field, and potentially generate diffuse throat aurora at the dayside ionosphere. Although some basic statistical properties of jets are well-established, their internal structure and interactions with the surrounding magnetosheath plasma are rather unknown. We present Magnetospheric Multiscale (MMS) observations which reveal a rich jet-internal structure of high-amplitude plasma moment and magnetic field variations and associated currents. These variations/structures are generally found to be in thermal and magnetic pressure balance; they mostly (but not always) convect with the plasma flow. Small velocity differences between plasma and structures are revealed via four-spacecraft timing analysis. Inside a jet core region, where the plasma velocity maximizes, structures are found to propagate forward (i.e., with the jet), whereas backward propagation is found outside that core region. Although super-magnetosonic flows are detected by MMS in the spacecraft frame of reference, no fast shock is seen as the jet plasma is sub-magnetosonic with respect to the ambient magnetosheath plasma. Instead, the fast jet plasma pushes ambient magnetosheath plasma ahead of the jet out of the way, possibly generating anomalous sunward flows in the vicinity, and modifies the magnetic field aligning it with the direction of jet propagation.

  7. Seven Years of World-Wide Participation in International Observe the Moon Night

    Science.gov (United States)

    Buxner, Sanlyn; Jones, Andrea J.; Bleacher, Lora; Wenger, Matthew; Shaner, Andrew; Joseph, Emily C. S.; Day, Brian; Canipe, Marti; InOMN Coordinating Committee

    2016-10-01

    International Observe the Moon Night (InOMN) is an annual worldwide public event that encourages observation, appreciation, and understanding of our Moon and its connection to NASA planetary science and exploration. Everyone on Earth is invited to join the celebration by hosting or attending an InOMN event - and uniting on one day each year to look at and learn about the Moon together. This year marks the seventh year of InOMN, which will be held on October 8, 2016. Between 2010 and 2015, a total of 3,275 events were registered worldwide, 49% of which were held in the United States. In 2015, a total of 545 events were registered on the InOMN website from around the world. These events were scheduled to be held in 54 different countries, 43% of which were registered in the United States from 40 states and the District of Columbia. InOMN events are hosted by a variety of institutions including astronomy clubs, observatories, schools, and universities and hosted at a variety of public and private institutions all over the world including museums, planetaria, schools, universities, observatories, parks, and private businesses and private homes. Evaluation of InOMN is led by the Planetary Science Institute who assesses the success of InOMN through analysis of event registrations, facilitator surveys, and visitor survey. Current InOMN efforts demonstrate success in meeting the overall goals of the LRO E/PO goals including raising visitors' awareness of lunar science and exploration, providing audiences with information about lunar science and exploration along with access to LRO data and science results, and inspiring visitors to want to learn more about the Moon and providing connections to opportunities to do so. InOMN is sponsored by NASA's Lunar Reconnaissance Orbiter, NASA's Solar System Exploration Research Virtual Institute (SSERVI), and the Lunar and Planetary Institute. Learn more at http://observethemoonnight.org/.

  8. Celebrating the Eighth Annual International Observe the Moon Night and Supporting the 2017 Solar Eclipse

    Science.gov (United States)

    Buxner, Sanlyn; Jones, Andrea; Bleacher, Lora; Shaner, Andy; Wenger, Matthew; Bakerman, Maya; Joseph, Emily; Day, Brian; White, Vivian; InOMN Coordinating Committee

    2017-01-01

    2017 marks the eighth International Observe the Moon Night (InOMN), which will be held on July 15, 2017. We will present findings from the first seven years, including the most recent figures from the October 2016 event, and provide an overview of the 2017 events which will support the Great American Eclipse which occurs about five weeks later, on August 21, 2017.InOMN is an annual worldwide public event that encourages observation, appreciation, and understanding of our Moon and its connection to NASA planetary science and exploration. This year InOMN’s event will support broad efforts to promote the eclipse by providing resources to help InOMN hosts highlight lunar science that will influence the eclipse, such as the topography of the Moon, which affects the edges of the eclipse path and the location and duration of Baily’s beads. The InOMN team will host webinars to discuss the Moon, lunar science, and lunar and solar eclipses.Each year, thousands of visitors take part in hundreds of events across the world. In the first seven years (2010 to 2016) over 3,700 events were registered worldwide and hosted by a variety of institutions including astronomy clubs, observatories, schools, and universities and held at a variety of public and private institutions all over the world including museums, planetaria, schools, universities, observatories, parks, and private businesses and homes. Evaluation of InOMN reveals that events are raising visitors’ awareness of lunar science and exploration, providing audiences with information about lunar science and exploration, and inspiring visitors to want to learn more about the Moon and providing connections to opportunities to do so.InOMN is sponsored by NASA's Lunar Reconnaissance Orbiter, NASA's Solar System Exploration Research Virtual Institute (SSERVI), and the Lunar and Planetary Institute. Learn more and register to host an event at http://observethemoonnight.org/.

  9. SAR Observation and Numerical Simulation of Internal Solitary Wave Refraction and Reconnection Behind the Dongsha Atoll

    Science.gov (United States)

    Jia, T.; Liang, J. J.; Li, X.-M.; Sha, J.

    2018-01-01

    The refraction and reconnection of internal solitary waves (ISWs) around the Dongsha Atoll (DSA) in the northern South China Sea (SCS) are investigated based on spaceborne synthetic aperture radar (SAR) observations and numerical simulations. In general, a long ISW front propagating from the deep basin of the northern SCS splits into northern and southern branches when it passes the DSA. In this study, the statistics of Envisat Advanced SAR (ASAR) images show that the northern and southern wave branches can reconnect behind the DSA, but the reconnection location varies. A previously developed nonlinear refraction model is set up to simulate the refraction and reconnection of the ISWs behind the DSA, and the model is used to evaluate the effects of ocean stratification, background currents, and incoming ISW characteristics at the DSA on the variation in reconnection locations. The results of the first realistic simulation agree with consecutive TerraSAR-X (TSX) images captured within 12 h of each other. Further sensitivity simulations show that ocean stratification, background currents, and initial wave amplitudes all affect the phase speeds of wave branches and therefore shift their reconnection locations while shapes and locations of incoming wave branches upstream of the DSA profoundly influence the subsequent propagation paths. This study clarifies the variation in reconnection locations of ISWs downstream of the DSA and reveals the important mechanisms governing the reconnection process, which can improve our understanding of the propagation of ISWs near the DSA.

  10. Acknowledgement of reviewer services to the International Journal Applied Earth Observation and Geoinformation

    Science.gov (United States)

    van der Meer, Freek

    2017-06-01

    Peer review is the backbone of the scientific process. In 2016 a total of 866 scientist provided reviewer services for the International Journal Applied Earth Observation and Geoinformation. Frequent reviewers receive a recognition from the publisher in form of a Certificate of Outstanding Contribution in Reviewing and receive a 30 days free access to Scopus and ScienceDirect. More importantly they gain first hand insight into the latest developments in science as they are the first to read exciting new scientific papers. Nevertheless it is hard to find reviewers as the number of papers submitted to our journal has increased substantially over the last years and more remote sensing journals are put in the market each year. We are grateful to all those individuals that have devoted their precious time to reviewing papers for JAG. This has improved the quality of our communications which is well reflected in the number of citations our papers receive and the impact factor of the journal. JAG ranks third of all 28 remote sensing journals not the least because of the quality of the reviews we provide. As a token of our appreciation it is my pleasure to thank all reviewers that were active in 2016 on behalf of the editorial board, the associate editors, the Publisher and myself as Editor-in-Chief of JAG. To honor them we list all reviewers that provide four or more reviews in 2016:

  11. Patient-reported outcomes with lanreotide Autogel/Depot for carcinoid syndrome: An international observational study.

    Science.gov (United States)

    Ruszniewski, Philippe; Valle, Juan W; Lombard-Bohas, Catherine; Cuthbertson, Daniel J; Perros, Petros; Holubec, Luboš; Delle Fave, Gianfranco; Smith, Denis; Niccoli, Patricia; Maisonobe, Pascal; Atlan, Philippe; Caplin, Martyn E

    2016-05-01

    Lanreotide Autogel/Depot effectively controls symptoms in patients with carcinoid syndrome associated with neuroendocrine tumours. Data on patient-reported outcomes are sparse. To evaluate the effect of lanreotide on patient-reported outcomes (PROs) with carcinoid syndrome. This was an international, open-label, observational study of adults with neuroendocrine tumours and history of diarrhoea, receiving lanreotide for >3 months for relief of carcinoid syndrome symptoms. The primary PRO measure was satisfaction with diarrhoea control. Secondary PRO measures included severity, change in symptoms and impact on daily life of diarrhoea; and patient satisfaction with flushing control. Of 273 patients enrolled, 76% were 'completely' or 'rather' satisfied with diarrhoea control; 79% reported improvement in diarrhoea with lanreotide. The proportion of patients with 'mild', 'minimal', or 'no diarrhoea' increased from 33% before treatment to 75% during treatment; 75% were unconcerned about the impact of diarrhoea on daily life. Satisfaction with flushing control amongst patients with significant flushing at treatment initiation was 73%. Lanreotide treatment was associated with improvements in symptoms as well as a range of PROs in patients with neuroendocrine tumours and carcinoid syndrome (ClinicalTrials.gov: NCT01234168). Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Comparing International Humanitarian Law and Islamic Law on War Captives: Observing ISIS

    Directory of Open Access Journals (Sweden)

    Fajri Matahati Muhammadin

    2016-08-01

    Full Text Available The Syrian conflict brings warfare to a new level where jihadists have evolved from small terrorist cells into large armed groups. The Islamic State of Iraq and Sham (ISIS seem to be the most outstanding and eye-catching of all, as they seem to be the strongest and most brutal among them.They have allegedly committed numerous breaches of international humanitarian law(IHL. especially in the treatment of War Captives. This includes summary execution, torture, and even acts of crucifixion. While ISIS claims to follow only Islamic law and dismisses other laws, does this mean that Islamic laws of war are inconsistent with IHL? This article will first examine relevant rules of IHL and Islamic laws of war with a focus on the treatment of war captives, finding that the two laws are generally consistent except for a few points. Then the practice of ISIS regarding the treatment of war captives will be observed, and it will be found that there are numerous evidence of violations towards both IHL and Islamic law.

  13. Aggregation in a high internal phase emulsion observed by SANS and USANS

    International Nuclear Information System (INIS)

    Zank, Johann; Reynolds, P.A.; Jackson, A.J.; Baranyai, K.J.; Perriman, A.W.; White, J.W.; Barker, J.G.; Kim, Man-Ho

    2005-01-01

    Full text: As part of a wider study into high internal phase emulsions, we have prepared and studied by SANS and USANS the structure of an unstable emulsion consisting of 90% by volume saturated ammonium nitrate dispersed as micron-scale droplets in hexadecane, stabilised by the surfactant Pluronic L92. Similar emulsions produced using polyisobutylene-based surfactants, reported earlier, are highly stabilised by a significant number of surfactant rich reverse micelles a few nanometres in diameter in the oil phase. The aqueous-oil droplet interfaces are coated with a monolayer of surfactant, while a very small amount of surfactant is aggregated into micron-scale surfactant-rich objects. In contrast, the Pluronic emulsion contains insignificant numbers of reverse micelles and a complex multilayered interface between oil and aqueous phases. Now, the great majority of added surfactant is in the form of micron scale, fractally linked, blocks of lamellar phase at the aqueous-oil droplet interfaces. The lamellar phase can be characterised by the Bragg peaks observed in three different isotopic contrasts by SANS. We attribute the shear instability of the Pluronic emulsion to the more hydrophilic nature of the surfactant which causes both depletion of reverse micelles in the oil phase, and aggregation into the blocks of lamellar phase. (authors)

  14. Patient-rated suitability of a novel electronic device for self-injection of subcutaneous interferon beta-1a in relapsing multiple sclerosis: an international, single-arm, multicentre, Phase IIIb study.

    Science.gov (United States)

    Devonshire, Virginia; Arbizu, Txomin; Borre, Bjorn; Lang, Michael; Lugaresi, Alessandra; Singer, Barry; Verdun di Cantogno, Elisabetta; Cornelisse, Peter

    2010-04-30

    Multiple sclerosis (MS) currently requires long-term treatment with disease-modifying drugs, administered parenterally up to once daily. The need for regular self-injection can be a barrier to treatment for many patients. Autoinjectors can help patients overcome problems or concerns with self-injection and could, therefore, improve treatment adherence. This study was performed to assess the suitability of a new electronic device for the subcutaneous (sc) administration of interferon (IFN) beta-1a, 44 mcg three times weekly, for relapsing MS. In this Phase IIIb, multicentre, single-arm study, patients with relapsing MS who had been consistently self-injecting sc IFN beta-1a using an autoinjector for at least 6 weeks were taught to use the new device and self-administered treatment for 12 weeks thereafter. Patient-rated suitability of the device was assessed at the end of Week 12 using the Patient User Trial Questionnaire. Patient satisfaction with, and evaluation of, the injection process was assessed using the MS Treatment Concern Questionnaire. Trainers evaluated the device using the Trainer User Trial Questionnaire. At Week 12, 71.6% (73/102) of patients considered the device 'very suitable' or 'suitable' for self-injection; 92.2% (94/102) reported some degree of suitability and only 7.8% (8/102) found the device 'not at all suitable'. At Weeks 4, 8 and 12, most patients reported that injection preparation and clean-up, performing injections and ease of device use in the previous 4 weeks compared favourably with, or was equivalent to, their previous experience of self-injection. Injection-related pain, injection reactions and 'flu-like' symptoms remained stable over the 12 weeks. Each device feature was rated 'very useful' or 'useful' by at least 80% of patients. All trainers and 95.2% (99/104) of patients found device functions 'very easy' or 'easy' to use. Overall convenience was considered the most important benefit of the device. Most patients considered the

  15. Moored Observations of Internal Waves in Luzon Strait: 3-D Structure, Dissipation, and Evolution

    Science.gov (United States)

    2016-03-01

    10 kW/m). At mooring S9 on the southern line, there are fewer signs of an interference pattern. Time-mean internal tidal energy fluxes were 25 (14...Alford led a group IWISE summary paper which was published in Nature. RESULTS Internal Tides and Energy Fluxes Measurements of velocity and...density are used to compute the energy and energy flux of the internal tide (Figure 2). A strong spring-neap modulation in energy and energy flux are seen

  16. Is international election observation credible? Evidence from Organization for Security and Co-operation in Europe missions

    Directory of Open Access Journals (Sweden)

    Max Bader

    2014-07-01

    Full Text Available While international election observations missions often aim to present generalizable claims about the quality and integrity of an election, their findings are rarely based on a representative sample of observations, undermining the credibility of the missions. Bias in the selection of polling stations, among other things, can inflate or deflate the percentage of polling stations where observers find significant flaws. This article uses original data from Organization for Security and Co-operation in Europe (OSCE election observation missions to illustrate the nature of the problem of selection bias in international election observation, and show how the percentage of ‘bad’ polling stations (in the absence of selection bias can be estimated through a weighting procedure. The article finds that, while there is a strong degree of selection bias, this does not significantly impact the overall percentage of ‘bad’ polling stations that is reported by OSCE observation missions.

  17. Is international election observation credible? Evidence from Organization for Security and Co-operation in Europe missions

    OpenAIRE

    Max Bader; Hans Schmeets

    2014-01-01

    While international election observations missions often aim to present generalizable claims about the quality and integrity of an election, their findings are rarely based on a representative sample of observations, undermining the credibility of the missions. Bias in the selection of polling stations, among other things, can inflate or deflate the percentage of polling stations where observers find significant flaws. This article uses original data from Organization for Security and Co-oper...

  18. Characterisation of patients receiving moxifloxacin for acute bacterial rhinosinusitis in clinical practice: results from an international, observational cohort study.

    Directory of Open Access Journals (Sweden)

    Ralph Mösges

    Full Text Available We conducted a prospective, non-controlled, multi-centre Phase IV observational cohort study of patients with acute bacterial rhinosinusitis who were treated with moxifloxacin in clinical practice in 19 countries in Asia Pacific, Europe and the Middle East. With the data collected we evaluated the presentation and course of the current disease episode, particularly in terms of the principal clinical signs and symptoms of acute rhinosinusitis and diagnostic procedures. A final assessment of moxifloxacin therapy was made to evaluate the impact of the sinusitis episode on activities of daily life and on sleep disturbance, and to evaluate the clinical outcome of treatment. A total of 7,090 patients were enrolled, of whom 3909 (57.6% were included in the valid for clinical outcome and safety population. Regional differences were observed in the main symptoms of acute rhinosinusitis and, according to several characteristics, disease episodes appeared to be more severe in patients in Europe than in the Asia Pacific or Middle East regions. The sinusitis episode impacted on daily living for mean (SD periods of 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 days and disturbed sleep for 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 nights in the Asia Pacific, Europe and Middle East regions, respectively. With moxifloxacin treatment, the mean (SD time to improvement of symptoms was 3.0 (1.5, 3.4 (1.6 and 3.2 (1.5 days, and the time to resolution of symptoms was 4.8 (2.6 days, 5.7 (2.4 days and 5.5 (2.5 days, in the Asia Pacific, Europe and Middle East regions, respectively. In conclusion, acute rhinosinusitis remains a substantial health burden with significant impact on patients' quality of life, and there are differences between global regions in the clinical presentation, diagnosis and clinical course of disease episodes. Moxifloxacin was an effective and well-tolerated treatment option in the overall population.ClinicalTrials.gov Identifier: NCT00930488.

  19. Earth Observation from the International Space Station -Remote Sensing in Schools-

    Science.gov (United States)

    Schultz, Johannes; Rienow, Andreas; Graw, Valerie; Heinemann, Sascha; Selg, Fabian; Menz, Gunter

    2016-04-01

    Since spring 2014, the NASA High Definition Earth Viewing (HDEV) mission at the International Space Station (ISS) is online. HDEV consists of four cameras mounted at ESA's Columbus laboratory and is recording the earth 24/7. The educational project 'Columbus Eye - Live-Imagery from the ISS in Schools' has published a learning portal for earth observation from the ISS (www.columbuseye.uni-bonn.de). Besides a video live stream, the portal contains an archive providing spectacular footage, web-GIS and an observatory with interactive materials for school lessons. Columbus Eye is carried out by the University of Bonn and funded by the German Aerospace Center (DLR) Space Administration. Pupils should be motivated to work with the footage in order to learn about patterns and processes of the coupled human-environment system like volcano eruptions or deforestation. The material is developed on the experiences of the FIS (German abbreviation for "Remote Sensing in Schools") project and its learning portal (http://www.fis.uni-bonn.de). Based on the ISS videos three different teaching material types are developed. The simplest teaching type are provided by worksheets, which have a low degree of interactivity. Alongside a short didactical commentary for teachers is included. Additionally, videos, ancillary information, maps, and instructions for interactive school experiments are provided. The observatory contains the second type of the Columbus Eye teaching materials. It requires a high degree of self-organisation and responsibility of the pupils. Thus, the observatory provides the opportunity for pupils to freely construct their own hypotheses based on a spatial analysis tool similar to those provided by commercial software. The third type are comprehensive learning and teaching modules with a high degree of interactivity, including background information, interactive animations, quizzes and different analysis tools (e.g. change detection, classification, polygon or NDVI

  20. Diagnostic screening of paroxysmal nocturnal hemoglobinuria: Prospective multicentric evaluation of the current medical indications.

    Science.gov (United States)

    Morado, Marta; Freire Sandes, Alex; Colado, Enrique; Subirá, Dolores; Isusi, Paloma; Soledad Noya, María; Belén Vidriales, María; Sempere, Amparo; Ángel Díaz, José; Minguela, Alfredo; Álvarez, Beatriz; Serrano, Cristina; Caballero, Teresa; Rey, Mercedes; Pérez Corral, Ana; Cristina Fernández Jiménez, María; Magro, Elena; Lemes, Angelina; Benavente, Celina; Bañas, Helena; Merino, Juana; Castejon, Celine; Gutierrez, Olivier; Rabasa, Pilar; Vescosi Gonçalves, Matheus; Perez-Andres, Martin; Orfao, Alberto

    2017-09-01

    Although consensus guidelines have been proposed in 2010 for the diagnostic screening of paroxysmal nocturnal hemoglobinuria (PNH) by flow cytometry (FCM), so far no study has investigated the efficiency of such medical indications in multicentric vs. reference laboratory settings. Here we evaluate the efficiency of consensus medical indications for PNH testing in 3,938 peripheral blood samples submitted to FCM testing in 24 laboratories in Spain and one reference center in Brazil. Overall, diagnostic screening based on consensus medical indications was highly efficient (14% of PNH + samples) both in the multicenter setting in Spain (10%) and the reference laboratory in Brazil (16%). The highest frequency of PNH + cases was observed among patients screened because of bone marrow (BM) failure syndrome (33%), particularly among those with aplastic anemia (AA; 45%) and to a less extent also a myelodysplastic syndrome (MDS; 10%). Among the other individuals studied, the most efficient medical indications for PNH screening included: hemolytic anemia (19%), hemoglobinuria (48%) and unexplained cytopenias (9%). In contrast, only a minor fraction of the patients who had been submitted for PNH testing because of unexplained thrombosis in the absence of cytopenia, were positive (0.4%). In summary, our results demonstrate that the current medical indications for PNH screening by FCM are highly efficient, although improved screening algorithms are needed for patients presenting with thrombosis and normal blood cell counts. © 2016 International Clinical Cytometry Society. © 2016 International Clinical Cytometry Society.

  1. Mid-frequency sound propagation through internal waves at short range with synoptic oceanographic observations.

    Science.gov (United States)

    Rouseff, Daniel; Tang, Dajun; Williams, Kevin L; Wang, Zhongkang; Moum, James N

    2008-09-01

    Preliminary results are presented from an analysis of mid-frequency acoustic transmission data collected at range 550 m during the Shallow Water 2006 Experiment. The acoustic data were collected on a vertical array immediately before, during, and after the passage of a nonlinear internal wave on 18 August, 2006. Using oceanographic data collected at a nearby location, a plane-wave model for the nonlinear internal wave's position as a function of time is developed. Experimental results show a new acoustic path is generated as the internal wave passes above the acoustic source.

  2. International prospective observational study of upper gastrointestinal haemorrhage: Does weekend admission affect outcome?

    DEFF Research Database (Denmark)

    Murray, Iain A.; Dalton, Harry R.; Stanley, Adrian J.

    2017-01-01

    Introduction Out of hours admissions have higher mortality for many conditions but upper gastrointestinal haemorrhage studies have produced variable outcomes. Methods Prospective study of 12 months consecutive admissions of upper gastrointestinal haemorrhage from four international high volume ce...

  3. International Comprehensive Ocean Atmosphere Data Set (ICOADS) And NCEI Global Marine Observations

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — International Comprehensive Ocean Atmosphere Data Set (ICOADS) consists of digital data set DSI-1173, archived at the National Center for Environmental Information...

  4. A prospective international Aspergillus terreus survey

    DEFF Research Database (Denmark)

    Risslegger, B; Zoran, T; Lackner, M

    2017-01-01

    OBJECTIVES: A prospective international multicentre surveillance study was conducted to investigate the prevalence and amphotericin B susceptibility of Aspergillus terreus species complex infections. METHODS: A total of 370 cases from 21 countries were evaluated. RESULTS: The overall prevalence o...

  5. International Collaboration Enhances Cancer Screening Efforts

    Science.gov (United States)

    CGH is working with the International Agency for Research on CancerExit Disclaimer (IARC) and the Pan American Health Organization (PAHO) on the ESTAMPA Study, a multi-centric study of cervical cancer screening and triage with HPV testing.

  6. Understanding the Internal Magnetic Field Configurations of ICMEs Using More than 20 Years of Wind Observations

    Science.gov (United States)

    Nieves-Chinchilla, T.; Vourlidas, A.; Raymond, J. C.; Linton, M. G.; Al-haddad, N.; Savani, N. P.; Szabo, A.; Hidalgo, M. A.

    2018-02-01

    The magnetic topology, structure, and geometry of the magnetic obstacles embedded within interplanetary coronal mass ejections (ICMEs) are not yet fully and consistently described by in situ models and reconstruction techniques. The main goal of this work is to better understand the status of the internal magnetic field of ICMEs and to explore in situ signatures to identify clues to develop a more accurate and reliable in situ analytical models. We take advantage of more than 20 years of Wind observations of transients at 1 AU to compile a comprehensive database of ICMEs through three solar cycles, from 1995 to 2015. The catalog is publicly available at wind.gsfc.nasa.gov and is fully described in this article. We identify and collect the properties of 337 ICMEs, of which 298 show organized magnetic field signatures. To allow for departures from idealized magnetic configurations, we introduce the term "magnetic obstacle" (MO) to signify the possibility of more complex configurations. To quantify the asymmetry of the magnetic field strength profile within these events, we introduce the distortion parameter (DiP) and calculate the expansion velocity within the magnetic obstacle. Circular-cylindrical geometry is assumed when the magnetic field strength displays a symmetric profile. We perform a statistical study of these two parameters and find that only 35% of the events show symmetric magnetic profiles and a low enough expansion velocity to be compatible with the assumption of an idealized cylindrical static flux rope, and that 41% of the events do not show the expected relationship between expansion and magnetic field compression in the front, with the maximum magnetic field closer to the first encounter of the spacecraft with the magnetic obstacle; 18% show contractions ( i.e. apparent negative expansion velocity), and 30% show magnetic field compression in the back. We derive an empirical relation between DiP and expansion velocity that is the first step toward

  7. Astronomy Education Research Observations from the iSTAR international Study of Astronomical Reasoning Database

    Science.gov (United States)

    Tatge, C. B.; Slater, S. J.; Slater, T. F.; Schleigh, S.; McKinnon, D.

    2016-12-01

    Historically, an important part of the scientific research cycle is to situate any research project within the landscape of the existing scientific literature. In the field of discipline-based astronomy education research, grappling with the existing literature base has proven difficult because of the difficulty in obtaining research reports from around the world, particularly early ones. In order to better survey and efficiently utilize the wide and fractured range and domain of astronomy education research methods and results, the iSTAR international Study of Astronomical Reasoning database project was initiated. The project aims to host a living, online repository of dissertations, theses, journal articles, and grey literature resources to serve the world's discipline-based astronomy education research community. The first domain of research artifacts ingested into the iSTAR database were doctoral dissertations. To the authors' great surprise, nearly 300 astronomy education research dissertations were found from the last 100-years. Few, if any, of the literature reviews from recent astronomy education dissertations surveyed even come close to summarizing this many dissertations, most of which have not been published in traditional journals, as re-publishing one's dissertation research as a journal article was not a widespread custom in the education research community until recently. A survey of the iSTAR database dissertations reveals that the vast majority of work has been largely quantitative in nature until the last decade. We also observe that modern-era astronomy education research writings reaches as far back as 1923 and that the majority of dissertations come from the same eight institutions. Moreover, most of the astronomy education research work has been done covering learners' grasp of broad knowledge of astronomy rather than delving into specific learning targets, which has been more in vogue during the last two decades. The surprisingly wide breadth

  8. In the absence of physical practice, observation and imagery do not result in updating of internal models for aiming.

    Science.gov (United States)

    Ong, Nicole T; Larssen, Beverley C; Hodges, Nicola J

    2012-04-01

    The presence of after-effects in adaptation tasks implies that an existing internal model has been updated. Previously, we showed that although observers adapted to a visuomotor perturbation, they did not show after-effects. In this experiment, we tested 2 further observer groups and an actor group. Observers were now actively engaged in watching (encouraged through imagery and movement estimation), with one group physically practising for 25% of the trials (mixed). Participants estimated the hand movements that produced various cursor trajectories and/or their own hand movement from a preceding trial. These trials also allowed us to assess the development of explicit knowledge as a function of the three practice conditions. The pure observation group did not show after-effects, whereas the actor and mixed groups did. The pure observation group improved their ability to estimate hand movement of the video model. Although the actor and mixed groups improved in actual reaching accuracy, they did not improve in explicit estimation. The mixed group was more accurate in reaching during adaptation and showed larger after-effects than the actors. We suggest that observation encourages an explicit mode of learning, enabling performance benefits without corresponding changes to an internal model of the mapping between output and sensory input. However, some physical practice interspersed with observation can change the manner with which learning is achieved, encouraging implicit learning and the updating of an existing internal model.

  9. Multicentric Chemodectomata at High Altitude | Nathanson | South ...

    African Journals Online (AJOL)

    Multicentric chemodectomata in the right glomus intravagale and both carotid bodies were excised from a 74year-old woman. These are rare tumours. The patient was born and lived at an altitude of 1 800 m above sea level. The effects of altitude and chronic hypoxia on the carotid bodies are discussed.

  10. Treating KSHV-Associated Multicentric Castleman Disease

    Science.gov (United States)

    In this study, patients with KSHV-associated multicentric Castleman disease will receive IV tocilizumab every other week for up to 12 weeks. Patients who do not benefit may go on to receive high-dose AZT and valganciclovir as well.

  11. Corticosteroid contact allergy: an EECDRG multicentre study

    DEFF Research Database (Denmark)

    Dooms-Goossens, A; Andersen, Klaus Ejner; Brandäo, F M

    1996-01-01

    This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet...

  12. An adjuvant autologous therapeutic vaccine (HSPPC-96; vitespen) versus observation alone for patients at high risk of recurrence after nephrectomy for renal cell carcinoma: a multicentre, open-label, randomised phase III trial.

    Science.gov (United States)

    Wood, Christopher; Srivastava, Pramod; Bukowski, Ronald; Lacombe, Louis; Gorelov, Andrei I; Gorelov, Sergei; Mulders, Peter; Zielinski, Henryk; Hoos, Axel; Teofilovici, Florentina; Isakov, Leah; Flanigan, Robert; Figlin, Robert; Gupta, Renu; Escudier, Bernard

    2008-07-12

    Treatment of localised renal cell carcinoma consists of partial or radical nephrectomy. A substantial proportion of patients are at risk for recurrence because no effective adjuvant therapy exists. We investigated the use of an autologous, tumour-derived heat-shock protein (glycoprotein 96)-peptide complex (HSPPC-96; vitespen) as adjuvant treatment in patients at high risk of recurrence after resection of locally advanced renal cell carcinoma. In this open-label trial, patients were randomly assigned to receive either vitespen (n=409) or observation alone (n=409) after nephrectomy. Randomisation was done in a one to one ratio by a computer-generated pseudo-random number generator, with a block size of four, and was stratified by performance score, lymph node status, and nuclear grade. Vitespen was given intradermally once a week for 4 weeks, then every 2 weeks until vaccine depletion. The primary endpoint was recurrence-free survival. The final analysis of recurrence-free survival was planned to take place after 214 or more events of disease recurrence or deaths before recurrence had occurred. Analysis was by intention to treat (ITT). This study is registered with ClinicalTrials.gov, number NCT00033904. 48 patients in the vitespen group and 42 in the observation group were excluded from the ITT population because they did not meet post-surgery inclusion criteria; the ITT population thus consisted of 361 patients in the vitespen group and 367 in the observation group. Final analysis of recurrence-free survival was triggered in November, 2005. Re-review of all patients in the ITT population by the clinical events committee identified 149 actual recurrences (73 in the vitespen group and 76 in the observation group), nine deaths before recurrence (two in the vitespen group and seven in the observation group), and 124 patients with baseline metastatic or residual disease (61 in the vitespen group and 63 in the observation group). Thus, after a median follow-up of 1

  13. Student performance of the general physical examination in internal medicine: an observational study

    NARCIS (Netherlands)

    Haring, C.M.; Cools, B.M.; Meer, J.W.M. van der; Postma, C.T.

    2014-01-01

    BACKGROUND: Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general

  14. Placebo effect characteristics observed in a single, international, longitudinal study in Huntington's disease.

    NARCIS (Netherlands)

    Cubo, E.; Gonzalez, M.; Puerto, I. del; Yebenes, J.G. de; Arconada, O.F.; Gabriel y Galan, J.M.; Kremer, H.P.H.; Warrenburg, B.P.C. van de; et al.,

    2012-01-01

    BACKGROUND: Classically, clinical trials are based on the placebo-control design. Our aim was to analyze the placebo effect in Huntington's disease. METHODS: Placebo data were obtained from an international, longitudinal, placebo-controlled trial for Huntington's disease (European Huntington's

  15. The Observance of Human Rights and Freedoms in the Extradition Proceedings at National and International Levels

    Directory of Open Access Journals (Sweden)

    Mariana (Mitra Radu

    2013-08-01

    Full Text Available The fundamental rights and freedoms contained in international documents may be the object of the denial of an extradition request as independent exceptions, even if they are not covered by extradition treaties. The right to life is a fundamental human right whose protection must be achieved in the extradition proceedings. By Law no. 30/1994, Romania ratified the Convention for the Protection of Human Rights and Fundamental Freedoms, adopted by the Council of Europe.

  16. Observation of Sea-ice Effects on Deep Internal Waves in the Southern Drake Passage

    Science.gov (United States)

    Park, J. H.; Donohue, K. A.; Kim, Y. H.; Ha, H. K.

    2016-12-01

    The recent sea-ice melting accelerated in the Arctic has been suggested to enhance the internal wave energy at the shelf and deep ocean, although supportive evidence is rare partly due to the difficulty of long-term measurements under the sea ice. This study presents inter-annual variations of high-frequency internal wave energy affected by the sea ice using near-bottom current measurements from an array which was continuously deployed in the southern Drake Passage during 2007-2011. Integrated horizontal kinetic energy at periods shorter than 10.5 days during summers reveals no significant year-to-year differences, while that during winters shows a reduction by a factor of two and a half at the most southern site in 2011 when it was occupied by highly-concentrated sea ice. Our results support that the sea-ice extension changes related with climate changes can modulate the high-frequency internal wave energy in the deep ocean, which has a potential to affect ocean dynamics and ecosystems significantly in polar oceans.

  17. An extreme internal solitary wave event observed in the northern South China Sea.

    Science.gov (United States)

    Huang, Xiaodong; Chen, Zhaohui; Zhao, Wei; Zhang, Zhiwei; Zhou, Chun; Yang, Qingxuan; Tian, Jiwei

    2016-07-21

    With characteristics of large amplitude and strong current, internal solitary wave (ISW) is a major hazard to marine engineering and submarine navigation; it also has significant impacts on marine ecosystems and fishery activity. Among the world oceans, ISWs are particular active in the northern South China Sea (SCS). In this spirit, the SCS Internal Wave Experiment has been conducted since March 2010 using subsurface mooring array. Here, we report an extreme ISW captured on 4 December 2013 with a maximum amplitude of 240 m and a peak westward current velocity of 2.55 m/s. To the authors' best knowledge, this is the strongest ISW of the world oceans on record. Full-depth measurements also revealed notable impacts of the extreme ISW on deep-ocean currents and thermal structures. Concurrent mooring measurements near Batan Island showed that the powerful semidiurnal internal tide generation in the Luzon Strait was likely responsible for the occurrence of the extreme ISW event. Based on the HYCOM data-assimilation product, we speculate that the strong stratification around Batan Island related to the strengthening Kuroshio may have contributed to the formation of the extreme ISW.

  18. Success of a weight loss plan for overweight dogs: The results of an international weight loss study

    OpenAIRE

    Flanagan, John; Bissot, Thomas; Hours, Marie-Anne; Moreno, Bernabe; Feugier, Alexandre; German, Alexander J.

    2017-01-01

    Introduction Obesity is a global concern in dogs with an increasing prevalence, and effective weight loss solutions are required that work in different geographical regions. The main objective was to conduct an international, multi-centre, weight loss trial to determine the efficacy of a dietary weight loss intervention in obese pet dogs. Methods A 3-month prospective observational cohort study of weight loss in 926 overweight dogs was conducted at 340 veterinary practices in 27 countries. Co...

  19. Lightning Observations from the International Space Station (ISS) for Science Research and Operational Applications

    Science.gov (United States)

    Blakeslee, R. J.; Christian, H. J.; Mach, D. M.; Buechler, D. E.; Koshak, W. J.; Walker, T. D.; Bateman, M.; Stewart, M. F.; O'Brien, S.; Wilson, T.; hide

    2015-01-01

    There exist several core science applications of LIS lightning observations, that range from weather and climate to atmospheric chemistry and lightning physics due to strong quantitative connections that can be made between lightning and other geophysical processes of interest. The space-base vantage point, such as provided by ISS LIS, still remains an ideal location to obtain total lightning observations on a global basis.

  20. Multicentric Chemodectomata at High Altitude

    African Journals Online (AJOL)

    The cranial nerves were intact. The eardrums were normal. The mouth, pharynx and larynx (by indirect laryngoscopy) showed no evidence of tumour. There was no evidence of cardiac or respiratory decompensation. Fig. 1. Right carotid arteriogram, showing the internal and external carotid arteries splayed at their origin br ...

  1. A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2012-02-01

    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn\\'s disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate\\/severe Crohn\\'s disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn\\'s disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate\\/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate\\/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn\\'s disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.

  2. Characteristics and outcomes of Italian patients from the observational, multicentre, hypopituitary control and complications study (HypoCCS) according to tertiles of growth hormone peak concentration following stimulation testing at study entry.

    Science.gov (United States)

    Losa, Marco; Beck-Peccoz, Paolo; Aimaretti, Gianluca; Di Somma, Carolina; Ambrosio, Maria Rosaria; Ferone, Diego; Giampietro, Antonella; Corsello, Salvatore M; Poggi, Maurizio; Scaroni, Carla; Jia, Nan; Mossetto, Gilberto; Cannavò, Salvatore; Rochira, Vincenzo

    2015-10-01

    To determine whether characteristics and outcomes of Italian patients in the observational global Hypopituitary Control and Complication Study (HypoCCS) differed according to the degree of GH deficiency (GHD). Patients were grouped by tertiles of stimulated GH peak concentration at baseline (Group A lowest tertile, n = 342; Group B middle tertile, n = 345; Group C highest tertile, n = 338). Baseline demographics, lipid levels, body mass index categories and mean Framingham cardiovascular risk indexes were similar in the three groups and remained substantially unchanged over time, with no subsequent significant between-group differences (except mean levels of triglycerides increased in the highest tertile group). GHD was adult-onset for >75% of patients in all groups. The percentage of patients with multiple pituitary deficiencies was higher in Group A than in the other groups; isolated GHD was reported with highest frequency in Group C. Patients in Group A received the lowest mean starting dose of GH. Hyperlipidaemia at baseline was reported in 35·1%, 31·1% and 24·7% of patients in groups A, B and C, respectively (P = 0·029). Mean duration of GH treatment was 7·21, 5·45 and 4·96 years, respectively. The proportion of patients with adverse events did not differ significantly between groups, with a low prevalence over time of diabetes and cancer. In Italian patients from HypoCCS, the level of GH deficit did not influence changes over time in metabolic parameters or adverse event profile, despite differences in GHD severity at baseline and in the starting GH dose. © 2015 John Wiley & Sons Ltd.

  3. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study.

    Science.gov (United States)

    O'Sullivan, Brian; Huang, Shao Hui; Su, Jie; Garden, Adam S; Sturgis, Erich M; Dahlstrom, Kristina; Lee, Nancy; Riaz, Nadeem; Pei, Xin; Koyfman, Shlomo A; Adelstein, David; Burkey, Brian B; Friborg, Jeppe; Kristensen, Claus A; Gothelf, Anita B; Hoebers, Frank; Kremer, Bernd; Speel, Ernst-Jan; Bowles, Daniel W; Raben, David; Karam, Sana D; Yu, Eugene; Xu, Wei

    2016-04-01

    Human papillomavirus-related (HPV+) oropharyngeal cancer is a rapidly emerging disease with generally good prognosis. Many prognostic algorithms for oropharyngeal cancer incorporate HPV status as a stratification factor, rather than recognising the uniqueness of HPV+ disease. The International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) aimed to develop a TNM classification specific to HPV+ oropharyngeal cancer. The ICON-S study included patients with non-metastatic oropharyngeal cancer from seven cancer centres located across Europe and North America; one centre comprised the training cohort and six formed the validation cohorts. We ascertained patients' HPV status with p16 staining or in-situ hybridisation. We compared overall survival at 5 years between training and validation cohorts according to 7th edition TNM classifications and HPV status. We used recursive partitioning analysis (RPA) and adjusted hazard ratio (AHR) modelling methods to derive new staging classifications for HPV+ oropharyngeal cancer. Recent hypotheses concerning the effect of lower neck lymph nodes and number of lymph nodes were also investigated in an exploratory training cohort to assess relevance within the ICON-S classification. Of 1907 patients with HPV+ oropharyngeal cancer, 661 (35%) were recruited at the training centre and 1246 (65%) were enrolled at the validation centres. 5-year overall survival was similar for 7th edition TNM stage I, II, III, and IVA (respectively; 88% [95% CI 74-100]; 82% [71-95]; 84% [79-89]; and 81% [79-83]; global p=0·25) but was lower for stage IVB (60% [53-68]; pHPV+ oropharyngeal cancer is suitable for the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer TNM classification. Future work is needed to ascertain whether T and N categories should be further refined and whether non-anatomical factors might augment the full classification. None. Copyright © 2016 Elsevier Ltd. All rights

  4. Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model--a study based on data from an international multicentre project (EPCRC-CSA).

    Science.gov (United States)

    Blum, D; Stene, G B; Solheim, T S; Fayers, P; Hjermstad, M J; Baracos, V E; Fearon, K; Strasser, F; Kaasa, S

    2014-08-01

    Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (stores, intake, catabolism and function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: model 1) and examine a four-group (model 2) classification system regarding these domains as well as survival. Data from an international patient sample with advanced cancer (N = 1070) were analysed. In model 1, the diagnostic criteria for cancer cachexia [weight loss/body mass index (BMI)] were used. Model 2 classified patients into four groups 0-III, according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models. Eight hundred and sixty-one patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III and IV, and performance status not between group 0 and I. Survival was shorter in group II and III compared with other groups. By adding other cachexia domains to the model, survival differences were demonstrated. The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (intake, catabolism and function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  5. Definition of a multicentral bond index

    International Nuclear Information System (INIS)

    Giambiagi, M.; Giambiagi, M.S. de; Mundim, K.C.

    1989-01-01

    The tensor character of the first-order density matrix leads to the definition of an MO multicentral bond index for closed-shell systems. It is here applied to three-center bonds. Satisfactory results are obtained for compounds involving 'secondary' bonds, strong and normal hydrogen bonds; the index for the peptide bond is found to be similar to that of strong hydrogen bonds. (author) [pt

  6. The observance of the Kyoto Protocol on climate changes: stakes of the international control of compliance with commitments

    International Nuclear Information System (INIS)

    Maljean-Dubois, S.

    2007-01-01

    The author presents the conclusions of multidisciplinary research which has examined the relationship between the Kyoto protocol's observance mechanisms (control of compliance of commitments and sanction in case of non compliance) and the more conventional mechanisms of international conflict solving. It also examines the peculiar characteristics of these mechanisms, whether legal or not. Finally, the author examines the impact of the adopted procedure, and whether it is constraining

  7. Internal Variability and Disequilibrium Confound Estimates of Climate Sensitivity From Observations

    Science.gov (United States)

    Marvel, Kate; Pincus, Robert; Schmidt, Gavin A.; Miller, Ron L.

    2018-02-01

    An emerging literature suggests that estimates of equilibrium climate sensitivity (ECS) derived from recent observations and energy balance models are biased low because models project more positive climate feedback in the far future. Here we use simulations from the Coupled Model Intercomparison Project Phase 5 (CMIP5) to show that across models, ECS inferred from the recent historical period (1979-2005) is indeed almost uniformly lower than that inferred from simulations subject to abrupt increases in CO2 radiative forcing. However, ECS inferred from simulations in which sea surface temperatures are prescribed according to observations is lower still. ECS inferred from simulations with prescribed sea surface temperatures is strongly linked to changes to tropical marine low clouds. However, feedbacks from these clouds are a weak constraint on long-term model ECS. One interpretation is that observations of recent climate changes constitute a poor direct proxy for long-term sensitivity.

  8. [Clinical observation of dynamic cervical implant (DCI) internal fixation in the surgical treatment of cervical spondylosis].

