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Sample records for model patients carrying

  1. Which melanoma patient carries a BRAF-mutation? A comparison of predictive models.

    Science.gov (United States)

    Eigentler, Thomas; Assi, Zeinab; Hassel, Jessica C; Heinzerling, Lucie; Starz, Hans; Berneburg, Mark; Bauer, Jürgen; Garbe, Claus

    2016-06-14

    In patients with advanced melanoma the detection of BRAF mutations is considered mandatory before the initiation of an expensive treatment with BRAF/MEK inhibitors. Sometimes it is difficult to perform such an analysis if archival tumor tissue is not available and fresh tissue has to be collected. 514 of 1170 patients (44%) carried a BRAF mutation. All models revealed age and histological subtype of melanoma as the two major predictive variables. Accuracy ranged from 0.65-0.71, being best in the random forest model. Sensitivity ranged 0.76-0.84, again best in the random forest model. Specificity was low in all models ranging 0.51-0.55. We collected the clinical data and mutational status of 1170 patients with advanced melanoma and established three different predictive models (binary logistic regression, classification and regression trees, and random forest) to forecast the BRAF status. Up to date statistical models are not able to predict BRAF mutations in an acceptable accuracy. The analysis of the mutational status by sequencing or immunohistochemistry must still be considered as standard of care.

  2. Carry

    DEFF Research Database (Denmark)

    Koijen, Ralph S.J.; Moskowitz, Tobias; Pedersen, Lasse Heje

    2018-01-01

    -sectionally and in time series for a host of different asset classes, including global equities, global bonds, commodities, US Treasuries, credit, and options. Carry is not explained by known predictors of returns from these asset classes, and it captures many of these predictors, providing a unifying framework...... for return predictability. We reject a generalized version of Uncovered Interest Parity and the Expectations Hypothesis in favor of models with varying risk premia, in which carry strategies are commonly exposed to global recession, liquidity, and volatility risks, though none fully explains carry’s premium....

  3. Carry

    DEFF Research Database (Denmark)

    Koijen, Ralph S.J.; Moskowitz, Tobias J.; Heje Pedersen, Lasse

    that include global equities, global bonds, currencies, commodities, US Treasuries, credit, and equity index options. This predictability underlies the strong returns to "carry trades" that go long high-carry and short low-carry securities, applied almost exclusively to currencies, but shown here...

  4. Error propagation in energetic carrying capacity models

    Science.gov (United States)

    Pearse, Aaron T.; Stafford, Joshua D.

    2014-01-01

    Conservation objectives derived from carrying capacity models have been used to inform management of landscapes for wildlife populations. Energetic carrying capacity models are particularly useful in conservation planning for wildlife; these models use estimates of food abundance and energetic requirements of wildlife to target conservation actions. We provide a general method for incorporating a foraging threshold (i.e., density of food at which foraging becomes unprofitable) when estimating food availability with energetic carrying capacity models. We use a hypothetical example to describe how past methods for adjustment of foraging thresholds biased results of energetic carrying capacity models in certain instances. Adjusting foraging thresholds at the patch level of the species of interest provides results consistent with ecological foraging theory. Presentation of two case studies suggest variation in bias which, in certain instances, created large errors in conservation objectives and may have led to inefficient allocation of limited resources. Our results also illustrate how small errors or biases in application of input parameters, when extrapolated to large spatial extents, propagate errors in conservation planning and can have negative implications for target populations.