    Science.gov (United States)

    Li, Zhong-hai; Hou, Shu-xun; Li, Li; Yu, Shun-zhi; Hou, Tie-sheng

    2014-12-01

    To investigate the early clinical effects and radiological outcome of dynamic cervical implant (DCI) internal fixation in treating cervical spondylosis, and evaluate its safety and efficiency. From June 2009 to December 2011, 19 patients with cervical spondylosis correspond to the indication of DCI internal fixation in the study, including 5 cases of cervical spondylotic myelopathy and 14 cases of cervical spondylotic radiculopathy. There were 8 males and 11 females, aged from 35 to 54 years with a mean of 43.2 years. Pathological segments included C3,4 in 1 case, C4,5 in 6, C5,6 in 6, C6,7 in 4, C3,4 and C5,6, C6,7 in 2. All patients were treated with anterior discectomy and decompression and DCI internal fixation, meanwhile, 2 cases of them with anterior cervical corpectomy and fusion plate fixation. Clinical evaluation included Modified Japanese orthopedics association (mJOA), neck disability index (NDI), visual analogue scale (VAS) score and patient satisfaction index (PSI) at pre-operation and final follow-up. Radiographic evaluation included flexion/extension lateral view at operative level and adjacent segment. The adjacent level degeneration was analyzed according to Miyazaki classification on MRI images. All patients were followed up from 12 to 42 months with an average of 19.8 months. Preoperative mJOA score was 13.6±1.1 and at final follow-up was 16.3±1.2 with improvement rate of 85.0%. Preoperative VAS,NDI was 6.6± 1.4, 17.1±7.4 and at final follow-up was 1.4±0.8, 6.1±3.9, respectively; there was statistical significance in all above-mentioned results between preoperative and final follow-up (P0.05). Preoperative DHI at operation level was (6.3±1.1) mm and final follow-up was (7.1±0.8) mm, there was statistical significance in DHI between preoperative and final follow-up (Pspondylosis with dynamic cervical implant can got satisfactory outcome in early follow-up. Activity of operative segment obtain reservation in some degree. The incidence of

  9. Placebo effect characteristics observed in a single, international, longitudinal study in Huntington's disease.

    Science.gov (United States)

    Cubo, Esther; González, Miguel; del Puerto, Inés; de Yébenes, Justo Garcia; Arconada, Olga Fernández; Gabriel y Galán, José María Trejo

    2012-03-01

    Classically, clinical trials are based on the placebo-control design. Our aim was to analyze the placebo effect in Huntington's disease. Placebo data were obtained from an international, longitudinal, placebo-controlled trial for Huntington's disease (European Huntington's Disease Initiative Study Group). One-hundred and eighty patients were evaluated using the Unified Huntington Disease Rating Scale over 36 months. A placebo effect was defined as an improvement of at least 50% over baseline scores in the Unified Huntington Disease Rating Scale, and clinically relevant when at least 10% of the population met it. Only behavior showed a significant placebo effect, and the proportion of the patients with placebo effect ranged from 16% (first visit) to 41% (last visit). Nondepressed patients with better functional status were most likely to be placebo-responders over time. In Huntington's disease, behavior seems to be more vulnerable to placebo than overall motor function, cognition, and function Copyright © 2011 Movement Disorder Society.

  10. Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream infection

    Science.gov (United States)

    Al-Abdely, Hail M; Alshehri, Areej Dhafer; Rosenthal, Victor Daniel; Mohammed, Yassir Khidir; Banjar, Weam; Orellano, Pablo Wenceslao; Assiri, Abdullah Mufareh; Kader, Nahla Moustafa Abedel; Enizy, Hessa Abdullah Al; Mohammed, Diaa Abdullah; Al-Awadi, Duaa Khalil; Cabato, Analen Fabros; Wasbourne, Maria; Saliya, Randa; Aromin, Rosita Gasmin; Ubalde, Evangelina Balon; Diab, Hanan Hanafy; Alkamaly, Modhi Abdullah; Alanazi, Nawal Mohammed; Hassan Assiry, Ibtesam Yahia; Molano, Apsia Musa; Flores Baldonado, Celia; Al-Azhary, Mohamed; Al Atawi, Sharifa; Molano, Apsia Musa; Al Adwani, Fatima Mohammad; Casuyon Pahilanga, Arlu Marie; Nakhla, Raslan; Al Adwani, Fatma Mohammad; Nair, Deepa Sasithran; Sindayen, Grace; Malificio, Annalyn Amor; Helali, Najla Jameel; Al Dossari, Haya Barjas; Kelany, Ashraf; Algethami, Abdulmajid Ghowaizi; Yanne, Leigh; Tan, Avigail; Babu, Sheema; Abduljabbar, Shatha Mohammad; Bukhari, Syed Zahid; Basri, Roaa Hasan; Mushtaq, Jeyashri Jaji; Rushdi, Hala; Turkistani, Abdullah Abdulaziz; Gonzales Celiz, Jerlie Mae; Al Raey, Mohammed Abdullah; Al-Zaydani Asiri, Ibrahim AM; Aldarani, Saeed Ali; Laungayan Cortez, Elizabeth; Demaisip, Nadia Lynette; Aziz, Misbah Rehman; Omer Abdul Aziz, Ali; Al Manea, Batool; Samy, Eslam; Al-Dalaton, Mervat; Alaliany, Mohammed Jkedeb

    2016-01-01

    Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in five intensive care units (ICUs) from October 2013 to September 2015. Design: Prospective, before-after surveillance study of 3769 patients hospitalised in four adult ICUs and one paediatric ICU in five hospitals in five cities. During baseline, we performed outcome and process surveillance of CLABSI applying CDC/NHSN definitions. During intervention, we implemented IMA and ISOS, which included: (1) a bundle of infection prevention practice interventions; (2) education; (3) outcome surveillance; (4) process surveillance; (5) feedback on CLABSI rates and consequences; and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed. Results: During baseline, 4468 central line (CL) days and 31 CLABSIs were recorded, accounting for 6.9 CLABSIs per 1000 CL-days. During intervention, 12,027 CL-days and 37 CLABSIs were recorded, accounting for 3.1 CLABSIs per 1000 CL-days. The CLABSI rate was reduced by 56% (incidence-density rate, 0.44; 95% confidence interval, 0.28–0.72; P = 0.001). Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in the ICUs of Saudi Arabia. PMID:28989500

  11. Atmospheric gravity waves observed by an international network of micro-barographs

    International Nuclear Information System (INIS)

    Marty, Julien

    2010-01-01

    The Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) manages an international network of forty-two operational infra-sound stations recording the pressure fluctuations produced at the ground surface by infrasonic waves. This thesis demonstrates that most of these stations also accurately detect the pressure fluctuations in the entire gravity wave band. This work includes carrying out and analyzing several metrological laboratory experiments and a field campaign (M2008) in Mongolia in 2008. The layout of the experiments as well as the interpretation of their results gave rise to the development of a new linear spectral numerical model able to simulate the generation and propagation of gravity waves. This model was used to quantify the gravity waves produced by the atmospheric cooling that occurs during solar eclipses. The pressure fluctuations expected at ground level were estimated and compared to the data recorded during the 1 August 2008 solar eclipse by the CTBTO and M2008 stations. A detailed data analysis reveals two waves with similar time-frequency characteristics to those simulated for a stratospheric and tropospheric cooling. This constitutes, to our knowledge, a unique result. The validation of worldwide and pluri-annual pressure measurements in the entire gravity wave band allowed the statistical study of gravity wave spectra and atmospheric tides. The work presented throughout this thesis has led to the publication of two articles. A third one is in the drafting process. (author)

  12. Symptoms Of Common Mental Disorders In Professional Rugby: An International Observational Descriptive Study.

    Science.gov (United States)

    Gouttebarge, Vincent; Hopley, Phil; Kerkhoffs, Gino; Verhagen, Evert; Viljoen, Wayne; Wylleman, Paul; Lambert, Mike I

    2017-10-01

    The aim of the study was to determine the prevalence of symptoms of common mental disorders among professional rugby players across countries. A cross-sectional analysis of the baseline questionnaires from an ongoing prospective cohort study was conducted. Nine national players' associations and three rugby unions distributed questionnaires based on validated scales for assessing symptoms of common mental disorders. Among the whole study sample (N=990; overall response rate of 28%), prevalence (4-week) of symptoms of common mental disorders ranged from 15% for adverse alcohol use to 30% for anxiety/depression. These findings support the prevalence rates of symptoms of common mental disorders found in previous studies among professional (i. e., elite) athletes across other sports, and suggestions can be made that the prevalence of symptoms of anxiety/depression seems slightly higher in professional rugby than in other general/occupational populations. Awareness of the prevalence of symptoms of common mental disorders should be improved in international rugby, and an interdisciplinary approach including psychological attention should be fostered in the medical care of professional rugby players. Adequate supportive measures to enhance awareness and psychological resilience would lead not only to improved health and quality of life among rugby players but arguably to enhanced performance in rugby. © Georg Thieme Verlag KG Stuttgart · New York.

  13. M2 Internal Tides and Their Observed Wavenumber Spectra from Satellite Altimetry*

    Science.gov (United States)

    Ray, R. D.; Zaron, E. D.

    2015-01-01

    A near-global chart of surface elevations associated with the stationary M2 internal tide is empirically constructed from multi-mission satellite altimeter data. An advantage of a strictly empirical mapping approach is that results are independent of assumptions about ocean wave dynamics and, in fact, can be used to test such assumptions. A disadvantage is that present-day altimeter coverage is only marginally adequate to support mapping such short-wavelength features. Moreover, predominantly north-south ground-track orientations and contamination from nontidal oceanographic variability can lead to deficiencies in mapped tides. Independent data from Cryosphere Satellite-2 (CryoSat-2) and other altimeters are used to test the solutions and show positive reduction in variance except in regions of large mesoscale variability. The tidal fields are subjected to two-dimensional wavenumber spectral analysis, which allows for the construction of an empirical map of modal wavelengths. Mode-1 wavelengths show good agreement with theoretical wavelengths calculated from the ocean's mean stratification, with a few localized exceptions (e.g., Tasman Sea). Mode-2 waves are detectable in much of the ocean, with wavelengths in reasonable agreement with theoretical expectations, but their spectral signatures grow too weak to map in some regions.

  14. Simulation Model of Microsphere Distribution for Selective Internal Radiation Therapy Agrees With Observations.

    Science.gov (United States)

    Högberg, Jonas; Rizell, Magnus; Hultborn, Ragnar; Svensson, Johanna; Henrikson, Olof; Mölne, Johan; Gjertsson, Peter; Bernhardt, Peter

    2016-10-01

    To perform a detailed analysis of microsphere distribution in biopsy material from a patient treated with (90)Y-labeled resin spheres and characterize microsphere distribution in the hepatic artery tree, and to construct a novel dichotomous bifurcation model for microsphere deposits and evaluate its accuracy in simulating the observed microsphere deposits. Our virtual model consisted of arteries that successively branched into 2 new generations of arteries at 20 nodes. The artery diameter exponentially decreased from the lowest generation to the highest generation. Three variable parameters were optimized to obtain concordance between simulations and measure microsphere distributions: an artery coefficient of variation (ACV) for the diameter of all artery generations and the microsphere flow distribution at the nodes; a hepatic tree distribution volume (HDV) for the artery tree; and an artery diameter reduction (ADR) parameter. The model was tested against previously measured activity concentrations in 84 biopsies from the liver of 1 patient. In 16 of 84 biopsies, the microsphere distribution regarding cluster size and localization in the artery tree was determined via light microscopy of 30-μm sections (mean concentration, 14 microspheres/mg; distributions divided into 3 groups with mean microsphere concentrations of 4.6, 14, and 28 microspheres/mg). Single spheres and small clusters were observed in terminal arterioles, whereas large clusters, up to 450 microspheres, were observed in larger arterioles. For 14 microspheres/mg, the optimized parameter values were ACV=0.35, HDV = 50 cm(3), and ADR=6 μm. For 4.6 microspheres/mg, ACV and ADR decreased to 0.26 and 0 μm, respectively, whereas HDV increased to 130 cm(3). The opposite trend was observed for 28 microspheres/mg: ACV = 0.49, HDV = 20 cm(3), and ADR = 8 μm. Simulations and measurements reveal that microsphere clusters are larger and more common in volumes with high microsphere concentrations

  15. Simulation Model of Microsphere Distribution for Selective Internal Radiation Therapy Agrees With Observations

    Energy Technology Data Exchange (ETDEWEB)

    Högberg, Jonas, E-mail: jonas.hogberg@radfys.gu.se [Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Gothenburg (Sweden); Rizell, Magnus [Department of Surgery, Sahlgrenska University Hospital, Gothenburg (Sweden); Hultborn, Ragnar; Svensson, Johanna [Department of Oncology, Sahlgrenska University Hospital, Gothenburg (Sweden); Henrikson, Olof [Department of Radiology, Sahlgrenska University Hospital, Gothenburg (Sweden); Mölne, Johan [Department of Pathology, Sahlgrenska University Hospital, Gothenburg (Sweden); Gjertsson, Peter [Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg (Sweden); Bernhardt, Peter [Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Gothenburg (Sweden); Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg (Sweden)

    2016-10-01

    Purpose: To perform a detailed analysis of microsphere distribution in biopsy material from a patient treated with {sup 90}Y-labeled resin spheres and characterize microsphere distribution in the hepatic artery tree, and to construct a novel dichotomous bifurcation model for microsphere deposits and evaluate its accuracy in simulating the observed microsphere deposits. Methods and Materials: Our virtual model consisted of arteries that successively branched into 2 new generations of arteries at 20 nodes. The artery diameter exponentially decreased from the lowest generation to the highest generation. Three variable parameters were optimized to obtain concordance between simulations and measure microsphere distributions: an artery coefficient of variation (ACV) for the diameter of all artery generations and the microsphere flow distribution at the nodes; a hepatic tree distribution volume (HDV) for the artery tree; and an artery diameter reduction (ADR) parameter. The model was tested against previously measured activity concentrations in 84 biopsies from the liver of 1 patient. In 16 of 84 biopsies, the microsphere distribution regarding cluster size and localization in the artery tree was determined via light microscopy of 30-μm sections (mean concentration, 14 microspheres/mg; distributions divided into 3 groups with mean microsphere concentrations of 4.6, 14, and 28 microspheres/mg). Results: Single spheres and small clusters were observed in terminal arterioles, whereas large clusters, up to 450 microspheres, were observed in larger arterioles. For 14 microspheres/mg, the optimized parameter values were ACV=0.35, HDV = 50 cm{sup 3}, and ADR=6 μm. For 4.6 microspheres/mg, ACV and ADR decreased to 0.26 and 0 μm, respectively, whereas HDV increased to 130 cm{sup 3}. The opposite trend was observed for 28 microspheres/mg: ACV = 0.49, HDV = 20 cm{sup 3}, and ADR = 8 μm. Conclusion: Simulations and measurements reveal that microsphere clusters are

  16. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study

    OpenAIRE

    Preisler, Jessica; Kopeika, Julia; Ismail, Laure; Vathanan, Veluppillai; Farren, Jessica; Abdallah, Yazan; Battacharjee, Parijat; Van Holsbeke, Caroline; Bottomley, Cecilia; Gould, Deborah; Johnson, Susanne; Stalder, Catriona; Van Calster, Ben; Hamilton, Judith; Timmerman, Dirk

    2015-01-01

    Objectives To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty. Secondary aims were to examine the influence of gestational age on interpretation of mean gestational sac diameter and crown-rump length values, determine the optimal intervals between scans and findings on repeat scans that definitively diagnose pregnancy failure.) Design Prospect...

  17. Diversity of Pneumocystis jirovecii Across Europe: A Multicentre Observational Study

    Directory of Open Access Journals (Sweden)

    Alexandre Alanio

    2017-08-01

    Our study showed the wide population diversity across Europe, with evidence of local clusters of patients harbouring a given genotype. These data suggest a specific association between genotype and underlying disease, with evidence of a different natural history of PCP in HIV patients and renal transplant recipients.

  18. Solar occultation observations from the international space station: Deployment of a FTS for Atmospheric chemistry and trend studies

    Science.gov (United States)

    Rinsland, C. P.; Chu, W. P.; Cunnold, D. M.

    1999-01-01

    We propose the deployment of SAGE IV on the International Space Station (ISS) for recording solar occultation observations in the 2008-2013 time period. The design of SAGE IV is based on the SAGE III near UV-visible grating spectrometer with a 1.55 μm PIN diode, but also includes a compact Fourier transform spectrometer operating between 740 and 4100 cm-1. The combined instrumentation would focus on obtaining simultaneous high vertical resolution stratospheric profiles of ozone, over 30 other molecules, temperature, density, and aerosols at low to mid-latitudes to monitor the recovery of the ozone layer as the abundances of the chlorofluorocarbons decline. SAGE IV would extend the SAGE III ISS observational record to 2008-2013 with a consistent set of observations and data processing methods.

  19. 186th International School of Physics "Enrico Fermi" : New Horizons for Observational Cosmology

    CERN Document Server

    Komatsu, E; Melchiorri, A; Lamagna, L

    2014-01-01

    This school comes at a unique time in cosmology. Our understanding of the universe has been revolutionized by observations of the cosmic microwave background (in particular Wilkinson Microwave Anisotropy Probe), the large-scale structure of the universe (Two-degree-Field Galaxy Redshift Survey and Sloan Digital Sky Survey), and distant supernovae. These studies have conclusively shown that we are living in a strange universe: 96% of the present-day energy density of the universe is dominated by the so-called dark matter and dark energy. However, we do not know what dark matter and dark energy actually are. The data also suggest that it is likely that the universe underwent a rapid accelerating expansion phase in the very early universe called the inflationary phase. However, we still do not know how inflation happened.

  20. Flare Energy Release: Internal Conflict, Contradiction with High Resolution Observations, Possible Solutions

    Science.gov (United States)

    Pustilnik, L.

    2017-06-01

    All accepted paradigm of solar and stellar flares energy release based on 2 whales: 1. Source of energy is free energy of non-potential force free magnetic field in atmosphere above active region; 2. Process of ultrafast dissipation of magnetic fields is Reconnection in Thin Turbulent Current Sheet (RTTCS). Progress in observational techniques in last years provided ultra-high spatial resolution and in physics of turbulent plasma showed that real situation is much more complicated and standard approach is in contradiction both with observations and with problem of RTTCS stability. We present critical analysis of classic models of pre-flare energy accumulation and its dissipation during flare energy release from pioneer works Giovanelli (1939, 1947) up to topological reconnection. We show that all accepted description of global force-free fields as source of future flare cannot be agreed with discovered in last years fine and ultra-fine current-magnetic structure included numerouse arcs-threads with diameters up to 100 km with constant sequence from photosphere to corona. This magnetic skeleton of thin current magnetic threads with strong interaction between them is main source of reserved magnetic energy insolar atmosphere. Its dynamics will be controlled by percolation of magnetic stresses through network of current-magnetic threads with transition to flare state caused by critical value of global current. We show that thin turbulent current sheet is absolutely unstable configuration both caused by splitting to numerous linear currents by dissipative modes like to tearing, and as sequence of suppress of plasma turbulence caused by anomalous heating of turbulent plasma. In result of these factors primary RTTCS will be disrupted in numerous turbulent and normal plasma domains like to resistors network. Current propagation through this network will have percolation character with all accompanied properties of percolated systems: self-organization with formation power

  1. US Voluntary Observing Ship (VOS) - International Maritime Meteorological Tape (IMMT) data from SEAS version 9.1 E-Logbook Software

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The US Voluntary Observing Ships (VOS) report surface marine observations in both real-time (FM-13 ship format) and delayed-mode (International Maritime...

  2. US Voluntary Observing Ship (VOS) - International Maritime Meteorological Tape (IMMT) data from TurboWin version 5.0 E-Logbook Software

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The US Voluntary Observing Ships (VOS) report surface marine observations in both real-time (FM-13 ship format) and delayed-mode (International Maritime...

  3. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M. [University of Edinburgh, Western General Hospital, Division of Neuroimaging Sciences, Edinburgh (United Kingdom); Kummer, Ruediger von [Dresden University Stroke Centre, University Hospital, Department of Neuroradiology, Dresden (Germany); Adami, Alessandro [Sacro Cuore-Don Calabria Hospital, Stroke Center, Department of Neurology, Negrar (Italy); White, Philip M. [Stroke Research Group, Newcastle upon Tyne (United Kingdom); Adams, Matthew E. [National Hospital for Neurology and Neurosurgery, Department of Neuroradiology, London (United Kingdom); Yan, Bernard [Royal Melbourne Hospital, Neurovascular Research Group, Parkville (Australia); Demchuk, Andrew M. [Calgary Stroke Program, Department of Clinical Neurosciences, Calgary (Canada); Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J. [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom); Boyd, Elena V. [Northwick Park Hospital, Department of Radiology, Harrow (United Kingdom); Cohen, Geoff; Perry, David; Sandercock, Peter A.G. [University of Edinburgh, Western General Hospital, Division of Clinical Neurosciences, Edinburgh (United Kingdom); Lindley, Richard [University of Sydney, Westmead Hospital Clinical School and The George Institute for Global Health, Sydney (Australia); Collaboration: The IST-3 Collaborative Group

    2014-10-07

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  4. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

    International Nuclear Information System (INIS)

    Mair, Grant; Farrall, Andrew J.; Sellar, Robin J.; Mollison, Daisy; Sakka, Eleni; Palmer, Jeb; Wardlaw, Joanna M.; Kummer, Ruediger von; Adami, Alessandro; White, Philip M.; Adams, Matthew E.; Yan, Bernard; Demchuk, Andrew M.; Ramaswamy, Rajesh; Rodrigues, Mark A.; Samji, Karim; Baird, Andrew J.; Boyd, Elena V.; Cohen, Geoff; Perry, David; Sandercock, Peter A.G.; Lindley, Richard

    2015-01-01

    CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5 years experience reading CTA) and seven radiology trainees (<2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff's-alpha (K-alpha). Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60-0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33-0.72). For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best. (orig.)

  5. SIOS: A regional cooperation of international research infrastructures as a building block for an Arctic observing system

    Science.gov (United States)

    Holmen, K. J.; Lønne, O. J.

    2016-12-01

    The Svalbard Integrated Earth Observing System (SIOS) is a regional response to the Earth System Science (ESS) challenges posed by the Amsterdam Declaration on Global Change. SIOS is intended to develop and implement methods for how observational networks in the Arctic are to be designed in order to address such issues in a regional scale. SIOS builds on the extensive observation capacity and research installations already in place by many international institutions and will provide upgraded and relevant Observing Systems and Research Facilities of world class in and around Svalbard. It is a distributed research infrastructure set up to provide a regional observational system for long term measurements under a joint framework. As one of the large scale research infrastructure initiatives on the ESFRI roadmap (European Strategy Forum on Research Infrastructures), SIOS is now being implemented. The new research infrastructure organization, the SIOS Knowledge Center (SIOS-KC), is instrumental in developing methods and solutions for setting up its regional contribution to a systematically constructed Arctic observational network useful for global change studies. We will discuss cross-disciplinary research experiences some case studies and lessons learned so far. SIOS aims to provide an effective, easily accessible data management system which makes use of existing data handling systems in the thematic fields covered by SIOS. SIOS will, implement a data policy which matches the ambitions that are set for the new European research infrastructures, but at the same time be flexible enough to consider `historical' legacies. Given the substantial international presence in the Svalbard archipelago and the pan-Arctic nature of the issue, there is an opportunity to build SIOS further into a wider regional network and pan-Arctic context, ideally under the umbrella of the Sustaining Arctic Observing Networks (SAON) initiative. It is necessary to anchor SIOS strongly in a European

  6. Predicting global thunderstorm activity for sprite observations from the International Space Station

    Science.gov (United States)

    Yair, Y.; Mezuman, K.; Ziv, B.; Priente, M.; Glickman, M.; Takahashi, Y.; Inoue, T.

    2012-04-01

    The global rate of sprites occurring above thunderstorms, estimated from the ISUAL satellite data, is ~0.5 per minute (Chen et al., 2008). During the summer 2011, in the framework of the "Cosmic Shore" project, we conducted a concentrated attempt to image sprites from the ISS. The methodology for target selection was based on that developed for the space shuttle MEIDEX sprite campaign (Ziv et al., 2004). There are several types of convective systems generating thunderstorms which differ in their effectiveness for sprite production (Lyons et al., 2009), and so we had to evaluate the ability of the predicted storms to produce sprites. We used the Aviation Weather Center (http://aviationweather.gov) daily significant weather forecast maps (SIGWX) to select regions with high probability for convective storms and lightning such that they were within the camera filed-of-view as deduced from the ISS trajectory and distance to the limb. In order to enhance the chance for success, only storms with predicted "Frequent Cb" and cloud tops above 45 Kft (~14 km) were selected. Additionally, we targeted tropical storms and hurricanes over the oceans. The accuracy of the forecast method enabled obtaining the first-ever color images of sprites from space. We will report the observations showing various types of sprites in many different geographical locations, and correlated parent lightning properties derived from ELF and global and local lightning location networks. Chen, A. B., et al. (2008), Global distributions and occurrence rates of transient luminous events, J. Geophys. Res., 113,A08306, doi:10.1029/2008JA013101 Lyons, W. A., et al. (2009), The meteorological and electrical structure of TLE-producing convective storms. In: Betz et al. (eds.): Lighting: principles instruments and applications, Springer-Science + Business Media B.V.. Ziv, B., Y. Yair, K. Pressman and M. Fullekrug, (2004), Verification of the Aviation Center global forecasts of Mesoscale Convective Systems

  7. Inferring internal properties of Earth's core dynamics and their evolution from surface observations and a numerical geodynamo model

    Directory of Open Access Journals (Sweden)

    J. Aubert

    2011-10-01

    Full Text Available Over the past decades, direct three-dimensional numerical modelling has been successfully used to reproduce the main features of the geodynamo. Here we report on efforts to solve the associated inverse problem, aiming at inferring the underlying properties of the system from the sole knowledge of surface observations and the first principle dynamical equations describing the convective dynamo. To this end we rely on twin experiments. A reference model time sequence is first produced and used to generate synthetic data, restricted here to the large-scale component of the magnetic field and its rate of change at the outer boundary. Starting from a different initial condition, a second sequence is next run and attempts are made to recover the internal magnetic, velocity and buoyancy anomaly fields from the sparse surficial data. In order to reduce the vast underdetermination of this problem, we use stochastic inversion, a linear estimation method determining the most likely internal state compatible with the observations and some prior knowledge, and we also implement a sequential evolution algorithm in order to invert time-dependent surface observations. The prior is the multivariate statistics of the numerical model, which are directly computed from a large number of snapshots stored during a preliminary direct run. The statistics display strong correlation between different harmonic degrees of the surface observations and internal fields, provided they share the same harmonic order, a natural consequence of the linear coupling of the governing dynamical equations and of the leading influence of the Coriolis force. Synthetic experiments performed with a weakly nonlinear model yield an excellent quantitative retrieval of the internal structure. In contrast, the use of a strongly nonlinear (and more realistic model results in less accurate static estimations, which in turn fail to constrain the unobserved small scales in the time integration of the

  8. First Year Observations of Antarctic Circumpolar Current Variability and Internal Wave Activity from the DIMES Mooring Array

    Science.gov (United States)

    Brearley, J. A.; Sheen, K. L.; Naveira-Garabato, A. C.

    2012-04-01

    A key component of DIMES (Diapycnal and Isopycnal Mixing Experiment in the Southern Ocean) is the deployment of a two-year cross-shaped mooring array in the Antarctic Circumpolar Current to the east of Drake Passage close to 57°W. Motivation for the cluster arises from the need to understand how eddies dissipate in the Southern Ocean, and specifically how much energy is extracted from the mesoscale by breaking internal waves, which in turn leads to turbulent mixing. The location of the mooring cluster was chosen to fulfil these objectives, being situated in a region of pronounced finestructure with high eddy kinetic energy and rough topography. The array, comprising 34 current meters and Microcats and a downward-looking ADCP, was first deployed in December 2009 and serviced in December 2010. Time series of current meter results from the most heavily-instrumented 'C' mooring indicate that a strong (up to 80 cms-1) surface-intensified north-eastward directed ACC occupies the region for most of the year, with over 85% of the variability in current speed being accounted for by equivalent barotropic fluctuations. A strong mean poleward heat flux is observed at the site, which compares favourably in magnitude with literature results from other ACC locations. Interestingly, four episodes of mid-depth (~2000 m) current speed maxima, each of a few days duration, were found during the 360-day time series, a situation also observed by the lowered ADCP during mooring servicing in December 2010. Early results indicate that these episodes, which coincide with time minima in stratification close to 2000 m, could profoundly influence the nature of eddy-internal wave interactions at these times. Quantification of the energy budget at the mooring cluster has been a key priority. When compared with previous moorings located in Drake Passage (Bryden, 1977), a near threefold-increase in mean eddy kinetic energy (EKE) is observed despite a small reduction in the mean kinetic energy

  9. Internal noise in channelized Hotelling observer (CHO) study of detectability index-differential phase contrast CT vs. conventional CT

    Science.gov (United States)

    Tang, Xiangyang; Yang, Yi

    2014-03-01

    The channelized Hotelling observer (CHO) model, wherein internal noise plays an important role to account for the psychophysiological uncertainty in human's visual perception, has found extensive applications in the assessment of image quality in nuclear medicine, mammography and conventional CT. Recently, we extended its application to investigating the detectability index of differential phase contrast (DPC) CT-an emerging CT technology with the potential of increasing the capability in soft tissue differentiation. We found that the quantitative determination of internal noise in the CHO study of DPC-CT's detectability index should differ from that in the conventional CT. It is believed that the root cause of such a difference lies in the distinct noise spectra between the DPC-CT and conventional CT. In this paper, we present the preliminary results and investigate the adequate strategies to quantitatively determine the internal noise of CHO model for its application in the assessment of image quality in DPC-CT and its comparison with that of the conventional CT.

  10. Observation of three-dimensional internal structure of steel materials by means of serial sectioning with ultrasonic elliptical vibration cutting.

    Science.gov (United States)

    Fujisaki, K; Yokota, H; Nakatsuchi, H; Yamagata, Y; Nishikawa, T; Udagawa, T; Makinouchi, A

    2010-01-01

    A three-dimensional (3D) internal structure observation system based on serial sectioning was developed from an ultrasonic elliptical vibration cutting device and an optical microscope combined with a high-precision positioning device. For bearing steel samples, the cutting device created mirrored surfaces suitable for optical metallography, even for long-cutting distances during serial sectioning of these ferrous materials. Serial sectioning progressed automatically by means of numerical control. The system was used to observe inclusions in steel materials on a scale of several tens of micrometers. Three specimens containing inclusions were prepared from bearing steels. These inclusions could be detected as two-dimensional (2D) sectional images with resolution better than 1 mum. A three-dimensional (3D) model of each inclusion was reconstructed from the 2D serial images. The microscopic 3D models had sharp edges and complicated surfaces.

  11. Observationally constrained modeling of sound in curved ocean internal waves: examination of deep ducting and surface ducting at short range.

    Science.gov (United States)

    Duda, Timothy F; Lin, Ying-Tsong; Reeder, D Benjamin

    2011-09-01

    A study of 400 Hz sound focusing and ducting effects in a packet of curved nonlinear internal waves in shallow water is presented. Sound propagation roughly along the crests of the waves is simulated with a three-dimensional parabolic equation computational code, and the results are compared to measured propagation along fixed 3 and 6 km source/receiver paths. The measurements were made on the shelf of the South China Sea northeast of Tung-Sha Island. Construction of the time-varying three-dimensional sound-speed fields used in the modeling simulations was guided by environmental data collected concurrently with the acoustic data. Computed three-dimensional propagation results compare well with field observations. The simulations allow identification of time-dependent sound forward scattering and ducting processes within the curved internal gravity waves. Strong acoustic intensity enhancement was observed during passage of high-amplitude nonlinear waves over the source/receiver paths, and is replicated in the model. The waves were typical of the region (35 m vertical displacement). Two types of ducting are found in the model, which occur asynchronously. One type is three-dimensional modal trapping in deep ducts within the wave crests (shallow thermocline zones). The second type is surface ducting within the wave troughs (deep thermocline zones). © 2011 Acoustical Society of America

  12. International Observe the Moon Night: A Worldwide Public Observing Event that Annually Engages Scientists, Educators, and Citizen Enthusiasts in NASA Science

    Science.gov (United States)

    Buxner, S.; Jones, A. P.; Bleacher, L.; Wasser, M. L.; Day, B. H.; Shaner, A. J.; Bakerman, M. N.; Joseph, E.

    2017-12-01

    International Observe the Moon Night (InOMN) is an annual worldwide event, held in the fall, that celebrates lunar and planetary science and exploration. InOMN is sponsored by NASA's Lunar Reconnaissance Orbiter (LRO) in collaboration with NASA's Solar System Exploration Research Virtual Institute (SSERVI), the NASA's Heliophysics Education Consortium, CosmoQuest, Night Sky Network, and Science Festival Alliance. Other key partners include the NASA Museum Alliance, Night Sky Network, and NASA Solar System Ambassadors. In 2017, InOMN will bring together thousands of people across the globe to observe and learn about the Moon and its connection to planetary science. We are partnering with the NASA Science Mission Directorate total solar eclipse team to highlight InOMN as an opportunity to harness and sustain the interest and momentum in space science and observation following the August 21st eclipse. This is part of a new partnership with the Sun-Earth Day team, through the Heliophysics Education Consortium, to better connect the two largest NASA-sponsored public engagement events, increase participation in both events, and share best practices in implementation and evaluation between the teams. Over 3,800 InOMN events have been registered between 2010 and 2016, engaging over 550,000 visitors worldwide. Most InOMN events are held in the United States, with strong representation from many other countries. InOMN events are evaluated to determine the value of the events and to allow us to improve the experience for event hosts and visitors. Our results show that InOMN events are hosted by scientists, educators, and citizen enthusiasts around the world who leverage InOMN to bring communities together, get visitors excited and learn about the Moon - and beyond, and share resources to extend engagement in lunar and planetary science and observation. Through InOMN, we annually provide resources such as event-specific Moon maps, presentations, advertising materials, and

  13. International

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    This rubric reports on 10 short notes about international economical facts about nuclear power: Electricite de France (EdF) and its assistance and management contracts with Eastern Europe countries (Poland, Hungary, Bulgaria); Transnuclear Inc. company (a 100% Cogema daughter company) acquired the US Vectra Technologies company; the construction of the Khumo nuclear power plant in Northern Korea plays in favour of the reconciliation between Northern and Southern Korea; the delivery of two VVER 1000 Russian reactors to China; the enforcement of the cooperation agreement between Euratom and Argentina; Japan requested for the financing of a Russian fast breeder reactor; Russia has planned to sell a floating barge-type nuclear power plant to Indonesia; the control of the Swedish reactor vessels of Sydkraft AB company committed to Tractebel (Belgium); the renewal of the nuclear cooperation agreement between Swiss and USA; the call for bids from the Turkish TEAS electric power company for the building of the Akkuyu nuclear power plant answered by three candidates: Atomic Energy of Canada Limited (AECL), Westinghouse (US) and the French-German NPI company. (J.S.)

  14. Observation of radiation environment in the International Space Station in 2012–March 2013 by Liulin-5 particle telescope

    Directory of Open Access Journals (Sweden)

    Semkova Jordanka

    2014-01-01

    Full Text Available Since June 2007 the Liulin-5 charged particle telescope, located in the spherical tissue-equivalent phantom of the MATROSHKA-R project onboard the International Space Station (ISS, has been making measurements of the local energetic particle radiation environment. From 27 December 2011 to 09 March 2013 measurements were conducted in and outside the phantom located in the MIM1 module of the ISS. In this paper Liulin-5 dose rates, due to galactic cosmic rays and South Atlantic Anomaly trapped protons, measured during that period are presented. Particularly, dose rates and particle fluxes for the radiation characteristics in the phantom during solar energetic particle (SEP events occurring in March and May 2012 are discussed. Liulin-5 SEP observations are compared with other ISS data, GOES proton fluxes as well as with solar energetic particle measurements obtained onboard the Mir space station during previous solar cycles.

  15. Feeding strategies in pediatric cancer patients with gastrointestinal mucositis: a multicenter prospective observational study and international survey.

    Science.gov (United States)

    Kuiken, Nicoline S S; Rings, Edmond H H M; van den Heuvel-Eibrink, Marry M; van de Wetering, Marianne D; Tissing, Wim J E

    2017-10-01

    Currently, there is no adequate prevention or treatment for both oral and gastrointestinal mucositis induced by chemotherapy and/or radiotherapy. Supportive care of symptoms plays a primary role during mucositis in the pediatric clinical setting. We aimed to get insight in the currently used feeding strategies in clinical practice in pediatric cancer patients with chemotherapy-induced mucositis. A prospective observational study was performed to identify feeding strategies after chemotherapy courses causing mucositis in almost all patients at the University Medical Center Groningen (UMCG), the Academic Medical Center Amsterdam (AMC), and the Princess Maxima Center Utrecht (PMC). Consecutive patients, aged 0-18 years, either diagnosed with B cell non-Hodgkin lymphoma (B-NHL) or scheduled for autologous stem cell transplantation (SCT) between April 2015 and September 2016 were included in this study. In addition to the observational study in the Netherlands, an international online questionnaire was conducted for pediatric oncology centers. A total of 13 patients were included, after 21 chemotherapy courses. No nutritional support was administered after 23.8% courses, tube feeding after 19.0% of the courses, TPN in 19.0% of courses, and 38.1% received a combination of tube feeding and TPN. The international survey revealed that 63.2% of the centers administered tube feeding as first choice, 31.6% administered only TPN as first choice, and one center administered a combination as first choice. There is a variability in feeding strategies in the clinical practice both in the Netherlands as well as worldwide. This study is a basis for future studies in this important clinical field to develop clinical trials comparing tube feeding and TPN both in adult and pediatric patients.

  16. The impact of study design and diagnostic approach in a large multi-centre ADHD study: Part 2: Dimensional measures of psychopathology and intelligence

    NARCIS (Netherlands)

    Muller, U.C.; Asherson, P.; Banaschewski, T.; Buitelaar, J.K.; Ebstein, R.P.; Eisenberg, J.; Gill, M.; Manor, I.; Miranda, A.; Oades, R.D.; Roeyers, H.; Rothenberger, A.; Sergeant, J.A.; Sonuga-Barke, E.J.S.; Thompson, M.; Faraone, S.V.; Steinhausen, H.C.

    2011-01-01

    BACKGROUND: The International Multi-centre ADHD Genetics (IMAGE) project with 11 participating centres from 7 European countries and Israel has collected a large behavioural and genetic database for present and future research. Behavioural data were collected from 1068 probands with ADHD and 1446

  17. Medication Errors in an Internal Intensive Care Unit of a Large Teaching Hospital: A Direct Observation Study

    Directory of Open Access Journals (Sweden)

    Saadat Delfani

    2012-06-01

    Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

  18. ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures

    DEFF Research Database (Denmark)

    Weiss, Helmut; Zorron, R; Vestweber, K-H

    2017-01-01

    patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal......BACKGROUND: The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment. METHODS: Consecutive...

  19. Cultural Competence Among Italian Nurses: A Multicentric Survey.

    Science.gov (United States)

    Cicolini, Giancarlo; Della Pelle, Carlo; Comparcini, Dania; Tomietto, Marco; Cerratti, Francesca; Schim, Stephanie M; Di Giovanni, Pamela; Simonetti, Valentina

    2015-11-01

    To assess Italian nurses' cultural competence, as they are increasingly called upon to care for people of foreign origins. A cross-sectional, multicentric study. From September 2013 to May 2014, a survey was carried out among Italian nurses. Cultural competence was assessed by the Cultural Competence Assessment tool, translated and adapted to the Italian context. Nurses who completed the survey numbered 1,432; 70.6% were female; 42.6% ranged in age from 41 to 50 years; and 50.0% were bachelor's prepared. More than 50% had participated in some kind of cultural diversity training. Overall, cultural competence was moderate, showing a moderately high level of cultural awareness and sensitivity (mean = 5.41; SD = 0.66) and a moderate level of culturally competent behaviors (mean = 4.33; SD = 1.10). Although Italian nurses' cultural competence was acceptable, given the growing diversity of the patient population, nurses should be better prepared to face the changing health requests. Providing culturally competent care has been associated with improved provider-client communication, higher satisfaction with care, and health status improvement, as full comprehension of health status, adherence to medications and lifestyle recommendations, and appropriate utilization of the health system. Healthcare providers need to be adequately trained to provide culturally competent care. This research provides, for the first time, a report on Italian nurses' levels of cultural competence, and strengthens the current literature underlining the need for continuous education to enhance cultural competence among nurses. © 2015 Sigma Theta Tau International.

  20. Guidelines for the International Observation by the Agency of Nuclear Explosions for Peaceful Purposes under the Provisions of the Treaty on the Non-Proliferation of Nuclear Weapons or Analogous Provisions in Other International Agreements

    International Nuclear Information System (INIS)

    1973-01-01

    On 21 June 1972 the Board of Governors approved guidelines for the international observation by the Agency of nuclear explosions for peaceful purposes under the provisions of the Treaty on the Non-Proliferation of Nuclear Weapons or analogous provisions in other international agreements. These guidelines are now reproduced herein for the information of all Members

  1. Multicentric Castleman's Disease in a Child Revealed by Chronic Diarrhea.

    Science.gov (United States)

    Benmiloud, Sarra; Chaouki, Sana; Atmani, Samir; Hida, Moustapha

    2015-01-01

    Multicentric Castleman's disease is a rare benign and unexplained lymphoproliferative disorder that is extremely uncommon in children. It presents with fever, systemic symptoms, generalized lymphadenopathy, and laboratory markers of inflammation. Its treatment is not standardized and its prognosis is poor. We report a novel case of multicentric Castleman's disease in a 13-year-old girl who had presented with chronic diarrhea as the only initial presenting symptom. The diagnosis of celiac or inflammatory bowel diseases was suspected, but two and a half years later, the diagnosis of multicentric Castleman's disease was brought following the appearance of abdominal mass whose biopsy revealed Castleman's disease in the plasma cell form. The outcome was favorable after treatment by corticosteroid, chemotherapy, and surgery. The occurrence of diarrhea as the initial symptom of multicentric Castleman's disease without lymph node involvement is very rare. This case report underlines the diagnostic difficulties and the long interval between onset and diagnosis when diarrhea occurs first.

  2. International VLBI Service for Geodesy and Astrometry. Delivering high-quality products and embarking on observations of the next generation

    Science.gov (United States)

    Nothnagel, A.; Artz, T.; Behrend, D.; Malkin, Z.

    2017-07-01

    The International VLBI Service for Geodesy and Astrometry (IVS) regularly produces high-quality Earth orientation parameters from observing sessions employing extensive networks or individual baselines. The master schedule is designed according to the telescope days committed by the stations and by the need for dense sampling of the Earth orientation parameters (EOP). In the pre-2011 era, the network constellations with their number of telescopes participating were limited by the playback and baseline capabilities of the hardware (Mark4) correlators. This limitation was overcome by the advent of software correlators, which can now accommodate many more playback units in a flexible configuration. In this paper, we describe the current operations of the IVS with special emphasis on the quality of the polar motion results since these are the only EOP components which can be validated against independent benchmarks. The polar motion results provided by the IVS have improved continuously over the years, now providing an agreement with IGS results at the level of 20-25 μas in a WRMS sense. At the end of the paper, an outlook is given for the realization of the VLBI Global Observing System.

  3. An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

    Science.gov (United States)

    Barbieri, Carlo; Molina, Manuel; Ponce, Pedro; Tothova, Monika; Cattinelli, Isabella; Ion Titapiccolo, Jasmine; Mari, Flavio; Amato, Claudia; Leipold, Frank; Wehmeyer, Wolfgang; Stuard, Stefano; Stopper, Andrea; Canaud, Bernard

    2016-08-01

    Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  4. Observation Platform for Dynamic Biomedical and Biotechnology Experiments Using the International Space Station (ISS) Light Microscopy Module (LMM)

    Science.gov (United States)

    Kurk, Michael A. (Andy)

    2015-01-01

    Techshot, Inc., has developed an observation platform for the LMM on the ISS that will enable biomedical and biotechnology experiments. The LMM Dynamic Stage consists of an electronics module and the first two of a planned suite of experiment modules. Specimens and reagent solutions can be injected into a small, hollow microscope slide-the heart of the innovation-via a combination of small reservoirs, pumps, and valves. A life science experiment module allows investigators to load up to two different fluids for on-orbit, real-time image cytometry. Fluids can be changed to initiate a process, fix biological samples, or retrieve suspended cells. A colloid science experiment module conducts microparticle and nanoparticle tests for investigation of colloid self-assembly phenomena. This module includes a hollow glass slide and heating elements for the creation of a thermal gradient from one end of the slide to the other. The electronics module supports both experiment modules and contains a unique illuminator/condenser for bright and dark field and phase contrast illumination, power supplies for two piezoelectric pumps, and controller boards for pumps and valves. This observation platform safely contains internal fluids and will greatly accelerate the research and development (R&D) cycle of numerous experiments, products, and services aboard the ISS.

  5. Results of collagen plug occlusion of anal fistula: a multicentre study of 126 patients.

    Science.gov (United States)

    Blom, J; Husberg-Sellberg, B; Lindelius, A; Gustafsson, U-M; Carlens, S; Oppelstrup, H; Bragmark, M; Yin, L; Nyström, P-O

    2014-08-01

    The Biodesign(®) anal fistula plug was introduced as a means of obliterating the fistula tract and promoting healing through biocompatibility. The results demonstrated unexplained variations from good to bad. This report analysed the results of a retrospective multicentre study. All plug procedures performed in four Stockholm hospitals between June 2006 and June 2010 were identified and studied using a common protocol. The outcome after the first plug-insertion procedure was assessed by chart review performed a minimum of 8 months after plug insertion. Cox proportional-hazards models were used to assess the associations of various factors with fistula healing. One-hundred and twenty-six patients (mean age 47 years) were deemed suitable for the plug procedure. Eighty-five per cent of fistulae were cryptoglandular, 64% of patients were male and a mean of 2.9 previous fistulae procedures had been performed. All patients, except four, had an indwelling seton at the time of the plug procedure, which was performed in accordance with previously established principles of day surgery. After a median of 13 months, 30 (24%) fistulae had closed with no discomfort or secretion reported. The outcome in the four hospitals varied from 13% to 33% with similar numbers of patients in each hospital. A success rate of 12% was observed for patients with anterior fistula compared with 32% for those with posterior tracks [hazard ratio (HR) for successful healing = 2.98; 95% CI: 1.01-8.78) and 41% for those with a lateral internal opening (HR = 3.76; 95% CI: 1.03-13.75). Age, sex and number of previous procedures were not associated with healing. Four independent patient groups showed low success rates after the first plug-insertion procedure. Anterior fistulae were much less likely to heal compared with fistulae in other locations. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  6. A multi-centre clinical evaluation of reactive oxygen topical wound gel in 114 wounds.

    Science.gov (United States)

    Dryden, M; Dickinson, A; Brooks, J; Hudgell, L; Saeed, K; Cutting, K F

    2016-03-01

    This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds. This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible. We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis. SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds. Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a

  7. An International Coordinated Effort to Further the Documentation & Development of Quality Assurance, Quality Control, and Best Practices for Oceanographic Observations

    Science.gov (United States)

    Bushnell, M.; Waldmann, C.; Hermes, J.; Tamburri, M.

    2017-12-01

    Many oceanographic observation groups create and maintain QA, QC, and best practices (BP) to ensure efficient and accurate data collection and quantify quality. Several entities - IOOS® QARTOD, AtlantOS, ACT, WMO/IOC JCOMM OCG - have joined forces to document existing practices, identify gaps, and support development of emerging techniques. While each group has a slightly different focus, many underlying QA/QC/BP needs can be quite common. QARTOD focuses upon real-time data QC, and has produced manuals that address QC tests for eleven ocean variables. AtlantOS is a research and innovation project working towards the integration of ocean-observing activities across all disciplines in the Atlantic Basin. ACT brings together research institutions, resource managers, and private companies to foster the development and adoption of effective and reliable sensors for coastal, freshwater, and ocean environments. JCOMM promotes broad international coordination of oceanographic and marine meteorological observations and data management and services. Leveraging existing efforts of these organizations is an efficient way to consolidate available information, develop new practices, and evaluate the use of ISO standards to judge the quality of measurements. ISO standards may offer accepted support for a framework for an ocean data quality management system, similar to the meteorological standards defined by WMO (https://www.wmo.int/pages/prog/arep/gaw/qassurance.html). We will first cooperatively develop a plan to create a QA/QC/BP manual. The resulting plan will describe the need for such a manual, the extent of the manual, the process used to engage the community in creating it, the maintenance of the resultant document, and how these things will be done. It will also investigate standards for metadata. The plan will subsequently be used to develop the QA/QC/BP manual, providing guidance which advances the standards adopted by IOOS, AtlantOS, JCOMM, and others.

  8. Outcomes of an International Coordination Workshop to Understand Aerosol Observability Capabilities and Requirements for the Next Decade

    Science.gov (United States)

    Reid, J. S.; Benedetti, A.; Colarco, P. R.; Carmichael, G. R.; Icap Team

    2010-12-01

    In late April 2010 roughly 15 developers for many of the world’s operational numerical weather prediction centers with aerosol forecasting mandates met with an equal number of representatives of satellite data providers to discuss aerosol observability issues facing the next generation of aerosol forecast and modeling systems. While the last 3 years has seen rapid operational implementation of aerosol and pollution models around the world, the key to further development of these models is aerosol observational data from satellites for model evaluation and data assimilation. However, while the dynamical meteorology community has a well developed near real-time observing system to support forecasting, the aerosol community is only beginning to address the problem. This meeting was the first ever to combine the lead aerosol developers and remote sensing data providers from around the globe in discussing state-of-the-art technologies and operational requirements for aerosol forecasting. Participants included: operational centers representatives of ECMWF, FNMOC, JMA, NCEP, and UKMO; remote sensing data providers from EUMETSAT, ESA, JAXA, NASA, and NOAA NESDIS; and additional developers from NASA GMAO, NGST, NOAA, NRL, and several universities. Indeed, the smooth transition from the NASA EOS/A-Train into the international constellation of multi-model, multi-sensor products which satisfy both research and operational communities will require coordination among all of the above participants. In this paper, we provide an overview of important meeting outcomes that should interest the broader atmospheric composition community, including an overview of future satellite and ground systems and their capabilities, key definitions of operational diction, desires for error metrics, specialized product development, and customer outreach and research product delivery. These outcomes are already effecting CONOPS at major data and forecasting sensors.

  9. International Observe the Moon Night: Eight Years of Engaging Scientists, Educators, and Citizen Enthusiasts in NASA Science

    Science.gov (United States)

    Buxner, Sanlyn; Jones, Andrea; Bleacher, Lora; Wasser, Molly; Day, Brian; Bakerman, Maya; Shaner, Andrew; Joseph, Emily; International Observe the Moon Night Coordinating Committee

    2018-01-01

    International Observe the Moon Night (InOMN) is an annual worldwide event, held in the fall, that celebrates lunar and planetary science and exploration. InOMN is sponsored by NASA’s Lunar Reconnaissance Orbiter (LRO) in collaboration with NASA’s Solar System Exploration Research Virtual Institute (SSERVI), the NASA’s Heliophysics Education Consortium, CosmoQuest, Night Sky Network, and Science Festival Alliance. Other key partners include the NASA Museum Alliance, Night Sky Network, and NASA Solar System Ambassadors.In 2017 InOMN will be held on October 28th, and will engage thousands of people across the globe to observe and learn about the Moon and its connection to planetary science. This year, we have partnered with the NASA Science Mission Directorate total solar eclipse team to highlight InOMN as an opportunity to harness and sustain the interest and momentum in space science and observation following the August 21st eclipse. Since 2010, over 3,800 InOMN events have been registered engaging over 550,000 visitors worldwide. Most InOMN events are held in the United States, with strong representation from many other countries. We will present current results from the 2017 InOMN evaluation.Through InOMN, we annually provide resources such as event-specific Moon maps, presentations, advertising materials, and certificates of participation. Additionally, InOMN highlights partner resources such as online interfaces including Moon Trek (https://moontrek.jpl.nasa.gov) and CosmoQuest (https://cosmoquest.org/x/) to provide further opportunities to engage with NASA science.Learn more about InOMN at http://observethemoonnight.org.

  10. The Stratospheric Aerosol and Gas Experiment III - International Space Station: Extending Long-Term Ozone and Aerosol Observations (Invited)

    Science.gov (United States)

    Eckman, R.; Zawodny, J. M.; Cisewski, M.; Gasbarre, J.; Flittner, D. E.; Hill, C.; Roell, M.; Moore, J. R.; Hernandez, G.; McCormick, M. P.

    2013-12-01

    The Stratospheric Aerosol and Gas Experiment III - International Space Station (SAGE III on ISS) will extend the global measurements of vertical profiles of ozone, aerosols, water vapor, nitrogen dioxide, and other trace gases begun with SAGE I in 1979, enabling the detection of long-term trends. SAGE III on ISS is the fourth in a series of instruments developed for monitoring these constituents in the stratosphere and troposphere. The SAGE III instrument is a moderate resolution spectrometer covering wavelengths from 290 nm to 1550 nm, using the heritage occultation technique, utilizing both the sun and the moon. Launch to ISS is planned for early 2015 aboard a Falcon 9 spacecraft. SAGE III will investigate the spatial and temporal variability of the measured species in order to determine their role in climatological processes, biogeochemical cycles, the hydrologic cycle, and atmospheric chemistry. It will characterize tropospheric, as well as stratospheric aerosols and upper tropospheric and stratospheric clouds, and investigate their effects on the Earth's environment including radiative, microphysical, and chemical interactions. The multi-decadal SAGE ozone and aerosol data sets have undergone intense scrutiny and are the international standard for accuracy and stability. SAGE data have been used to monitor the effectiveness of the Montreal Protocol. Amongst its key objectives will be to assess the state of the recovery in the distribution of ozone, to reestablish the aerosol measurements needed by both climate and ozone models, and to gain further insight into key processes contributing to ozone and aerosol variability. The ISS is ideal for Earth observing experiments; its mid-inclination orbit allows for a large range in latitude sampling and nearly continuous communications with payloads. In this presentation, we describe the SAGE III on ISS mission, its implementation, current status, and concentrate on its key science objectives.

  11. All quiet on election day? International election observation and incentives for pre-election violence in African elections

    NARCIS (Netherlands)

    Daxecker, U.E.

    2014-01-01

    This article argues that the increasing international interest in elections as exemplified by the rise of international election monitoring induces temporal shifts in the use of violent intimidation by political actors. The presence of international electoral missions lowers the potential for

  12. "I Have No English Friends": Some Observations on the Practice of Action Learning with International Business Students

    Science.gov (United States)

    Brook, Cheryl; Milner, Christopher

    2014-01-01

    This account reports on some experiences of facilitating action learning with international business students. Interest in international student learning and the international student experience is significant and increasing with a considerable range of literature on the subject. Some of this literature is concerned with the perceived…

  13. Colorectal cancer and its association with the metabolic syndrome: a Malaysian multi-centric case-control study.

    Science.gov (United States)

    Ulaganathan, V; Kandiah, M; Zalilah, M S; Faizal, J A; Fijeraid, H; Normayah, K; Gooi, B H; Othman, R

    2012-01-01

    Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two. Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280). MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed. This study provides evidence for a positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.

  14. Enhancing our Understanding of the Arctic Atmospheric Hydrological Cycle using Observations from an International Arctic Water Vapor Isotope Network

    Science.gov (United States)

    Masson-Delmotte, V.; Steen-Larsen, H. C.; Werner, M.

    2014-12-01

    Due to the role of water vapor and clouds in positive feedback mechanisms, water vapor is a key player in the future of Arctic climate. Ecosystems and human societies are vulnerable to climate change through even minor changes in precipitation patterns, including the occurrence of extreme events. It is therefore essential to monitor, understand and model correctly the mechanisms of transport of moisture, at the regional scale. Water isotopes - the relative abundance of heavy and light water in the atmosphere - hold the key to understanding the physical processes influencing future Arctic climate. Water isotope observations in the atmosphere are a modern analog to the Rosetta Stone for understanding the processes involved in evaporation, moisture transport, cloud formation and to track moisture origin. Indeed, technological progress now allows continuous, in situ or remote sensing monitoring of water isotopic composition. In parallel, a growing number of atmospheric circulation models are equipped with the explicit modeling of water stable isotopes, allowing evaluation at the process scale. We present here data obtained through national or bi-national initiatives from stations onboard an icebreaker and land based stations in Greenland, Iceland, Svalbard, and Siberia - together forming an emerging international Arctic water vapor isotope network. Using water tagging and back trajectories we show water vapor of Arctic origin to have a high d-excess fingerprint. This show the potential of using water vapor isotopes as tracer for changes in the Arctic hydrological cycle. Using the network of monitoring stations we quantify using the isotopes advection of air masses and the key processes affecting the water vapor en-route between stations. We have successfully used the obtained atmospheric water vapor isotope observations to benchmark isotope-enabled general circulation models. This comparison allows us to address key processes of the atmospheric hydrological cycle for

  15. Nonlinear internal waves and plumes generated in response to sea-loch outflow, AUV, and time-lapse photography observations

    Science.gov (United States)

    Toberman, Matthew; Inall, Mark; Boyd, Tim; Dumount, Estelle; Griffiths, Colin

    2017-07-01

    The tidally modulated outflow of brackish water from a sea loch forms a thin surface layer that propagates into the coastal ocean as a buoyant gravity current, transporting nutrients and sediments, as well as fresh water, heat and momentum. The fresh intrusion both propagates into and generates a strongly stratified environment which supports trains of nonlinear internal waves (NLIWs). NLIWs are shown to propagate ahead of this buoyancy input in response to propagation of the outflow water into the stratified environment generated by the previous release as well as in the opposing direction after the reflection from steep bathymetry. Oblique aerial photographs were taken and photogrammetric rectification led to the identification of the buoyant intrusion and the subsequent generation of NLIWs. An autonomous underwater vehicle (AUV) was deployed on repeated reciprocal transects in order to make simultaneous CTD, ADCP, and microstructure shear measurements of the evolution of these phenomena in conjunction with conventional mooring measurements. AUV-based temperature and salinity signals of NLIWs of depression were observed together with increased turbulent kinetic energy dissipation rates of over 2 orders of magnitude within and in the wake of the NLIWs. Repeated measurements allow a unique opportunity to investigate the horizontal structure of these phenomena. Simple metric scaling demonstrates that these processes are likely to be feature of many fjordic systems located on the west coast of Scotland but may also play a key role in the assimilation of the outflow from many tidally dominated fjordic systems throughout the world.

  16. The Moon's Moment in the Sun - Extending Public Engagement after the Total Solar Eclipse with International Observe the Moon Night

    Science.gov (United States)

    Bleacher, L.; Jones, A. P.; Wasser, M. L.; Petro, N. E.; Wright, E. T.; Ladd, D.; Keller, J. W.

    2017-12-01

    2017 presented an amazing opportunity to engage the public in learning about lunar and space science, the motions of the Earth-Moon-Sun system, and NASA's fleet of space missions, beginning with the 2017 total solar eclipse on 21 August and continuing with International Observe the Moon Night (InOMN) on 28 October. On 21 August 2017, everyone in the continental United States had the opportunity to witness a solar eclipse, weather permitting, in total or partial form. The path of totality, in which the Sun was completely obscured from view by the Moon, stretched from Oregon to South Carolina. The Education and Communication Team of NASA's Lunar Reconnaissance Orbiter (LRO) worked to highlight the Moon, the "central player" in the total solar eclipse, in a variety of ways for the public. Efforts included collaborating with Minor League Baseball teams to host eclipse-viewing events along the path of totality, communicating the Moon's role in the eclipse through public engagement products, communicating about InOMN as an experiential opportunity beyond the eclipse, and more. InOMN is an annual event, during which everyone on Earth is invited to observe and learn about the Moon and its connection to planetary science, and to share personal and community connections we all have to the Moon [2, 3, 4 and references therein]. For viewers across the United States, the total solar eclipse of 21 August provided an exciting opportunity to watch a New Moon cross in front of the Sun, casting the viewer in shadow and providing amazing views of the solar corona. The public observed the Moon in a different part of its orbit, when reflected sunlight revealed a fascinating lunar landscape - and extended their excitement for space science - by participating in InOMN on 28 October. With InOMN taking place barely two months after the total solar eclipse, it offered an opportunity to sustain and grow public interest in lunar and space science generated by the eclipse. We will report on

  17. [Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up].

    Science.gov (United States)

    Blanco Saiz, I; López Carballo, M T; Martínez Fernández, J; Carrión Maldonado, J; Cabrera Pereira, A; Moral Alvarez, S; Santamaría Girón, L; Cantero Cerquella, F; López Secades, A; Díaz González, D; Llaneza Folgueras, A; Aira Delgado, F J

    2014-01-01

    Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  18. Multicentric lymphoma in a giant anteater (Myrmecophaga tridactyla).

    Science.gov (United States)

    Sanches, Adrien W D; Werner, Pedro R; Margarido, Tereza C C; Pachaly, Jose R

    2013-03-01

    Neoplastic disease is not well documented in giant anteaters. This report describes a disseminated lymphoma in an adult male giant anteater (Myrmecophaga tridactyla) from the City Zoo of Curitiba, State of Paraná, Brazil. No clinical signs were noticed before its death, except for a slight inappetence. At postmortem examination, pale white to yellow, variably sized nodules infiltrated the heart, liver, and intestinal lymph nodes. Histologically, two distinct cell populations were present in the nodular lesions: one characterized by smaller cells, primarily lymphocytic in nature, and another characterized by larger rounded cells with loose chromatin and frequently indented nuclei resembling histiocytes. Giant binucleated cells were occasionally observed. Mitotic figures numbered 2-3 mitotic figures/x400 field. Both cellular populations presented with moderate pleomorphism, large nuclei, a high nucleus-to-cytoplasm ratio, distinct nucleoli, and coarse nuclear chromatin. The neoplasia was classified as a form of multicentric lymphohistiocytic lymphoma (Rappaport Classification) and as an intermediate grade lymphoma (National Cancer Institute Working Formulation).

  19. [Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)].

    Science.gov (United States)

    Rodríguez-Hernández, M Jesús; Ruiz-Pérez de Pipaon, Maite; Márquez-Solero, Manuel; Martín-Rico, Patricia; Castón-Osorio, Juan José; Guerrero-Sánchez, Francisca M; Vidal-Verdú, Elisa; García-Figueras, Carolina; Del Arco-Jiménez, Alfonso; Rodríguez-Baño, Jesús; Martín-Mazuelos, Estrella; Cisneros-Herreros, José Miguel

    2011-05-01

    Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  20. Compliance with the International Code of Marketing of breast-milk substitutes: an observational study of pediatricians' waiting rooms.

    Science.gov (United States)

    Dodgson, Joan E; Watkins, Amanda L; Bond, Angela B; Kintaro-Tagaloa, Cheryl; Arellano, Alondra; Allred, Patrick A

    2014-04-01

    Abstract The importance of breastmilk as a primary preventative intervention is widely known and understood by most healthcare providers. The actions or non-actions that heathcare providers take toward promoting and supporting breastfeeding families make a difference in the success and duration of breastfeeding. Recognizing this relationship, the World Health Organization developed the International Code of Marketing of Breast-milk Substitutes (the Code), which defines best practices in breastfeeding promotion, including physicians' offices. The pediatric practices' waiting rooms are often a family's first experience with pediatric care. The specific aims of this study were to describe (1) Code compliance, (2) the demographic factors affecting the Code compliance, and (3) the amount and type of breastfeeding-supportive materials available in the pediatricians' waiting rooms. An observational cross-sectional design was used to collect data from 163 (82%) of the pediatric practices in Maricopa County, Arizona. None of the 100 waiting rooms that had any materials displayed (61%) was found to be completely Code compliant, with 81 of the offices having formula-promotional materials readily available. Waiting rooms in higher income areas offered more non-Code-compliant materials and gifts. Breastfeeding support information and materials were lacking in all but 18 (18%) offices. A positive relationship (t97=-2.31, p=0.02) occurred between the presence of breastfeeding educational materials and higher income areas. We were able to uncover some practice-related patterns that impact families and potentially undermine breastfeeding success. To move current practices toward breastfeeding-friendly physicians' offices, change is needed.

  1. Multicentric lymphoma in buffaloes in the Amazon region, Brazil

    Directory of Open Access Journals (Sweden)

    Cairo H S De Oliveira

    2016-10-01

    Full Text Available Abstract Background The presence of lymphoma in buffaloes was first reported in India in the 1960s. The disease is similar to Enzootic Bovine Leucosis (EBL caused by Bovine leukemia virus (BLV in cattle; however, according to our results and those of other studies, the etiology of these lymphomas in buffalo do not appear to be associated with BLV. The objectives of this study are to describe four cases of the disease in buffaloes belonging to the same herd in the Amazon region of Brazil and to perform a clinical-anatomopathological, immunohistochemical, and etiological study of the lymphomas. Results Over a period of ten years, four buffaloes were observed presenting progressive weight loss, swelling of peripheral lymph nodes, and nodules in the subcutaneous tissue. Upon necropsy, whitish-colored tumor masses were observed in the form of nodules in the subcutaneous tissue, along with miliary nodules on the serosal surfaces of abdominal and thoracic organs and tumors in lymph nodes and other organs. Neoplastic lymphocyte proliferation was observed through histopathology. An immunohistochemical study revealed that the neoplasias were formed by proliferation of predominantly B lymphocytes. The presence of BLV genome was not detected in the lymphomas when using the real-time PCR technique, nor was it detected through immunohistochemical staining using monoclonal antibodies against two viral proteins. Bovine herpesvirus 6 was not detected in the tumors. However, Bovine immunodeficiency virus (BIV was detected in samples of lymphoma and in the lymph nodes and kidneys of one of the animals. Conclusions The occurrence of lymphoma in buffaloes is reported for the first time in Brazil and is characterized by B-cell multicentric lymphoma. The etiology of the disease does not appear to be associated with BLV; however, the detection of BIV in samples of lymphoma from one sick animal deserves further study, considering the oncogenic potential of this virus.

  2. Multicentric Giant Cell Tumor of Bone: Synchronous and Metachronous Presentation

    Directory of Open Access Journals (Sweden)

    Reiner Wirbel

    2013-01-01

    Full Text Available A 27-year-old man treated 2.5 years ago for synchronous multicentric giant cell tumor of bone located at the right proximal humerus and the right 5th finger presented now with complaints of pain in his right hip and wrist of two-month duration. Radiology and magnetic resonance revealed multicentric giant cell tumor lesions of the right proximal femur, the left ileum, the right distal radius, and the left distal tibia. The patient has an eighteen-year history of a healed osteosarcoma of the right tibia that was treated with chemotherapy, resection, and allograft reconstruction. A literature review establishes this as the first reported case of a patient with synchronous and metachronous multicentric giant cell tumor who also has a history of osteosarcoma.

  3. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008)

    NARCIS (Netherlands)

    Klingspor, L.; Tortorano, A.M.; Peman, J.; Willinger, B.; Hamal, P.; Sendid, B.; Velegraki, A.; Kibbler, C.; Meis, J.F.G.M.; Sabino, R.; Ruhnke, M.; Arikan-Akdagli, S.; Salonen, J.; Doczi, I.

    2015-01-01

    A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of

  4. A case study evaluation of ethics review systems for multicentre clinical trials.

    Science.gov (United States)

    Hicks, Sian C; James, Rebecca E; Wong, Nicole; Tebbutt, Niall C; Wilson, Kate

    2009-09-07

    To evaluate the difference in time taken for ethics and site governance approval for multicentre clinical trials using two different systems of ethics review. We evaluated the times to final ethics and governance approval for two international, multicentre clinical trials of treatment for metastatic colorectal cancer: the MAX trial, using a non-centralised ethics review system, and the CO.20 trial, using the new New South Wales centralised ethics review system. Time from trial submission to overall study approval. The median time taken to obtain ethics approval for the MAX trial at 16 NSW sites was 100 days (range, 36-161 days). The median time to obtain central ethics approval for the CO.20 trial at 14 NSW sites was 77 days, with an additional 60 days (range 20-79 days) required to obtain site-specific research governance approval. Any difference in time to approval between the review systems was outweighed by the overall time taken. However, the time spent by both the coordinating centre and local sites in collation, submission and correspondence was greatly reduced, and the centralised process allowed for standardised documentation at all study sites.

  5. Sleep and Alertness in Medical Interns and Residents: An Observational Study on the Role of Extended Shifts.

    Science.gov (United States)

    Basner, Mathias; Dinges, David F; Shea, Judy A; Small, Dylan S; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian J; Novak, Cristina; Bellini, Lisa M; Volpp, Kevin G

    2017-04-01

    Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Sleep-wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy. Alertness was assessed daily with a brief Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale. Interns averaged 6.93 hours (95% confidence interval [CI] 6.84-7.03 hours) sleep per 24 hours across shifts, significantly less than residents not working overnight shifts (7.18 hours, 95% CI 7.06-7.30 hours, p = .007). Interns obtained on average 2.19 hours (95% CI 2.02-2.36 hours) sleep during on-call nights (17.5% obtained no sleep). Alertness was significantly lower on mornings after on-call nights compared to regular shifts (p Sleep inertia significantly affected alertness in the 60 minutes after waking on-call. Extended overnight shifts increase the likelihood of chronic sleep restriction in interns. Reduced levels of alertness after on-call nights need to be mitigated. A systematic comparison of sleep, alertness, and safety outcomes under current and past duty hour rules is encouraged. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  6. Young Children's Behavioral Inhibition Mediates the Association between Maternal Negative Affectivity and Internalizing Problems: Observations, Parent-Report, and Moderation of Associations by Age

    Science.gov (United States)

    Fang, Haolei; Gagne, Jeffrey Robert

    2018-01-01

    Employing a multi-method approach, we investigated observed and parent-rated child behavioral inhibition (BI) and maternal reports of their own negative affectivity (NA) as predictors of young children's internalizing problems. Participants were 201 children who were siblings between 2.5 and 5.5 years of age (mean = 3.86, standard deviation =…

  7. Purposeful interaction and the professional development of content teachers : Observations of small-group teaching and learning in the international classroom

    NARCIS (Netherlands)

    Haines, Kevin; Valcke, Jennifer; Wilkinson, Robert

    2017-01-01

    This article discusses the development of a model of ‘purposeful interaction’, which can be used as a framework of reference when supporting the work of content teachers in ‘international classrooms’ in higher education. This model has been developed during observations of the work of content

  8. But I Don't Understand You: One Faculty's Observations of the Challenges Facing International Healthcare Students

    Science.gov (United States)

    DuBose, Cheryl O.

    2017-01-01

    International students face many challenges when pursuing a degree in higher education. Communication and cultural differences are typically cited as the most challenging aspects of any study abroad program. Students attempting to complete a healthcare program face sometimes insurmountable issues, as communication, cultural differences, and…

  9. Internal structure of an intact Convallaria majalis pollen grain observed with X-ray Fresnel coherent diffractive imaging

    NARCIS (Netherlands)

    Mancuso, Adrian P; Groves, Matthew R; Polozhentsev, Oleg E; Williams, Garth J; McNulty, Ian; Antony, Claude; Santarella-Mellwig, Rachel; Soldatov, Aleksander V; Lamzin, Victor; Peele, Andrew G; Nugent, Keith A; Vartanyants, Ivan A

    2012-01-01

    We have applied Fresnel Coherent Diffractive Imaging (FCDI) to image an intact pollen grain from Convallaria majalis. This approach allows us to resolve internal structures without the requirement to chemically treat or slice the sample into thin sections. Coherent X-ray diffraction data from this

  10. Multiple myeloma in Nigeria: a multi-centre epidemiological and ...

    African Journals Online (AJOL)

    Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study. Nkiruka Nnonyelum Odunukwe, Jude Anazoeze Madu, Obigeli Eunice Nnodu, Titilola Stella Akingbola, Inyama Marcus Asuquo, Modupe Taiwo Balogun, Olufunto Olufela Kalejaiye, John Chinawaeze Aneke, Joseph Aondowase Orkuma, ...

  11. A Mobitz type II atrioventricular block in multicentric ischemic stroke ...

    African Journals Online (AJOL)

    Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic stroke. In this study, we present a rare case of multicentric ischemic stroke induced by Mobitz type II atrioventricular block. The Pan African ...

  12. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

    2015-01-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for th...... to the original source....

  13. Simulations and observation of nonlinear internal waves on the continental shelf: Korteweg–de Vries and extended Korteweg–de Vries solutions

    Directory of Open Access Journals (Sweden)

    K. O'Driscoll

    2017-09-01

    Full Text Available Numerical solutions of the Korteweg–de Vries (KdV and extended Korteweg–de Vries (eKdV equations are used to model the transformation of a sinusoidal internal tide as it propagates across the continental shelf. The ocean is idealized as being a two-layer fluid, justified by the fact that most of the oceanic internal wave signal is contained in the gravest mode. The model accounts for nonlinear and dispersive effects but neglects friction, rotation and mean shear. The KdV model is run for a number of idealized stratifications and unique realistic topographies to study the role of the nonlinear and dispersive effects. In all model solutions the internal tide steepens forming a sharp front from which a packet of nonlinear solitary-like waves evolve. Comparisons between KdV and eKdV solutions are made. The model results for realistic topography and stratification are compared with observations made at moorings off Massachusetts in the Middle Atlantic Bight. Some features of the observations compare well with the model. The leading face of the internal tide steepens to form a shock-like front, while nonlinear high-frequency waves evolve shortly after the appearance of the jump. Although not rank ordered, the wave of maximum amplitude is always close to the jump. Some features of the observations are not found in the model. Nonlinear waves can be very widely spaced and persist over a tidal period.

  14. Observation of changing of the internal conversion coefficient under Moessbauer effect at magnetic transition in Rh-Fe system

    International Nuclear Information System (INIS)

    Ruskov, T.

    1998-01-01

    The magnetic disorder-order transition in the Rh-Fe alloy is studied by conversion electron Moessbauer spectroscopy. The drastic increase of the area under the Moessbauer spectrum at the transition from the paramagnetic to the magnetic state could be explained by diminishing the internal conversion coefficient. Thus our experimental results directly confirm the theory of the collective effect in the system of radiating developed by Yukalov

  15. Evaluation of the channelized Hotelling observer with an internal-noise model in a train-test paradigm for cardiac SPECT defect detection

    International Nuclear Information System (INIS)

    Brankov, Jovan G

    2013-01-01

    The channelized Hotelling observer (CHO) has become a widely used approach for evaluating medical image quality, acting as a surrogate for human observers in early-stage research on assessment and optimization of imaging devices and algorithms. The CHO is typically used to measure lesion detectability. Its popularity stems from experiments showing that the CHO's detection performance can correlate well with that of human observers. In some cases, CHO performance overestimates human performance; to counteract this effect, an internal-noise model is introduced, which allows the CHO to be tuned to match human-observer performance. Typically, this tuning is achieved using example data obtained from human observers. We argue that this internal-noise tuning step is essentially a model training exercise; therefore, just as in supervised learning, it is essential to test the CHO with an internal-noise model on a set of data that is distinct from that used to tune (train) the model. Furthermore, we argue that, if the CHO is to provide useful insights about new imaging algorithms or devices, the test data should reflect such potential differences from the training data; it is not sufficient simply to use new noise realizations of the same imaging method. Motivated by these considerations, the novelty of this paper is the use of new model selection criteria to evaluate ten established internal-noise models, utilizing four different channel models, in a train-test approach. Though not the focus of the paper, a new internal-noise model is also proposed that outperformed the ten established models in the cases tested. The results, using cardiac perfusion SPECT data, show that the proposed train-test approach is necessary, as judged by the newly proposed model selection criteria, to avoid spurious conclusions. The results also demonstrate that, in some models, the optimal internal-noise parameter is very sensitive to the choice of training data; therefore, these models are prone

  16. Coordination and relationships between organisations during the civil-military international response against Ebola in Sierra Leone: an observational discussion.

    Science.gov (United States)

    Forestier, Colleen; Cox, A T; Horne, S

    2016-06-01

    The Ebola virus disease (EVD) crisis in West Africa began in March 2014. At the beginning of the outbreak, no one could have predicted just how far-reaching its effects would be. The EVD epidemic proved to be a unique and unusual humanitarian and public health crisis. It caused worldwide fear that impeded the rapid response required to contain it early. The situation in Sierra Leone (SL) forced the formation of a unique series of civil-military interagency relationships to be formed in order to halt the epidemic. Civil-military cooperation in humanitarian situations is not unique to this crisis; however, the slow response, the unusual nature of the battle itself and the uncertainty of the framework required to fight this deadly virus created a situation that forced civilian and military organisations to form distinct, cooperative relationships. The unique nature of the Ebola virus necessitated a steering away from normal civil-military relationships and standard pillar responses. National and international non-governmental organisations (NGOs), Department for International Development (DFID) and the SL and UK militaries were required to disable this deadly virus (as of 7 November 2015, SL was declared EVD free). This paper draws on personal experiences and preliminary distillation of information gathered in formal interviews. It discusses some of the interesting features of the interagency relationships, particularly between the military, the UK's DFID, international organisations, NGOs and departments of the SL government. The focus is on how these relationships were key to achieving a coordinated solution to EVD in SL both on the ground and within the larger organisational structure. It also discusses how these relationships needed to rapidly evolve and change along with the epidemiological curve. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. A comparison of predicted and observed turbulent wind fields present in natural and internal wind park environments

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, N D; Wright, A D

    1991-10-01

    This paper assesses the accuracy of simulated wind fields for both the natural flow and that within a wind park environment. The simulated fields are compared with the observed ones in both the time and frequency domains. Actual measurements of the wind fields and the derived kinematic scaling parameters upwind and downwind of a large San Gorgonio Pass wind park are used. The deviations in the modeled wind field from the observed are discussed. 10 refs., 6 figs., 2 tabs.

  18. Observed improvements in an intern's ability to initiate critical emergency skills in different cardiac arrest scenarios using high-fidelity simulation.

    Science.gov (United States)

    Starmer, David J; Duquette, Sean A; Guiliano, Dominic; Tibbles, Anthony; Miners, Andrew; Finn, Kevin; Stainsby, Brynne E

    2014-10-01

    Objective : The objective of this study was to report observed changes in an intern's ability to initiate critical emergency skills in different cardiac arrest scenarios with high-fidelity simulation over a 10-month period. Methods : One intern's performance was retrospectively analyzed using video recordings of 4 simulations at different stages in the training program. The key outcome was the duration of time expired for 4 critical skills, including activating the emergency response system, initiating cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED), and passively administrating oxygen. Results : The intern became more efficient in each subsequent simulation for activating the emergency response system and initiating CPR. The time to use the AED stayed relatively constant. The administration of oxygen was inconsistent. Conclusion : An improvement in the speed of applying emergency critical skills was observed with this intern. These improvements in skill may improve patient outcomes and survival rates. We propose further educational research with high-fidelity simulation in the area of assessing emergency skills.

  19. Botulinum Toxin Injection for Internal Rotation Contractures in Brachial Plexus Birth Palsy. A Minimum 5-Year Prospective Observational Study.

    Science.gov (United States)

    Duijnisveld, Bouke J; van Wijlen-Hempel, Marie S; Hogendoorn, Simone; de Boer, Kees S; Malessy, Martijn J A; Keurentjes, J Christiaan; Nagels, Jochem; Nelissen, Rob G H H

    Brachial plexus birth palsy is frequently associated with internal rotation contractures of the shoulder as a result of muscle imbalance. The purpose of this study is to assess the effect of botulinum toxin A (BTX-A) injection in the subscapular (SC) muscle on external rotation and the need for tendon transfer for external rotation of the shoulder. A prospective comparative study was performed including 15 consecutive patients treated with BTX-A and a historic control group of 67 patients with mean age 30 months (SD 10). The BTX-A injection (2 IU/kg body weight) was performed immediately following MRI under general anesthesia in the SC muscle. Passive external rotation, the need for tendon transfer surgery, glenohumeral deformity, and muscle degeneration were evaluated. The hazard ratio for no relapse of internal rotation contracture after BTX-A injection compared with no BTX-A injection was calculated. In the BTX-A group, the passive external rotation in adduction increased from -1 degree (95% CI, -10 to 8) to 32 degrees (95% CI, 17-46) at 3 months and 6 patients were indicated for surgery compared with a decline from -2 degrees (95% CI, -7 to 3) to -11 degrees (95% CI, -17 to -6) in the control group with 66 indications for surgery. At 5 years of follow-up, 10 patients in the BTX-A group were indicated for surgery with a hazard ratio of 4.0 (95% CI, 1.9 to 8.4). BTX-A injection in the SC muscle of brachial plexus birth palsy patients can reduce internal rotation contractures and subsequently the need for tendon transfer surgery. At 5 years of follow-up a relapse was seen in 67% of the patients treated with BTX-A. Because at MRI less SC degeneration was found in the good responders on BTX-A treatment, this group seems to be the best target group. Further research is needed on patient selection for BTX-A injection including glenohumeral deformity, SC degeneration, as well as doses of BTX-A to be used. Level II-prospective comparative study.

  20. Counterdiffusion protein crystallisation in microgravity and its observation with PromISS (protein microscope for the international space station)

    Science.gov (United States)

    Zegers, Ingrid; Carotenuto, Luigi; Evrard, Christine; Garcia-Ruiz, JuanMa; De Gieter, Philippe; Gonzales-Ramires, Luis; Istasse, Eric; Legros, Jean-Claude; Martial, Joseph; Minetti, Christophe; Otalora, Fermin; Queeckers, Patrick; Schockaert, Cedric; VandeWeerdt, Cecile; Willaert, Ronnie; Wyns, Lode; Yourassowsky, Catherine; Dubois, Frank

    2006-09-01

    The crystallisation by counterdiffusion is a very efficient technique for obtaining high-quality protein crystals. A prerequisite for the use of counterdiffusion techniques is that mass transport must be controlled by diffusion alone. Sedimentation and convection can be avoided by either working in gelled systems, working in systems of small dimensions, or in the absence of gravity. We present the results from experiments performed on the ISS using the Protein Microscope for the International Space Station (PromISS), using digital holography to visualise crystal growth processes. We extensively characterised three model proteins for these experiments (cablys3*lysozyme, triose phosphate isomerase, and parvalbumin) and used these to assess the ISS as an environment for crystallisation by counterdiffusion. The possibility to visualise growth and movement of crystals in different types of experiments (capillary counterdiffusion and batch-type) is important, as movement of crystals is clearly not negligible.

  1. Numerical Computation of Optical Properties of Internally Mixed Soot in Biomass Burning Constrained by Field and Laboratory Observations

    Science.gov (United States)

    China, S.; Scarnato, B. V.; Gorkowski, K.; Aiken, A. C.; Liu, S.; Dubey, M. K.; Mazzoleni, C.

    2014-12-01

    Carbonaceous aerosol emitted from biomass burning (BB) contributes significantly to atmospheric aerosol loadings regionally and globally. Direct radiative forcing of BB aerosol is highly uncertain due to its complex composition, morphology and mixing state. Soot particles are the strongest light absorbing aerosols in BB smoke. In BB smoke, soot particles are normally internally mixed with other material and the mixing state can affect their optical properties. In this study we investigated morphology and mixing state of soot particles emitted from BB smoke from field and laboratory measurements. Smoke particles were collected 1) during the Las Conchas wildfire in New Mexico (June, 2011) and 2) at the U.S. Forest Service's Fire Science Laboratory in 2012, during the fourth Fire Laboratory at Missoula Experiment (FLAME-4). Single particles were analyzed with electron microscopy, and were categorized and characterized by their morphology, and mixing state. We found that soot particles were mostly heavily coated. Based on the characterization on field and laboratory samples, synthetic soot particles with various morphologies and mixing states were generated and their optical properties were numerically calculated using the discrete dipole approximation. We used organic material as a coating agent and investigated the spectral dependency of scattering and absorption for internally mixed soot particles. We found enhancement in scattering and absorption when most of the soot particle was embedded within the organic coating. The aim of this study is to improve our understanding of the effect of morphology and mixing on light scattering and absorption by soot particles and ultimately their effects on the direct radiative forcing.

  2. Iron-chelating therapy with deferasirox in transfusion-dependent, higher risk myelodysplastic syndromes: a retrospective, multicentre study.

    Science.gov (United States)

    Musto, Pellegrino; Maurillo, Luca; Simeon, Vittorio; Poloni, Antonella; Finelli, Carlo; Balleari, Enrico; Ricco, Alessandra; Rivellini, Flavia; Cortelezzi, Agostino; Tarantini, Giuseppe; Villani, Oreste; Mansueto, Giovanna; Milella, Maria R; Scapicchio, Daniele; Marziano, Gioacchino; Breccia, Massimo; Niscola, Pasquale; Sanna, Alessandro; Clissa, Cristina; Voso, Maria T; Fenu, Susanna; Venditti, Adriano; Santini, Valeria; Angelucci, Emanuele; Levis, Alessandro

    2017-06-01

    Iron chelation is controversial in higher risk myelodysplastic syndromes (HR-MDS), outside the allogeneic transplant setting. We conducted a retrospective, multicentre study in 51 patients with transfusion-dependent, intermediate-to-very high risk MDS, according to the revised international prognostic scoring system, treated with the oral iron chelating agent deferasirox (DFX). Thirty-six patients (71%) received azacitidine concomitantly. DFX was given at a median dose of 1000 mg/day (range 375-2500 mg) for a median of 11 months (range 0·4-75). Eight patients (16%) showed grade 2-3 toxicities (renal or gastrointestinal), 4 of whom (8%) required drug interruption. Median ferritin levels decreased from 1709 μg/l at baseline to 1100 μg/l after 12 months of treatment (P = 0·02). Seventeen patients showed abnormal transaminase levels at baseline, which improved or normalized under DFX treatment in eight cases. One patient showed a remarkable haematological improvement. At a median follow up of 35·3 months, median overall survival was 37·5 months. The results of this first survey of DFX in HR-MDS are comparable, in terms of safety and efficacy, with those observed in lower-risk MDS. Though larger, prospective studies are required to demonstrate real clinical benefits, our data suggest that DFX is feasible and might be considered in a selected cohort of HR-MDS patients. © 2017 John Wiley & Sons Ltd.

  3. Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC).

    Science.gov (United States)

    Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato

    2017-09-13

    The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan

  4. Internal magnetic fluctuations and electron heat transport in the TORE SUPRA Tokamak. Observation by cross polarisation scattering

    International Nuclear Information System (INIS)

    Colas, L.; Paume, M.; Zou, X.L.; Chareau, J.M.; Guiziou, L.; Hoang, G.T.; Michelot, Y.; Gresillon, D.

    1997-03-01

    Magnetic fluctuations (radial size ∼ 5 mm) are measured by a cross polarisation scattering (CPS) diagnostic in TORE SUPRA. These fluctuations are investigated quantitatively in the ohmic and low confinement regimes over a wide range of plasma currents, densities and additional heating powers. Simultaneously, electron heat diffusivities expected from these fluctuations are compared to those obtained by profile analysis. A radial profile of the magnetic fluctuations in the gradient region ( 0.3 e mag = πqRv th (δ B r / B) 2 . Both the order of magnitude and the parametric dependence of χ e mag show similarities with electron diffusivities determined by transport analysis. In particular, a threshold is observed for the dependence of fluctuation-induced heat fluxes on the local temperature gradient, which is close to the critical gradient observed for the measured heat fluxes. (author)

  5. Hyperfine structure and Λ doubling in the A 2Δ state of CH : Observation of an internal hyperfine perturbation

    NARCIS (Netherlands)

    Ubachs, Wim; Van Herpen, W. M.; ter Meulen, J.J.; Dymanus, A.

    1986-01-01

    We report the observation of a resonance between hyperfine states, due to the crossing of rotational ladders at N=10 of Δ5/2 and Δ3/2 spin-doublet states in the excited A 2Δ state of CH. Accurate values for the hyperfine constants a, b, and c in the A 2Δ state were obtained. From measurements of the

  6. Transit time distributions and StorAge Selection functions in a sloping soil lysimeter with time-varying flow paths: Direct observation of internal and external transport variability

    Science.gov (United States)

    Kim, Minseok; Pangle, Luke A.; Cardoso, Charléne; Lora, Marco; Volkmann, Till H. M.; Wang, Yadi; Harman, Ciaran J.; Troch, Peter A.

    2016-09-01

    Transit times through hydrologic systems vary in time, but the nature of that variability is not well understood. Transit times variability was investigated in a 1 m3 sloping lysimeter, representing a simplified model of a hillslope receiving periodic rainfall events for 28 days. Tracer tests were conducted using an experimental protocol that allows time-variable transit time distributions (TTDs) to be calculated from data. Observed TTDs varied with the storage state of the system, and the history of inflows and outflows. We propose that the observed time variability of the TTDs can be decomposed into two parts: "internal" variability associated with changes in the arrangement of, and partitioning between, flow pathways; and "external" variability driven by fluctuations in the flow rate along all flow pathways. These concepts can be defined quantitatively in terms of rank StorAge Selection (rSAS) functions, which is a theory describing lumped transport dynamics. Internal variability is associated with temporal variability in the rSAS function, while external is not. The rSAS function variability was characterized by an "inverse storage effect," whereby younger water is released in greater proportion under wetter conditions than drier. We hypothesize that this effect is caused by the rapid mobilization of water in the unsaturated zone by the rising water table. Common approximations used to model transport dynamics that neglect internal variability were unable to reproduce the observed breakthrough curves accurately. This suggests that internal variability can play an important role in hydrologic transport dynamics, with implications for field data interpretation and modeling.