  5. Physical fitness of young women: carrying simulated patients.

    Science.gov (United States)

    von Restorff, W

    2000-06-01

    An evaluation of physical fitness prior to employment appears to be mandatory for several occupations in order to protect the employee from overburdening and the employer from placing excess demands on the employee. One such occupation seems to be that of the field medical specialist who needs special physical strength since terrain conditions deny wheel-assisted transport of stretcher patients. The anthropometric and isometric force data of a total of 62 female and 48 male recruits for the medical service of the Bundeswehr were evaluated, together with their ability to carry a patient on a stretcher (weight = 14 kg) within a gymnasium. Initially the 'casualties' were simulated by sandbags weighing 60, 70, 80 and 90 kg each on stretchers; subsequently equivalent-weight water cans were used. The tests were administered at the beginning and at the end of the general Basic Military Training (BMT). While all males were able to carry the simulated 90 kg patient, only 22 out of 62 female recruits were able to do so at the beginning of BMT. At the end, the number had improved to 29 out of 55 women soldiers completing training. At the beginning of BMT 22.5% of the women soldiers were unable to rescue a simulated 70 kg patient; at the end of BMT the number had fallen to 18%. The isometric force values as measured revealed the hand grip strength as the best predictor for the capacity to carry simulated 90 kg patients. It is, therefore, suggested that a hand strength test be administered prior to field medical specialist training in order to channel unsuitable candidates into other training schemes.

  6. [Evolvement of ecological footprint model representing ecological carrying capacity].

    Science.gov (United States)

    Cao, Shu-yan; Xie, Gao-di

    2007-06-01

    Ecological footprint (EF) is an important index of ecological carrying capacity. The original EF model is excellent in simplicity, aggregation, comparability, and lifelikeness in presenting results, but short in predictability, configuration, and applicability. To overcome these shortcomings, many researches were conducted to modify and promote the EF model, and developed it from static with single time scale to diversified ones, which included: 1) time series EF model, 2) input-output analysis based EF model, 3) integrated assessment incorporated EF model, 4) land disturbance degree based EF model, and 5) life cycle analysis based EF model, or component EF model. The function of EF as a measurement of ecological carrying capacity was significantly improved, but its accuracy and integrality still need to be advanced.

  7. Care for patients carrying out dialysis therapy at home.

    Science.gov (United States)

    Imada, Akio

    2012-01-01

    The goal of home dialysis is to more successfully reintegrate dialysis patients with high activities in daily life (ADL) into society as compared to hemodialysis (HD), which is carried out at a dialysis facility. By achieving this goal, this therapy can prove to be more effective than renal plantation, which has been carried out only in a few cases in Japan. Since self-management forms the basis of home dialysis, dialysis complications can be reduced by arranging meals, fluid management and dialysis schedule according to the lifestyle of the patient himself. In addition, long-term survival rate with health conditions similar to that of a healthy person can be increased. On the other hand, the goal of home dialysis for dialysis patients with a lower ADL is to strengthen the family bond, and improve quality of life and life prognosis, since nursing and support from family members are essential to ensure a long-term survival rate and ADL. For safe operation of home dialysis, which can be more effective than HD carried out in dialysis facilities, it is important for doctors, nurses, clinical engineers, social workers and all other members of the dialysis staff to work together as a united team. The type of nursing varies depending on period (during conservative treatment of end-stage renal disease, during the introduction and maintenance of dialysis, and when changing to end-stage renal disease replacement therapy). It also varies depending on whether continuous ambulatory peritoneal dialysis or home hemodialysis is implemented. The important points of nursing in home dialysis for each treatment period, depending on whether by continuous ambulatory peritoneal dialysis and home hemodialysis, are summarized here. Copyright © 2012 S. Karger AG, Basel.

  8. Models and impact of patient and public involvement in studies carried out by the Medical Research Council Clinical Trials Unit at University College London: findings from ten case studies.

    Science.gov (United States)

    South, Annabelle; Hanley, Bec; Gafos, Mitzy; Cromarty, Ben; Stephens, Richard; Sturgeon, Kate; Scott, Karen; Cragg, William J; Tweed, Conor D; Teera, Jacqueline; Vale, Claire L