  7. [Motor dysfunction in stroke of subacute stage treated with acupuncture: multi-central randomized controlled study].

    Science.gov (United States)

    Chen, Li-Fang; Fang, Jian-Qiao; Wu, Yuan-Yuan; Ma, Rui-Jie; Xu, Shou-Yu; Shen, Lai-Hua; Luo, Kai-Tao; Gao, Feng; Bao, Ye-Hua; Ni, Ke-Feng; Li, Li-Ping

    2014-04-01

    To verify the clinical efficacy of acupuncture on motor dysfunction in ischemic stroke of subacute stage. The multi-central randomized controlled trial was adopted. One hundred and twenty-six cases of ischemic stroke of subacute stage were randomized into an acupuncture group (61 cases) and a conventional treatment group (65 cases). The basic treatment of western internal medicine and rehabilitation training were applied to the patients of the two groups. In the acupuncture group, acupuncture was supplemented at the body points located on the extensor of the upper limbs and the flexor of the lower limbs. In combination, scalp acupuncture was applied to NS5, MS6 and MS6 on the affected side. The treatment was given 5 times a week and totally 8 weeks were required. The follow-up observation lasted for 3 months. The scores in Fugl-Meyer scale and NIHSS scale and Barthel index were compared between the two groups before treatment, in 4 and 8 weeks of treatment and the 3-month follow-up observation after treatment separately. In 4 and 8 weeks of treatment and the follow-up observation, Fugl-Meyer scale score was improved obviously in the patients of the two groups (all PFugl-Meyer scale score in the acupuncture groupwas im proved much apparently as compared with that in the conventional treatment group [68. 0 (43. 0,86. 5) vs 52. 5 (30.3, 77.0), 77.0 (49.5, 89.0) vs 63. 0 (33.0, 84.0), both Pscale score was not reduced apparently in 4 weeks of treatment in the conventional treatment group (P>0.05), the results of NIHSS scale at the other time points were all decreased obviously as compared with those before treatment in the patients of the two groups (all P<0. 01). In 8 weeks of treatment and the follow-up observation, the results in the acupuncture group were reduced much apparently as compared with those in the conventional treatment group [5. 0 (3.0,8.0) vs 7. 0 (3.0,13.8), 4. 0 (1.5,7.0) vs 6.0 (2.0,11.7) ,both P<0. 05]. In 8 weeks of treatment and the follow

  8. Bowen′s disease of multicentric origin

    Directory of Open Access Journals (Sweden)

    Zawar V

    1993-01-01

    Full Text Available We describe a case of Bowen′s disease who developed multiple lesions, despite an absence of definite predisposing factors or an association with internal malignancy. The case is reported for this unusual feature for its rarity among the Indians.

  9. What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

    Science.gov (United States)

    Mulpuri, Kishore; Schaeffer, Emily K; Kelley, Simon P; Castañeda, Pablo; Clarke, Nicholas M P; Herrera-Soto, Jose A; Upasani, Vidyadhar; Narayanan, Unni G; Price, Charles T

    2016-05-01

    Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies. (1) How do patient demographics differ across participating centers at presentation? (2) How do patient diagnoses (severity and laterality) differ across centers? (3) How do initial treatment approaches differ across participating centers? A multicenter prospective hip dysplasia study database was analyzed from 2010 to April 2015. Patients younger than 6 months of age at diagnosis were included if at least one hip was completely dislocated, whereas patients between 6 and 18 months of age at diagnosis were included with any form of DDH. Participating centers (academic, urban, tertiary care hospitals) span five countries across three continents. Baseline data (patient demographics, diagnosis, swaddling history, baseline International Hip Dysplasia Institute classification, and initial treatment) were compared among all nine centers. A total of 496 patients were enrolled with site enrolment ranging from 10 to 117. The proportion of eligible patients who were enrolled and followed at the nine participating centers was 98%. Patient enrollment rates were similar across all sites, and data collection/completeness for relevant variables at initial presentation was comparable. In total, 83% of all patients were female (410 of 496), and the median age at presentation was 2.2 months (range, 0-18 months). Breech presentation occurred more often in younger (Hip Dysplasia Institute classification), which included 58% (51 of 88) of all classified dislocated hips. Splintage was the primary initial treatment of choice at 80% (395 of 496), but was far more likely in younger compared with older patients (94% [309 of 328] versus 18% [17 of 93]; p < 0.001). With the lack of strong prognostic indicators for DDH

  10. The relativistic solar particle event of May 17th, 2012 observed on board the International Space Station

    Directory of Open Access Journals (Sweden)

    Berrilli Francesco

    2014-05-01

    Full Text Available High-energy charged particles represent a severe radiation risk for astronauts and spacecrafts and could damage ground critical infrastructures related to space services. Different natural sources are the origin of these particles, among them galactic cosmic rays, solar energetic particles and particles trapped in radiation belts. Solar particle events (SPE consist in the emission of high-energy protons, alpha-particles, electrons and heavier particles from solar flares or shocks driven by solar plasma propagating through the corona and interplanetary space. Ground-level enhancements (GLE are rare solar events in which particles are accelerated to near relativistic energies and affect space and ground-based infrastructures. During the current solar cycle 24 a single GLE event was recorded on May 17th, 2012 associated with an M5.1-class solar flare. The investigation of such a special class of solar events permits us to measure conditions in space critical to both scientific and operational research. This event, classified as GLE71, was detected on board the International Space Station (ISS by the active particle detectors of the ALTEA (Anomalous Long Term Effects in Astronauts experiment. The collected data permit us to study the radiation environment inside the ISS. In this work we present the first results of the analysis of data acquired by ALTEA detectors during GLE71 associated with an M5.1-class solar flare. We estimate the energy loss spectrum of the solar particles and evaluate the contribution to the total exposure of ISS astronauts to solar high-energy charged particles.

  11. [Observation of single-layered inverted internal limiting membrane flap technique for macular hole with retinal detachment in high myopia].

    Science.gov (United States)

    Xu, C Z; Wu, J H; He, J W; Feng, C

    2017-05-11

    Objective: To compare the outcome of pars plana vitrectomy (PPV) with a single-layered inverted internal limiting membrane (ILM) flap versus PPV with ILM peeling for the treatment of macular hole associated retinal detachment (MHRD) in high myopia. Methods: In a retrospective cohort study, PPV with 2 kinds of adjuvant surgical procedures were used in 35 moderately high myopia eyes with MHRD. These eyes were divided into 2 groups: group 1 (17 eyes) receiving PPV and ILM peeling and group 2 (18 eyes) receiving PPV with a single-layered inverted ILM flap. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity (BCVA) were measured at 6 months after surgery. Results: The retina was successfully reattached in all cases. The difference of the retinal reattachment rate between the two groups was not statistically significant (Fisher's exact test, P= 1.000). The rate of macular hole closure was 47.1% in group 1 (8 eyes) and 88.9% in group 2 (16 eyes). The difference of the macular hole closure rate between the two groups was statistically significant (Fisher's exact test, P= 0.012). Significant improvement in logarithm of minimal angle of resolution (logMAR) BCVA was achieved in both groups. There was no difference in the initial, final, or improved logMAR BCVA in the 2 groups. Conclusion: Single-layered inverted ILM flap technique effectively helps close the macular hole in moderately high myopia with MHRD. This may prevent the possible redetachment from the macular hole. (Chin J Ophthalmol, 2017, 53: 338 - 343) .

  12. A developmental hypothesis to explain the multicentricity of breast cancer

    OpenAIRE

    Sharpe, C R

    1998-01-01

    In this article the author proposes that the multicentricity of breast cancer might be explained by a developmental hypothesis. Genetic alterations ("hits") occurring in epithelial stem cells during the development of the breast may be transmitted to populations of daughter cells during growth. As a result, areas of the breast may be predisposed to malignant transformation with the occurrence of further genetic hits. Areas with the same predisposition should be anatomically connected, and ear...

  13. Iohexol in investigations of the spinal canal. Multicentre study

    International Nuclear Information System (INIS)

    Bories, J.

    1988-01-01

    The author presents the results of a multicentric study of Iohexol in investigation of the spinal canal undertaken at the request of Winthrop Laboratories in 32 Radiological departments. The study involved 329 adults of both sexes. It confirmed the excellent quality of results obtained with this preparation in the literature and its excellent tolerance. On the basis of these results Iohexol may be considered to be definitely one of the best currently available preparations for investigation of the spinal canal [fr

  14. Observation planning algorithm of a Japanese space-borne sensor: Hyperspectral Imager SUIte (HISUI) onboard International Space Station (ISS) as platform

    Science.gov (United States)

    Ogawa, Kenta; Konno, Yukiko; Yamamoto, Satoru; Matsunaga, Tsuneo; Tachikawa, Tetsushi; Komoda, Mako

    2017-09-01

    Hyperspectral Imager Suite (HISUI) is a Japanese future space-borne hyperspectral instrument being developed by Ministry of Economy, Trade, and Industry (METI). HISUI will be launched in 2019 or later onboard International Space Station (ISS) as platform. HISUI has 185 spectral band from 0.4 to 2.5 μm with 20 by 30 m spatial resolution with swath of 20 km. Swath is limited as such, however observations in continental scale area are requested in HISUI mission lifetime of three years. Therefore we are developing a scheduling algorithm to generate effective observation plans. HISUI scheduling algorithm is to generate observation plans automatically based on platform orbit, observation area maps (we say DAR; "Data Acquisition Request" in HISUI project), their priorities, and available resources and limitation of HISUI system such as instrument operation time per orbit and data transfer capability. Then next we need to set adequate DAR before start of HISUI observation, because years of observations are needed to cover continental scale wide area that is difficult to change after the mission started. To address these issues, we have developed observation simulator. The simulator's critical inputs are DAR and the ISS's orbit, HISUI limitations in observation minutes per orbit, data storage and past cloud coverage data for term of HISUI observations (3 years). Then the outputs of simulator are coverage map of each day. Areas with cloud free image are accumulated for the term of observation up to three years. We have successfully tested the simulator and tentative DAR and found that it is possible to estimate coverage for each of requests for the mission lifetime.

  15. Multicentric ameboma of the colon mimicking Crohn′s disease

    Directory of Open Access Journals (Sweden)

    Biggs Saravanan Ramachandran

    2015-01-01

    Full Text Available Entamoeba histolytica infection can lead to colitis, colonic perforation abscess, and ameboma formation. Amebic colitis is common in developing countries, with its varied and nonspecific symptoms. Amebomas can occur rarely due to the formation of excess granulation tissue which usually occurs in cecum and ascending colon. A 64-year-old lady presented with abdominal pain and mass in the right side of abdomen. Imaging showed multicentric colonic masses. On colonoscopy multiple stricturizing ulcerated lesions involving cecum, ascending, proximal transverse colon, and splenic flexure were seen, which were suggestive of Crohn′s disease or multicentric neoplasm. Histopathological examination revealed multicentric lesion with focal necrosis and trophozoites of E. histolytica. Diagnosis of ameboma was made and antiamoebic treatment was started. She had full resolution of symptoms. We present this case since it is a case of ameboma, a rare complication of amebic colitis with an extremely rare presentation of multiple ulcerated stricturizing lesions, involving cecum, ascending, transverse colon, and splenic flexure which typically resembled Crohn′s disease.

  16. Internal solitary waves on the Saya de Malha bank of the Mascarene Plateau: SAR observations and interpretation

    Science.gov (United States)

    New, A. L.; Magalhaes, J. M.; da Silva, J. C. B.

    2013-09-01

    Energetic Internal Solitary Waves (ISWs) were recently discovered radiating from the central region of the Mascarene Plateau in the south-western Indian Ocean (da Silva et al., 2011). SAR imagery revealed the two-dimensional structure of the waves which propagated for several hundred kilometres in deep water both to the east and west of a sill, located near 12.5°S, 61°E between the Saya de Malha and Nazareth banks. These waves were presumed to originate from the disintegration of a large lee wave formed on the western side of the sill at the time of maximum barotropic flow to the west. In the present paper we focus instead on ISWs propagating in the shallow water above the Saya da Malha (SM) bank (to the north of the sill), rather than on those propagating in deep water (here denominated as type-I or -II waves if propagating to the west or east respectively). Analysis of an extended SAR image dataset reveals strong sea surface signatures of complex patterns of ISWs propagating over the SM bank arising from different sources. We identify three distinct types of waves, and propose suitable generation mechanisms for them using synergy from different remotely sensed datasets, together with analyses of linear phase speeds (resulting from local stratification and bathymetry). In particular, we find a family of ISWs (termed here A-type waves) which results from the disintegration of a lee wave which forms on the western slopes of SM. We also identify two further wave trains (B- and C-type waves) which we suggest result from refraction of the deep water type-I and -II waves onto the SM bank. Therefore, both B- and C-type waves can be considered to result from the same generation source as the type-I and -II waves. Finally, we consider the implications of the ISWs for mixing and biological production over the SM bank, and provide direct evidence, from ocean colour satellite images, of enhanced surface chlorophyll over a shallow topographic feature on the bank, which is

  17. Data rescue of NASA First ISLSCP (International Satellite Land Surface Climatology Project) Field Experiment (FIFE) aerial observations

    Science.gov (United States)

    Santhana Vannan, S. K.; Boyer, A.; Deb, D.; Beaty, T.; Wei, Y.; Wei, Z.

    2017-12-01

    The Oak Ridge National Laboratory Distributed Active Archive Center (ORNL DAAC) for biogeochemical dynamics is one of the NASA Earth Observing System Data and Information System (EOSDIS) data centers. ORNL DAAC (https://daac.ornl.gov) is responsible for data archival, product development and distribution, and user support for biogeochemical and ecological data and models. In particular, ORNL DAAC has been providing data management support for NASA's terrestrial ecology field campaign programs for the last several decades. Field campaigns combine ground, aircraft, and satellite-based measurements in specific ecosystems over multi-year time periods. The data collected during NASA field campaigns are archived at the ORNL DAAC (https://daac.ornl.gov/get_data/). This paper describes the effort of the ORNL DAAC team for data rescue of a First ISLSCP Field Experiment (FIFE) dataset containing airborne and satellite data observations from the 1980s. The data collected during the FIFE campaign contain high resolution aerial imageries collected over Kansas. The data rescue workflow was prepared to test for successful recovery of the data from a CD-ROM and to ensure that the data are usable and preserved for the future. The imageries contain spectral reflectance data that can be used as a historical benchmark to examine climatological and ecological changes in the Kansas region since the 1980s. Below are the key steps taken to convert the files to modern standards. Decompress the imageries using custom compression software provided with the data. The compression algorithm created for MS-DOS in 1980s had to be set up to run on modern computer systems. Decompressed files were geo-referenced by using metadata information stored in separate compressed header files. Standardized file names were applied (File names and details were described in separate readme documents). Image files were converted to GeoTIFF format with embedded georeferencing information. Leverage Open Geospatial

  18. Internationally coordinated multi-mission planning is now critical to sustain the space-based rainfall observations needed for managing floods globally

    International Nuclear Information System (INIS)

    Reed, Patrick M; Herman, Jonathan D; Chaney, Nathaniel W; Wood, Eric F; Ferringer, Matthew P

    2015-01-01

    At present 4 of 10 dedicated rainfall observing satellite systems have exceeded their design life, some by more than a decade. Here, we show operational implications for flood management of a ‘collapse’ of space-based rainfall observing infrastructure as well as the high-value opportunities for a globally coordinated portfolio of satellite missions and data services. Results show that the current portfolio of rainfall missions fails to meet operational data needs for flood management, even when assuming a perfectly coordinated data product from all current rainfall-focused missions (i.e., the full portfolio). In the full portfolio, satellite-based rainfall data deficits vary across the globe and may preclude climate adaptation in locations vulnerable to increasing flood risks. Moreover, removing satellites that are currently beyond their design life (i.e., the reduced portfolio) dramatically increases data deficits globally and could cause entire high intensity flood events to be unobserved. Recovery from the reduced portfolio is possible with internationally coordinated replenishment of as few as 2 of the 4 satellite systems beyond their design life, yielding rainfall data coverages that outperform the current full portfolio (i.e., an optimized portfolio of eight satellites can outperform ten satellites). This work demonstrates the potential for internationally coordinated satellite replenishment and data services to substantially enhance the cost-effectiveness, sustainability and operational value of space-based rainfall observations in managing evolving flood risks. (letter)

  19. Can nuclear physics explain the anomaly observed in the internal pair production in the Beryllium-8 nucleus?

    Directory of Open Access Journals (Sweden)

    Xilin Zhang

    2017-10-01

    Full Text Available Recently the experimentalists in Krasznahorkay (2016 [1] announced observing an unexpected enhancement of the e+–e− pair production signal in one of the 8Be nuclear transitions. The subsequent studies have been focused on possible explanations based on introducing new types of particle. In this work, we improve the nuclear physics modeling of the reaction by studying the pair emission anisotropy and the interferences between different multipoles in an effective field theory inspired framework, and examine their possible relevance to the anomaly. The connection between the previously measured on-shell photon production and the pair production in the same nuclear transitions is established. These improvements, absent in the original experimental analysis, should be included in extracting new particle's properties from the experiment of this type. However, the improvements can not explain the anomaly. We then explore the nuclear transition form factor as a possible origin of the anomaly, and find the required form factor to be unrealistic for the 8Be nucleus. The reduction of the anomaly's significance by simply rescaling our predicted event count is also investigated.

  20. The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.

    Science.gov (United States)

    Rasova, Kamila; Freeman, Jenny; Martinkova, Patricia; Pavlikova, Marketa; Cattaneo, Davide; Jonsdottir, Johanna; Henze, Thomas; Baert, Ilse; Van Asch, Paul; Santoyo, Carme; Smedal, Tori; Beiske, Antonie Giæver; Stachowiak, Małgorzata; Kovalewski, Mariusz; Nedeljkovic, Una; Bakalidou, Daphne; Guerreiro, José Manuel Alves; Nilsagård, Ylva; Dimitrova, Erieta Nikolikj; Habek, Mario; Armutlu, Kadriye; Donzé, Cécile; Ross, Elaine; Ilie, Ana Maria; Martić, Andrej; Romberg, Anders; Feys, Peter

    2016-10-06

    Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe. Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined. Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046). This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service

  1. Characterization and utilization of an international neurofibromatosis web-based, patient-entered registry: An observational study.

    Directory of Open Access Journals (Sweden)

    Mindell Seidlin

    Full Text Available The neurofibromatoses (neurofibromatosis type 1, neurofibromatosis type 2 and schwannomatosis are rare disorders having clinical manifestations that vary greatly from patient to patient. The rarity and variability of these disorders has made it challenging for investigators to identify sufficient numbers of patients with particular clinical characteristics or specific germline mutations for participation in interventional studies. Similarly, because the natural history of all types of neurofibromatosis (NF is variable and unique for each individual, it is difficult to identify meaningful clinical outcome measures for potential therapeutic interventions. In 2012, the Children's Tumor Foundation created a web-based patient-entered database, the NF Registry, to inform patients of research opportunities for which they fit general eligibility criteria and enable patients to contact investigators who are seeking to enroll patients in approved trials. Registrants were recruited through CTF-affiliated NF clinics and conferences, through its website, and by word-of-mouth and social media. Following online consent, demographic information and details regarding manifestations of NF were solicited on the Registry website. Statistical analyses were performed on data from a cohort of 4680 registrants (the number of registrants as of October 9, 2015 who met diagnostic criteria for one of the 3 NF conditions. The analyses support our hypothesis that patient-reported symptom incidences in the NF Registry are congruent with published clinician-sourced data. Between April 26, 2013 and July 8, 2016, the registry has been useful to investigators in recruitment, particularly for observational trials, especially those for development of patient-reported outcomes.

  2. Fast neutrons in the treatment of head and neck cancers: the results of a multi-centre randomly controlled trial

    International Nuclear Information System (INIS)

    Duncan, W.; Arnott, S.J.; Orr, J.A.; Kerr, G.R.; Schmitt, G.

    1984-01-01

    The results are presented of a multi-centre randomly controlled trial of fast neutron irradiation and mega-voltage X-rays in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck region. No significant difference was observed in local tumour control rates. Salvage surgery was performed in a similar number of patients in the two groups. Late morbidity was also similar in the two treatment groups. Patients in a subgroup with cancer of the larynx treated by photons had a significantly better survival than those in the neutron treated group. (Auth.)

  3. First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study

    Directory of Open Access Journals (Sweden)

    Kajiwara N

    2017-10-01

    referral visiting the Department of Internal Medicine at a medium-sized acute care hospital in Japan. Common RFEs were abdominal pain, cough, and fever. A tendency toward overprescription of antibiotics was observed among primary care physicians. Keywords: medium-sized hospital, general internal medicine, general practice, reason for encounter, International Classification of Primary Care, antibiotic overuse

  4. Mini-EUSO: A Precursor Mission on the International Space Station for the Observation of Atmosphere and Earth in the UV Light

    Science.gov (United States)

    Ricci, Marco

    For any experiment aiming at the observation of Ultra High Energy Cosmic Rays (UHECRs) from space, one key measurement is related to the UV emissions produced in the Earth's atmosphere. In view of the planned missions under study (KLYPVE-EUSO, JEM-EUSO, EUSO-FF) at the International Space Station (ISS) and on board of free-flyer satellites, a small, compact UV telescope, Mini-EUSO, is being developed by the JEM-EUSO International Collaboration to be placed at the UV-transparent, nadir looking window of the Russian module of the ISS. In addition to the main purpose of mapping the Earth in the UV range (300-400 nm), Mini-EUSO will also perform studies of atmospheric phenomena, observation of meteors, strange quark matter search and space debris tracking. It will as well enhance the technological readiness level of the EUSO concept and instruments. Mini-EUSO is a mission approved and selected by the Italian Space Agency (ASI) and, under the name "UV atmosphere", by the Russian Space Agency Roscosmos.

  5. Clinical Outcome after the Use of a New Craniocaudal Expandable Implant for Vertebral Compression Fracture Treatment: One Year Results from a Prospective Multicentric Study

    OpenAIRE

    Noriega, David; Kr?ger, Antonio; Ardura, Francisco; Hansen-Algenstaedt, Nils; Hassel, Frank; Barreau, Xavier; Beyerlein, J?rg

    2015-01-01

    The purpose of this prospective multicentric observational study was to confirm the safety and clinical performance of a craniocaudal expandable implant used in combination with high viscosity PMMA bone cement for the treatment of vertebral compression fractures. Thirty-nine VCFs in 32 patients were treated using the SpineJack minimally invasive surgery protocol. Outcome was determined by using the Visual Analogue Scale for measuring pain, the Oswestry Disability Index for scoring functional ...

  6. Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study

    OpenAIRE

    Noriega, David; Maestretti, Gianluca; Renaud, Christian; Francaviglia, Natale; Ould-Slimane, Mourad; Queinnec, Steffen; Ekkerlein, Helmut; Hassel, Frank; Gumpert, Rainer; Sabatier, Pascal; Huet, Herv?; Plasencia, Miguel; Theumann, Nicolas; Kunsky, Alexander; Kr?ger, Antonio

    2015-01-01

    This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 ho...

  7. Role of the internet as an information resource before anaesthesia consultation: A French prospective multicentre survey.

    Science.gov (United States)

    Nucci, Bastian; Claret, Pierre-Geraud; Leclerc, Gilles; Chaumeron, Arnaud; Grillo, Philippe; Buleon, Clément; Leprince, Vincent; Raux, Mathieu; Minville, Vincent; Futier, Emmanuel; Lefrant, Jean-Yves; Cuvillon, Philippe

    2017-12-01

    Use of the internet as an information search tool has increased dramatically. Our study assessed preoperative use of the internet by patients to search for information regarding anaesthesia, surgery, pain or outcomes. The aim of this study was to test whether patients used the internet prior to surgery and what kinds of information they looked for (anaesthetic technique, pain, adverse events, outcomes and surgery). Correlation between patient age and information sought about surgery from the internet was also explored. A prospective multicentre observational study. In total, 14 French private and public institutions from May 2015 to January 2016. In total, 3161 adult patients scheduled for elective surgery under regional or general anaesthesia. An anonymous questionnaire was presented to adult patients scheduled for elective surgery under regional or general anaesthesia for completion before the first meeting with the anaesthesiologist. The investigator at each centre completed specific items that the patient could not complete. We defined the primary endpoint as the number of patients who searched for information about their anaesthesia or surgery on the internet by the time of the their preanaesthetic consultation. Of the 3234 questionnaires distributed, responses were received from 3161 patients. Within this respondent sample, 1304 (45%) were professionally active and 1664 (59%) used the internet at least once per day. Among 3098 (98%) patients who answered the question concerning the primary endpoint, 1506 (48%) had searched the internet for information about their health. In total, 784 (25%) used the internet to find information about their surgery and 113 (3.5%) looked for specific information about anaesthesia. Of the 3161, 52% reported difficulty searching for appropriate information about anaesthesia on the internet. 'Daily use of the web' [odds ratio (OR) 2.0; (95% CI: 1.65 to 2.55) P internet was not widely used by patients scheduled for elective

  8. Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study.

    Science.gov (United States)

    Iliou, Marie C; Vergès-Patois, Bénédicte; Pavy, Bruno; Charles-Nelson, Anais; Monpère, Catherine; Richard, Rudy; Verdier, Jean C

    2017-08-01

    Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant

  9. Risk of, and survival following, histological transformation in follicular lymphoma in the rituximab era. A retrospective multicentre study by the Spanish GELTAMO group.

    Science.gov (United States)

    Alonso-Álvarez, Sara; Magnano, Laura; Alcoceba, Miguel; Andrade-Campos, Marcio; Espinosa-Lara, Natalia; Rodríguez, Guillermo; Mercadal, Santiago; Carro, Itziar; Sancho, Juan M; Moreno, Miriam; Salar, Antonio; García-Pallarols, Francesc; Arranz, Reyes; Cannata, Jimena; Terol, María José; Teruel, Ana I; Rodríguez, Antonia; Jiménez-Ubieto, Ana; González de Villambrosia, Sonia; Bello, José L; López, Lourdes; Monsalvo, Silvia; Novelli, Silvana; de Cabo, Erik; Infante, María S; Pardal, Emilia; García-Álvarez, María; Delgado, Julio; González, Marcos; Martín, Alejandro; López-Guillermo, Armando; Caballero, María D

    2017-09-01

    The diagnostic criteria for follicular lymphoma (FL) transformation vary among the largest series, which commonly exclude histologically-documented transformation (HT) mandatorily. The aims of this retrospective observational multicentre study by the Spanish Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea, which recruited 1734 patients (800 males/934 females; median age 59 years), diagnosed with FL grades 1-3A, were, (i) the cumulative incidence of HT (CI-HT); (ii) risk factors associated with HT; and (iii) the role of treatment and response on survival following transformation (SFT). With a median follow-up of 6·2 years, 106 patients developed HT. Ten-year CI-HT was 8%. Considering these 106 patients who developed HT, median time to transformation was 2·5 years. High-risk FL International Prognostic Index [Hazard ratio (HR) 2·6, 95% confidence interval (CI): 1·5-4·5] and non-response to first-line therapy (HR 2·9, 95% CI: 1·3-6·8) were associated with HT. Seventy out of the 106 patients died (5-year SFT, 26%). Response to HT first-line therapy (HR 5·3, 95% CI: 2·4-12·0), autologous stem cell transplantation (HR 3·9, 95% CI: 1·5-10·1), and revised International Prognostic Index (HR 2·2, 95% CI: 1·1-4·2) were significantly associated with SFT. Response to treatment and HT were the variables most significantly associated with survival in the rituximab era. Better therapies are needed to improve response. Inclusion of HT in clinical trials with new agents is mandatory. © 2017 John Wiley & Sons Ltd.

  10. Multicentric Castleman’s Disease, Associated with Idiopathic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Ruchi Sood

    2013-01-01

    Full Text Available The most common cause of a neck mass in young adults is hyperplastic lymphadenopathy consequent to infection and inflammation. Castleman’s disease (CD, an unusual benign lymphoproliferative disorder, infrequently causes neck masses. It occurs in unicentric (UCD and multicentric (MCD forms and is associated with human immunodeficiency virus (HIV, human herpes virus 8 (HHV-8, and Kaposi's sarcoma. We present the third known association between MCD and previous immune thrombocytopenia in the absence of HIV and HHV-8 infection and review its association with other autoimmune disorders and attendant implications for pathogenesis. Finally, we summarize the current approach to therapy.

  11. Masquerade Syndrome of Multicentre Primary Central Nervous System Lymphoma

    Directory of Open Access Journals (Sweden)

    Silvana Guerriero

    2011-01-01

    Full Text Available Purpose. In Italy we say that the most unlucky things can happen to physicians when they get sick, despite the attention of colleagues. To confirm this rumor, we report the sad story of a surgeon with bilateral vitreitis and glaucoma unresponsive to traditional therapies. Methods/Design. Case report. Results. After one year of steroidal and immunosuppressive therapy, a vitrectomy, and a trabeculectomy for unresponsive bilateral vitreitis and glaucoma, MRI showed a multicentre primary central nervous system lymphoma, which was the underlying cause of the masquerade syndrome. Conclusions. All ophthalmologists and clinicians must be aware of masquerade syndromes, in order to avoid delays in diagnosis.

  12. Hypercalcaemic multicentric lymphoma in a dog presenting as clitoromegaly

    Directory of Open Access Journals (Sweden)

    Anthony B. Zambelli

    2013-12-01

    Full Text Available Clitoromegaly is a clinical manifestation of various local and systemic conditions in all species. The external genitalia are a very rare site of primary or metastatic lymphoma in canines, with only one previously-reported case in a dog and only sparse reports in the medical literature. Lymphoma is also very rare in dogs less than four years of age. This account reports on a T-cell multicentric lymphoma in a 16-month-old Basset hound presented primarily for clitoromegaly. The patient survived for 68 days with cyclophosphamide-vincristine-prednisolone therapy. The causes of clitoromegaly in all species, including humans, are tabulated with references.

  13. A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa-accreta: A STROBE compliant article.

    Science.gov (United States)

    Fan, Yao; Gong, Xun; Wang, Nan; Mu, Ketao; Feng, Ling; Qiao, Fuyuan; Chen, Suhua; Zeng, Wanjiang; Liu, Haiyi; Wu, Yuanyuan; Zhou, Qiong; Tian, Yuan; Li, Qiang; Yang, Meitao; Li, Fanfan; He, Mengzhou; Beejadhursing, Rajluxmee; Deng, Dongrui

    2017-11-01

    We studied the efficacy of prophylactic internal iliac artery balloon catheterization for managing severe hemorrhage caused by pernicious placenta previa.This prospective observational study was conducted in Tongji Hospital, Wuhan, China. One hundred sixty-three women past 32-week's gestation with placenta previa-accreta were recruited and managed. Women in the balloon group accepted prophylactic internal iliac artery balloon catheterization before scheduled caesarean delivery and controls had a conventional caesarean delivery. Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complications, and neonatal outcomes were discussed.Significant differences were detected in estimated blood loss (1236.0 mL vs 1694.0 mL, P = .01), calculated blood loss (CBL) (813.8 mL vs 1395.0 mL, P < .001), CBL of placenta located anteriorly (650.5 mL vs 1196.0 mL, P = .03), and anterioposteriorly (928.3 mL vs 1680.0 mL, P = .02). Prophylactic balloon catheterization could reduce intraoperative red blood cell transfusion (728.0 mL vs 1205.0 mL, P = .01) and lessen usage of perioperative hemostatic methods. The incidence of hysterectomy was lower in balloon group. Mean radiation dose was 29.2 mGy and mean exposure time was 92.2 seconds. Neonatal outcomes and follow-up data did not have significant difference.Prophylactic internal iliac artery balloon catheterization is an effective method for managing severe hemorrhage caused by placenta previa-accreta as it reduced intraoperative blood loss, lessened perioperative hemostatic measures and intraoperative red cell transfusions, and reduce hysterectomies.

  14. Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience

    Directory of Open Access Journals (Sweden)

    Cirocchi Roberto

    2012-04-01

    Full Text Available Abstract Background We conducted an observational multicentric clinical study on a cohort of patients undergoing thyroidectomy for thyroid carcinoma. The aim of this study was to evaluate the benefits of the use of ultrasonic dissector (UAS vs. the use of a conventional technique (vessel clamp and tie in patients undergoing thyroid surgery for cancer. Methods From June 2009 to May 2010 we evaluated 321 consecutive patients electively admitted to undergo total thyroidectomy for thyroid carcinoma. The first 201 patients (89 males, 112 females presenting to our Department underwent thyroidectomy with the use of UAS while the following 120 patients (54 males, 66 females underwent thyroidectomy performed with a conventional technique (CT: vessel clamp and tie. Results The operative time (mean: 75 min in UAS vs. 113 min in CT, range: 54 to 120 min in UAS vs. 68 to 173 min in CT was much shorter in the group of thyroidectomies performed with UAS. The incidence of transient laryngeal nerve palsy (UAS 3/201 patients (1.49%; CT 1/120 patients (0.83% was higher in the group of UAS; the incidence of permanent laryngeal nerve palsy was similar in the two groups (UAS 2/201 patients (0.99% vs. CT 2/120 patients (1.66%. The incidence of transient hypocalcaemia (UAS 17/201 patients (8.4% vs. CT 9/120 patients (7.5% was higher in the UAS group; no relevant differences were reported in the incidence of permanent hypocalcaemia in the two groups (UAS 5/201 patients (2.48% vs. 2/120 patients (1.66%. Also the average postoperative length of stay was similar in two groups (2 days. Conclusion The only significant advantage proved by this study is represented by the cost-effectiveness (reduction of the usage of operating room for patients treated with UAS, secondary to the significant reduction of the operative time. The analysis failed to show any advantages in terms of postoperative transient complications in the group of patients treated with ultrasonic

  15. Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: A study protocol of an ongoing multi-centre randomised controlled clinical trial [ISRCTN27450856

    Directory of Open Access Journals (Sweden)

    Krämer Jürgen

    2004-03-01

    Full Text Available Abstract Background Controlled clinical trials produced contradictory results with respect to a specific analgesic effect of acupuncture. There is a lack of large multi-centre acupuncture trials. The German Acupuncture Trial represents the largest multi-centre study of acupuncture in the treatment of chronic pain caused by gonarthrosis up to now. Methods 900 patients will be randomised to three treatment arms. One group receives verum acupuncture, the second sham acupuncture, and the third conservative standard therapy. The trial protocol is described with eligibility criteria, detailed information on the treatment definition, blinding, endpoints, safety evaluation, statistical methods, sample size determination, monitoring, legal aspects, and the current status of the trial. Discussion A critical discussion is given regarding the considerations about standardisation of the acupuncture treatment, the choice of the control group, and the blinding of patients and observers.

  16. Expedition Earth and Beyond: Using Crew Earth Observation Imagery from the International Space Station to Facilitate Student-Led Authentic Research

    Science.gov (United States)

    Graff, P. V.; Stefanov, W. L.; Willis, K. J.; Runco, S.

    2012-01-01

    Student-led authentic research in the classroom helps motivate students in science, technology, engineering, and mathematics (STEM) related subjects. Classrooms benefit from activities that provide rigor, relevance, and a connection to the real world. Those real world connections are enhanced when they involve meaningful connections with NASA resources and scientists. Using the unique platform of the International Space Station (ISS) and Crew Earth Observation (CEO) imagery, the Expedition Earth and Beyond (EEAB) program provides an exciting way to enable classrooms in grades 5-12 to be active participants in NASA exploration, discovery, and the process of science. EEAB was created by the Astromaterials Research and Exploration Science (ARES) Education Program, at the NASA Johnson Space Center. This Earth and planetary science education program has created a framework enabling students to conduct authentic research about Earth and/or planetary comparisons using the captivating CEO images being taken by astronauts onboard the ISS. The CEO payload has been a science payload onboard the ISS since November 2000. ISS crews are trained in scientific observation of geological, oceanographic, environmental, and meteorological phenomena. Scientists on the ground select and periodically update a series of areas to be photographed as part of the CEO science payload.

  17. Development of a Geomagnetic Storm Correction to the International Reference Ionosphere E-Region Electron Densities Using TIMED/SABER Observations

    Science.gov (United States)

    Mertens, C. J.; Xu, X.; Fernandez, J. R.; Bilitza, D.; Russell, J. M., III; Mlynczak, M. G.

    2009-01-01

    Auroral infrared emission observed from the TIMED/SABER broadband 4.3 micron channel is used to develop an empirical geomagnetic storm correction to the International Reference Ionosphere (IRI) E-region electron densities. The observation-based proxy used to develop the storm model is SABER-derived NO+(v) 4.3 micron volume emission rates (VER). A correction factor is defined as the ratio of storm-time NO+(v) 4.3 micron VER to a quiet-time climatological averaged NO+(v) 4.3 micron VER, which is linearly fit to available geomagnetic activity indices. The initial version of the E-region storm model, called STORM-E, is most applicable within the auroral oval region. The STORM-E predictions of E-region electron densities are compared to incoherent scatter radar electron density measurements during the Halloween 2003 storm events. Future STORM-E updates will extend the model outside the auroral oval.

  18. Observation of New Properties of Secondary Cosmic Rays Lithium, Beryllium, and Boron by the Alpha Magnetic Spectrometer on the International Space Station.

    Science.gov (United States)

    Aguilar, M; Ali Cavasonza, L; Ambrosi, G; Arruda, L; Attig, N; Aupetit, S; Azzarello, P; Bachlechner, A; Barao, F; Barrau, A; Barrin, L; Bartoloni, A; Basara, L; Başeğmez-du Pree, S; Battarbee, M; Battiston, R; Becker, U; Behlmann, M; Beischer, B; Berdugo, J; Bertucci, B; Bindel, K F; Bindi, V; de Boer, W; Bollweg, K; Bonnivard, V; Borgia, B; Boschini, M J; Bourquin, M; Bueno, E F; Burger, J; Burger, W J; Cadoux, F; Cai, X D; Capell, M; Caroff, S; Casaus, J; Castellini, G; Cervelli, F; Chae, M J; Chang, Y H; Chen, A I; Chen, G M; Chen, H S; Cheng, L; Chou, H Y; Choumilov, E; Choutko, V; Chung, C H; Clark, C; Clavero, R; Coignet, G; Consolandi, C; Contin, A; Corti, C; Creus, W; Crispoltoni, M; Cui, Z; Dadzie, K; Dai, Y M; Datta, A; Delgado, C; Della Torre, S; Demirköz, M B; Derome, L; Di Falco, S; Dimiccoli, F; Díaz, C; von Doetinchem, P; Dong, F; Donnini, F; Duranti, M; D'Urso, D; Egorov, A; Eline, A; Eronen, T; Feng, J; Fiandrini, E; Fisher, P; Formato, V; Galaktionov, Y; Gallucci, G; García-López, R J; Gargiulo, C; Gast, H; Gebauer, I; Gervasi, M; Ghelfi, A; Giovacchini, F; Gómez-Coral, D M; Gong, J; Goy, C; Grabski, V; Grandi, D; Graziani, M; Guo, K H; Haino, S; Han, K C; He, Z H; Heil, M; Hsieh, T H; Huang, H; Huang, Z C; Huh, C; Incagli, M; Ionica, M; Jang, W Y; Jia, Yi; Jinchi, H; Kang, S C; Kanishev, K; Khiali, B; Kim, G N; Kim, K S; Kirn, Th; Konak, C; Kounina, O; Kounine, A; Koutsenko, V; Kulemzin, A; La Vacca, G; Laudi, E; Laurenti, G; Lazzizzera, I; Lebedev, A; Lee, H T; Lee, S C; Leluc, C; Li, H S; Li, J Q; Li, Q; Li, T X; Li, Y; Li, Z H; Li, Z Y; Lim, S; Lin, C H; Lipari, P; Lippert, T; Liu, D; Liu, Hu; Lordello, V D; Lu, S Q; Lu, Y S; Luebelsmeyer, K; Luo, F; Luo, J Z; Lyu, S S; Machate, F; Mañá, C; Marín, J; Martin, T; Martínez, G; Masi, N; Maurin, D; Menchaca-Rocha, A; Meng, Q; Mikuni, V M; Mo, D C; Mott, P; Nelson, T; Ni, J Q; Nikonov, N; Nozzoli, F; Oliva, A; Orcinha, M; Palermo, M; Palmonari, F; Palomares, C; Paniccia, M; Pauluzzi, M; Pensotti, S; Perrina, C; Phan, H D; Picot-Clemente, N; Pilo, F; Pizzolotto, C; Plyaskin, V; Pohl, M; Poireau, V; Quadrani, L; Qi, X M; Qin, X; Qu, Z Y; Räihä, T; Rancoita, P G; Rapin, D; Ricol, J S; Rosier-Lees, S; Rozhkov, A; Rozza, D; Sagdeev, R; Schael, S; Schmidt, S M; Schulz von Dratzig, A; Schwering, G; Seo, E S; Shan, B S; Shi, J Y; Siedenburg, T; Son, D; Song, J W; Tacconi, M; Tang, X W; Tang, Z C; Tescaro, D; Ting, Samuel C C; Ting, S M; Tomassetti, N; Torsti, J; Türkoğlu, C; Urban, T; Vagelli, V; Valente, E; Valtonen, E; Vázquez Acosta, M; Vecchi, M; Velasco, M; Vialle, J P; Vitale, V; Wang, L Q; Wang, N H; Wang, Q L; Wang, X; Wang, X Q; Wang, Z X; Wei, C C; Weng, Z L; Whitman, K; Wu, H; Wu, X; Xiong, R Q; Xu, W; Yan, Q; Yang, J; Yang, M; Yang, Y; Yi, H; Yu, Y J; Yu, Z Q; Zannoni, M; Zeissler, S; Zhang, C; Zhang, F; Zhang, J; Zhang, J H; Zhang, S W; Zhang, Z; Zheng, Z M; Zhuang, H L; Zhukov, V; Zichichi, A; Zimmermann, N; Zuccon, P

    2018-01-12

    We report on the observation of new properties of secondary cosmic rays Li, Be, and B measured in the rigidity (momentum per unit charge) range 1.9 GV to 3.3 TV with a total of 5.4×10^{6} nuclei collected by AMS during the first five years of operation aboard the International Space Station. The Li and B fluxes have an identical rigidity dependence above 7 GV and all three fluxes have an identical rigidity dependence above 30 GV with the Li/Be flux ratio of 2.0±0.1. The three fluxes deviate from a single power law above 200 GV in an identical way. This behavior of secondary cosmic rays has also been observed in the AMS measurement of primary cosmic rays He, C, and O but the rigidity dependences of primary cosmic rays and of secondary cosmic rays are distinctly different. In particular, above 200 GV, the secondary cosmic rays harden more than the primary cosmic rays.

  19. Observation of New Properties of Secondary Cosmic Rays Lithium, Beryllium, and Boron by the Alpha Magnetic Spectrometer on the International Space Station

    Science.gov (United States)

    Aguilar, M.; Ali Cavasonza, L.; Ambrosi, G.; Arruda, L.; Attig, N.; Aupetit, S.; Azzarello, P.; Bachlechner, A.; Barao, F.; Barrau, A.; Barrin, L.; Bartoloni, A.; Basara, L.; Başeǧmez-du Pree, S.; Battarbee, M.; Battiston, R.; Becker, U.; Behlmann, M.; Beischer, B.; Berdugo, J.; Bertucci, B.; Bindel, K. F.; Bindi, V.; de Boer, W.; Bollweg, K.; Bonnivard, V.; Borgia, B.; Boschini, M. J.; Bourquin, M.; Bueno, E. F.; Burger, J.; Burger, W. J.; Cadoux, F.; Cai, X. D.; Capell, M.; Caroff, S.; Casaus, J.; Castellini, G.; Cervelli, F.; Chae, M. J.; Chang, Y. H.; Chen, A. I.; Chen, G. M.; Chen, H. S.; Cheng, L.; Chou, H. Y.; Choumilov, E.; Choutko, V.; Chung, C. H.; Clark, C.; Clavero, R.; Coignet, G.; Consolandi, C.; Contin, A.; Corti, C.; Creus, W.; Crispoltoni, M.; Cui, Z.; Dadzie, K.; Dai, Y. M.; Datta, A.; Delgado, C.; Della Torre, S.; Demirköz, M. B.; Derome, L.; Di Falco, S.; Dimiccoli, F.; Díaz, C.; von Doetinchem, P.; Dong, F.; Donnini, F.; Duranti, M.; D'Urso, D.; Egorov, A.; Eline, A.; Eronen, T.; Feng, J.; Fiandrini, E.; Fisher, P.; Formato, V.; Galaktionov, Y.; Gallucci, G.; García-López, R. J.; Gargiulo, C.; Gast, H.; Gebauer, I.; Gervasi, M.; Ghelfi, A.; Giovacchini, F.; Gómez-Coral, D. M.; Gong, J.; Goy, C.; Grabski, V.; Grandi, D.; Graziani, M.; Guo, K. H.; Haino, S.; Han, K. C.; He, Z. H.; Heil, M.; Hsieh, T. H.; Huang, H.; Huang, Z. C.; Huh, C.; Incagli, M.; Ionica, M.; Jang, W. Y.; Jia, Yi; Jinchi, H.; Kang, S. C.; Kanishev, K.; Khiali, B.; Kim, G. N.; Kim, K. S.; Kirn, Th.; Konak, C.; Kounina, O.; Kounine, A.; Koutsenko, V.; Kulemzin, A.; La Vacca, G.; Laudi, E.; Laurenti, G.; Lazzizzera, I.; Lebedev, A.; Lee, H. T.; Lee, S. C.; Leluc, C.; Li, H. S.; Li, J. Q.; Li, Q.; Li, T. X.; Li, Y.; Li, Z. H.; Li, Z. Y.; Lim, S.; Lin, C. H.; Lipari, P.; Lippert, T.; Liu, D.; Liu, Hu; Lordello, V. D.; Lu, S. Q.; Lu, Y. S.; Luebelsmeyer, K.; Luo, F.; Luo, J. Z.; Lyu, S. S.; Machate, F.; Mañá, C.; Marín, J.; Martin, T.; Martínez, G.; Masi, N.; Maurin, D.; Menchaca-Rocha, A.; Meng, Q.; Mikuni, V. M.; Mo, D. C.; Mott, P.; Nelson, T.; Ni, J. Q.; Nikonov, N.; Nozzoli, F.; Oliva, A.; Orcinha, M.; Palermo, M.; Palmonari, F.; Palomares, C.; Paniccia, M.; Pauluzzi, M.; Pensotti, S.; Perrina, C.; Phan, H. D.; Picot-Clemente, N.; Pilo, F.; Pizzolotto, C.; Plyaskin, V.; Pohl, M.; Poireau, V.; Quadrani, L.; Qi, X. M.; Qin, X.; Qu, Z. Y.; Räihä, T.; Rancoita, P. G.; Rapin, D.; Ricol, J. S.; Rosier-Lees, S.; Rozhkov, A.; Rozza, D.; Sagdeev, R.; Schael, S.; Schmidt, S. M.; Schulz von Dratzig, A.; Schwering, G.; Seo, E. S.; Shan, B. S.; Shi, J. Y.; Siedenburg, T.; Son, D.; Song, J. W.; Tacconi, M.; Tang, X. W.; Tang, Z. C.; Tescaro, D.; Ting, Samuel C. C.; Ting, S. M.; Tomassetti, N.; Torsti, J.; Türkoǧlu, C.; Urban, T.; Vagelli, V.; Valente, E.; Valtonen, E.; Vázquez Acosta, M.; Vecchi, M.; Velasco, M.; Vialle, J. P.; Vitale, V.; Wang, L. Q.; Wang, N. H.; Wang, Q. L.; Wang, X.; Wang, X. Q.; Wang, Z. X.; Wei, C. C.; Weng, Z. L.; Whitman, K.; Wu, H.; Wu, X.; Xiong, R. Q.; Xu, W.; Yan, Q.; Yang, J.; Yang, M.; Yang, Y.; Yi, H.; Yu, Y. J.; Yu, Z. Q.; Zannoni, M.; Zeissler, S.; Zhang, C.; Zhang, F.; Zhang, J.; Zhang, J. H.; Zhang, S. W.; Zhang, Z.; Zheng, Z. M.; Zhuang, H. L.; Zhukov, V.; Zichichi, A.; Zimmermann, N.; Zuccon, P.; AMS Collaboration

    2018-01-01

    We report on the observation of new properties of secondary cosmic rays Li, Be, and B measured in the rigidity (momentum per unit charge) range 1.9 GV to 3.3 TV with a total of 5.4 ×106 nuclei collected by AMS during the first five years of operation aboard the International Space Station. The Li and B fluxes have an identical rigidity dependence above 7 GV and all three fluxes have an identical rigidity dependence above 30 GV with the Li /Be flux ratio of 2.0 ±0.1 . The three fluxes deviate from a single power law above 200 GV in an identical way. This behavior of secondary cosmic rays has also been observed in the AMS measurement of primary cosmic rays He, C, and O but the rigidity dependences of primary cosmic rays and of secondary cosmic rays are distinctly different. In particular, above 200 GV, the secondary cosmic rays harden more than the primary cosmic rays.

  20. Observation of an Aligned Gas - Solid "Eutectic" during Controlled Directional Solidification Aboard the International Space Station - Comparison with Ground-based Studies

    Science.gov (United States)

    Grugel, R. N.; Anilkumar, A.

    2005-01-01

    Direct observation of the controlled melting and solidification of succinonitrile was conducted in the glovebox facility of the International Space Station (ISS). The experimental samples were prepared on ground by filling glass tubes, 1 cm ID and approximately 30 cm in length, with pure succinonitrile (SCN) in an atmosphere of nitrogen at 450 millibar pressure for eventual processing in the Pore Formation and Mobility Investigation (PFMI) apparatus in the glovebox facility (GBX) on board the ISS. Real time visualization during controlled directional melt back of the sample showed nitrogen bubbles emerging from the interface and moving through the liquid up the imposed temperature gradient. Over a period of time these bubbles disappear by dissolving into the melt. Translation is stopped after melting back of about 9 cm of the sample, with an equilibrium solid-liquid interface established. During controlled re-solidification, aligned tubes of gas were seen growing perpendicular to the planar solid/liquid interface, inferring that the nitrogen previously dissolved into the liquid SCN was now coming out at the solid/liquid interface and forming the little studied liquid = solid + gas eutectic-type reaction. The observed structure is evaluated in terms of spacing dimensions, interface undercooling, and mechanisms for spacing adjustments. Finally, the significance of processing in a microgravity environment is ascertained in view of ground-based results.

  1. Quality control and data-handling in multicentre studies: the case of the Multicentre Project for Tuberculosis Research

    Directory of Open Access Journals (Sweden)

    Caloto Teresa

    2001-12-01

    Full Text Available Abstract Background The Multicentre Project for Tuberculosis Research (MPTR was a clinical-epidemiological study on tuberculosis carried out in Spain from 1996 to 1998. In total, 96 centres scattered all over the country participated in the project, 19935 "possible cases" of tuberculosis were examined and 10053 finally included. Data-handling and quality control procedures implemented in the MPTR are described. Methods The study was divided in three phases: 1 preliminary phase, 2 field work 3 final phase. Quality control procedures during the three phases are described. Results: Preliminary phase: a organisation of the research team; b design of epidemiological tools; training of researchers. Field work: a data collection; b data computerisation; c data transmission; d data cleaning; e quality control audits; f confidentiality. Final phase: a final data cleaning; b final analysis. Conclusion The undertaking of a multicentre project implies the need to work with a heterogeneous research team and yet at the same time attain a common goal by following a homogeneous methodology. This demands an additional effort on quality control.

  2. Variability in drug use among newborns admitted to NICUs: a proposal for a European multicentre study

    Directory of Open Access Journals (Sweden)

    Laura Cuzzolin

    2014-01-01

    Full Text Available The use of drugs in newborns admitted to NICUs is characterized by a great variability. This widespread phenomenon, observed both within and between different countries, has been highlighted by reporting data on the treatment of neonatal sepsis and PDA throughout Europe: the dosages and the intervals between administrations of ciprofloxacin and fluconazole varied significantly and a wide variation was also observed as regards the use of NSAIDs to treat PDA. Given the unique characteristics of the neonatal population, the use of drugs on an individual basis could be sometimes justified. However, other factors such as the lack of evidence-based guidelines and the common use of drugs in an off-label manner (more than 80% of newborns receive this kind of treatment could contribute to the variability in medicine use, making the neonatal population vulnerable to adverse drug reactions (ADRs and medication errors: the potential ADRs rate, 3 times higher in pediatric wards, is more significantly higher in NICUs and the frequency of medication errors (mostly dose errors widely exceeds the medium value. The differences in clinical practices observed between NICUs need to be addressed at a European level and a multicentre study could be useful to harmonize drug use in newborns.

  3. At-Risk Phenotype of Neurofibromatose-1 Patients: A Multicentre Case-Control Study

    Directory of Open Access Journals (Sweden)

    Ferkal Salah

    2011-07-01

    Full Text Available Abstract Objectives To assess associations between subcutaneous neurofibromas (SC-NFs and internal neurofibromas in patients with neurofibromatosis type 1 (NF-1 and to determine whether the association between SC-NFs and peripheral neuropathy was ascribable to internal neurofibromas. Patients and methods Prospective multicentre case-control study. Between 2005 and 2008, 110 NF-1 adults having two or more SC-NFs were individually matched for age, sex and hospital with 110 controls who had no SC-NF. Patients underwent standardized MRI of the spinal cord, nerve roots and sciatic nerves and an electrophysiological study. Analyses used adjusted multinomial logistic regression (ORa to estimate the risk of the presence of internal neurofibromas or peripheral neuropathies associated with patients presented 2 to 9 SC-NFs, at least 10 SC-NFs as compared to patients without any (referential category. Results Cases had a mean age of 41 (± 13 years; 85 (80% had two to nine SC-NFs and 21 (19% at least ten SC-NFs. SC-NFs were more strongly associated with internal neurofibromas in patients with ten or more SC-NFs than in patients with fewer NF-SCs (e.g., sciatic nerve, aOR = 29.1 [8.5 to 100] vs. 4.3 [2.1 to 9.0]. The association with SC-NFs was stronger for diffuse, intradural, and > 3 cm internal neurofibromas than with other internal neurofibromas. Axonal neuropathy with slowed conduction velocities (SCV was more strongly associated with having at least ten SC-NFs (aOR = 29.9, 5.5 to 162.3 than with having fewer SC-NFs (aOR = 4.4, 0.9 to 22.0. Bivariate analyses showed that the association between axonal neuropathy with SCV and sciatic neurofibromas was mediated by the association between SC-NFs and sciatic neurofibromas. Conclusion The at-risk phenotype of NF-1 patients (i.e. NF-1 patients with SC-NFs is ascribable to associations linking SC-NFs to internal neurofibromas at risk for malignant transformation and to axonal neuropathies with slowed

  4. Multicentre dose audit for clinical trials of radiation therapy in Asia.

    Science.gov (United States)

    Mizuno, Hideyuki; Fukuda, Shigekazu; Fukumura, Akifumi; Nakamura, Yuzuru-Kutsutani; Jianping, Cao; Cho, Chul-Koo; Supriana, Nana; Dung, To Anh; Calaguas, Miriam Joy; Devi, C R Beena; Chansilpa, Yaowalak; Banu, Parvin Akhter; Riaz, Masooma; Esentayeva, Surya; Kato, Shingo; Karasawa, Kumiko; Tsujii, Hirohiko

    2017-05-01

    A dose audit of 16 facilities in 11 countries has been performed within the framework of the Forum for Nuclear Cooperation in Asia (FNCA) quality assurance program. The quality of radiation dosimetry varies because of the large variation in radiation therapy among the participating countries. One of the most important aspects of international multicentre clinical trials is uniformity of absolute dose between centres. The National Institute of Radiological Sciences (NIRS) in Japan has conducted a dose audit of participating countries since 2006 by using radiophotoluminescent glass dosimeters (RGDs). RGDs have been successfully applied to a domestic postal dose audit in Japan. The authors used the same audit system to perform a dose audit of the FNCA countries. The average and standard deviation of the relative deviation between the measured and intended dose among 46 beams was 0.4% and 1.5% (k = 1), respectively. This is an excellent level of uniformity for the multicountry data. However, of the 46 beams measured, a single beam exceeded the permitted tolerance level of ±5%. We investigated the cause for this and solved the problem. This event highlights the importance of external audits in radiation therapy. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  5. EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies

    Energy Technology Data Exchange (ETDEWEB)

    Aide, Nicolas [University Hospital, Nuclear Medicine Department, Caen (France); Caen University, Inserm U1086 ANTICIPE, Caen (France); Lasnon, Charline [Caen University, Inserm U1086 ANTICIPE, Caen (France); Francois Baclesse Cancer Centre, Nuclear Medicine Department, Caen (France); Veit-Haibach, Patrick [University Hospital Zurich, Department of Nuclear Medicine and Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); University Health Network, University of Toronto, Joint Department Medical Imaging, Toronto (Canada); Sera, Terez [University of Szeged, Nuclear Medicine Department, Szeged (Hungary); Sattler, Bernhard [University Hospital of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Boellaard, Ronald [University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen (Netherlands); VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands)

    2017-08-15

    Quantitative positron emission tomography/computed tomography (PET/CT) can be used as diagnostic or prognostic tools (i.e. single measurement) or for therapy monitoring (i.e. longitudinal studies) in multicentre studies. Use of quantitative parameters, such as standardized uptake values (SUVs), metabolic active tumor volumes (MATVs) or total lesion glycolysis (TLG), in a multicenter setting requires that these parameters be comparable among patients and sites, regardless of the PET/CT system used. This review describes the motivations and the methodologies for quantitative PET/CT performance harmonization with emphasis on the EANM Research Ltd. (EARL) Fluorodeoxyglucose (FDG) PET/CT accreditation program, one of the international harmonization programs aiming at using FDG PET as a quantitative imaging biomarker. In addition, future accreditation initiatives will be discussed. The validation of the EARL accreditation program to harmonize SUVs and MATVs is described in a wide range of tumor types, with focus on therapy assessment using either the European Organization for Research and Treatment of Cancer (EORTC) criteria or PET Evaluation Response Criteria in Solid Tumors (PERCIST), as well as liver-based scales such as the Deauville score. Finally, also presented in this paper are the results from a survey across 51 EARL-accredited centers reporting how the program was implemented and its impact on daily routine and in clinical trials, harmonization of new metrics such as MATV and heterogeneity features. (orig.)

  6. Reduced prevalence of obesity in children with primary fructose malabsorption: a multicentre, retrospective cohort study.

    Science.gov (United States)

    Disse, S C; Buelow, A; Boedeker, R-H; Keller, K-M; Kim-Berger, H-S; Wudy, S A; Zimmer, K-P

    2013-08-01

    Studies in animals and in man have demonstrated that excessive consumption of fructose can cause all components of the metabolic syndrome. To investigate the impact of a condition resulting in decreased absorption of fructose, on obesity. In a multicentre study, we analyzed a cohort of paediatric patients with suspected primary fructose malabsorption (FM). Patients with chronic intestinal diseases were excluded. The final cohort comprised 628 patients. 302 patients were diagnosed with primary FM (48.1%). The proportion of obese patients was lower among FM patients, compared to non-FM patients (2.3 vs. 6.1%, P = 0.029). Logistic regression analysis with inclusion of various covariates showed that FM was negatively associated with obesity (OR 0.35, 95% CI [0.13; 0.97]). We discuss several mechanisms involving the metabolic, endocrine and gastrointestinal system. Our data indicate that primary FM is negatively associated with childhood obesity. © 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.

  7. Multicentre performance evaluation of the E170 module for modular analytics.

    Science.gov (United States)

    Bieglmayer, Christian; Chan, Daniel W; Sokoll, Lori; Imdahl, Roland; Kobayashi, Masaji; Yamada, Erike; Lilje, Diana J; Luthe, Hilmar; Meissner, Jochen; Messeri, Gianni; Celli, Alessandra; Tozzi, Paola; Roth, Heinz-Jürgen; Schmidt, Frank-Peter; Mächler, Marie-Luise; Schuff-Werner, Peter; Zingler, Christiana; Smitz, Johan; Schiettecatte, Johan; Vonderschmitt, Dieter J; Pei, Patrick; Ng, Katherine; Ebert, Christoph; Kirch, Peter; Wanger, Michael; McGovern, Margaret; Stockmann, Wolfgang; Kuns, Albert

    2004-01-01

    The E170 module was evaluated at 13 sites in an international multicentre study. The objective of the study was to assess the analytical performance of 49 analytes, and to collect feedback on the system's reliability and practicability. The typical, within-run coefficients of variation (CVs) for most of the quantitative assays ranged between 1 and 2% while a range of 2-4% was achieved with the infectious disease methods. Total precision CVs were found to be within the manufacturer's expected performance ranges, demonstrating good concordance of the system's measuring channels and a high reproducibility during the 2-4-week trial period. The functional sensitivity of 11 selected assays met the clinical requirements (e.g., thyreotroponin (TSH) 0.008 mU/l, troponin T 0.02 microg/l, total prostate-specific antigen (PSA) 0.03 microg/l). The E170 showed no drift during an 8-hour period and no relevant reagent carryover. Accuracy was confirmed by ring trial experiments and method comparisons vs. Elecsys 2010. The reliability and practicability of the system's hardware and software met with, or even exceeded, the evaluator's requirements. Workflow studies showed that E170 can cover the combined workload of various routine analysers in a variety of laboratory environment. Throughput and sample processing time requirements were achieved while personnel 'hands-on-time' could be reduced.

  8. The Role of the Specialist Portal in the Global Data Bazaar- A Case Study of the International Arctic System for Observing the Atmosphere Data Portal Development

    Science.gov (United States)

    Starkweather, S.; Uttal, T.

    2013-12-01

    The virtual space for global data discovery has been compared to a bazaar [Parsons et al. 2011], where 'specialist portals provide the expertise, information, and referrals necessary to identify and understand data within a specific disciplinary context'. What then does an individual stall in this bazaar resemble? What are the technical and social actions by which this individual portal leverages the commons to increase activity in their area? The International Arctic Systems for Observing the Atmosphere (IASOA) was initiated to address key Arctic atmospheric science questions through coordinating the considerable atmospheric observing assets at ten pan-Arctic observatories. Since its formation, IASOA has discovered and linked to over 700 long-term datasets of relevance to its mission. IASOA science experts recognized that lack of uniform access to these datasets across contributing observatories was an impediment to progress in science synthesis. In the last year, structured, machine-readable metadata has been produced and harvested using an implementation of ISO-19115-2. The IASOA portal presents this collection within a dynamic measurement and place-based view that succinctly demonstrates data-rich and data-poor areas in Arctic atmospheric science. This presentation will demonstrate the achievements of IASOA's redesigned data portal. Technical highlights include a dynamic measurement-based organization of available data that leverages the semantics of leading global atmospheric science networks; a search results design which supports flexible and rapid access to original data and file format information; and information-rich linkages between platform-sensor metadata and dataset metadata. These achievements were not the result of cyber-infrastructure developments alone. This presentation will also review the social actions which underpin such a development, such as a cooperative schema development among data managers and an engaged community of experts focused on

  9. A significantly lower potency observed for the 3rd WHO International Standard for Parvovirus B19V DNA with the cobas TaqScreen DPX test.

    Science.gov (United States)

    Pisani, G; Cristiano, K; Fabi, S; Simeoni, M; Marino, F; Gaggioli, A

    2016-08-01

    In the context of the Official Medicines Control Laboratories plasma pool testing for Parvovirus B19 DNA, we use the cobas TaqScreen DPX test. When we re-evaluated this method using the 3rd B19 DNA WHO IS at the final concentration of 4 log IU/mL, we observed a titre lower than expected, i.e. 3.79 log IU/mL. Therefore, we further investigated the accuracy of the DPX test. The following B19V DNA materials were tested by using both the DPX test and an in-house real-time PCR: The 1st, 2nd and 3rd WHO ISs for B19V DNA The Non WHO B19V DNA Reference Material for NAT The Biological Reference Preparation B19 virus DNA for NAT testing, batch 1 . The DPX test showed a good accuracy for all B19V DNA materials with the exception of the 3rd WHO IS for B19V DNA. In fact, an underestimation of about 38% was observed for all dilutions of this standard with respect to the nominal titre. With the B19V in-house real-time PCR, all four materials proved to be well calibrated against the 1(st) WHO IS for B19V DNA, used as external standard curve. In this study, we demonstrated that the DPX test underestimates the B19V DNA content of the 3rd WHO IS for B19V DNA and that this is not due to an incorrect potency assigned to the standard but, most probably, to a mismatch between the primers/probe and the sequence of the target region in the 3rd WHO IS for B19V DNA. © 2016 International Society of Blood Transfusion.

  10. The interaction of large amplitude internal seiches with a shallow sloping lakebed: observations of benthic turbulence in Lake Simcoe, Ontario, Canada.

    Directory of Open Access Journals (Sweden)

    Remo Cossu

    Full Text Available Observations of the interactions of large amplitude internal seiches with the sloping boundary of Lake Simcoe, Canada show a pronounced asymmetry between up- and downwelling. Data were obtained during a 42-day period in late summer with an ADCP and an array of four thermistor chains located in a 5 km line at the depths where the thermocline intersects the shallow slope of the lakebed. The thermocline is located at depths of 12-14 m during the strongly stratified period of late summer. During periods of strong westerly winds the thermocline is deflected as much as 8 m vertically and interacts directly with the lakebed at depth between 14-18 m. When the thermocline was rising at the boundary, the stratification resembles a turbulent bore that propagates up the sloping lakebed with a speed of 0.05-0.15 m s(-1 and a Froude number close to unity. There were strong temperature overturns associated with the abrupt changes in temperature across the bore. Based on the size of overturns in the near bed stratification, we show that the inferred turbulent diffusivity varies by up to two orders of magnitude between up- and downwellings. When the thermocline was rising, estimates of turbulent diffusivity were high with KZ ∼10(-4 m(2s(-1, whereas during downwelling events the near-bed stratification was greatly increased and the turbulence was reduced. This asymmetry is consistent with previous field observations and underlines the importance of shear-induced convection in benthic bottom boundary layers of stratified lakes.

  11. Multicentric Castleman's disease and Kaposi's sarcoma in a cyclosporin treated, HIV-1 negative patient: case report

    NARCIS (Netherlands)

    Bollen, J. M.; Polstra, A. M.; van der Kuyl, A. C.; Weel, J. F.; Noorduyn, L. A.; van Oers, M. H. J.; Cornelissen, M.

    2003-01-01

    BACKGROUND: Multicentric Castleman's disease (MCD) is a rare disease, but is more frequent in AIDS patients. MCD has only been reported twice before in patients receiving immunosuppressive therapy after renal transplantation, and never in patients receiving immunosuppressive therapy without

  12. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  13. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  14. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

  15. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

  16. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP: an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

    Directory of Open Access Journals (Sweden)

    Namkje A. R. Vellinga

    2012-01-01

    Full Text Available Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP. Methods. 36 ICU’s worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill.

  17. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP): an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

    Science.gov (United States)

    Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M.; Bakker, Jan; Ince, Can

    2012-01-01

    Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Methods. 36 ICU's worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill. PMID:22666566

  18. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

    Science.gov (United States)

    Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

    2013-01-01

    Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

  19. Multicentric Biatrial Myxoma in a Young Female Patient: Case Report

    Science.gov (United States)

    Yoon, Sang Jeong; Park, Soon Chang; You, Yun Pyo; Kim, Bum Yong; Kim, Myong Kon; Jeong, Kyung Tae; Lee, Jae Won

    2000-01-01

    We report a case of multicentric, biatrial cardiac myxoma in a 29-year-old female who complained of exertional dyspnea, abdominal distension and peripheral edema. Any other associated skin lesions, breast mass or endocrine disorder presenting complex form were not seen on her. Also, there was no contributory medical history, hypertension and diabetes mellitus. By using transthoracic echocardiography, we identified a biatrial myxoma attached to the interatrial septum. During surgical excision, we found a large right atrial myxoma with extension through the fossa ovalis into the left atrium and small myxoma attached to the right atrial free wall. After successful resection of interatrial septum and free wall, atrial septal defect was created during the resection and safely repaired by bovine pericardial patch. PMID:11242813

  20. Multicentric Castleman's disease in a child with subpectoral involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kosucu, Polat; Ahmetoglu, Ali; Guemele, Halit Resit [Department of Radiology, Farabi Hospital, Medical School of Karadeniz Technical University, 61080 Trabzon (Turkey); Imamoglu, Mustafa; Cay, Ali [Department of Pediatric Surgery, Farabi Hospital, Medical School of Karadeniz Technical University, Trabzon (Turkey); Cobanoglu, Uemit [Department of Pathology, Farabi Hospital, Medical School of Karadeniz Technical University, Trabzon (Turkey)

    2003-08-01

    Castleman's disease is a benign lymphoproliferative disorder characterised by enlarged hyperplastic lymph nodes. It is rare in children and usually presents as localised disease. Subpectoral involvement has not been previously described in multicentric Castleman's disease in children. We present the CT, US and Doppler US findings of hyaline-vascular type multicentric Castleman's disease in a 5 year-old-boy with masses in the left subpectoral region and supraclavicular and axillary lymphadenopathy. (orig.)

  1. Safety of intramuscular influenza vaccine in patients receiving oral anticoagulation therapy: a single blinded multi-centre randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Benítez Mència

    2008-05-01

    Full Text Available Abstract Background Influenza vaccines are recommended for administration by the intramuscular route. However, many physicians use the subcutaneous route for patients receiving an oral anticoagulant because this route is thought to induce fewer hemorrhagic side effects. Our aim is to assess the safety of intramuscular administration of influenza vaccine in patients on oral anticoagulation therapy. Methods Design: Randomised, controlled, single blinded, multi-centre clinical trial. Setting: 4 primary care practices in Barcelona, Spain. Participants: 229 patients on oral anticoagulation therapy eligible for influenza vaccine during the 2003–2004 season. Interventions: intramuscular administration of influenza vaccine in the experimental group (129 patients compared to subcutaneous administration in the control group (100 patients. Primary outcome: change in the circumference of the arm at the site of injection at 24 hours. Secondary outcomes: appearance of local reactions and pain at 24 hours and at 10 days; change in INR (International Normalized Ratio at 24 hours and at 10 days. Analysis was by intention to treat using the 95% confidence intervals of the proportions or mean differences. Results Baseline variables in the two groups were similar. No major side effects or major haemorrhage during the follow-up period were reported. No significant differences were observed in the primary outcome between the two groups. The appearance of local adverse reactions was more frequent in the subcutaneous administration group (37,4% vs. 17,4%, 95% confidence interval of the difference 8,2% to 31,8%. Conclusion This study shows that the intramuscular administration route of influenza vaccine in patients on anticoagulant therapy does not have more side effects than the subcutaneous administration route. Registration number NCT00137579 at clinicaltrials.gov

  2. Baseline characteristics and management of patients with atrial fibrillation/flutter in the emergency department: results of a prospective, multicentre registry in China.

    Science.gov (United States)

    Zhang, H; Yang, Y; Zhu, J; Shao, X; Liu, Y; Zhao, L; Yu, P; Zhang, H; He, Q; Gu, X

    2014-08-01

    There have been several studies of atrial fibrillation (AF) over the past decades; however, data from Chinese patients are scarce. The aim of the study was therefore to describe the patient characteristics, risk profile and management strategies for Chinese AF patients presenting to emergency department (ED). We conducted a prospective, multicentre registry of patients with AF or atrial flutter (AFL) in China. Participants were enrolled at 20 EDs, then data regarding baseline characteristics and treatment in EDs were collected. Of the 2016 Chinese patients, 1104 (54.8%) were female. Six hundred eighteen (30.7%) had paroxysmal AF, 452 (22.4%) had persistent AF and 945 (46.9%) had permanent AF. The most common comorbidity was hypertension (55.5%), followed by coronary artery disease (41.8%) and heart failure (HF, 37.4%). The prevalence of concomitant cardiovascular risk factors, such as HF and valvular heart disease, increased as AF progressed. Among the patients with non-valvular AF, 110 (12.7%) of those with CHADS2 (congestive HF, hypertension, age of 75 years and greater, diabetes mellitus and history of stroke) ≥2 were prescribed oral anticoagulants (OAC), while 119 (15.6%) of those with CHADS2 3.0) in 96 patients only (26.4%). Moreover, a total of 16.2% of the patients received ≥1 anti-arrhythmic agents, whereas rate control agents were used more frequently (68.4%). According to the present study, the risk profile and management of Chinese patients with AF/AFL differed from that observed in previous studies. The use of OAC inadequately deviate from current guidelines. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  3. Intra- and interobserver analysis in the morphological assessment of early stage embryos during an IVF procedure: a multicentre study

    Directory of Open Access Journals (Sweden)

    Devroe Johanna

    2011-09-01

    Full Text Available Abstract Background Quality control programs are necessary to maintain good clinical practice. Embryo grading has been described as one of the external quality assurance schemes. Although the evaluation of embryos is based on the assessment of morphological characteristics, considerable intra- and inter-observer variability has been described. In this multicentre study, the variability in the embryo evaluation has been evaluated using morphological characteristics on day 1, day 2 and day 3 of embryo development. Methods Five embryologists of four different IVF centers participated in this study. Multilevel images of embryos were presented on a website at different time points to evaluate intra-and inter-observer agreement in the assessment of embryo morphology. The embryos were evaluated on day 1, day 2 and day 3 of their development and each embryologist had to decide if the embryo had to be transferred, cryopreserved or discarded. Results Both intra-observer agreement and inter-observer agreement were good to excellent for the position of the pronuclei on day 1, the number of blastomeres on day 2 and day 3 and the clinical decision (transfer, cryopreservation, discard. For all other characteristics (size of pronuclei, presence of cytoplasomic halo, degree of fragmentation and size of blastomeres the intra- and inter-observer agreement was moderate to very poor. Conclusions Mono- or multicentre quality control on embryo scoring by morphological assessment can easily be performed through the design of a simple website. In the future the website design can be adapted to generate statistical feedback upon scoring and can even include a training module.

  4. Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China

    Directory of Open Access Journals (Sweden)

    Zheng Hui

    2011-03-01

    Full Text Available Abstract Background In order to evaluate the safety of acupuncture in China objectively, we investigated the adverse events associated with acupuncture based on three multicentre randomized controlled trials (RCTs to assess the safety of acupuncture, identifying the common types of acupuncture adverse events, and analysing the related risk factors for their occurrence. Methods This observational study included patients who received acupuncture from three multicentre RCTs respectively for migraine, functional dyspepsia and Bell's palsy. The 1968 patients and their acupuncturists documented adverse events associated with acupuncture after treatment. We collected data about adverse events due to acupuncture treatment from their case report forms. We analysed the incidence and details of the adverse effects, and studied the risk factors for acupuncture adverse events with non-conditional logistic regression analysis. Results Among the 1968 patients, 74 patients (3.76% suffered at least one adverse event throughout the treatment period. We did not observe the occurrence of serious adverse events. 73 patients with adverse events recovered within 2 weeks through effective treatment such as physiotherapy or self-treatment. A total of 3 patients withdrew because of adverse events. There were 9 types of adverse events related to acupuncture, including subcutaneous haematoma, bleeding, skin bruising and needle site pain. Subcutaneous haematoma and haemorrhage in the needling points were the most common adverse events. Age and gender were related to the occurrence of acupuncture adverse events. The older the patients were, the higher the risk of adverse events was. In addition, male patients had slightly higher risk of an adverse event than female patients. Conclusions Acupuncture is a safe therapy with low risk of adverse events in clinical practice. The risk factors for adverse events (AEs were related to the patients' gender and age and the local

  5. Results of a national multicentric study on compliance to treatment with various disphosphonate formulations in patients with postmenopausal osteoporosis.

    Science.gov (United States)

    Vinicola, V; Giampà, E; Di Bonito, M; Ferretti, V; Nuvoli, G; Paoletti, F; Piazzini, M; Ranieri, M; Tuveri, M A

    2015-09-01

    Compliance to pharmacological treatment for osteoporosis is crucial if the risk of fracture is to be reduced. Case series show that treatment with traditional bisphosphonates in the form of tablets has a compliance of between approximately 30% and 70%. The aims of this paper were to assess compliance to treatment with various formulations of bisphonates and to identify those at highest risk of discontinuation. In this multicentre retrospective observational study, a population of 387 women diagnosed with postmenopausal osteoporosis under treatment with bisphosphonates (risedronate, ibandronate, alendronate in tablet form, alendronate in a fluid solution per os) was observed for at least a year. Demographic data and information pertaining to the type of drug taken, compliance to treatment, side effects, reasons for discontinuation, the basal examination and follow-up at 18 months and later were recorded. Analysis of patient compliance to a prescribed treatment plan showed a significantly higher persistence (Pmenopause, risked discontinuation.

  6. The GLOBAL Learning and Observations to Benefit the Environment (GLOBE) Collaboration System. Building a robust international collaboration environment for teachers, scientists and students.

    Science.gov (United States)

    Overoye, D.; Lewis, C.

    2016-12-01

    The Global Learning and Observations to Benefit the Environment (GLOBE) Program is a worldwide hands-on, primary and secondary school-based science and education program founded on Earth Day 1995. Implemented in 117 countries, GLOBE promotes the teaching and learning of science, supporting students, teachers and scientists worldwide to collaborate with each other on inquiry-based investigations of the Earth system. As an international platform supporting a large number and variety of stakeholders, the GLOBE Data Information System (DIS) was re-built with the goal of providing users the support needed to foster and develop collaboration between teachers, students and scientists while supporting the collection and visualization of over 50 different earth science investigations (protocols). There have been many challenges to consider as we have worked to prototype and build various tools to support collaboration across the GLOBE community - language, security, time zones, user roles and the Child Online Protection Act (COPA) to name a few. During the last 3 years the re-built DIS has been in operation we have supported user to user collaboration, school to school collaboration, project/campaign to user collaboration and scientist to scientist collaboration. We have built search tools to facilitate finding collaboration partners. The tools and direction continue to evolve based on feedback, evolving needs and changes in technology. With this paper we discuss our approach for dealing with some of the collaboration challenges, review tools built to encourage and support collaboration, and analyze which tools have been successful and which have not. We will review new ideas for collaboration in the GLOBE community that are guiding upcoming development.

  7. Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

    Science.gov (United States)

    Vergo, Maxwell T; Sachs, Sharona; MacMartin, Meredith A; Kirkland, Kathryn B; Cullinan, Amelia M; Stephens, Lisa A

    2017-05-01

    Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. To assess skills acquisition and acceptability for IM residents not selecting an elective. A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points. IM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation. Pre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience. Twelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters. A required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.

  8. Form and formation of flares and parabolae based on new observations of the internal shell structure in lytoceratid and perisphinctid ammonoids

    Directory of Open Access Journals (Sweden)

    Gregor Radtke

    2016-08-01

    Full Text Available The ultrastructure of pristine shells of Jurassic and Cretaceous lytoceratid and perisphinctid ammonoids indicates that flares and parabolae represent homologous structures. Both mark an interruption of shell growth. We dismiss earlier interpretations of parabolae as actual aperture, relics of resorbed apophyses or superstructure of the musculature associated to a semi-internal shell. Instead we propose an episodic growth model including several growth stops at the aperture during the formation of a frill-like aperture for parabolae and flares. Such an aperture is composed of the outer prismatic layer, the nacreous layer and an apertural prismatic coating. Here, we observed the apertural prismatic coating for the first time as an integral part of flares and parabolae. The apertural prismatic coating covers only the inner surface of the frill and was secreted by a permanent mantle cover indicating a prolonged period without the production of new shell material. Parabolae differ from flares by their general shape and the presence of ventro-lateral parabolic notches and nodes. The notches were formed by folding of the frill and had the potential to form semi-open spines. The corresponding parabolic nodes are caused by an outward swelling of the shell-secreting mantle tissue producing new shell material at the position of the folding. New shell material that belongs to the conch tube is attached to the base of flares and parabolae after withdrawal of the mantle edge representing the continuation of shell growth. Usually, the frilled aperture associated with flares and parabolae were removed during lifetime. This study reports on flares in Argonauticeras for the first time. In this genus they are typically associated with varices.

  9. CHAMBARA: The changing hydrography and man made biomass burning in Africa: a concept for earth observations from the International Space Station.

    Science.gov (United States)

    Muller, Christian

    2010-05-01

    In parallel to vegetation mapping exemplified by VEGETATION and spectral thematic instruments as MERIS, other important natural and man-made phenomena characterize the equatorial and low latitude regions region covered especially well by the International Space Station orbit. The agreement between the space agencies evolves now to a lifetime of the ISS up to 2025. Two themes can be proposed: hydrography and biomass burning. Hydrography has an extreme human importance as human life and agriculture depend on water, transport as well; also the hydroelectric energy which could be harnessed from the hydrological network is tremendous and would allow a sustainable development of the entire region. The CHAMBARA proposed concept differs from other satellite observation programmes in a sense that the images are taken either according either to pre-planned scientific campaigns controlled from an operation centre either according to real time unexpected events or emergencies. For example, biomass burning imaging campaigns are organised at the end of the dry season, while deltas and lake are monitored at specific points of the dry seasons and, if the cloud cover allows it, at periods of the wet season. In exceptional cases, as natural disasters or rapidly varying scenes, the operation centre will reschedule the programme and even ask for exceptional crew assistance. This project aims at this point to the European and African scientific communities specialized on Sub-Saharan Africa which is currently studied by several Belgian scientific institutions but its techniques could also be extended to the Amazon basin, tropical Asia and Oceania. The equipment proposed will be an advanced true colour rapid camera, external mounting is wished in order to free the optical window but nadir pointing should be the nominal position. An example of the concept is given by the serendipitous image ISS004E11 Central African observation (ISS photograph, May 16, 2002, centered near 8.6 degrees

  10. Exploring the potential role of tungsten carbide cobalt (WC-Co) nanoparticle internalization in observed toxicity toward lung epithelial cells in vitro.

    Science.gov (United States)

    Armstead, Andrea L; Arena, Christopher B; Li, Bingyun

    2014-07-01

    Tungsten carbide cobalt (WC-Co) has been recognized as a workplace inhalation hazard in the manufacturing, mining and drilling industries by the National Institute of Occupational Safety and Health. Exposure to WC-Co is known to cause "hard metal lung disease" but the relationship between exposure, toxicity and development of disease remain poorly understood. To better understand this relationship, the present study examined the role of WC-Co particle size and internalization on toxicity using lung epithelial cells. We demonstrated that nano- and micro-WC-Co particles exerted toxicity in a dose- and time-dependent manner and that nano-WC-Co particles caused significantly greater toxicity at lower concentrations and shorter exposure times compared to micro-WC-Co particles. WC-Co particles in the nano-size range (not micron-sized) were internalized by lung epithelial cells, which suggested that internalization may play a key role in the enhanced toxicity of nano-WC-Co particles over micro-WC-Co particles. Further exploration of the internalization process indicated that there may be multiple mechanisms involved in WC-Co internalization such as actin and microtubule based cytoskeletal rearrangements. These findings support our hypothesis that WC-Co particle internalization contributes to cellular toxicity and suggest that therapeutic treatments inhibiting particle internalization may serve as prophylactic approaches for those at risk of WC-Co particle exposure. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Exploring the potential role of tungsten carbide cobalt (WC-Co) nanoparticle internalization in observed toxicity toward lung epithelial cells in vitro

    Science.gov (United States)

    Armstead, Andrea L.; Arena, Christopher B.; Li, Bingyun

    2014-01-01

    Tungsten carbide cobalt (WC-Co) has been recognized as a workplace inhalation hazard in the manufacturing, mining and drilling industries by the National Institute of Occupational Safety and Health. Exposure to WC-Co is known to cause “hard metal lung disease” but the relationship between exposure, toxicity and development of disease remain poorly understood. To better understand this relationship, the present study examined the role of WC-Co particle size and internalization on toxicity using lung epithelial cells. We demonstrated that nano- and micro-WC-Co particles exerted toxicity in a dose- and time-dependent manner and that nano-WC-Co particles caused significantly greater toxicity at lower concentrations and shorter exposure times compared to micro-WC-Co particles. WC-Co particles in the nano-size range (not micron-sized) were internalized by lung epithelial cells, which suggested that internalization may play a key role in the enhanced toxicity of nano-WC-Co particles over micro-WC-Co particles. Further exploration of the internalization process indicated that there may be multiple mechanisms involved in WC-Co internalization such as actin and microtubule based cytoskeletal rearrangements. These findings support our hypothesis that WC-Co particle internalization contributes to cellular toxicity and suggests that therapeutic treatments inhibiting particle internalization may serve as prophylactic approaches for those at risk of WC-Co particle exposure. PMID:24746988

  12. Exploring the potential role of tungsten carbide cobalt (WC-Co) nanoparticle internalization in observed toxicity toward lung epithelial cells in vitro

    International Nuclear Information System (INIS)

    Armstead, Andrea L.; Arena, Christopher B.; Li, Bingyun

    2014-01-01

    Tungsten carbide cobalt (WC-Co) has been recognized as a workplace inhalation hazard in the manufacturing, mining and drilling industries by the National Institute of Occupational Safety and Health. Exposure to WC-Co is known to cause “hard metal lung disease” but the relationship between exposure, toxicity and development of disease remain poorly understood. To better understand this relationship, the present study examined the role of WC-Co particle size and internalization on toxicity using lung epithelial cells. We demonstrated that nano- and micro-WC-Co particles exerted toxicity in a dose- and time-dependent manner and that nano-WC-Co particles caused significantly greater toxicity at lower concentrations and shorter exposure times compared to micro-WC-Co particles. WC-Co particles in the nano-size range (not micron-sized) were internalized by lung epithelial cells, which suggested that internalization may play a key role in the enhanced toxicity of nano-WC-Co particles over micro-WC-Co particles. Further exploration of the internalization process indicated that there may be multiple mechanisms involved in WC-Co internalization such as actin and microtubule based cytoskeletal rearrangements. These findings support our hypothesis that WC-Co particle internalization contributes to cellular toxicity and suggest that therapeutic treatments inhibiting particle internalization may serve as prophylactic approaches for those at risk of WC-Co particle exposure. - Highlights: • Hard metal (WC-Co) particle toxicity was established in lung epithelial cells. • Nano-WC-Co particles caused greater toxicity than micro-WC-Co particles. • Nano- and micro-WC-Co particles were capable of inducing cellular apoptosis. • Nano-WC-Co particles were internalized by lung epithelial cells. • WC-Co particle internalization was mediated by actin dynamics

  13. Exploring the potential role of tungsten carbide cobalt (WC-Co) nanoparticle internalization in observed toxicity toward lung epithelial cells in vitro

    Energy Technology Data Exchange (ETDEWEB)

    Armstead, Andrea L. [Biomaterials, Bioengineering and Nanotechnology Laboratory, Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506 (United States); Pharmaceutical and Pharmacological Sciences Graduate Program, School of Pharmacy, West Virginia University, Morgantown, WV 26506 (United States); Arena, Christopher B. [Biomaterials, Bioengineering and Nanotechnology Laboratory, Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506 (United States); E.J. Van Liere Research Program, School of Medicine, West Virginia University, Morgantown, WV 26506 (United States); Li, Bingyun, E-mail: bili@hsc.wvu.edu [Biomaterials, Bioengineering and Nanotechnology Laboratory, Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506 (United States); Pharmaceutical and Pharmacological Sciences Graduate Program, School of Pharmacy, West Virginia University, Morgantown, WV 26506 (United States); E.J. Van Liere Research Program, School of Medicine, West Virginia University, Morgantown, WV 26506 (United States); Mary Babb Randolph Cancer Center, Morgantown, WV 26506 (United States)

    2014-07-01

    Tungsten carbide cobalt (WC-Co) has been recognized as a workplace inhalation hazard in the manufacturing, mining and drilling industries by the National Institute of Occupational Safety and Health. Exposure to WC-Co is known to cause “hard metal lung disease” but the relationship between exposure, toxicity and development of disease remain poorly understood. To better understand this relationship, the present study examined the role of WC-Co particle size and internalization on toxicity using lung epithelial cells. We demonstrated that nano- and micro-WC-Co particles exerted toxicity in a dose- and time-dependent manner and that nano-WC-Co particles caused significantly greater toxicity at lower concentrations and shorter exposure times compared to micro-WC-Co particles. WC-Co particles in the nano-size range (not micron-sized) were internalized by lung epithelial cells, which suggested that internalization may play a key role in the enhanced toxicity of nano-WC-Co particles over micro-WC-Co particles. Further exploration of the internalization process indicated that there may be multiple mechanisms involved in WC-Co internalization such as actin and microtubule based cytoskeletal rearrangements. These findings support our hypothesis that WC-Co particle internalization contributes to cellular toxicity and suggest that therapeutic treatments inhibiting particle internalization may serve as prophylactic approaches for those at risk of WC-Co particle exposure. - Highlights: • Hard metal (WC-Co) particle toxicity was established in lung epithelial cells. • Nano-WC-Co particles caused greater toxicity than micro-WC-Co particles. • Nano- and micro-WC-Co particles were capable of inducing cellular apoptosis. • Nano-WC-Co particles were internalized by lung epithelial cells. • WC-Co particle internalization was mediated by actin dynamics.

  14. [Multicentric lymphoma in 411 dogs - an epidemiological study].

    Science.gov (United States)

    Ernst, Theresa; Kessler, Martin; Lautscham, Esther; Willimzig, Lisanne; Neiger, Reto

    2016-08-17

    To provide an overview of the epidemiology of canine multicentric lymphoma in Germany. A total of 411 dogs with multicentric malignant lymphoma were retrospectively analysed regarding breed, age, sex, weight and the number of animals dogs with hypercalcaemic lymphoma and B-/T-immunophenotype, and compared to two reference populations (total own clinic population, n   =   52  142; dogs with health insurance in Germany, n   =   123  423). In total, 298 (72.5%) of the 411 dogs belonged to 86 different breeds, while 113 (27.5%) dogs were mixed breed. In comparison to both reference populations, a breed predisposition for the American Pitbull Terrier (odds ratio [OR] 5.2 and 18.5), American Staffordshire Terrier (OR 3.3 and 4.6), Briard (OR 5.6 and 9.5), Bullmastiff (OR 7.8 and 5.0), Irish Setter (OR 3.3 and 4.1) and Rottweiler (OR 2.8 and 3.6) was found. Golden Retrievers (n = 22, OR 1.3 and 0.9) and Bernese Mountain Dogs (n = 22, OR 2.4 and 2.0) were frequently affected in absolute numbers, but when compared to the reference populations an OR < 3 was detected. Mean body weight was 30.2 ± 13.7 kg; only 75 (18%) dogs weighed < 15 kg. Amongst the small dogs (< 15 kg), there was a large number of West Highland White Terriers (n = 12). Mean age of the dogs with lymphoma was 7.9 ± 2.7 years. Dogs weighing ≥ 15 kg were significantly (p < 0.001) younger (7.6 ± 2.4 years) compared to dogs weighing < 15 kg (9.3 ± 3.2 years). Dogs with a B-cell immunophenotype (8.5 ± 2.6 years) were significantly older compared to dogs with a T-cell immunophenotype (6.4 ± 1.8 years) (p < 0.001). There was no gender predisposition (54% male, 46% female). Hypercalcaemia as an indicator of T-cell lymphoma was present in 44 (11.4%) of the dogs. A T-cell and B-cell immunophenotype was found in 20.6% and 79.4% of the dogs, respectively. This study confirms previous data about breed predispositions for canine malignant multicentric

  15. Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

    Science.gov (United States)

    McAuliffe, Carmel; Corcoran, Paul; Keeley, Helen S; Arensman, Ella; Bille-Brahe, Unni; De Leo, Diego; Fekete, Sandor; Hawton, Keith; Hjelmeland, Heidi; Kelleher, Margaret; Kerkhof, Ad J F M; Lönnqvist, Jouko; Michel, Konrad; Salander-Renberg, Ellinor; Schmidtke, Armin; Van Heeringen, Kees; Wasserman, Danuta

    2006-01-01

    While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

  16. HPV and cofactors for invasive cervical cancer in Morocco: a multicentre case-control study.

    Science.gov (United States)

    Berraho, Mohamed; Amarti-Riffi, Afaf; El-Mzibri, Mohammed; Bezad, Rachid; Benjaafar, Noureddine; Benideer, Abdelatif; Matar, Noureddine; Qmichou, Zinab; Abda, Naima; Attaleb, Mohammed; Znati, Kaoutar; El Fatemi, Hind; Bendahhou, Karima; Obtel, Majdouline; Filali Adib, Abdelhai; Mathoulin-Pelissier, Simone; Nejjari, Chakib

    2017-06-20

    Limited national information is available in Morocco on the prevalence and distribution of HPV-sub-types of cervical cancer and the role of other risk factors. The aim was to determine the frequency of HPV-sub-types of cervical cancer in Morocco and investigate risk factors for this disease. Between November 2009 and April 2012 a multicentre case-control study was carried out. A total of 144 cases of cervical cancer and 288 age-matched controls were included. Odds-ratios and corresponding confidence-intervals were computed by conditional logistic regression models. Current HPV infection was detected in 92.5% of cases and 13.9% of controls. HPV16 was the most common type for both cases and controls. Very strong associations between HPV-sub-types and cervical cancer were observed: total-HPV (OR = 39), HPV16 (OR = 49), HPV18 (OR = 31), and multiple infections (OR = 13). Education, high parity, sexual intercourse during menstruation, history of sexually transmitted infections, and husband's multiple sexual partners were also significantly associated with cervical cancer in the multivariate analysis. Our results could be used to establish a primary prevention program and to prioritize limited screening to women who have specific characteristics that may put them at an increased risk of cervical cancer.

  17. Chikungunya Infection in India: Results of a Prospective Hospital Based Multi-Centric Study

    Science.gov (United States)

    Ray, Pratima; Ratagiri, Vinod H.; Kabra, Sushil K.; Lodha, Rakesh; Sharma, Sumit; Sharma, B. S.; Kalaivani, Mani; Wig, Naveet

    2012-01-01

    Background Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India. Methods and Findings A total of 540 patients with fever of up to 7days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (pchikungunya confirmed cases (pchikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus. PMID:22363413

  18. Specific differential phase observations of multicell convection during natural and triggered lightning strikes at the International Center for Lightning Research and Testing

    Science.gov (United States)

    Hyland, P.; Biggerstaff, M. I.; Uman, M. A.; Hill, J. D.; Krehbiel, P. R.; Rison, W.

    2012-12-01

    During the summers of 2011-2012, a C-band polarimetric Shared Mobile Atmospheric Research and Teaching (SMART) radar from the University of Oklahoma was deployed to Keystone Heights, FL to study the relationship between cloud structure and the propagation of triggered and natural lightning channels. The radar was operated in Range-Height-Indicator (RHI) volume scanning mode over a narrow azimuthal sector that provided high spatial vertical resolution every 90 seconds over the rocket launch facility at the International Center for Lightning Research and Testing (ICLRT) at Camp Blanding, FL. In this presentation, we will focus on observations collected in 2011. Seven successful triggers (with return strokes) out of 20 attempts were sampled by the SMART-R from June to August. Most of the trigger attempts occurred during the dissipating stages of convection with steady ground electric field values. Specific differential phase (KDP) showed evidence of ice crystal alignment due to strong electric fields within the upper portions of the convection over ICLRT around the time of launch attempts. Consecutive RHI sweeps over ICLRT revealed changes in KDP that suggested the building of electric fields and subsequent relaxation after a triggered flash. KDP signatures relative to other radar variables will also be investigated to determine the microphysical and convective nature of the storms in which natural and triggered lightning strikes occurred. Lightning Mapping Array (LMA) sources of the triggered flash channels showed a preference for horizontal propagation just above the radar bright band associated with the melting layer. This finding agrees with several past studies that used balloon soundings and found intense layers of charge near the 0°C isotherm. The propagation path also seemed to be related to the vertical distribution of KDP in some of the triggered flashes. A preferred path through areas of generally positive values of KDP suggests that triggered lightning

  19. The association between serum biomarkers and disease outcome in influenza A(H1N1pdm09 virus infection: results of two international observational cohort studies.

    Directory of Open Access Journals (Sweden)

    Richard T Davey

    Full Text Available Prospective studies establishing the temporal relationship between the degree of inflammation and human influenza disease progression are scarce. To assess predictors of disease progression among patients with influenza A(H1N1pdm09 infection, 25 inflammatory biomarkers measured at enrollment were analyzed in two international observational cohort studies.Among patients with RT-PCR-confirmed influenza A(H1N1pdm09 virus infection, odds ratios (ORs estimated by logistic regression were used to summarize the associations of biomarkers measured at enrollment with worsened disease outcome or death after 14 days of follow-up for those seeking outpatient care (FLU 002 or after 60 days for those hospitalized with influenza complications (FLU 003. Biomarkers that were significantly associated with progression in both studies (p<0.05 or only in one (p<0.002 after Bonferroni correction were identified.In FLU 002 28/528 (5.3% outpatients had influenza A(H1N1pdm09 virus infection that progressed to a study endpoint of complications, hospitalization or death, whereas in FLU 003 28/170 (16.5% inpatients enrolled from the general ward and 21/39 (53.8% inpatients enrolled directly from the ICU experienced disease progression. Higher levels of 12 of the 25 markers were significantly associated with subsequent disease progression. Of these, 7 markers (IL-6, CD163, IL-10, LBP, IL-2, MCP-1, and IP-10, all with ORs for the 3(rd versus 1(st tertile of 2.5 or greater, were significant (p<0.05 in both outpatients and inpatients. In contrast, five markers (sICAM-1, IL-8, TNF-α, D-dimer, and sVCAM-1, all with ORs for the 3(rd versus 1(st tertile greater than 3.2, were significantly (p≤.002 associated with disease progression among hospitalized patients only.In patients presenting with varying severities of influenza A(H1N1pdm09 virus infection, a baseline elevation in several biomarkers associated with inflammation, coagulation, or immune function strongly predicted a

  20. Sleep patterns among shift-working flight controllers of the International Space Station: an observational study on the JAXA Flight Control Team.

    Science.gov (United States)

    Mizuno, Koh; Matsumoto, Akiko; Aiba, Tatsuya; Abe, Takashi; Ohshima, Hiroshi; Takahashi, Masaya; Inoue, Yuichi

    2016-09-01

    Flight controllers of the International Space Station (ISS) are engaged in shift work to provide 24-h coverage to support ISS systems. The purpose of this study was to investigate the prevalence and associated factors of shift work sleep disorder (SWSD) among Japanese ISS flight controllers. A questionnaire study was conducted using the Standard Shiftwork Index to evaluate sleep-related problems and possible associated variables. Among 52 respondents out of 73 flight controllers, 30 subjects were identified as night shift workers who worked 3 or more night shifts per month. Those night shift workers who answered "almost always" to questions about experiencing insomnia or excessive sleepiness in any case of work shifts and days off were classified as having SWSD. Additionally, 7 night shift workers participated in supplemental wrist actigraphy data collection for 7 to 8 days including 3 to 4 days of consecutive night shifts. Fourteen of 30 night shift workers were classified as having SWSD. Significant group differences were observed where the SWSD group felt that night shift work was harder and reported more frequent insomniac symptoms after a night shift. However, no other variables demonstrated remarkable differences between groups. Actigraphy results characterized 5 subjects reporting better perceived adaptation as having regular daytime sleep, for 6 to 9 h in total, between consecutive night shifts. On the other hand, 2 subjects reporting perceived maladaptation revealed different sleep patterns, with longer daytime sleep and large day-to-day variation in daytime sleep between consecutive night shifts, respectively. As the tasks for flight control require high levels of alertness and cognitive function, several characteristics, namely shift-working schedule (2 to 4 consecutive night shifts), very short break time (5 to 10 min/h) during work shifts, and cooperative work with onboard astronauts during the evening/night shift, accounted for increasing

  1. The proximity between hallucination and delusion dimensions: An observational, analytic, cross-sectional, multicentre study

    Directory of Open Access Journals (Sweden)

    Diogo Telles-correia

    2016-11-01

    Full Text Available 5.In the current psychiatric classifications, hallucinations (mainly auditory hallucinations are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorder’s diagnoses.6.Throughout the history of Psychiatry the conceptual proximity between delusions and hallucinations in the psychiatric patient was maintained until the end of the XIX century,with several supporters during the XX century. Their frontier was not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models.7.In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations.8.One hundred patients with schizophrenia or schizoaffective disorder from both the outpatient and inpatient units of the Psychiatry Department of Hospital of Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS. 9.In this study we found an empirical based model, where the main dimensions of hallucinations are determined by the central dimensions of delusions. 10.Keywords: Psyrats, Hallucinations, Psychopathology, Psychosis, delusions

  2. Knowledge of Driving Vehicle Licensing Agency guidelines among NHS doctors: a multicentre observational study.

    Science.gov (United States)

    Ng, Ka Y Bonnie; Garnham, Jack; Syed, Usama M; Green, Ben L; Watson, Robert; Gollop, Nicholas D; Shalhoub, Joseph; Maruthappu, Mahiben

    2015-10-01

    Over half of the UK population holds a driver's licence. The DVLA have produced guidelines to ensure drivers with medical conditions drive safely. Doctors should ensure that patients are given appropriate information and advice if they have a medical condition affecting their driving. We sought to evaluate doctors' knowledge of DVLA guidelines. A 25-point questionnaire was designed from DVLA guidelines ('The DVLA Questionnaire'). Five questions were included for each of neurology, cardiology, drug and alcohol abuse, visual, and respiratory disorders. Ealing Hospital, Northwick Park Hospital, Watford General Hospital, Norfolk and Norwich University Hospital and Leeds Teaching Hospitals Trust. 140 UK doctors. Questionnaire scores assessing knowledge of DVLA guidelines in five specialty areas. The median overall questionnaire score was 28%, interquartile range 20-36% and range 0-100% [Watford 28%, Leeds 30%, Norfolk and Norwich 36%, Ealing 30%, Northwick Park 28%]. There were no significant differences between the scores for each centre (p = 0.1332), Mean scores for specialty areas were: neurology 33.1%, standard deviation 22.1; cardiology 35.6%, standard deviation 26.9; drug and alcohol abuse 30.6%, standard deviation 23.8; visual disorders 33.9%, standard deviation 23.5 and respiratory disorders 20.3%, standard deviation 24.8; overall score 30.7%. There was no significant difference between the scores of the specialty areas (p = 0.4060). Knowledge of DVLA guidelines in our cohort was low. There is a need for increased awareness among hospital doctors through focused education on driving restrictions for common medical conditions. Improving physician knowledge in this area may help optimise patient safety.

  3. A multicentric observational study to evaluate the role of homoeopathic therapy in vitiligo

    Directory of Open Access Journals (Sweden)

    P S Chakraborty

    2015-01-01

    Results: The changes in the mean VSS at intervals of every 6 months was found to be statistically significant. Homoeopathic treatment was found to be useful in relieving vitiligo in varying degrees in 126 patients, out of which 4 (2.94% cases showed marked improvement, 15 (11.03% cases showed moderate improvement, 77 (56.62% cases showed mild improvement, and 30 patients although improved, fell in the category of not significant improvement group (below 25% improvement. Ten homoeopathic medicines were found useful in the study of which Sulphur (n = 27, Arsenicum album (n = 19, Phosphorus (n = 19, and Lycopodium clavatum (n = 10 were the most commonly indicated and useful medicines.

  4. Malnutrition in Hospitalised Older Adults: A Multicentre Observational Study of Prevalence, Associations and Outcomes.

    Science.gov (United States)

    O'Shea, E; Trawley, S; Manning, E; Barrett, A; Browne, V; Timmons, S

    2017-01-01

    Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population. Prospective Cohort Study. Six hospital sites (five public, one private). In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment - short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation. The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p Malnutrition was associated with outcomes including an increased length of stay (p < .001), new institutionalisation (p =<0.001) and in-hospital mortality (p < .001). These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

  5. Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study

    Science.gov (United States)

    Jun, Min; Lix, Lisa M; Durand, Madeleine; Dahl, Matt; Paterson, J Michael; Dormuth, Colin R; Ernst, Pierre; Yao, Shenzhen; Renoux, Christel; Tamim, Hala; Wu, Cynthia; Mahmud, Salaheddin M

    2017-01-01

    Objective To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous thromboembolism. Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016. Setting Community based, using healthcare data from six jurisdictions in Canada and the United States. Participants 59 525 adults (12 489 DOAC users; 47 036 warfarin users) with a new diagnosis of venous thromboembolism and a prescription for a DOAC or warfarin within 30 days of diagnosis. Main outcome measures Outcomes included hospital admission or emergency department visit for major bleeding and all cause mortality within 90 days after starting treatment. Propensity score matching and shared frailty models were used to estimate adjusted hazard ratios of the outcomes comparing DOACs with warfarin. Analyses were conducted independently at each site, with meta-analytical methods used to estimate pooled hazard ratios across sites. Results Of the 59 525 participants, 1967 (3.3%) had a major bleed and 1029 (1.7%) died over a mean follow-up of 85.2 days. The risk of major bleeding was similar for DOAC compared with warfarin use (pooled hazard ratio 0.92, 95% confidence interval 0.82 to 1.03), with the overall direction of the association favouring DOAC use. No difference was found in the risk of death (pooled hazard ratio 0.99, 0.84 to 1.16) for DOACs compared with warfarin use. There was no evidence of heterogeneity across centres, between patients with and without chronic kidney disease, across age groups, or between male and female patients. Conclusions In this analysis of adults with incident venous thromboembolism, treatment with DOACs, compared with warfarin, was not associated with an increased risk of major bleeding or all cause mortality in the first 90 days of treatment. Trial registration Clinical trials NCT02833987. PMID:29042362

  6. Demonstration of the metaphylactic use of gamithromycin against bacterial pathogens associated with bovine respiratory disease in a multicentre farm trial.

    Science.gov (United States)

    Baggott, D; Casartelli, A; Fraisse, F; Manavella, C; Marteau, R; Rehbein, S; Wiedemann, M; Yoon, S

    2011-03-05

    On five commercial cattle rearing sites across Europe, a total of 802 young cattle at high risk of developing bovine respiratory disease (BRD) associated with the bacterial pathogens Mannheimia haemolytica or Pasteurella multocida and/or Mycoplasma bovis were enrolled into a multicentre, controlled field trial. Half were treated with a single dose of gamithromycin at 6 mg/kg bodyweight by subcutaneous injection and half received an injection of a saline placebo as the control. All animals were observed daily for 14 days for signs of BRD as defined by set criteria. The proportion of metaphylactic preventive treatment successes, defined as animals surviving to day 14 without signs of BRD, in the gamithromycin-treated group (86 per cent) was significantly (P=0.0012) higher than in the saline-treated controls (61 per cent). Morbidity among the treated animals was reduced by 64 per cent compared with the controls.

  7. Demonstration of the metaphylactic use of gamithromycin against bacterial pathogens associated with bovine respiratory disease in a multicentre farm trial

    Science.gov (United States)

    Baggott, D.; Casartelli, A.; Fraisse, F.; Manavella, C.; Marteau, R.; Rehbein, S.; Wiedemann, M.; Yoon, S.

    2011-01-01

    On five commercial cattle rearing sites across Europe, a total of 802 young cattle at high risk of developing bovine respiratory disease (BRD) associated with the bacterial pathogens Mannheimia haemolytica or Pasteurella multocida and/or Mycoplasma bovis were enrolled into a multicentre, controlled field trial. Half were treated with a single dose of gamithromycin at 6 mg/kg bodyweight by subcutaneous injection and half received an injection of a saline placebo as the control. All animals were observed daily for 14 days for signs of BRD as defined by set criteria. The proportion of metaphylactic preventive treatment successes, defined as animals surviving to day 14 without signs of BRD, in the gamithromycin-treated group (86 per cent) was significantly (P=0.0012) higher than in the saline-treated controls (61 per cent). Morbidity among the treated animals was reduced by 64 per cent compared with the controls. PMID:21493573

  8. Serum C-reactive protein concentration as an indicator of remission status in dogs with multicentric lymphoma

    DEFF Research Database (Denmark)

    Nielsen, Lise; Toft, Nils; Eckersall, David

    2007-01-01

    -two dogs with untreated multicentric lymphoma. Methods: Prospective observational study. Blood samples were collected at the time of diagnosis, before each chemotherapy session, and at follow-up visits, resulting in 287 serum samples. Results: Before therapy, a statistically significant majority......Background: The acute-phase protein C-reactive protein (CRP) is used as a diagnostic and prognostic marker in humans with various neoplasias, including non-Hodgkin's lymphoma. Objective: To evaluate if CRP could be used to detect different remission states in dogs with lymphoma. Animals: Twenty...... of the dogs (P = .0019) had CRP concentrations above the reference range (68%, 15/22). After achieving complete remission 90% (18/20) of the dogs had CRP concentrations within the reference range, and the difference in values before and after treatment was statistically significant (P

  9. Captopril radionuclide test in renovascular hypertension: a European multicentre study

    Energy Technology Data Exchange (ETDEWEB)

    Fommei, E. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Ghione, S. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Hilson, A.J.W. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Mezzasalma, L. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Oei, H.Y. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Piepsz, A. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); Volterrani, D. (Inst. of Clinical Physiology, C.N.R., Multicentre Study Central Office, Pisa (Italy)); European Multicentre Study Group

    1993-07-01

    The efficacy of renal scintigraphy with technetium-99m DTPA before and after captopril was evaluated in a multicentre study. All 380 hypertensive patients in the study underwent renal arteriography; 125 had renal arterial stenosis [>=]70%, and 54 had a technically successful intervention to correct the stenosis. The post-captopril study had a sensitivity of 93% and a specificity of 100% for predicting blood pressure response to intervention, if renal function was normal and a combination of quantitative parameters was applied. In the entire population renal artery stenosis [>=]70% was detected with a sensitivity of 83% and a specificity of 93% if renal function was normal. In patients with abnormal renal function the performance of the test was worse, owing to a lower specificity which could be increased by using only time parameters. The performance of the test was optimal when the post-captopril findings were examined; no improvement was achieved by evaluation of the changes induced by captopril from the baseline. The test can thus be simplified by performing only a post-captopril study for routine use: a negative test would exclude a curable form of renovascular hypertension in right angle 80% and a positive test would predict it in right angle 90% of the patients selected for suspicion of the disease. Usefulness of the scintigraphic test for monitoring the clinical results of intervention is suggested by correlating post-intervention outcome with pre- and post-intervention scintigraphic results. (orig./MG)

  10. Feline primary erythrocytosis: a multicentre case series of 18 cats.

    Science.gov (United States)

    Darcy, Hannah; Simpson, Katherine; Gajanayake, Isuru; Seth, Mayank; McGrotty, Yvonne; Szladovits, Balazs; Glanemann, Barbara

    2018-01-01

    Case series summary A retrospective multicentre case series of feline primary erythrocytosis (PE) was evaluated. The aim was to gain better understanding of disease presentation and progression to guide management and prognostication. Case records were assessed for evidence of increased packed cell volume (PCV; >48%), sufficient investigation to rule out relative and secondary erythrocytosis, and follow-up data for at least 12 months or until death. Eighteen cats were included in the case series. No significant trends in signalment were noted. Seizures and mentation changes were the most common presenting signs (both n = 10). Median PCV was 70% (median total protein concentration of 76 g/l) with no other consistent haematological changes. Sixteen cats survived to discharge. Phlebotomy was performed initially in 15/16 surviving animals and performed after discharge in 10/16. Hydroxyurea was the most common adjunctive therapy, used in 10/16 cats. Of the 16 patients surviving to discharge, 14 patients were still alive at the conclusion of the study (survival time >17 months post-discharge), with the two non-survivors having lived for 5 years or more after diagnosis. PCV, when stabilised, did not correlate with resolution of clinical signs. Relevance and novel information In contrast to perceptions, feline PE was generally well managed via a combination of phlebotomy and medical therapy, with evidence of prolonged survival times. The use of hydroxyurea enabled cessation or repeat phlebotomies.

  11. Multiple sclerosis in Belgian children: A multicentre retrospective study.

    Science.gov (United States)

    Verhelst, Helene; De Waele, Liesbeth; Deconinck, Nicolas; Ceulemans, Berten; Willekens, Barbara; Van Coster, Rudy

    2017-03-01

    Although the diagnosis of multiple sclerosis (MS) in the paediatric population remains challenging, paediatric-onset MS is increasingly recognized worldwide. We report on the clinical and biochemical features of a Belgian multicentre cohort of paediatric MS patients in a national retrospective descriptive study. Twenty one paediatric MS patients from four Belgian University Hospitals were included. In nine patients, onset of MS was before the age of ten years which makes the study cohort of special interest. We report a higher incidence of acute disseminated encephalomyelitis (ADEM)-like first MS attacks and an overall higher proportion of polysymptomatic episodes than in adult and most paediatric cohorts reported in the literature. The clinical presentation in our cohort was rather severe with high median EDSS-score during the first clinical manifestation and barely more than half of our study patients showing full recovery after their first clinical manifestation. Also, a significant proportion of children in our cohort has severe disease progression despite disease modifying therapy and 9.5% of patients showed transition to secondary progressive multiple sclerosis during adolescence. An early and correct diagnosis of paediatric MS is essential to start early adequate treatment. As illustrated by our study cohort, current treatment options in childhood are unsatisfactory. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  12. Recurrent pericarditis in children and adolescents: a multicentre cohort study.

    Science.gov (United States)

    Imazio, Massimo; Brucato, Antonio; Pluymaekers, Nikki; Breda, Luciana; Calabri, Giovanni; Cantarini, Luca; Cimaz, Rolando; Colimodio, Filomena; Corona, Fabrizia; Cumetti, Davide; Cuccio, Chiara Di Blasi Lo; Gattorno, Marco; Insalaco, Antonella; Limongelli, Giuseppe; Russo, Maria Giovanna; Valenti, Anna; Finkelstein, Yaron; Martini, Alberto

    2016-09-01

    Limited data are available about recurrent pericarditis in children. We sought to explore contemporary causes, characteristics, therapies and outcomes of recurrent pericarditis in paediatric patients. A multicentre (eight sites) cohort study of 110 consecutive cases of paediatric patients with at least two recurrences of pericarditis over an 11-year period (2000-2010) [median 13 years, interquartile range (IQR) 5, 69 boys]. Recurrences were idiopathic or viral in 89.1% of cases, followed by postpericardiotomy syndrome (9.1%) and familial Mediterranean fever (0.9%). Recurrent pericarditis was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in 80.9% of cases, corticosteroids in 64.8% and colchicine was added in 61.8%. Immunosuppressive therapies were administered in 15.5% of patients after subsequent recurrences. After a median follow-up of 60th months, 528 subsequent recurrences were recorded (median 3, range 2-25). Corticosteroid-treated patients experienced more recurrences (standardized risk of recurrence per 100 person-years was 93.2 for patients treated with corticosteroids and 45.2 for those without), side effects and disease-related hospitalizations (for all P pericarditis developed in 2.7% of patients. Recurrent pericarditis has an overall favourable prognosis in children, although it may require frequent readmissions and seriously affect the quality of life, especially in patients treated with corticosteroids. Colchicine or anakinra therapies were associated with significant decrease in the risk of recurrence.

  13. Comparison of manual and semi-automatic measuring techniques in MSCT scans of patients with lymphoma: a multicentre study

    Energy Technology Data Exchange (ETDEWEB)

    Hoeink, A.J.; Wessling, J.; Schuelke, C.; Kohlhase, N.; Wassenaar, L.; Heindel, W.; Buerke, B. [University Hospital Muenster, Department of Clinical Radiology, Muenster (Germany); Koch, R. [University of Muenster, Institute of Biostatistics and Clinical Research (IBKF), Muenster (Germany); Mesters, R.M. [University Hospital Muenster, Department of Haematology and Oncology, Muenster (Germany); D' Anastasi, M.; Graser, A.; Karpitschka, M. [University Hospital Muenchen (LMU), Institute of Clinical Radiology, Muenchen (Germany); Fabel, M.; Wulff, A. [University Hospital Kiel, Department of Clinical Radiology, Kiel (Germany); Pinto dos Santos, D. [University Hospital Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Kiessling, A. [University Hospital Marburg, Department of Diagnostic and Interventional Radiology, Marburg (Germany); Dicken, V.; Bornemann, L. [Institute of Medical Imaging Computing, Fraunhofer MeVis, Bremen (Germany)

    2014-11-15

    Multicentre evaluation of the precision of semi-automatic 2D/3D measurements in comparison to manual, linear measurements of lymph nodes regarding their inter-observer variability in multi-slice CT (MSCT) of patients with lymphoma. MSCT data of 63 patients were interpreted before and after chemotherapy by one/tworadiologists in five university hospitals. In 307 lymph nodes, short (SAD)/long (LAD) axis diameter and WHO area were determined manually and semi-automatically. Volume was solely calculated semi-automatically. To determine the precision of the individual parameters, a mean was calculated for every lymph node/parameter. Deviation of the measured parameters from this mean was evaluated separately. Statistical analysis entailed intraclass correlation coefficients (ICC) and Kruskal-Wallis tests. Median relative deviations of semi-automatic parameters were smaller than deviations of manually assessed parameters, e.g. semi-automatic SAD 5.3 vs. manual 6.5 %. Median variations among different study sites were smaller if the measurement was conducted semi-automatically, e. g. manual LAD 5.7/4.2 % vs. semi-automatic 3.4/3.4 %. Semi-automatic volumetry was superior to the other parameters (2.8 %). Semi-automatic determination of different lymph node parameters is (compared to manually assessed parameters) associated with a slightly greater precision and a marginally lower inter-observer variability. These results are with regard to the increasing mobility of patients among different medical centres and in relation to the quality management of multicentre trials of importance. (orig.)

  14. Governance approval for multisite, non-interventional research: what can Harmonisation of Multi-Centre Ethical Review learn from the New South Wales experience?

    Science.gov (United States)

    Vajdic, C M; Meagher, N S; Hicks, S C; Faedo, M; Ward, R L; Pearson, S-A

    2012-02-01

    In 2007, New South Wales Health mandated the separation of ethical and scientific review from research governance at all New South Wales public health sites based on their distinction in the National Health and Medical Research Council National Statement. This separation allowed for single-site ethical review of multicentre studies. To investigate the time taken for governance approval of multicentre studies through the site-specific approval (SSA) process. A retrospective audit of the SSA process for five non-interventional studies proposed by a university cancer research unit. The median total governance approval time for all submissions (n= 28) was 12 weeks (range 2.5-64); median time from starting the SSA to submission was 8 weeks (range 1-48) and median time for governance approval was 5 weeks (range 0.3-40). Approval times were shorter for public compared to private institutions. Reasons for delays in finalising submissions for approval were the absence of institutional governance officers, lack of clarity regarding signatories, the need to identify a principal investigator employed by the institution, and lack of recognition of ethical approval by private institutions. The need to develop legal agreements between the university and hospital was the main reason for lengthy delays in obtaining approval. The advantages of a harmonised single ethical review process were undermined by the coexistence of a fragmented, complex and lengthy governance approval process. This experience has implications for the success of the national Harmonisation of Multi-Centre Ethical Review (HoMER) model. A harmonised and fully supported national approach to research governance should be developed contemporaneously with HoMER. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

  15. Characterisation of a plastic scintillation detector to be used in a multicentre stereotactic radiosurgery dosimetry audit

    Science.gov (United States)

    Dimitriadis, A.; Patallo, I. Silvestre; Billas, I.; Duane, S.; Nisbet, A.; Clark, C. H.

    2017-11-01

    Scintillation detectors are considered highly suitable for dosimetric measurement of small fields in radiotherapy due to their near-tissue equivalence and their small size. A commercially available scintillation detector, the Exradin W1 (Standard Imaging, Middleton, USA), has been previously characterised by two independent studies (Beierholm et al., 2014; Carrasco et al., 2015a, 2015b) but the results from these publications differed in some aspects (e.g. energy dependence, long term stability). The respective authors highlighted the need for more studies to be published (Beierholm et al., 2015; Carrasco et al., 2015a, 2015b). In this work, the Exradin W1 was characterised in terms of dose response, dependence on dose rate, energy, temperature and angle of irradiation, and long-term stability. The observed dose linearity, short-term repeatability and temperature dependence were in good agreement with previously published data. Appropriate corrections should therefore be applied, where possible, in order to achieve measurements with low-uncertainty. The angular dependence was characterised along both the symmetrical and polar axis of the detector for the first time in this work and a dose variation of up to 1% was observed. The response of the detector was observed to decrease at a rate of approximately 1.6% kGy-1 for the first 5 kGy delivered, and then stabilised to 0.2% kGy-1 in the subsequent 20 kGy. The main goal of this work was to assess the suitability of the Exradin W1 for use in dose verification measurements for stereotactic radiosurgery. The results obtained confirm that the detector is suitable for use in such situations. The detector is now utilised in a multi-centre stereotactic radiosurgery dosimetric audit, with the application of appropriate correction factors.

  16. A multicentre molecular analysis of hepatitis B and blood-borne virus coinfections in Viet Nam.

    Science.gov (United States)

    Dunford, Linda; Carr, Michael J; Dean, Jonathan; Nguyen, Linh Thuy; Ta Thi, Thu Hong; Nguyen, Binh Thanh; Connell, Jeff; Coughlan, Suzie; Nguyen, Hien Tran; Hall, William W; Thi, Lan Anh Nguyen

    2012-01-01

    Hepatitis B (HBV) infection is endemic in Viet Nam, with up to 8.4 million individuals estimated to be chronically infected. We describe results of a large, multicentre seroepidemiological and molecular study of the prevalence of HBV infection and blood-borne viral coinfections in Viet Nam. Individuals with varying risk factors for infection (n = 8654) were recruited from five centres; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. A mean prevalence rate of 10.7% was observed and levels of HBsAg were significantly higher in injecting drug users (IDUs) (17.4%, n = 174/1000) and dialysis patients (14.3%, n = 82/575) than in lower-risk groups (9.4%; pa predominance of genotype B4 (82.6%); genotypes C1 (14.6%), B2 (2.7%) and C5 (0.5%) were also identified. The precore mutation G1896A was identified in 35% of all specimens, and was more frequently observed in genotype B (41%) than genotype C (3%; pa' region of the surface gene, point mutations were identified in 31% (n = 58/187) of sequences, and 2.2% (n = 4/187) and 5.3% (n = 10/187) specimens contained the major vaccine escape mutations G145A/R and P120L/Q/S/T, respectively. 368 HBsAg positive individuals were genotyped for the IL28B SNP rs12979860 and no significant association between the IL28B SNP and clearance of HBsAg, HBV viral load or HBeAg was observed. This study confirms the high prevalence of HBV infection in Viet Nam and also highlights the significant levels of blood-borne virus coinfections, which have important implications for hepatitis-related morbidity and development of effective management strategies.

  17. Erysipelas of the leg (cellulitis in sub-Saharan Africa: A multicentric study of 562 cases

    Directory of Open Access Journals (Sweden)

    Bayaki Saka

    2017-01-01

    Full Text Available Introduction: Erysipelas of the leg is a common and serious infection. We carried out this study aiming at describing the epidemiological and clinical characteristics, and assessing the risks factors associated with the local complications of erysipelas of the leg in sub-Saharan Africa. Methods: This was a prospective multicentric study carried out in the dermatology units of Hospitals located in seven sub-Saharan African countries during a period of 12 months. Patients aged 15 and above with a first episode of erysipelas of the leg were recruited. Results: In this study, 562 patients were recruited, having a mean age of 43.7±16.9 years and a sex-ratio (M/F of 0.67. Patients infected on one leg were 562 while those infected with two were 27. Bullous forms of the disease were observed in 95 patients, while purpuric forms were observed in 167 patients. The existence of a point of entry (485 cases, obesity (230, lymph edema (130 and the use of bleaching agents (97 were the mains risk factors. Complications during the course of the infection such as necrotizing fasciitis (34 cases and abscesses (63 cases were observed. They were due to the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm. Conclusion: This study reveals that existence of a point of entry, obesity and lymph edema, and the use of bleaching agents were the mains risk factors influencing the local complications of erysipelas of the leg. Necrotizing fasciitis and abscesses were influenced by the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm.

  18. Ethics and observational studies in medical research: various rules in a common framework

    Science.gov (United States)

    Claudot, Frédérique; Alla, François; Fresson, Jeanne; Calvez, Thierry; Coudane, Henry; Bonaïti-Pellié, Catherine

    2009-01-01

    Background Research ethics have become universal in their principles through international agreements. The standardization of regulations facilitates the internationalization of research concerning drugs. However, in so-called observational studies (i.e. from data collected retrospectively or prospectively, obtained without any additional therapy or monitoring procedure), the modalities used for applying the main principles vary from one country to the other. This situation may entail problems for the conduct of multi-centric international studies, as well as for the publication of results if the authors and editors come from countries governed by different regulations. In particular, several French observational studies were rejected or retracted by United States peer reviewed journals, because their protocols have not been submitted to an Institutional Review Board/Independent Ethics Committee (IRB/IEC). Methods national legislation case analysis Results In accordance with European regulation, French observational studies from data obtained without any additional therapy or monitoring procedure, do not need the approval of an IRB/IEC. Nevertheless, these researches are neither exempt from scientific opinion nor from ethical and legal authorization. Conclusion We wish to demonstrate through the study of this example that different bodies of law can provide equivalent levels of protection that respect the same ethical principles. Our purpose in writing this paper was to encourage public bodies, scientific journals, and researchers to gain a better understanding of the various sets of specific national regulations and to speak a common language. PMID:19336436

  19. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2010-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming a partici......Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...... as the idea of the naïve observer becomes a void. Not recognizing and observing oneself as observer and co-producer of empirical data simply leaves the process of observation as the major unobserved absorber of contingency in data production based on participating observation....

  20. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2011-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming a partici......Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...... as the idea of the naïve observer becomes a void. Not recognizing and observing oneself as observer and co-producer of empirical data simply leaves the process of observation as the major unobserved absorber of contingency in data production based on participating observation....

  1. Severe reduction of blood lysosomal acid lipase activity in cryptogenic cirrhosis: A nationwide multicentre cohort study.

    Science.gov (United States)

    Angelico, Francesco; Corradini, Stefano Ginanni; Pastori, Daniele; Fargion, Silvia; Fracanzani, Anna Ludovica; Angelico, Mario; Bolondi, Luigi; Tozzi, Giulia; Pujatti, Pietro Luigi; Labbadia, Giancarlo; Corazza, Gino Roberto; Averna, Maurizio; Perticone, Francesco; Croce, Giuseppe; Persico, Marcello; Bucci, Tommaso; Baratta, Francesco; Polimeni, Licia; Del Ben, Maria; Violi, Francesco

    2017-07-01

    Blood lysosomal acid lipase (LAL) is reduced in non-alcoholic steatohepatitis, which is the major cause of cryptogenic cirrhosis (CC); few data on LAL activity in CC do exist. We investigated LAL activity in a cohort of patients with liver cirrhosis. This is a multicentre cohort study including 274 patients with liver cirrhosis of different aetiology from 19 centres of Internal Medicine, Gastroenterology and Hepatology distributed throughout Italy. Blood LAL activity (nmol/spot/h) was measured with dried blood spot extracts using Lalistat 2. Overall, 133 patients had CC, and 141 patients had cirrhosis by other causes (61 viral, 53 alcoholic, 20 alcoholic + viral, 7 autoimmune). Mean age was 64.2 ± 13.4 years, and 28.5% were women. Patients with CC were older compared to other aetiology-cirrhosis, with a lower Child-Turcotte-Pugh (CTP, p=0.003) and MELD (p=0.009) score, and a higher prevalence of cardio-metabolic risk factors and previous ischemic events. In the whole cohort, median LAL activity value was 0.58 nmol/spot/h, 0.49 and 0.65 in the groups of CC and known-aetiology cirrhosis, respectively (p=0.002). The difference remained significant after adjustment for white blood cells count (p=0.001). Multivariable linear regression analysis showed that CC (vs. known aetiology, Beta = -0.144, p=0.018), platelet count (Beta = 0.398, p < 0.001) and CTP score (Beta = -0.133, p=0.022) were associated with log-LAL activity. Similar results were found using MELD as covariate. We found a marked reduction of LAL activity in patients with cryptogenic cirrhosis compared to the other known aetiologies. A prospective study will clarify the role of LAL in chronic liver diseases. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Integrative medicine for subacute stroke rehabilitation: a study protocol for a multicentre, randomised, controlled trial

    Science.gov (United States)

    Fang, Jianqiao; Chen, Lifang; Chen, Luni; Wang, Chao; Keeler, Crystal Lynn; Ma, Ruijie; Xu, Shouyu; Shen, Laihua; Bao, Yehua; Ji, Conghua

    2014-01-01

    Introduction Many patients with stroke receive integrative medicine in China, which includes the basic treatment of Western medicine and routine rehabilitation, in conjunction with acupuncture and Chinese medicine. The question of whether integrative medicine is efficacious for stroke rehabilitation is still controversial and very little research currently exists on the integrated approach for this condition. Consequently, we will conduct a multicentre, randomised, controlled, assessor-blinded clinical trial to assess the effectiveness of integrative medicine on stroke rehabilitation. Methods and analysis 360 participants recruited from three large Chinese medical hospitals in Zhejiang Province will be randomly divided into the integrative medicine rehabilitation (IMR) group and the conventional rehabilitation (CR) group in a 1:1 ratio. Participants in the IMR group will receive acupuncture and Chinese herbs in addition to basic Western medicine and rehabilitation treatment. The CR group will not receive acupuncture and Chinese herbal medicine. The assessment data will be collected at baseline, 4 and 8 weeks postrandomisation, and then at 12 weeks’ follow-up. The primary outcome is measured by the Modified Barthel Index. The secondary outcomes are the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment, the mini-mental state examination and Montreal Cognitive, Hamilton's Depression Scale and Self-Rating Depression Scale, and the incidence of adverse events. Ethics and dissemination Ethical approval was obtained from ethics committees of three hospitals. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients by telephone, during follow-up calls inquiring on patient's post-study health status. Trial registration number Chinese Clinical Trial Register: ChiCTR-TRC-12001972, http://www.chictr.org/en/proj/show.aspx?proj=2561 PMID:25475247

  3. Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study.

    Science.gov (United States)

    Kleinschmidt, Immo; Bradley, John; Knox, Tessa Bellamy; Mnzava, Abraham Peter; Kafy, Hmooda Toto; Mbogo, Charles; Ismail, Bashir Adam; Bigoga, Jude D; Adechoubou, Alioun; Raghavendra, Kamaraju; Cook, Jackie; Malik, Elfatih M; Nkuni, Zinga José; Macdonald, Michael; Bayoh, Nabie; Ochomo, Eric; Fondjo, Etienne; Awono-Ambene, Herman Parfait; Etang, Josiane; Akogbeto, Martin; Bhatt, Rajendra M; Chourasia, Mehul Kumar; Swain, Dipak K; Kinyari, Teresa; Subramaniam, Krishanthi; Massougbodji, Achille; Okê-Sopoh, Mariam; Ogouyemi-Hounto, Aurore; Kouambeng, Celestin; Abdin, Mujahid Sheikhedin; West, Philippa; Elmardi, Khalid; Cornelie, Sylvie; Corbel, Vincent; Valecha, Neena; Mathenge, Evan; Kamau, Luna; Lines, Jonathan; Donnelly, Martin James

    2018-04-09

    Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden. This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis. Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1·4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0·63, 95% CI 0·51-0·78) and disease incidence (adjusted rate ratio [RR] 0·62, 0·41-0·94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0·86, 0·70-1·06) or incidence (adjusted RR 0·89, 0·72-1·10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0·023, [95% CI 0·016-0·033] per person-year in India, to 0·80 [0·65-0·97] per person

  4. Salmeterol versus slow-release theophylline combined with ketotifen in nocturnal asthma: a multicentre trial. French Multicentre Study Group.

    Science.gov (United States)

    Muir, J F; Bertin, L; Georges, D

    1992-11-01

    We wished to assess the efficacy of inhaled salmeterol (SML; 50 micrograms b.i.d.) compared to a combination of slow-release theophylline and ketotifen p.o. (TK; T 300 mg+K 1 mg b.i.d.) for the treatment of nocturnal asthma. Ninety six patients with nocturnal asthma, (forced expiratory volume in one second (FEV1) 60-90% of predicted value, reversibility > or = 15%, at least two nocturnal awakenings per week) were eligible for a multicentre, double-blind, double-dummy cross-over study (14-day run-in, two successive 28-day treatment periods). Efficacy was assessed as success/failure, success being defined as the complete disappearance of nocturnal symptoms/awakening during the last week of each treatment period. There was a statistically significant difference between SML and TK for this criterion: 46% and 39% success with SML during periods I (first 28-day period) and II (following the cross-over), compared to only 15% and 26% with TK, respectively (p < 0.01). SML was also significantly better for the other criteria (lung function, rescue salbutamol intake during day and night). Side-effects were five times less frequent in SML-treated patients (p < 0.004). Efficacy and tolerance of SML were obviously far better than those of TK in patients with nocturnal asthma.

  5. Observed internal tides and near-inertial waves on the continental shelf and slope off Jaigarh, central west coast of India

    Digital Repository Service at National Institute of Oceanography (India)

    Subeesh, M.P.; Unnikrishnan, A.S.

    The characteristics of internal tides (ITs) and near-inertial waves (NIWs) on the continental shelf and slope off Jaigarh (17degreeN), central west coast of India were studied. Eight-month (March–October) long Acoustic Doppler Current Profiler (ADCP...

  6. Multi-Centrality Graph Spectral Decompositions and Their Application to Cyber Intrusion Detection

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Pin-Yu; Choudhury, Sutanay; Hero, Alfred

    2016-03-01

    Many modern datasets can be represented as graphs and hence spectral decompositions such as graph principal component analysis (PCA) can be useful. Distinct from previous graph decomposition approaches based on subspace projection of a single topological feature, e.g., the centered graph adjacency matrix (graph Laplacian), we propose spectral decomposition approaches to graph PCA and graph dictionary learning that integrate multiple features, including graph walk statistics, centrality measures and graph distances to reference nodes. In this paper we propose a new PCA method for single graph analysis, called multi-centrality graph PCA (MC-GPCA), and a new dictionary learning method for ensembles of graphs, called multi-centrality graph dictionary learning (MC-GDL), both based on spectral decomposition of multi-centrality matrices. As an application to cyber intrusion detection, MC-GPCA can be an effective indicator of anomalous connectivity pattern and MC-GDL can provide discriminative basis for attack classification.

  7. The new system of review by multicentre research ethics committees: prospective study.

    Science.gov (United States)

    Tully, J; Ninis, N; Booy, R; Viner, R

    2000-04-29

    To assess the function of the new system of review by multicentre research ethics committees and to highlight areas where improvement is still needed. Prospectively collected data from a multicentre study was examined with respect to the ethics review process. Administrative, financial, and time elements of the review process were audited. A single multicentre research ethics committee and 125 local ethics committees from six regions of England. Time to reply, time to approval, and number of non-local changes to the application requested. Only 40% of local ethics committees considered our study in the manner specified in the 1998 directive. Less than a third of committees replied within the 21 day period stipulated, although committees acting by executive subcommittee replied more quickly than those not acting by executive subcommittee. There was a tendency for executive subcommittees to approve studies in a shorter time. Local ethics committees asked for a large number of non-local changes to the application. The financial cost of applying to multiple ethics committees remains high, mainly because multiple copies of research applications are being requested. The new system of approval by multicentre research ethics committee for multicentre studies was introduced to reduce administrative costs, speed up the process of reviews by multiple research ethics committees, and standardise the conclusions of the local research ethics committees. Since its introduction an improvement has been seen, but the system is not yet universally functioning as intended. Ethics review still remains a hindrance to the financial resources and commencement of national studies. We strongly support the structure of review by multicentre research ethics committees but suggest that the system has yet to achieve its aims.

  8. External quality assessment of HLA-B*5701 reporting: an international multicentre survey.

    Science.gov (United States)

    Hammond, Emma; Almeida, Coral-Ann; Mamotte, Cyril; Nolan, David; Phillips, Elizabeth; Schollaardt, Tineke Asma; Gill, M John; Angel, Jonathan B; Neurath, Doris; Li, Jianping; Giulivi, Tony; McIntyre, Cathy; Koultchitski, Galina; Wong, Betty; Reis, Marciano; Rachlis, Anita; Cole, David E; Chew, Choo Beng; Neifer, Stefan; Lalonde, Richard; Roger, Michel; Jeanneau, Annie; Mallal, Simon

    2007-01-01

    HLA-B*5701 strongly predicts abacavir hypersensitivity (HSR), but implementation of effective routine screening into clinical practice requires testing be practical and accurate. We tested the proficiency of HLA-B*5701 typing among laboratories using sequence-specific primer PCR. DNA panels (1 and 2) were distributed to seven laboratories (A to G) for blinded typing of the HLA-B*5701 allele. Panel 1 (n = 10 samples; n = 7 laboratories) included 3 positives and other closely related B17 subtypes (B*5702, B*5703, B*5704 and B*5801). Panel 2 (n = 96 samples; n = 4 laboratories) included 36 positives among a broad spectrum of other B alleles. Two laboratories (A and B) also submitted 96 routine samples, typed by the same methodology, to the reference centre for additional analysis by sequence-based typing. All laboratories correctly typed panel 1 for HLA-B*5701 carriage. Laboratories A, B and C identified HLA-B*5701 alleles in panel 2 with 100% sensitivity and 100% specificity. Laboratory D reported one false negative, reportedly due to a sampling error. The results obtained for routine samples typed by laboratories A and B and those generated by the reference laboratory using sequencing were fully concordant. Detection of HLA-B*5701 alleles among laboratories was 100% specific and 99.4% sensitive, indicating that participating HIV testing laboratories were currently offering effective primary screening to identify individuals at high risk of abacavir HSR. Accurate reporting of HLA-B*5701 status is critical for the safe administration of this drug and participation in quality assurance programmes by all sites who report HLA-B*5701 status should be promoted.

  9. Retrospective exposure assessment and quality control in an international multi-centre case-control study

    DEFF Research Database (Denmark)

    Tinnerberg, H; Heikkilä, P; Huici-Montagud, A

    2003-01-01

    was higher among the original assessors (the assessor from the same country as the subject) than the average prevalence assessed by the other four in the quality control round. The original assessors classified more job situations as exposed than the others. Several reasons for this are plausible: real...... of the assessors, as Cohen's kappa and as overall proportion of the agreements. The reassessment of the exposures changed the exposure statuses significantly, when compared with the original cohort. Harmonization of the exposure criteria increased the conformity of the assessments. The prevalence of exposure...

  10. Internal fixation for the treatment of the thoracic spine fractures - Multicentric experience

    International Nuclear Information System (INIS)

    Maria Ibarra, Javier Ernesto; Arrieta Maria, Victor Elias; Chaparro Rondon, Walker

    2003-01-01

    Thoracic spine fractures has a high social impact because of its frequent association with neurological deficit. There is much controversy about the way to treat them: using transpedicular screws (Roy Camille), books (Harrington) or sublaminar wires (Luque) systems. Forty patients were reviewed in time span from 1993 to 2002; average age 37 years, average follow up 54 months. The analyzed variables were: technique used, diagnostic, mechanism of trauma, neurological deficit, additional injuries, decompressive procedures, anatomic level and complications. There were 28 (70%) luxofractures. The causes of the injuries found were 21 (52%) cases of vehicle motor accidents. 24 patients (60%) had neurological deficit and seven of them required decompression procedures, the mean of levels fixed per patient were seven. the modified Harrington-Luque technique was used in 26 patients and the modular technique was used in 14. The complications presented were two acute infections

  11. Epidural spinal cord stimulation for neuropathic pain: a neurosurgical multicentric Italian data collection and analysis.

    Science.gov (United States)

    Colombo, Elena Virginia; Mandelli, Carlo; Mortini, Pietro; Messina, Giuseppe; De Marco, Nicola; Donati, Roberto; Irace, Claudio; Landi, Andrea; Lavano, Angelo; Mearini, Massimo; Podetta, Stefano; Servello, Domenico; Zekaj, Edvin; Valtulina, Carlo; Dones, Ivano

    2015-04-01

    Spinal cord stimulation (SCS) is a technique used worldwide to treat several types of chronic neuropathic pain refractory to any conservative treatment. The aim of this data collection is to enforce evidence of SCS effectiveness on neuropathic chronic pain reported in the literature and to speculate on the usefulness of the trial period in determining the long-term efficacy. Moreover, the very low percentage of undesired side effects and complications reported in our case series suggests that all implants should be performed by similarly well-trained and experienced professionals. A multicentric data collection on a common database from 11 Italian neurosurgical departments started 3 years ago. Two different types of electrodes (paddle or percutaneous leads) were used. Of 122 patients, 73 % (N = 89) were submitted to a trial period, while the remaining patients underwent the immediate permanent implant (N = 33). Statistical comparisons of continuous variables between groups were performed. Most of the patients (80 %) had predominant pain to their lower limbs, while only 17 % of patients had prevalent axial pain. Significant reduction in pain, as measured by variation in visual analogue scale (VAS) score, was observed at least 1 year after implantation in 63.8 % of the cases, 59.5 % of patients who underwent a test trial and 71.4 % of patients who underwent permanent implant at once. No statistical differences were found between the lower-limb pain group and the axial pain group. No relevant differences in long-term outcomes were observed in previously tested patients compared with patients implanted at once. Through this analysis we hope to recruit new centres, to give more scientific value to our results.

  12. Reliability and validity of telephonic Barthel Index: an experience from multi-centric randomized control study.

    Science.gov (United States)

    Prasad, Kameshwar; Kumar, Amit; Misra, Shubham; Yadav, Arun K; Johri, Sarat; Sarkar, R S; Gorthi, S P; Hassan, K M; Prabhakar, Sudesh; Misra, Usha Kant; Kumar, Pradeep

    2018-03-01

    Telephonic Barthel Index (BI) assessment is less time-consuming and more feasible than a face-to-face interview. The aim of this study was to test the validity as well as reliability of the BI administered by telephone in comparison with face-to-face assessment in a multi-centric study. The study was conducted during the course of a randomized controlled trial in which 120 patients with subacute strokes from five teaching hospitals from different parts of India were recruited. Central telephonic follow-up and face-to-face assessment of BI and modified Rankin Scale (mRS) at 3 and 6 months were done by trained and certified blinded researchers. Kappa or weighted kappa (wK) was estimated. Sensitivity and specificity at various cutoff levels of telephonic BI were calculated. Concurrent validity of the telephonic BI was assessed by correlating it with the mRS and National Institutes of Health Stroke Scales (NIHSS) at 3 and 6 months. We observed high sensitivity and specificity at various cutoff levels of BI. Moderate to substantial agreement was observed between the two methods at 6 months wK 0.72 (95% CI 0.70-0.77). Item-wise and center-wise kappa also reflected substantial agreement. The study shows that telephonic assessment of activities of daily living with the BI in moderate to severely disabled stroke patients is valid and reliable compared to face-to-face assessment. Our study shows that telephonic assessment requires smaller sample size compared to face-to-face assessment of BI.

  13. Chikungunya infection in India: results of a prospective hospital based multi-centric study.

    Science.gov (United States)

    Ray, Pratima; Ratagiri, Vinod H; Kabra, Sushil K; Lodha, Rakesh; Sharma, Sumit; Sharma, B S; Kalaivani, Mani; Wig, Naveet

    2012-01-01

    Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India. A total of 540 patients with fever of up to 7 days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (pchikungunya confirmed cases (pchildren. Anti-CHIK antibodies (IgM) were detected for more than 60 days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ∼99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children. The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus.

  14. A prospective multi-centric open clinical trial of homeopathy in diabetic distal symmetric polyneuropathy.

    Science.gov (United States)

    Nayak, Chaturbhuja; Oberai, Praveen; Varanasi, Roja; Baig, Hafeezullah; Ch, Raveender; Reddy, G R C; Devi, Pratima; S, Bhubaneshwari; Singh, Vikram; Singh, V P; Singh, Hari; Shitanshu, Shashi Shekhar

    2013-04-01

    To evaluate homeopathic treatment in the management of diabetic distal symmetric polyneuropathy. A prospective multi-centric clinical observational study was carried out from October 2005 to September 2009 by Central Council for Research in Homeopathy (CCRH) (India) at its five institutes/units. Patients suffering from diabetes mellitus (DM) and presenting with symptoms of diabetic polyneuropathy (DPN) were screened, investigated and were enrolled in the study after fulfilling the inclusion and exclusion criteria. Patients were evaluated by the diabetic distal symmetric polyneuropathy symptom score (DDSPSS) developed by the Council. A total of 15 homeopathic medicines were identified after repertorizing the nosological symptoms and signs of the disease. The appropriate constitutional medicine was selected and prescribed in 30, 200 and 1 M potency on an individualized basis. Patients were followed up regularly for 12 months. Out of 336 patients (167 males and 169 females) enrolled in the study, 247 patients (123 males and 124 females) were analyzed. All patients who attended at least three follow-up appointments and baseline curve conduction studies were included in the analysis.). A statistically significant improvement in DDSPSS total score (p = 0.0001) was found at 12 months from baseline. Most objective measures did not show significant improvement. Lycopodium clavatum (n = 132), Phosphorus (n = 27) and Sulphur (n = 26) were the medicines most frequently prescribed. Adverse event of hypoglycaemia was observed in one patient only. This study suggests homeopathic medicines may be effective in managing the symptoms of DPN patients. Further studies should be controlled and include the quality of life (QOL) assessment. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  15. [Orthogeriatrics: The First multicentre regional register of hip fractures in Castilla y León (Spain)].

    Science.gov (United States)

    Muñoz-Pascual, Angélica; Sáez-López, Pilar; Jiménez-Mola, Sonia; Sánchez-Hernández, Natalia; Alonso-García, Noelia; Andrés-Sainz, Ana Isabel; Macias-Montero, M Cruz; Vázquez-Pedrezuela, Carmen; Pereira de Castro Juez, Nieves; Del Pozo-Tagarro, Pilar; Pablos-Hernández, Carmen; Cervera-Díaz, Carmen; Cerón-Fernández, Ana; Vuelta-Calzada, Esther; Perez-Jara Carrera, Javier; González-Ramírez, Alfonso; Collado-Díaz, Teresa; Idoate-Gil, Javier; Guerrero-Díaz, M Teresa; Gutierrez-Bejarano, Dayro; Martín-Perez, Encarnación

    The objective of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during three monthly periods (November 2014, and October and November 2015). The Castilla y León orthogeriatrics work group created a common register to collect data on hip fractures. The study included patients 75 years-old and over hospitalised with hip fractures in the 13 public hospitals in the community during November 2014, and October and November 2015. A multicentre, prospective, and observational study was conducted, in which clinical, functional, and social variables, as well as in-hospital mortality, were collected. The analysis included data from a total of 776 patients with a mean age of 86 (±6) years. The surgical delay was 4±2.8 days, and the mean hospital stay was 10±4.7 days. The anaesthesia risk was ASA 3±0.6. Around two-thirds (66.5%) of the patients had medical complications while in hospital, and 55.5% required a transfusion. In-hospital mortality was 4.6%. The mean pre-surgical stay was related to the overall stay: P<.001. Hip fracture registers are an essential tool for evaluating the process and for improving the treatment quality of these patients. This is the first multicentre register of hip fracture in the elderly created in a Spanish region, and could be a good precedent reference for a future national register. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Questing for circadian dependence in ST-segment-elevation acute myocardial infarction: A multicentric and multiethnic study

    KAUST Repository

    Ammirati, Enrico

    2013-05-09

    Rationale: Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment-elevation acute myocardial infarction (STEMI). Objective: To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population. Methods and Results: We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6:00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI. Conclusions: Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time-dynamic mechanisms underlying such a relation. © 2013 American Heart Association, Inc.

  17. Sensitivity of imaging for multifocal-multicentric breast carcinoma

    Directory of Open Access Journals (Sweden)

    Viale Giuseppe

    2008-09-01

    Full Text Available Abstract Background This retrospective study aims to determine: 1 the sensitivity of preoperative mammography (Mx and ultrasound (US, and re-reviewed Mx to detect multifocal multicentric breast carcinoma (MMBC, defined by pathology on surgical specimens, and 2 to analyze the characteristics of both detected and undetected foci on Mx and US. Methods Three experienced breast radiologists re-reviewed, independently, digital mammography of 97 women with MMBC pathologically diagnosed on surgical specimens. The radiologists were informed of all neoplastic foci, and blinded to the original mammograms and US reports. With regards to Mx, they considered the breast density, number of foci, the Mx characteristics of the lesions and their BI-RADS classification. For US, they considered size of the lesions, BI-RADS classification and US pattern and lesion characteristics. According to the histological size, the lesions were classified as: index cancer, 2nd lesion, 3rd lesion, and 4th lesion. Any pathologically identified malignant foci not previously described in the original imaging reports, were defined as undetected or missed lesions. Sensitivity was calculated for Mx, US and re-reviewed Mx for detecting the presence of the index cancer as well as additional satellite lesions. Results Pathological examination revealed 13 multifocal and 84 multicentric cancers with a total of 303 malignant foci (282 invasive and 21 non invasive. Original Mx and US reports had an overall sensitivity of 45.5% and 52.9%, respectively. Mx detected 83/97 index cancers with a sensitivity of 85.6%. The number of lesions undetected by original Mx was 165/303. The Mx pattern of breasts with undetected lesions were: fatty in 3 (1.8%; scattered fibroglandular density in 40 (24.3%, heterogeneously dense in 91 (55.1% and dense in 31 (18.8% cases. In breasts with an almost entirely fatty pattern, Mx sensitivity was 100%, while in fibroglandular or dense pattern it was reduced to 45

  18. Data collection using open access technology in multicentre operational research involving patient interviews.

    Science.gov (United States)

    Shewade, H D; Chadha, S S; Gupta, V; Tripathy, J P; Satyanarayana, S; Sagili, K; Mohanty, S; Bera, O P; Pandey, P; Rajeswaran, P; Jayaraman, G; Santhappan, A; Bajpai, U N; Mamatha, A M; Maiser, R; Naqvi, A J; Pandurangan, S; Nath, S; Ghule, V H; Das, A; Prasad, B M; Biswas, M; Singh, G; Mallick, G; Jeyakumar Jaisingh, A J; Rao, R; Kumar, A M V

    2017-03-21

    Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

  19. Multi-centric universal pseudonymisation for secondary use of the EHR.

    Science.gov (United States)

    Lo Iacono, Luigi

    2007-01-01

    This paper discusses the importance of protecting the privacy of patient data kept in an Electronic Health Record (EHR) in the case, where it leaves the control- and protection-sphere of the health care realm for secondary uses such as clinical or epidemiological research projects, health care research, assessment of treatment quality or economic assessments. The paper focuses on multi-centric studies, where various data sources are linked together using Grid technologies. It introduces a pseudonymisation system which enables a multi-centric universal pseudonymisation, meaning that a patient's identity will result in the same pseudonym, regardless of which participating study center the patient data is collected.

  20. [Establishment and Management of Multicentral Collection Bio-sample Banks of Malignant Tumors from Digestive System].

    Science.gov (United States)

    Shen, Si; Shen, Junwei; Zhu, Liang; Wu, Chaoqun; Li, Dongliang; Yu, Hongyu; Qiu, Yuanyuan; Zhou, Yi

    2015-11-01

    To establish and manage of multicentral collection bio-sample banks of malignant tumors from digestive system, the paper designed a multicentral management system, established the standard operation procedures (SOPs) and leaded ten hospitals nationwide to collect tumor samples. The biobank has been established for half a year, and has collected 695 samples from patients with digestive system malignant tumor. The clinical data is full and complete, labeled in a unified way and classified to be managed. The clinical and molecular biology researches were based on the biobank, and obtained achievements. The biobank provides a research platform for malignant tumor of digestive system from different regions and of different types.

  1. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

    Directory of Open Access Journals (Sweden)

    Varun Sharma Tandra

    2015-01-01

    Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

  2. Vulvar cancer in Tunisia: Epidemiological and clinicopathological features multicentric study.

    Science.gov (United States)

    Kehila, Mehdi; Harabi, Souad; Mhiri, Raoudha; Touhami, Omar; Abouda, Hassine Saber; Khlifi, Abdeljalil; Hsairi, Mohamed; Chelli, Dalenda; Derbel, Mohamed; Kebaili, Sahbi; Boujelbane, Nadia; Chaabene, Kais; Chanoufi, Mohamed Badis

    2017-06-01

    To describe for the first time the epidemiologic and clinico-pathologic characteristics of vulvar cancer in Tunisia. Two parts are distinguished in this study: Part1: Multicentric retrospective study about the characteristics of all cancer cases diagnosed during a 17-years period (January 1998-December 2014) in three departments of Gynecology and Obstetrics: one in south Tunisia and two in the capital. Part 2: To determine the Incidence trend of invasive vulvar cancer in North Tunisia 1994-2009, on the basis of North Cancer Registry of Tunisia. A total of 76 cases of vulvar cancer were recorded. The median age at diagnosis was 65.4years and 86.9% of patients were more than 55years old. The symptomatology was dominated by vulvar pruritus in 48.7%. The average size of the tumor was 3.96cm. Stage III was the most frequent (53.7%) followed by stage II (28.3%). Only 10.4% of tumors were at stage I. The most common histologic type of vulvar malignancy was squamous cell carcinoma (SCC) (94.7%). Standardized incidence varied from 1.2/100 000 (1994) to 0.5/100 000 (2009). There was significant decrease of Standardized incidence (APC of -8.8% per year, 95% CI: -5.5%, -9.0%-pTunisia is a rare disease, occurs mostly in elderly women, and is diagnosed at advanced stages. Our findings emphasize that a greater effort should be made to facilitate early diagnosis, as treatment in earlier stages is less extensive and potentially curative. Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

  3. Surgical treatment of acute diverticulitis. A retrospective multicentre study.

    Science.gov (United States)

    Roig, José Vicente; Salvador, Antonio; Frasson, Matteo; Cantos, Míriam; Villodre, Celia; Balciscueta, Zutoia; García-Calvo, Rafael; Aguiló, Javier; Hernandis, Juan; Rodríguez, Rodolfo; Landete, Francisco; García-Granero, Eduardo

    2016-12-01

    To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD). Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD. A series of 385 patients: 218 men and 167 women, mean age 64.4±15.6 years, operated on in 10 hospitals were included. The median (25 th -75 th percentile) time from symptoms to surgery was 48 (24-72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosupression, presence of general risk factors and faecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications. Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Ocular and multicentric T-cell lymphoma in horse

    Directory of Open Access Journals (Sweden)

    Mariana C. Oliveira

    2016-11-01

    Full Text Available ABSTRACT. Oliveira M.C., Faleiro R.D., Santos C.C.A., Oliveira G.F., Daoualibi Y., Sonne L., Brito M.F. & Ubiali D.G. [Ocular and multicentric T-cell lymphoma in horse.] Linfoma de células T multicêntrico e ocular em equino. Revista Brasileira de Medicina Veterinária, 38(Supl.2:147-151, 2016. Setor de Anatomia Patológica, Departamento Epidemiologia e Saúde Pública, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23890-000, Brasil. E-mail: danielubiali@hotmail.com A 10-year-old gelding, mixed breed had body score condition 3 (1-10, with reluctance to move due to the loss of visual acuity in both eyes, right eye swelling and marked dyspnea. The ophthalmic examination showed no response to threat of reflection, objects test or direct reflection and consensus of both eyes. Examination with visor magnifier and Finoff transilluminator revealed buftalmia, hyphema, aqueous flare, corneal neovascularization and posterior synechiae with irregular bulging of the iris in the right eye and aqueous flare, central anterior synechiae and mature cataract in the left eye. It was found corneal integrity in both eyes with the fluorescein test. Urine sample submitted for PCR to Leptospira sp. resulted negative. Euthanasia was performed after unsuccessful treatment attempts. At necropsy there was a mass in the right eyeball, the pleural surface of the diaphragm and the mesentery. There was multifocal to coalescing whitish nodules between 1 and 4 cm in diameter in the lung, filling about 80% of the lungs’ surface, mainly in the ventral region. Morphology of masses was histopathologically compatible with lymphoma. Anti-CD3 antibody resulted positive in all samples analyzed characterizing immunophenotypic T-cell lymphoma.

  5. Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study

    DEFF Research Database (Denmark)

    Strøm, Camilla; Mollerup, Talie Khadem; Kromberg, Laurits Schou

    2017-01-01

    BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Interna......, unplanned readmission, and nosocomial infection. CONCLUSIONS: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department....

  6. Exploring the potential role of tungsten carbide cobalt (WC-Co) nanoparticle internalization in observed toxicity toward lung epithelial cells in vitro

    OpenAIRE

    Armstead, Andrea L.; Arena, Christopher B.; Li, Bingyun

    2014-01-01

    Tungsten carbide cobalt (WC-Co) has been recognized as a workplace inhalation hazard in the manufacturing, mining and drilling industries by the National Institute of Occupational Safety and Health. Exposure to WC-Co is known to cause “hard metal lung disease” but the relationship between exposure, toxicity and development of disease remain poorly understood. To better understand this relationship, the present study examined the role of WC-Co particle size and internalization on toxicity usin...

  7. Association between CASP8 -652 6N del polymorphism (rs3834129 and colorectal cancer risk: results from a multi-centric study.

    Directory of Open Access Journals (Sweden)

    Barbara Pardini

    Full Text Available The common -652 6N del variant in the CASP8 promoter (rs3834129 has been described as a putative low-penetrance risk factor for different cancer types. In particular, some studies suggested that the deleted allele (del was inversely associated with CRC risk while other analyses failed to confirm this. Hence, to better understand the role of this variant in the risk of developing CRC, we performed a multi-centric case-control study. In the study, the variant -652 6N del was genotyped in a total of 6,733 CRC cases and 7,576 controls recruited by six different centers located in Spain, Italy, USA, England, Czech Republic and the Netherlands collaborating to the international consortium COGENT (COlorectal cancer GENeTics. Our analysis indicated that rs3834129 was not associated with CRC risk in the full data set. However, the del allele was under-represented in one set of cases with a family history of CRC (per allele model OR = 0.79, 95% CI = 0.69-0.90 suggesting this allele might be a protective factor versus familial CRC. Since this multi-centric case-control study was performed on a very large sample size, it provided robust clarification of the effect of rs3834129 on the risk of developing CRC in Caucasians.

  8. Internal deformation in layered Zechstein-III K-Mg salts. Structures formed by complex deformation and high contrasts in viscosity observed in drill cores.

    Science.gov (United States)

    Raith, Alexander; Urai, Janos L.

    2016-04-01

    During the evaporation of a massive salt body, alternations of interrupted and full evaporation sequences can form a complex layering of different lithologies. Viscosity contrasts of up to five orders of magnitude between these different lithologies are possible in this environment. During the late stage of an evaporation cycle potassium and magnesium (K-Mg) salts are precipitated. These K-Mg salts are of economic interest but also a known drilling hazard due to their very low viscosity. How up to 200m thick layers of these evaporites affect salt deformation at different scales is not well known. A better understanding of salt tectonics with extreme mechanical stratification is needed for better exploration and production of potassium-magnesium salts and to predict the internal structure of potential nuclear waste repositories in salt. To gain a better understanding of the internal deformation of these layers we analyzed K-Mg salt rich drill cores out of the Zechstein III-1b subunit from the Veendam Pillow 10 km southeast of Groningen, near the city Veendam in the NE Netherlands. The study area has a complex geological history with multiple tectonic phases of extension and compression forming internal deformation in the pillow but also conserving most of the original layering. Beside halite the most common minerals in the ZIII-1b are carnallite, kieserite, anhydrite and bischofite alternating in thin layers of simple composition. Seismic interpretation revealed that the internal structure of the Veendam Pillow shows areas, in which the K-Mg salt rich ZIII 1b layer is much thicker than elsewhere, as a result of salt deformation. The internal structure of the ZIII-1b on the other hand, remains unknown. The core analysis shows a strong strain concentration in the weaker Bischofite (MgCl2*6H20) and Carnallite (KMgCl3*6H20) rich layers producing tectonic breccias and highly strained layers completely overprinting the original layering. Layers formed by alternating beds

  9. Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register.

    Science.gov (United States)

    Cardona, Victòria; Ferré-Ybarz, Laia; Guilarte, Mar; Moreno-Pérez, Nuria; Gómez-Galán, Catalina; Alcoceba-Borràs, Eva; Delavalle, Maria Belén; Garriga-Baraut, Teresa

    2017-01-01

    The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified. © 2017 S. Karger AG, Basel.

  10. Calibration test of PET scanners in a multi-centre clinical trial on breast cancer therapy monitoring using 18F-FLT.

    Directory of Open Access Journals (Sweden)

    Francis Bouchet

    Full Text Available A multi-centre trial using PET requires the analysis of images acquired on different systems We designed a multi-centre trial to estimate the value of 18F-FLT-PET to predict response to neoadjuvant chemotherapy in patients with newly diagnosed breast cancer. A calibration check of each PET-CT and of its peripheral devices was performed to evaluate the reliability of the results.11 centres were investigated. Dose calibrators were assessed by repeated measurements of a 68Ge certified source. The differences between the clocks associated with the dose calibrators and inherent to the PET systems were registered. The calibration of PET-CT was assessed with an homogeneous cylindrical phantom by comparing the activities per unit of volume calculated from the dose calibrator measurements with that measured on 15 Regions of Interest (ROIs drawn on 15 consecutive slices of reconstructed filtered back-projection (FBP images. Both repeatability of activity concentration based upon the 15 ROIs (ANOVA-test and its accuracy were evaluated.There was no significant difference for dose calibrator measurements (median of difference -0.04%; min = -4.65%; max = +5.63%. Mismatches between the clocks were less than 2 min in all sites and thus did not require any correction, regarding the half life of 18F. For all the PET systems, ANOVA revealed no significant difference between the activity concentrations estimated from the 15 ROIs (median of difference -0.69%; min = -9.97%; max = +9.60%.No major difference between the 11 centres with respect to calibration and cross-calibration was observed. The reliability of our 18F-FLT multi-centre clinical trial was therefore confirmed from the physical point of view. This type of procedure may be useful for any clinical trial involving different PET systems.

  11. Observation of the Near-seabed Velocity and Particles Resuspension During Nonlinear Internal Solitary Wave Events near the Dongsha Plateau at the Northern South China Sea

    Science.gov (United States)

    2015-09-30

    1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Observation of the Near-seabed Velocity and Particles...turbulence interaction and/or the dynamic pressure perturbation induced by ISWs cause the resuspension and redistribution of sediment particles and...likely form the continuous sediment waves on the seafloor [Ma et al., 2008 and Reeder et al., 2011]. To our knowledge, there are no direct observations

  12. Case study of inclined sporadic E layers in the Earth's ionosphere observed by CHAMP/GPS radio occultations: Coupling between the tilted plasma layers and internal waves

    Science.gov (United States)

    Gubenko, Vladimir N.; Pavelyev, A. G.; Kirillovich, I. A.; Liou, Y.-A.

    2018-04-01

    We have used the radio occultation (RO) satellite data CHAMP/GPS (Challenging Minisatellite Payload/Global Positioning System) for studying the ionosphere of the Earth. A method for deriving the parameters of ionospheric structures is based upon an analysis of the RO signal variations in the phase path and intensity. This method allows one to estimate the spatial displacement of a plasma layer with respect to the ray perigee, and to determine the layer inclination and height correction values. In this paper, we focus on the case study of inclined sporadic E (Es) layers in the high-latitude ionosphere based on available CHAMP RO data. Assuming that the internal gravity waves (IGWs) with the phase-fronts parallel to the ionization layer surfaces are responsible for the tilt angles of sporadic plasma layers, we have developed a new technique for determining the parameters of IGWs linked with the inclined Es structures. A small-scale internal wave may be modulating initially horizontal Es layer in height and causing a direction of the plasma density gradient to be rotated and aligned with that of the wave propagation vector k. The results of determination of the intrinsic wave frequency and period, vertical and horizontal wavelengths, intrinsic vertical and horizontal phase speeds, and other characteristics of IGWs under study are presented and discussed.

  13. ISBNPA 2007: Marketing, serious games and nanny states. Observations from the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity, Oslo 2007

    Directory of Open Access Journals (Sweden)

    Brug Johannes

    2007-09-01

    Full Text Available Abstract This commentary paper provides a selective overview of topics addressed at the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA. With 31 symposiums, 42 free paper sessions and 236 poster presentations ISBNPA 2007 provided a comprehensive overview of the state of the art and of new avenues for behavioral nutrition and physical activity research. Research presented at the conference helps to identify and specify important nutrition and physical activity behaviors for health promotion, as well as the correlates, predictors and determinants of these behaviors, and to build and test intervention strategies that go beyond traditional health education. ISBNPA 2007 also indicates that ISBNPA should strive to become more international by inclusion of more scientists from countries outside North America, Western Europe and Australia. ISBNPA should maintain its encouragement of research that is firmly rooted in behavioral theory and research that goes beyond applying cross-sectional research designs, and that addresses the most important public health issues associated with behavioral nutrition and physical activity.

  14. ISBNPA 2007: marketing, serious games and nanny states. Observations from the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity, Oslo 2007.

    Science.gov (United States)

    Brug, Johannes

    2007-09-19

    This commentary paper provides a selective overview of topics addressed at the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA). With 31 symposiums, 42 free paper sessions and 236 poster presentations ISBNPA 2007 provided a comprehensive overview of the state of the art and of new avenues for behavioral nutrition and physical activity research. Research presented at the conference helps to identify and specify important nutrition and physical activity behaviors for health promotion, as well as the correlates, predictors and determinants of these behaviors, and to build and test intervention strategies that go beyond traditional health education. ISBNPA 2007 also indicates that ISBNPA should strive to become more international by inclusion of more scientists from countries outside North America, Western Europe and Australia. ISBNPA should maintain its encouragement of research that is firmly rooted in behavioral theory and research that goes beyond applying cross-sectional research designs, and that addresses the most important public health issues associated with behavioral nutrition and physical activity.

  15. Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Andrea Párniczky

    Full Text Available The aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP.Eighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group.600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013.With respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality.Analysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP.

  16. Cognitive function in patients on androgen suppression: A prospective, multicentric study.

    Science.gov (United States)

    Morote, J; Tabernero, Á J; Álvarez-Ossorio, J L; Ciria, J P; Domínguez-Escrig, J L; Vázquez, F; Angulo, J; López, F J; de La Iglesia, R; Romero, J

    2018-03-01

    To assess the effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in patients with prostate cancer (PCa) after 6 months of treatment with luteinizing hormone-releasing hormone (LHRH) analogues. Prospective, observational, multicentre, open-label study of patients diagnosed with nonmetastatic or asymptomatic metastatic PCa scheduled to receive LHRH analogues for≥6 months. We assessed four CP domains at baseline and after 6 months of ADT: 1) Working memory: Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Subtest (WAIS III-Digit); 2) Visual memory: ad hoc visual memory test; 3) Visuospatial ability: Judgement of Line Orientation (JLO) and Mental Rotation of Three-Dimensional Objects (3D-Rotation); and 4) Nonverbal analytical reasoning: WAIS III Matrix Reasoning Test (WAIS III-MRT). Changes outside the baseline 95% confidence intervals were considered significant. A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test and 63 patients (20.4%) experienced significant changes in ≥1 test. Of these, most presented a change in only one test, distributed evenly between improvements (58 patients; 18.8%) and worsening (56 patients; 18.2%). For individual tests, most patients (87.8% to 91.8%) had no change from baseline; however, the significant changes (improvement vs. deterioration, respectively) were as follows: WAIS III-Digit (6.3% vs. 5.9%); visual memory (5.3% vs. 5.7%); JLO (5.3% vs. 4.5%); 3D-Rotation (4.1% vs. 4.1%); and WAIS III-MRT (4.8% vs. 5.8%). CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Self-confidence and knowledge of German ICU physicians in palliative care - a multicentre prospective study.

    Science.gov (United States)

    Krautheim, Veronika; Schmitz, Andrea; Benze, Gesine; Standl, Thomas; Schiessl, Christine; Waldeyer, Wolfgang; Hapfelmeier, Alexander; Kochs, Eberhard F; Schneider, Gerhard; Wagner, Klaus J; Schulz, Christian M

    2017-11-22

    Little is known about ICU physicians' self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine. In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge. Beyond descriptive statistics and non-parametric tests for group comparisons, linear regression analysis was used to assess the impact of independent variable on self-confidence and knowledge. Spearman's rank test was calculated. 55% of answers in the knowledge test were correct and more than half of the participants rated themselves as "rather confident" or "confident". Linear regression analysis revealed that an additional certificate in either pain or palliative medicine significantly increased both knowledge and self-confidence, but only 15 out of 137 participants had at least one of those certificates. Relation between self-confidence and the results of the knowledge test was weak (r = 0.270 in female) and very weak (r = -0.007 in male). Although the questionnaire needs improvement according to the item analysis, it appears that, with respect to palliative care, ICU Physicians' self-confidence is not related to their knowledge. An additional certificate in either pain or palliative medicine was positively correlated to both self-confidence and knowledge. However, only a minority of the participants were qualified through such a certificate.

  18. Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients.

    Science.gov (United States)

    Westerveld, Henrike; de Leeuw, Astrid; Kirchheiner, Kathrin; Dankulchai, Pittaya; Oosterveld, Bernard; Oinam, Arun; Hudej, Robert; Swamidas, Jamema; Lindegaard, Jacob; Tanderup, Kari; Pötter, Richard; Kirisits, Christian

    2016-09-01

    Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. In a subset of patients from the EMBRACE study, vaginal doses were evaluated. Doses at the applicator surface left/right and anterior/posterior and at 5mm depth were measured. In addition, the dose at the Posterior-Inferior Border of Symphysis (PIBS) vaginal dose point and PIBS±2cm, corresponding to the mid and lower vagina, was measured. 153 patients from seven institutions were included. Large dose variations expressed in EQD2 with α/β=3Gy were seen between patients, in particular at the top left and right vaginal wall (median 195 (range 61-947)Gy/178 (61-980)Gy, respectively). At 5mm depth, doses were 98 (55-212)Gy/91 (54-227)Gy left/right, and 71 (51-145)Gy/67 (49-189)Gy anterior/posterior, respectively. The dose at PIBS and PIBS±2cm was 41 (3-81)Gy, 54 (32-109)Gy and 5 (1-51)Gy, respectively. At PIBS+2cm (mid vagina) dose variation was coming from BT. The variation at PIBS-2cm (lower vagina) was mainly dependent on EBRT field border location. This novel method for reporting vaginal doses coming from EBRT and BT through well-defined dose points gives a robust representation of the dose along the vaginal axis. In addition, it allows comparison of vaginal dose between patients from different centres. The doses at the PIBS points represent the doses at the mid and lower parts of the vagina. Large variations in dose throughout the vagina were observed between patients and centres. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Blunt traumatic aortic injuries of the ascending aorta and aortic arch: a clinical multicentre study.

    Science.gov (United States)

    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Gulias, Daniel; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Herrera, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2013-09-01

    To report the clinical and radiological characteristics, management and outcomes of traumatic ascending aorta and aortic arch injuries. Historic cohort multicentre study including 17 major trauma patients with traumatic aortic injury from January 2000 to January 2011. The most common mechanism of blunt trauma was motor-vehicle crash (47%) followed by motorcycle crash (41%). Patients sustaining traumatic ascending aorta or aortic arch injuries presented a high proportion of myocardial contusion (41%); moderate or greater aortic valve regurgitation (12%); haemopericardium (35%); severe head injuries (65%) and spinal cord injury (23%). The 58.8% of the patients presented a high degree aortic injury (types III and IV). Expected in-hospital mortality was over 50% as defined by mean TRISS 59.7 (SD 38.6) and mean ISS 48.2 (SD 21.6) on admission. Observed in-hospital mortality was 53%. The cause of death was directly related to the ATAI in 45% of cases, head and abdominal injuries being the cause of death in the remaining 55% cases. Long-term survival was 46% at 1 year, 39% at 5 years, and 19% at 10 years. Traumatic aortic injuries of the ascending aorta/arch should be considered in any major thoracic trauma patient presenting cardiac tamponade, aortic valve regurgitation and/or myocardial contusion. These aortic injuries are also associated with a high incidence of neurological injuries, which can be just as lethal as the aortic injury, so treatment priorities should be modulated on an individual basis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. New Zealand; Financial Sector Assessment Program—Detailed Assessments of Observance of Standards and Codes—International Organization of Securities Commission (IOSCO)—Objectives and Principles of Securities Regulation

    OpenAIRE

    International Monetary Fund

    2004-01-01

    This paper evaluates the Observance of Standards and Codes on the International Organization of Securities Commission (IOSCO) Objectives and Principles of Securities Regulation for New Zealand. New Zealand equity markets are comparatively small with market capitalization of about 44 percent of GDP. Reflecting a preference for property investment, ownership of New Zealand-listed equities remains mostly in the hands of offshore investors and domestic institutional investors, with only about one...

  1. A multicentre study of motor functional connectivity changes in patients with multiple sclerosis

    NARCIS (Netherlands)

    Valsasina, P.; Rocca, M.A.; Absinta, M.; Sormani, M.P.; Mancini, L.; De Stefano, N.; Rovira, A.; Gass, A.; Enzinger, C.; Barkhof, F.; Wegner, C.; Matthews, P.M.; Filippi, M.

    2011-01-01

    In this multicentre study involving eight European centres, we characterized the spatial pattern of functional connectivity (FC) in the sensorimotor network from 61 right-handed patients with multiple sclerosis (MS) and 74 age-matched healthy subjects assessed with the use of functional magnetic

  2. Low sodium diet and pregnancy-induced hypertension: a multi-centre randomised controlled trial

    NARCIS (Netherlands)

    Knuist, M.; Bonsel, G. J.; Zondervan, H. A.; Treffers, P. E.

    1998-01-01

    To examine the effectiveness of the standard policy in the Netherlands to prescribe a sodium restricted diet to prevent or to treat mild pregnancy-induced hypertension. Multi-centre randomised controlled trial between April 1992 and April 1994. Seven practices of independent midwives and one

  3. Multicentre evaluation of the Tosoh HbA1c G8 analyser

    NARCIS (Netherlands)

    Chapelle, Jean-Paul; Teixeira, Jelda; Maisin, Diane; Assink, Hans; Barla, Gerhard; Stroobants, An K.; Delzenne, Barend; van den Eshof, Wouter

    2010-01-01

    We report a Dutch-Belgian multicentre evaluation of the Tosoh HLC-723G8 glycohaemoglobin analyser, an ion-exchange HPLC instrument for the separation and quantification of haemoglobin A1c (HbA1c) in whole blood. We evaluated the analytical performances of the Tosoh G8 analyser and compared the

  4. The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS) study: a randomised, controlled, multicentre clinical trial

    NARCIS (Netherlands)

    Howard, Jo; Malfroy, Moira; Llewelyn, Charlotte; Choo, Louise; Hodge, Renate; Johnson, Tony; Purohit, Shilpi; Rees, David C.; Tillyer, Louise; Walker, Isabeau; Fijnvandraat, Karin; Kirby-Allen, Melanie; Spackman, Eldon; Davies, Sally C.; Williamson, Lorna M.

    2013-01-01

    No consensus exists on whether preoperative blood transfusions are beneficial in patients with sickle-cell disease. We assessed whether perioperative complication rates would be altered by preoperative transfusion. We did a multicentre, randomised trial. Eligible patients were aged at least 1 year,

  5. Gastro-oesophageal reflux disease in The Netherlands. Results of a multicentre pH study

    NARCIS (Netherlands)

    Smout, A. J.; Geus, W. P.; Mulder, P. G.; Stockbrügger, R. W.; Lamers, C. B.

    1996-01-01

    Information on the relationships between gastro-oesophageal reflux (GOR), reflux symptoms, hiatal hernia (HH) and oesophagitis, and the response to antisecretory treatment is lacking. In a multicentre study endoscopy, ambulatory 24-h pH monitoring and symptom assessment were carried out in 142

  6. Multicentric Castleman’s Disease in a Child Revealed by Chronic Diarrhea

    Directory of Open Access Journals (Sweden)

    Sarra Benmiloud

    2015-01-01

    Full Text Available Multicentric Castleman’s disease is a rare benign and unexplained lymphoproliferative disorder that is extremely uncommon in children. It presents with fever, systemic symptoms, generalized lymphadenopathy, and laboratory markers of inflammation. Its treatment is not standardized and its prognosis is poor. We report a novel case of multicentric Castleman’s disease in a 13-year-old girl who had presented with chronic diarrhea as the only initial presenting symptom. The diagnosis of celiac or inflammatory bowel diseases was suspected, but two and a half years later, the diagnosis of multicentric Castleman’s disease was brought following the appearance of abdominal mass whose biopsy revealed Castleman’s disease in the plasma cell form. The outcome was favorable after treatment by corticosteroid, chemotherapy, and surgery. The occurrence of diarrhea as the initial symptom of multicentric Castleman’s disease without lymph node involvement is very rare. This case report underlines the diagnostic difficulties and the long interval between onset and diagnosis when diarrhea occurs first.

  7. Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

    Energy Technology Data Exchange (ETDEWEB)

    Malpani, A.R.; Sundaram, M. (Saint Louis Univ., MO (USA). Dept. of Radiology and Orthopedics); Ramani, S.K. (Grant Medical Coll., Bombay (India). Dept. of Radiology)

    1989-08-01

    This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG).

  8. Lung volume reduction coil treatment for patients with severe emphysema : a European multicentre trial

    NARCIS (Netherlands)

    Deslee, Gaetan; Klooster, Karin; Hetzel, Martin; Stanzel, Franz; Kessler, Romain; Marquette, Charles-Hugo; Witt, Christian; Blaas, Stefan; Gesierich, Wolfgang; Herth, Felix J. F.; Hetzel, Juergen; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial

  9. Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project.

    NARCIS (Netherlands)

    Roemer, W.; Hoek, G.; Brunekreef, B.; Haluszka, J.; Kalandidi, A.; Pekkanen, J.

    1998-01-01

    The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10), black smoke (BS), sulphur dioxide (SO2) and nitrogen dioxide (NO2) on the respiratory health of children with chronic

  10. Dislocation of the elbow: a retrospective multicentre study of 86 patients

    NARCIS (Netherlands)

    de Haan, Jeroen; Schep, Niels W. L.; Zengerink, Imme; van Buijtenen, Jesse; Tuinebreijer, Wim E.; den Hartog, Dennis

    2010-01-01

    The objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations.We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation. After a mean

  11. Dislocation of the Elbow: A Retrospective Multicentre Study of 86 Patients

    NARCIS (Netherlands)

    J. de Haan (Jeroen); J.F. Zengerink; D. den Hartog (Dennis); W.E. Tuinebreijer (Wim); J. Buijtenen (Jesse van); N.W.L. Schep (Niels)

    2010-01-01

    textabstractThe objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations.We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation.

  12. Prophylactic antibiotic regimens in tumour surgery (PARITY) : a pilot multicentre randomised controlled trial

    NARCIS (Netherlands)

    Ghert, M.; Bhandari, M.; Deheshi, B.; Guyatt, G.; Holt, G.; O'Shea, T.; Randall, R. L.; Thabane, L.; Wunder, J.; Evaniew, N.; McKay, P.; Schneider, P.; Turcotte, R.; Madden, K.; Scott, T.; Sprague, S.; Simunovic, N.; Swinton, M.; Racano, A.; Heels-Ansdell, D.; Buckingham, L.; Rose, P.; Brigman, B.; Pullenayegum, E.; Ghert, M.; Evaniew, N.; Mckay, P.; Schneider, P.; Sobhi, G.; Chan, R.; Biljan, M.; Ferguson, P.; Wunder, J.; Griffin, A.; Mantas, I.; Wylie, A.; Han, A.; Grewal, G.; Turcotte, R.; Goulding, K.; Dandachli, F.; Matte, G.; Werier, J.; Abdelbary, H.; Paquin, K.; Cosgrove, H.; Dugal, A-M.; Jutte, P.; Ploegmakers, J. J. W.; Stevens, M.

    2015-01-01

    Objective Clinical studies of patients with bone sarcomas have been challenged by insufficient numbers at individual centres to draw valid conclusions. Our objective was to assess the feasibility of conducting a definitive multi-centre randomised controlled trial (RCT) to determine whether a

  13. Prophylactic efficacy of lithium administered every second day: a WHO multicentre study

    DEFF Research Database (Denmark)

    Plenge, P; Amin, M; Agarwal, A K

    1999-01-01

    OBJECTIVES: To study the prophylactic efficacy of lithium administered every second day to patients with bipolar disorder or recurrent unipolar depressive disorder. METHODS: The study was carried out as a WHO multicentre study in five different psychiatric clinics: Russia (Moscow), Canada (Montre...

  14. Telemedicine techniques can be used to facilitate the conduct of multicentre trials.

    Science.gov (United States)

    Kennedy, C; Kirwan, J; Cook, C; Roux, P; Stulting, A; Murdoch, I

    2000-01-01

    A multicentre randomized controlled trial was established in Pretoria, Bloemfontein and Edendale in South Africa, and coordinated from London. The purpose of the trial was to determine the efficacy of low-dose beta irradiation of glaucoma. Five communication modalities (telephone, fax, e-mail, videoconferencing and face-to-face meetings) were examined in terms of their benefits in a multicentre trial. The eight stages of the multicentre trial examined were: set-up and training, recruitment, standardization, patient management, data transmission, update and data dissemination, clinical follow-up and monitoring, and publication. On four-point Likert scales for rating the usefulness of the communication modalities at each of the eight stages of the trial (from 0 = not useful to 3 = very useful; maximum score 24) the telephone was given a total score of 10, fax 9, e-mail 13, videoconferencing 15 and face-to-face meetings 9. Telemedicine techniques offer considerable benefits in the coordination of multicentre trials by improving data collection, maintaining the efficacy and monitoring of trials, while potentially offering reduced costs in terms of travel and time. The realtime scrutiny of patient records helps to ensure data uniformity and completeness of data collection. Videoconferencing was most useful when considered as one of several communication tools that can be used to improve the effectiveness of a service or process.

  15. Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients

    NARCIS (Netherlands)

    Westerveld, Henrike; de Leeuw, Astrid; Kirchheiner, Kathrin; Dankulchai, Pittaya; Oosterveld, Bernard; Oinam, Arun; Hudej, Robert; Swamidas, Jamema; Lindegaard, Jacob; Tanderup, Kari; Pötter, Richard; Kirisits, Christian

    2016-01-01

    Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. In a subset of patients from the

  16. Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 year follow-up

    NARCIS (Netherlands)

    Hariz, M. I.; Krack, P.; Alesch, F.; Augustinsson, L.-E.; Bosch, A.; Ekberg, R.; Johansson, F.; Johnels, B.; Meyerson, B. A.; N'Guyen, J.-P.; Pinter, M.; Pollak, P.; von Raison, F.; Rehncrona, S.; Speelman, J. D.; Sydow, O.; Benabid, A.-L.

    2008-01-01

    To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson's disease (PD) at 6 years post surgery. This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year

  17. Recommendations of the VAC2VAC workshop on the design of multi-centre validation studies.

    NARCIS (Netherlands)

    Halder, Marlies; Depraetere, Hilde; Delannois, Frédérique; Akkermans, Arnoud; Behr-Gross, Marie-Emmanuelle; Bruysters, Martijn; Dierick, Jean-François; Jungbäck, Carmen; Kross, Imke; Metz, Bernard; Pennings, Jeroen; Rigsby, Peter; Riou, Patrice; Balks, Elisabeth; Dobly, Alexandre; Leroy, Odile; Stirling, Catrina

    2018-01-01

    Within the Innovative Medicines Initiative 2 (IMI 2) project VAC2VAC (Vaccine batch to vaccine batch comparison by consistency testing), a workshop has been organised to discuss ways of improving the design of multi-centre validation studies and use the data generated for product-specific validation

  18. Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

    International Nuclear Information System (INIS)

    Malpani, A.R.; Sundaram, M.; Ramani, S.K.

    1989-01-01

    This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

  19. Proposal for the standardisation of multi-centre trials in nuclear medicine imaging

    DEFF Research Database (Denmark)

    Dickson, John Caddell; Tossici-Bolt, Livia; Sera, Terez

    2012-01-01

    Multi-centre trials are an important part of proving the efficacy of procedures, drugs and interventions. Imaging components in such trials are becoming increasingly common; however, without sufficient control measures the usefulness of these data can be compromised. This paper describes a framew...

  20. Violent women : A multicentre study into gender differences in forensic psychiatric patients

    NARCIS (Netherlands)

    de Vogel, Vivienne; Stam, Jeantine; Bouman, Yvonne H. A.; Ter Horst, P.R.M.; Lancel, Marike

    2016-01-01

    To gain insight into the relatively small, but increasing group of women in forensic psychiatry, a retrospective multicentre study was started gathering information from the files of 275 female patients of four Dutch forensic psychiatric hospitals on characteristics and violence risk factors.

  1. Round block technique is a useful oncoplastic procedure for multicentric fibroadenomas.

    Science.gov (United States)

    Lai, Hung-Wen; Kuo, Yao-Lung; Su, Chin-Chen; Chen, Chih-Jung; Kuo, Sou-Jen; Chen, Shou-Tung; Chen, Dar-Ren

    2016-02-01

    Multicentric fibroadenomas, defined as multiple fibroadenomas located at different quadrants of the breast, occur in 10-20% of women with fibroadenoma. The surgical management of multicentric fibroadenomas may be troublesome for surgeons and patients. In this study, we report our preliminary experience using the "round block technique" in the management of women with multicentric fibroadenomas of the breast. Records of patients with breast diseases managed with the round block technique were searched for in the Changhua Christian Hospital oncoplastic breast surgery database. The patients' clinicopathologic characteristics, type of surgery, operation time, blood loss, and complications were recorded. The cosmetic outcome was evaluated by the patient and operating surgeon two months after the surgery. Twenty patients with multicentric fibroadenomas managed by the round block technique comprised the current study cohort. The mean age of the subjects was 36.5 ± 10.4 years. Twelve (60%) patients had tumors on one side of the breast, and eight (40%) had bilateral breast lesions. The average number of tumors removed was 3.3 ± 1.2 (range 2-6) per breast, and mean tumor size was 2.2 ± 0.5 cm. Three (15%) patients developed mild ecchymosis of the breast undergoing operation, which resolved spontaneously. One (5%) patient had partial nipple ischemia/necrosis due to 2 tumors excised near the nipple-areolar complex. The aesthetic results were evaluated as good in 19 (95%) patients and fair in 1 (5%). The round block technique is a useful oncoplastic procedure for the management of multicentric fibroadenomas excised at the same time. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  2. International, prospective haemovigilance study on methylene blue-treated plasma.

    Science.gov (United States)

    Noens, L; Vilariño, Ma D; Megalou, A; Qureshi, H

    2017-05-01

    Methylene blue is a phenothiazine dye, which in combination with visible light has virucidal and bactericidal properties, disrupting the replication of a broad range of enveloped viruses and some non-enveloped viruses. The study objective was to collect data on adverse reactions occurring with methylene blue plasma administered in a routine clinical practice environment and document their characteristics and severity. This was an open label, multicentre, non-controlled, non-randomized, non-interventional study. Patients who receive a methylene blue plasma transfusion were observed for any signs and symptoms (adverse reactions) within 24 h safter the start of the transfusion, in different hospitals for a study duration of at least 1 year. A total of 19 315 methylene blue plasma units were transfused. There were eight patients with adverse reactions recorded during the study, one of them serious. Two had more than one reaction (two and four, respectively). Three patients had previous transfusions with methylene blue plasma only. Methylene blue plasma has a very acceptable safety profile with a rate of serious adverse reactions of 0·5/10 000 units. © 2017 International Society of Blood Transfusion.

  3. Exploring for the Sources of Internal Elastic Deformations Using Potential Fields and Their Poisson Wavelets; Possible Applications to InSAR Observations

    Science.gov (United States)

    Horowitz, F. G.; Hornby, P.

    2006-12-01

    From a restricted solution of the Cauchy-Navier equations of quasi-static infinitesimal elasticity theory [Green and Zerna, 1968, section 5.7] for an isotropic, linear elastic half-space with a shear-traction free ground surface, we find a scalar function ρ that is present underground wherever internal deformations are generated, and absent elsewhere. The "deformation source density" ρ is related to the magnitude of changes in body forces (e.g. frictional traction changes across a creeping fault surface) and is the source of a potential field, like mass density for vertical gravitational acceleration, or the divergence of magnetization for total magnetic intensity. Surveys of surface displacements (e.g. InSAR range changes) may be turned into the potential field at the surface of the half-space via standard 2D Fourier domain techniques. From this potential, a harmonic field may be constructed above the measurement plane. All of potential field theory and practice [e.g., Blakely, 1996] is applicable to analyzing such data for information about the underground distribution and strength of ρ. In particular the potential field Poisson wavelet system of Hornby, Boschetti,and Horowitz [1999] —-- being generated by the Green's function for harmonic potentials —-- is ideally suited for such analysis, with all of the multiscale edge ("worm") discontinuity analysis, and the dipole source inverse wavelet transform ideas being directly applicable. We regard this as a gentle approach "halfway to inversion" which allows for a visual interpretation of maps of surficial displacement measurements to occur before a full inversion is performed. References: Blakely, R. J. (1996), Potential Theory in Gravity and Magnetic Applications, Cambridge University Press, Cambridge. Green, A. E., and W. Zerna (1968), Theoretical Elasticity, 2nd ed., Oxford University Press, Clarendon. Hornby, P., F. Boschetti, and F. G. Horowitz (1999), Analysis of Potential Field Data in the Wavelet

  4. Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: study protocol of a prospective multicentre European registry (E-AVR registry).

    Science.gov (United States)

    Onorati, Francesco; Gherli, Riccardo; Mariscalco, Giovanni; Girdauskas, Evaldas; Quintana, Eduardo; Santini, Francesco; De Feo, Marisa; Sponga, Sandro; Tozzi, Piergiorgio; Bashir, Mohamad; Perrotti, Andrea; Pappalardo, Aniello; Ruggieri, Vito Giovanni; Santarpino, Giuseppe; Rinaldi, Mauro; Ronaldo, Silva; Nicolini, Francesco

    2018-02-10

    Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both 'sutured' and 'sutureless' valves) will provide a 'real-world' picture of available results of current surgical options and will help to clarify the 'grey zones' of current guidelines. European Aortic Valve Registry is a prospective observational open registry designed to collect all data from patients admitted for SAVS, with or without coronary artery disease, in 16 cardiac surgery centres located in six countries (France, Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over a 2-year period and followed up for a minimum of 5 years to a maximum of 10 years after enrolment. Outcome definitions are concordant with Valve Academic Research Consortium-2 criteria and established guidelines. Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at establishing 'early' 30-day all-cause and cardiovascular mortality, as well as major morbidity, and 'late' cardiovascular mortality, major morbidity, structural and non-structural valve complications, quality of life and echocardiographic results. The study protocol is approved by local

  5. Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

    NARCIS (Netherlands)

    Pinkney, T.; Battersby, N.; Bhangu, A.; Chaudhri, S.; El-Hussuna, A.; Frasson, M.; Nepogodiev, D.; Singh, B.; Vennix, S.; Zmora, O.; Altomare, D.; Bemelman, W.; Christensen, P.; D'Hoore, A.; Laurberg, S.; Morton, D.; Rubbini, M.; Vaizey, C.; Magill, L.; Perry, R.; Sheward, N.; Ives, N.; Mehta, S.; Cillo, M.; Estefania, D.; Patron Uriburu, J.; Ruiz, H.; Salomon, M.; Makhmudov, A.; Selnyahina, L.; Varabei, A.; Vizhynis, Y.; Claeys, D.; Defoort, B.; Muysoms, F.; Pletinckx, P.; Vergucht, V.; Debergh, I.; Feryn, T.; Reusens, H.; Nachtergaele, M.; Francart, D.; Jehaes, C.; Markiewicz, S.; Monami, B.; Weerts, J.; Bouckaert, W.; Houben, B.; Knol, J.; Sergeant, G.; Vangertruyden, G.; Haeck, L.; Lange, C.; Sommeling, C.; Vindevoghel, K.; Castro, S.; de Bruyn, H.; Huyghe, M.; de Wolf, E.; Reynders, D.; van Overstraeten, A. de Buck; Wolthuis, A.; Delibegovic, S.; Christiani, A.; Marchiori, M.; Rocha de Moraes, C.; Tercioti, V.; Arabadjieva, E.; Bulanov, D.; Dardanov, D.; Stoyanov, V.; Yonkov, A.; Angelov, K.; Maslyankov, S.; Sokolov, M.; Todorov, G.; Toshev, S.; Georgiev, Y.; Karashmalakov, A.; Zafirov, G.; Wang, X.; Condic, D.; Kraljik, D.; Mrkovic, H.; Pavkovic, V.; Raguz, K.; Bencurik, V.; Holaskova, E.; Skrovina, M.; Farkasova, M.; Grolich, T.; Kala, Z.; Antos, F.; Pruchova, V.; Sotona, O.; Chobola, M.; Dusek, T.; Ferko, A.; Orhalmi, J.; Hoch, J.; Kocian, P.; Martinek, L.; Bernstein, I.; Sunesen, K. Gotschalck; Leunbach, J.; Thorlacius-Ussing, O.; Oveson, A. Uth; Chirstensen, S. Dahl; Gamez, V.; Oeting, M.; Loeve, U. Schou; Ugianskis, A.; Jessen, M.; Krarup, P.; Linde, K.; Mirza, Q.; Stovring, J. Overgaard; Erritzoe, L.; Jakobsen, H. Loft; Lykke, J.; Colov, E. Palmgren; Madsen, A. Husted; Friis, T. Linde; Funder, J. Amstrup; Dich, R.; Kjaer, S.; Rasmussen, S.; Schlesinger, N.; Kjaer, M. Dilling; Qvist, N.; Khalid, A.; Ali, G.; Hadi, S.; Walker, L. Rosell; Kivela, A.; Lehtonen, T.; Lepisto, A.; Scheinin, T.; Siironen, P.; Kossi, J.; Kuusanmaki, P.; Tomminen, T.; Turunen, A.; Rautio, T.; Vierimaa, M.; Huhtinen, H.; Karvonen, J.; Lavonius, M.; Rantala, A.; Varpe, P.; Cotte, E.; Francois, Y.; Glehen, O.; Kepenekian, V.; Passot, G.; Maggiori, L.; Manceau, G.; Panis, Y.; Gout, M.; Rullier, E.; van Geluwe, B.; Chafai, N.; Lefevre, J. H.; Parc, Y.; Tiret, E.; Couette, C.; Duchalais, E.; Agha, A.; Hornberger, M.; Hungbauer, A.; Iesalnieks, I.; Weindl, I.; Crescenti, F.; Keller, M.; Kolodziejski, N.; Scherer, R.; Sterzing, D.; Bock, B.; Boehm, G.; El-Magd, M.; Krones, C.; Niewiera, M.; Buhr, J.; Cordesmeyer, S.; Hoffmann, M.; Krueckemeier, K.; Vogel, T.; Schoen, M.; Baral, J.; Lukoschek, T.; Muench, S.; Pullig, F.; Horisberger, K.; Kienle, P.; Magdeburg, J.; Post, S.; Batzalexis, K.; Germanos, S.; Agalianos, C.; Dervenis, C.; Gouvas, N.; Kanavidis, P.; Kottikias, A.; Katsoulis, I. E.; Korkolis, D.; Plataniotis, G.; Sakorafas, G.; Akrida, I.; Argentou, M.; Kollatos, C.; Lampropoulos, C.; Tsochatzis, S.; Besznyak, I.; Bursics, A.; Egyed, T.; Papp, G.; Svastics, I.; Atladottir, J.; Moller, P.; Sigurdsson, H.; Stefansson, T.; Valsdottir, E.; Andrews, E.; Foley, N.; Hechtl, D.; Majeed, M.; McCourt, M.; Hanly, A.; Hyland, J.; Martin, S.; O'Connell, P. R.; Winter, D.; Connelly, T.; Joyce, W.; Wrafter, P.; Berkovitz, R.; Avital, S.; Yahia, I. Haj; Hermann, N.; Shpitz, B.; White, I.; Lishtzinsky, Y.; Tsherniak, A.; Wasserberg, N.; Horesh, N.; Keler, U.; Pery, R.; Shapiro, R.; Tulchinsky, H.; Badran, B.; Dayan, K.; Iskhakov, A.; Lecaros, J.; Nabih, N.; Angrima, I.; Bardini, R.; Pizzolato, E.; Tonello, M.; Arces, F.; Balestri, R.; Ceccarelli, C.; Prosperi, V.; Rossi, E.; Giannini, I.; Vincenti, L.; Altomare, D. F.; Di Candido, F.; Di Iena, M.; Guglielmi, A.; Caputi-Iam-Brenghi, O.; Marsanic, P.; Mellano, A.; Muratore, A.; Annecchiarico, M.; Bencini, L.; Bona-Pasta, S. Amore; Coratti, A.; Guerra, F.; Asteria, C. R.; Boccia, L.; Gerard, L.; Pascariello, A.; Manca, G.; Marino, F.; Casaril, A.; Inama, M.; Moretto, G.; Bacchelli, C.; Carvello, M.; Mariani, N.; Montorsi, M.; Spinelli, A.; Romairone, E.; Scabini, S.; Belli, A.; Bianco, F.; de Franciscis, S.; Romano, G. Maria; Delrio, P.; Pace, U.; Rega, D.; Sassaroli, C.; Scala, D.; de Luca, R.; Ruggieri, E.; Elbetti, C.; Garzi, A.; Romoli, L.; Scatizzi, M.; Vannucchi, A.; Curletti, G.; Durante, V.; Galleano, R.; Mariani, F.; Reggiani, L.; Bellomo, R.; Infantino, A.; Franceschilli, L.; Sileri, P.; Clementi, I.; Coletta, D.; La Torre, F.; Mingoli, A.; Velluti, F.; Di Giacomo, A.; Fiorot, A.; Massani, M.; Padoan, L.; Ruffolo, C.; Caruso, S.; Franceschini, F.; Laessig, R.; Monaci, I.; Rontini, M.; de Nardi, P.; Elmore, U.; Lemma, M.; Rosati, R.; Tamburini, A.; de Luca, M.; Sartori, A.; Benevento, A.; Bottini, C.; Ferrari, C. C.; Pata, F.; Tessera, G.; Pellino, G.; Selvaggi, F.; Lanzani, A.; Romano, F.; Sgroi, G.; Steccanella, F.; Turati, L.; Yamamoto, T.; Ancans, G.; Gerkis, S.; Leja, M.; Pcolkins, A.; Sivins, A.; Latkauskas, T.; Lizdenis, P.; Saladzin-Skas, Z.; Svagzdys, S.; Tamelis, A.; Razbadauskas, A.; Sokolovas, M.; Dulskas, A.; Samalavicius, N.; Jotautas, V.; Mikalauskas, S.; Poskus, E.; Poskus, T.; Strupas, K.; Camenzuli, C.; Cini, C.; Predrag, A.; Psaila, J.; Spiteri, N.; Buskens, C.; de Groof, E. J.; Gooszen, J.; Tanis, P.; Belgers, E.; Davids, P.; Furnee, E.; Postma, E.; Pronk, A.; Smakman, N.; Clermonts, S.; Zimmerman, D.; Omloo, J.; van der Zaag, E.; van Duijvendijk, P.; Wassenaar, E.; Bruijninckx, M.; de Graff, E.; Doornebosch, P.; Tetteroo, G.; Vermaas, M.; Iordens, G.; Knops, S.; Toorenvliet, B.; van Westereenen, H. L.; Boerma, E.; Coene, P.; van der Harst, E.; van der Pool, A.; Raber, M.; Melenhorst, J.; de Castro, S.; Gerhards, M.; Arron, M.; Bremers, A.; de Wilt, H.; Ferenschild, F.; Yauw, S.; Cense, H.; Demirkiran, A.; Hunfeld, M.; Mulder, I.; Nonner, J.; Swank, H.; van Wagensveld, B.; Bolmers, M.; Briel, J.; van Geloven, A.; van Rossem, C.; Klemann, V.; Konsten, J.; Leenders, B.; Schok, T.; Bleeker, W.; Brun, M.; Helgeland, M.; Ignjatovic, D.; Oresland, T.; Yousefi, P.; Backe, I. Faten; Sjo, O. Helmer; Nesbakken, A.; Tandberg-Eriksen, M.; Cais, A.; Traeland, J. Hallvard; Herikstad, R.; Korner, H.; Lauvland, N.; Jajtner, D.; Kabiesz, W.; Rak, M.; Gmerek, L.; Horbacka, K.; Horst, N.; Krokowicz, P.; Kwiatkowski, A.; Pasnik, K.; Karcz, P.; Romaniszyn, M.; Rusek, T.; Walega, P.; Czarencki, R.; Obuszko, Z.; Sitarska, M.; Wojciech, W.; Zawadzki, M.; Amado, S.; Clara, P.; Couceiro, A.; Malaquias, R.; Rama, N.; Almeida, A.; Barbosa, E.; Cernadas, E.; Duarte, A.; Silva, P.; Costa, S.; Martinez Insua, C.; Pereira, J.; Pereira, C.; Sacchetti, M.; Carvalho Pinto, B.; Vieira Sousa, P. Jorge; Marques, R.; Oliveira, A.; Cardoso, R.; Carlos, S.; Corte-Real, J.; Moniz Pereira, P.; Souto, R.; Carneiro, C.; Marinho, R.; Nunes, V.; Rocha, R.; Sousa, M.; Leite, J.; Melo, F.; Pimentel, J.; Ventura, L.; Vila Nova, C.; Copacscu, C.; Bintintan, V.; Ciuce, C.; Dindelegan, G.; Scurtu, R.; Seicean, R.; Domansky, N.; Karachun, A.; Moiseenko, A.; Pelipas, Y.; Petrov, A.; Pravosudov, I.; Aiupov, R.; Akmalov, Y.; Parfenov, A.; Suleymanov, N.; Tarasov, N.; Jumabaev, H.; Mamedli, Z.; Rasulov, A.; Aliev, I.; Chernikovskiy, I.; Kochnev, V.; Komyak, K.; Smirnov, A.; Achkasov, S.; Bolikhov, K.; Shelygin, Y.; Sushkov, O.; Zapolskiy, A.; Gvozdenovic, M.; Jovanovic, D.; Lausevic, Z.; Cvetkovic, D.; Maravic, M.; Milovanovic, B.; Stojakovic, N.; Tripkovic, I.; Mihajlovic, D.; Nestorovic, M.; Pecic, V.; Petrovic, D.; Stanojevic, G.; Barisic, G.; Dimitrijevic, I.; Krivokapic, Z.; Markovic, V.; Popovic, M.; Aleksic, A.; Dabic, D.; Kostic, I.; Milojkovic, A.; Perunicic, V.; Lukic, D.; Petrovic, T.; Radovanovic, D.; Radovanovic, Z.; Cuk, V. M.; Cuk, V. V.; Kenic, M.; Kovacevic, B.; Krdzic, I.; Korcek, J.; Rems, M.; Toplak, J.; Escarra, J.; Gil Barrionuevo, M.; Golda, T.; Kreisler Moreno, E.; Zerpa Martin, C.; Alvarez Laso, C.; Cumplido, P.; Padin, H.; Baixauli Fons, J.; Hernandez-Lizoain, J.; Martinez-Ortega, P.; Molina-Fernandez, M.; Sanchez-Justicia, C.; Gracia Solanas, J. Antonio; Diaz de laspra, E. Cordoba; Echazarreta-Gallego, E.; Elia-Guedea, M.; Ramirez, J.; Arredondo Chaves, J.; Gonzalez, P. Diez; Elosua, T.; Sahagun, J.; Turienzo Frade, A.; Alvarez Conde, J.; Castrillo, E.; Diaz Maag, R.; Maderuelo, V.; Saldarriaga, L.; Aldrey Cao, I.; Fernandez Varela, X.; Nunez Fernandez, S.; Parajo Calvo, A.; Villar Alvarez, S.; Blesa Sierra, I.; Lozano, R.; Marquez, M.; Porcel, O.; Menendez, P.; Fernandez Hevia, M.; Flores Siguenza, L.; Jimenez Toscano, M.; Lacy Fortuny, A.; Ordonez Trujillo, J.; Espi, A.; Garcia-Botello, S.; Martin-Arevalo, J.; Moro-Valdezate, D.; Pla-Marti, V.; Blanco-Antona, F.; Abrisqueta, J.; Ibanez Canovas, N.; Lujan Mompean, J.; Escola Ripoll, D.; Martinez Gonzalez, S.; Parodi, J.; Fernandez Lopez, A.; Ramos Fernandez, M.; Castellvi Valls, J.; Ortiz de Zarate, L.; Ribas, R.; Sabia, D.; Viso, L.; Alonso Goncalves, S.; Gil Egea, M. Jose; Pascual Damieta, M.; Pera, M.; Salvans Ruiz, S.; Bernal, J.; Landete, F.; Ais, G.; Etreros, J.; Aguilo Lucia, J.; Bosca, A.; Deusa, S.; Garcia del Cano, J.; Viciano, V.; Garcia-Armengol, J.; Roig, J.; Blas, J.; Escartin, J.; Fatas, J.; Fernando, J.; Ferrer, R.; Arias Pacheco, R.; Garcia Florez, L.; Moreno Gijon, M.; Otero Diez, J.; Solar Garcia, L.; Aguilar Teixido, F.; Balaguer Ojo, C.; Bargallo Berzosa, J.; Lamas Moure, S.; Sierra, J. Enrique; Ferminan, A.; Herrerias, F.; Rufas, M.; Vinas, J.; Codina-Cazador, A.; Farres, R.; Gomez, N.; Julia, D.; Planellas, P.; Lopez, J.; Luna, A.; Maristany, C.; Munoz Duyos, A.; Puertolas, N.; Alcantara Moral, M.; Serra-Aracil, X.; Concheiro Coello, P.; Gomez, D.; Carton, C.; Miguel, A.; Reoyo Pascual, F.; Valero Cerrato, X.; Zambrano Munoz, R.; Cervera-Aldama, J.; Gonzalez, J. Garcia; Ramos-Prada, J.; Santamaria-Olabarrieta, M.; Uriguen-Echeverria, A.; Coves Alcover, R.; Espinosa Soria, J.; Fernandez Rodriguez, E.; Hernandis Villalba, J.; Maturana Ibanenz, V.; de la Torre Gonzalez, F.; Huerga, D.; Perez Viejo, E.; Rivera, A.; Ruiz Ucar, E.; Garcia-Septiem, J.; Jimenez, V.; Jimenez Miramon, J.; Ramons Rodriquez, J.; Rodriguez Alvarez, V.; Garcea, A.; Ponchietti, L.; Borda, N.; Enriquez-Navascues, J.; Saralegui, Y.; Febles Molina, G.; Nogues, E.; Rodriguez Mendez, A.; Roque Castellano, C.; Sosa Quesada, Y.; Alvarez-Gallego, M.; Pascual, I.; Rubio-Perez, I.; Diaz-San Andres, B.; Tone-Villanueva, F.; Alonso, J.; Cagigas, C.; Castillo, J.; gomez, M.; Martin-Parra, J.; Mengual Ballester, M.; Pellicer Franco, E.; Soria Aledo, V.; Valero Navarro, G.; Caballero Rodriguez, E.; Gonzalez de Chaves, P.; Hernandez, G.; Perez Alvarez, A.; Soto Sanchez, A.; Becerra Garcia, F. Cesar; Alonso Roque, J. Guillermo; Rodriguez Arias, F. Lopez; del Valle Ruiz, S. R.; Sanchez de la Villa, G.; Compan, A.; Garcia Marin, A.; Nofuentes, C.; Orts Mico, F.; Perez Auladell, V.; Carrasco, M.; Duque Perez, C.; Galvez-Pastor, S.; Navarro Garcia, I.; Sanchez Perez, A.; Enjuto, D.; Manuel Bujalance, F.; Marcelin, N.; Perez, M.; Serrano Garcia, R.; Cabrera, A.; de la Portilla, F.; Diaz-Pavon, J.; Jimenez-Rodriguez, R.; Vazquez-Monchul, J.; Daza Gonzalez, J.; Gomez Perez, R.; Rivera Castellano, J.; Roldan de la Rua, J.; Errasti Alustiza, J.; Fernandez, L.; Romeo Ramirez, J.; Sardon Ramos, J.; Cermeno Toral, B.; Alias, D.; Garcia-Olmo, D.; Guadalajara, H.; Herreros, M.; Pacheco, P.; del Castillo Diez, F.; Lima Pinto, F.; Martinez Alegre, J.; Ortega, I.; Nieto Antonio, A. Picardo; Caro, A.; Escuder, J.; Feliu, F.; Millan, M.; Alos Company, R.; Frangi Caregnato, A.; Lozoya Trujillo, R.; Rodriguez Carrillo, R.; Ruiz Carmona, M.; Alonso, N.; Ambrona Zafra, D.; Ayala Candia, B. Amilka; Bonnin Pascual, J.; Pineno Flores, C.; Alcazar Montero, J.; Angoso Clavijo, M.; Garcia, J.; Sanchez Tocino, J.; Gomez-Alcazar, C.; Costa-Navarro, D.; Ferri-Romero, J.; Rey-Riveiro, M.; Romero-Simo, M.; Arencibia, B.; Esclapez, P.; Garcia-Granero, E.; Granero, P.; Medina Fernandez, F. J.; Gallardo Herrera, A. B.; Diaz Lopez, C.; Navarro Rodriguez, E.; Torres Tordera, E.; Arenal, J.; Citores, M.; Marcos, J.; Sanchez, J.; Tinoco, C.; Espin, E.; Garcia Granero, A.; Jimenez Gomez, L.; Sanchez Garcia, J.; Vallribera, F.; Folkesson, J.; Skoldberg, F.; Bergman, K.; Borgstrom, E.; Frey, J.; Silfverberg, A.; Soderholm, M.; Nygren, J.; Segelman, J.; Gustafsson, D.; Lagerqvist, A.; Papp, A.; Pelczar, M.; Abraham-Nordling, M.; Ahlberg, M.; Sjovall, A.; Tengstrom, J.; Hagman, K.; Chabok, A.; Ezra, E.; Nikberg, M.; Smedh, K.; Tiselius, C.; Al-Naimi, N.; Duc, M. Dao; Meyer, J.; Mormont, M.; Ris, F.; Prevost, G.; Villiger, P.; Hoffmann, H.; Kettelhack, C.; Kirchhoff, P.; Oertli, D.; Weixler, B.; Aytac, B.; Leventoglu, S.; Mentes, B.; Yuksel, O.; Demirbas, S.; Ozkan, B. Busra; Ozbalci, G. Selcuk; Sungurtekin, U.; Gulcu, B.; Ozturk, E.; Yilmazlar, T.; Challand, C.; Fearnhead, N.; Hubbard, R.; Kumar, S.; Arthur, J.; Barben, C.; Skaife, P.; Slawik, S.; Williams, M.; Zammit, M.; Barker, J.; French, J.; Sarantitis, I.; Slawinski, C.; Clifford, R.; Eardley, N.; Johnson, M.; McFaul, C.; Vimalachandran, D.; Allan, S.; Bell, A.; Oates, E.; Shanmugam, V.; Brigic, A.; Halls, M.; Pucher, P.; Stubbs, B.; Agarwal, T.; Chopada, A.; Mallappa, S.; Pathmarajah, M.; Sugden, C.; Brown, C.; Macdonald, E.; Mckay, A.; Richards, J.; Robertson, A.; Kaushal, M.; Patel, P.; Tezas, S.; Touqan, N.; Ayaani, S.; Marimuthu, K.; Piramanayagam, B.; Vourvachis, M.; Iqbal, N.; Korsgen, S.; Seretis, C.; Shariff, U.; Arnold, S.; Chan, H.; Clark, E.; Fernandes, R.; Moran, B.; Bajwa, A.; McArthur, D.; Cao, K.; Cunha, P.; Pardoe, H.; Quddus, A.; Theodoropoulou, K.; Bolln, C.; Denys, G.; Gillespie, M.; Manimaran, N.; Reidy, J.; Malik, A. I.; Malik, A.; Pitt, J.; Aryal, K.; El-Hadi, A.; Lal, R.; Pal, A.; Velchuru, V.; Cunha, M. Oliveira; Thomas, M.; Bains, S.; Boyle, K.; Miller, A.; Norwood, M.; Yeung, J.; Goian, L.; Gurjar, S.; Saghir, W.; Sengupta, N.; Stewart-Parker, E.; Bailey, S.; Khalil, T.; Lawes, D.; Nikolaou, S.; Omar, G.; Church, R.; Muthiah, B.; Garrett, W.; Marsh, P.; Obeid, N.; Chandler, S.; Coyne, P.; Evans, M.; Hunt, L.; Lim, J.; Oliphant, Z.; Papworth, E.; Weaver, H.; Leon, K. Cuinas; Williams, G.; Hernon, J.; Kapur, S.; Moosvi, R.; Shaikh, I.; Swafe, L.; Aslam, M.; Evans, J.; Ihedioha, U.; Kang, P.; Merchant, J.; Hompes, R.; Middleton, R.; Broomfield, A.; Crutten-Wood, D.; Foster, J.; Nash, G.; Akhtar, M.; Boshnaq, M.; Eldesouky, S.; Mangam, S.; Rabie, M.; Ahmed, J.; Khan, J.; Goh, N. Ming; Shamali, A.; Stefan, S.; Thompson, C.; Amin, A.; Docherty, J.; Lim, M.; Walker, K.; Watson, A.; Hossack, M.; Mackenzie, N.; Paraoan, M.; Alam, N.; Daniels, I.; Narang, S.; Pathak, S.; Smart, N.; Al-Qaddo, A.; Codd, R.; Rutka, O.; Bronder, C.; Crighton, I.; Davies, E.; Raymond, T.; Bookless, L.; Griffiths, B.; Plusa, S.; Carlson, G.; Harrison, R.; Lees, N.; Mason, C.; Quayle, J.; Branagan, G.; Broadhurst, J.; Chave, H.; Sleight, S.; Awad, F.; Cruickshank, N.; Joy, H.; Boereboom, C.; Daliya, P.; Dhillon, A.; Watson, N.; Watson, R.; Artioukh, D.; Gokul, K.; Javed, M.; Kong, R.; Sutton, J.; Faiz, O.; Jenkins, I.; Leo, C. A.; Samaranayake, S. F.; Warusavitarne, J.; Arya, S.; Bhan, C.; Mukhtar, H.; Oshowo, A.; Wilson, J.; Duff, S.; Fatayer, T.; Mbuvi, J.; Sharma, A.; Cornish, J.; Davies, L.; Harries, R.; Morris, C.; Torkington, J.; Knight, J.; Lai, C.; Shihab, O.; Tzivanakis, A.; Hussain, A.; Luke, D.; Padwick, R.; Torrance, A.; Tsiamis, A.; Dawson, P.; Balfour, A.; Brady, R.; Mander, J.; Paterson, H.; Chandratreya, N.; Chu, H.; Cutting, J.; Vernon, S.; Ho, C. Wai; Andreani, S.; Patel, H.; Warner, M.; Tan, J. Yan Qi; Gidwani, A.; Lawther, R.; Loughlin, P.; Skelly, B.; Spence, R.; Iqbal, A.; Khan, A.; Perrin, K.; Raza, A.; Tan, S.

    2017-01-01

    Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit

  6. A multicentre molecular analysis of hepatitis B and blood-borne virus coinfections in Viet Nam.

    Directory of Open Access Journals (Sweden)

    Linda Dunford

    Full Text Available Hepatitis B (HBV infection is endemic in Viet Nam, with up to 8.4 million individuals estimated to be chronically infected. We describe results of a large, multicentre seroepidemiological and molecular study of the prevalence of HBV infection and blood-borne viral coinfections in Viet Nam. Individuals with varying risk factors for infection (n = 8654 were recruited from five centres; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. A mean prevalence rate of 10.7% was observed and levels of HBsAg were significantly higher in injecting drug users (IDUs (17.4%, n = 174/1000 and dialysis patients (14.3%, n = 82/575 than in lower-risk groups (9.4%; p<0.001. Coinfection with HIV was seen in 28% of HBV-infected IDUs (n = 49/174 and 15.2% of commercial sex workers (CSWs; n = 15/99. HCV infection was present in 89.8% of the HBV-HIV coinfected IDUs (n = 44/49 and 40% of HBV-HIV coinfected CSWs (n = 16/40. Anti-HDV was detected in 10.7% (n = 34/318 of HBsAg positive individuals. Phylogenetic analysis of HBV S gene (n = 187 showed a predominance of genotype B4 (82.6%; genotypes C1 (14.6%, B2 (2.7% and C5 (0.5% were also identified. The precore mutation G1896A was identified in 35% of all specimens, and was more frequently observed in genotype B (41% than genotype C (3%; p<0.0001. In the immunodominant 'a' region of the surface gene, point mutations were identified in 31% (n = 58/187 of sequences, and 2.2% (n = 4/187 and 5.3% (n = 10/187 specimens contained the major vaccine escape mutations G145A/R and P120L/Q/S/T, respectively. 368 HBsAg positive individuals were genotyped for the IL28B SNP rs12979860 and no significant association between the IL28B SNP and clearance of HBsAg, HBV viral load or HBeAg was observed. This study confirms the high prevalence of HBV infection in Viet Nam and also highlights the significant levels of blood-borne virus coinfections, which have important implications for hepatitis-related morbidity and development of effective

  7. Chikungunya infection in India: results of a prospective hospital based multi-centric study.

    Directory of Open Access Journals (Sweden)

    Pratima Ray

    Full Text Available BACKGROUND: Chikungunya (CHIKV has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India. METHODS AND FINDINGS: A total of 540 patients with fever of up to 7 days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS, Karnataka (South; Sawai Man Singh Medical College (SMS Rajasthan (West, and All India Institute of Medical Sciences (AIIMS New Delhi (North from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM. Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36% followed by west (16.28% and north (0.56% India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05. Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05. Adults were affected more than children. Anti-CHIK antibodies (IgM were detected for more than 60 days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15 revealed ∼99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children. CONCLUSIONS: The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate

  8. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study.

    Science.gov (United States)

    Friedl, Alexander; Mühlstädt, Sandra; Zachoval, Roman; Giammò, Alessandro; Kivaranovic, Danijel; Rom, Maximilian; Fornara, Paolo; Brössner, Clemens

    2017-05-01

    To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS ® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  9. Is the pre-Tg DSC endotherm observed with solid state proteins associated with the protein internal dynamics? Investigation of bovine serum albumin by solid state hydrogen/deuterium exchange.

    Science.gov (United States)

    Mizuno, Masayasu; Pikal, Michael J

    2013-10-01

    DSC thermograms of solid state pure proteins often show a distinct endotherm at a temperature far below the glass transition temperature of the system (Tg). We hypothesized this endotherm represents enthalpy recovery associated with an internal mobility transition of the protein molecule. Although the existence of an internal transition has been postulated, whether this endotherm is associated with such a transition has not previously been discussed. The purpose of this study was to investigate the origin of the pre-Tg endotherm in lyophilized bovine serum albumin (BSA). Due to strong glass behavior, the system Tg was determined by extrapolating Tg data of disaccharide/BSA formulations to zero saccharide. A small pre-Tg endotherm around 40-60 °C was observed in amorphous BSA equilibrated at 11%RH. The apparent activation energy suggested the endotherm was "α-mobility"-related. A solid state hydrogen/deuterium exchange study using FTIR was conducted over a temperature range spanning the endotherm. We found a fast phase, followed by essentially a plateau level which is highly temperature dependent in the 40-60 °C range, suggesting enhanced internal protein motion as the system passes through the temperature range of the endotherm. These results suggest the pre-Tg endotherm is associated with a protein internal mobility transition. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. A surprisingly poor correlation between in vitro and in vivo testing of biomaterials for bone regeneration: results of a multicentre analysis.

    Science.gov (United States)

    Hulsart-Billström, G; Dawson, J I; Hofmann, S; Müller, R; Stoddart, M J; Alini, M; Redl, H; El Haj, A; Brown, R; Salih, V; Hilborn, J; Larsson, S; Oreffo, R O

    2016-05-24

    New regenerative materials and approaches need to be assessed through reliable and comparable methods for rapid translation to the clinic. There is a considerable need for proven in vitro assays that are able to reduce the burden on animal testing, by allowing assessment of biomaterial utility predictive of the results currently obtained through in vivo studies. The purpose of this multicentre review was to investigate the correlation between existing in vitro results with in vivo outcomes observed for a range of biomaterials. Members from the European consortium BioDesign, comprising 8 universities in a European multicentre study, provided data from 36 in vivo studies and 47 in vitro assays testing 93 different biomaterials. The outcomes of the in vitro and in vivo experiments were scored according to commonly recognised measures of success relevant to each experiment. The correlation of in vitro with in vivo scores for each assay alone and in combination was assessed. A surprisingly poor correlation between in vitro and in vivo assessments of biomaterials was revealed indicating a clear need for further development of relevant in vitro assays. There was no significant overall correlation between in vitro and in vivo outcome. The mean in vitro scores revealed a trend of covariance to in vivo score with 58 %. The inadequacies of the current in vitro assessments highlighted here further stress the need for the development of novel approaches to in vitro biomaterial testing and validated pre-clinical pipelines.