    2016-07-29

    Patient and public involvement (PPI) in studies carried out by the UK Medical Research Council Clinical Trials Unit (MRC CTU) at University College London varies by research type and setting. We developed a series of case studies of PPI to document and share good practice. We used purposive sampling to identify studies representing the scope of research at the MRC CTU and different approaches to PPI. We carried out semi-structured interviews with staff and patient representatives. Interview notes were analysed descriptively to categorise the main aims and motivations for involvement; activities undertaken; their impact on the studies and lessons learned. We conducted 19 interviews about ten case studies, comprising one systematic review, one observational study and 8 randomised controlled trials in HIV and cancer. Studies were either open or completed, with start dates between 2003 and 2011. Interviews took place between March and November 2014 and were updated in summer 2015 where there had been significant developments in the study (i.e. if the study had presented results subsequent to the interview taking place). A wide range of PPI models, including representation on trial committees or management groups, community engagement, one-off task-focused activities, patient research partners and participant involvement had been used. Overall, interviewees felt that PPI had a positive impact, leading to improvements, for example in the research question; study design; communication with potential participants; study recruitment; confidence to carry out or complete a study; interpretation and communication of results; and influence on future research. A range of models of PPI can benefit clinical studies. Researchers should consider different approaches to PPI, based on the desired impact and the people they want to involve. Use of multiple models may increase the potential impacts of PPI in clinical research.

  9. Modelling of carry-over in recovery furnaces

    Energy Technology Data Exchange (ETDEWEB)

    Fakhrai, Reza [Royal Inst. of Tech., Stockholm (Sweden). Dept. of Metallurgy

    2000-04-01

    Development of mathematical modelling of the combustion process in the furnace of recovery boilers is the subject of this work. This work as a continuation of many years of modelling efforts carried out at KTH/Vaerme- och Ugnsteknik focussed particularly on: char bed modelling; droplets-wall interaction modelling; and carry-over modelling. The char bed model has been studied. Droplets/parcels were considered as a single reactor working independently of the other droplets. The mass of the droplets was not distributed uniformly but induced in the landing place. The droplets hitting the char bed will stick to it and they are alive and part of the calculation. In this way the distribution of the mass on the char bed is only dependent on the parameters which effect flight history such as droplet/parcel diameter, boilers flow field, etc. The droplet- wall interaction model has been studied and found to be very important for obtaining the correct temperature distribution in the recovery furnace. The new approach is based on removal of droplets which hits the wall in the upper part of the recovery boiler from carryover calculation. This model has been proposed and implemented into the GRFM (General Recovery Furnace Model). The carryover modelling effort was based on mass balance in which the number and physical statistics of the droplets/parcel were estimated and the amount of unburned mass was calculated. All of the above listed models were tested together with all other models of heat and mass transfer processes in recovery furnaces using a GRFM. Three-dimensional numerical simulations of the industrial recovery boiler (63 kg/s, 82 bar, 480 deg C) were performed. The number of grid was 232,000 and the number of air ports in this simulation was 178. The air entering the furnace by these ports has different flow rates. Flow and temperature fields as well as species distributions were calculated. The results show good agreement with previously published data and modelling

  10. The logistic model-generated carrying capacities, maximum ...

    African Journals Online (AJOL)

    This paper deals with the derivation of logistic models for cattle, sheep and goats in a commercial ranching system in Machakos District, Kenya, a savannah ecosystem with average annual rainfall of 589.3 ± 159.3mm and an area of 10 117ha. It involves modelling livestock population dynamics as discrete-time logistic ...

  11. Modeling of predictive muscular strength for sustained one-handed carrying task.

    Science.gov (United States)

    Li, Kai Way; Wang, Chien Wen; Yu, Ruifeng

    2015-01-01

    Manual materials handling (MMH) tasks are common. They are considered major contributors of musculoskeletal injuries and are the sources of financial burden for industries in terms of lost work days and worker compensation costs. One-handed carrying is common and could result in arm fatigue. The purpose of this study was to establish predictive models for one-handed carrying strength considering weight handed and handedness conditions. Twenty male subjects were recruited for the study. The subject carried a weight of 6 or 12 kg using either dominant or non-dominant hand lasting a time period of 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, or 4 minutes. The results showed that handedness (p carrying strength. Predictive models of single arm carrying strength were established under handedness and weight conditions. The MADs of these models ranged from 0.39 to 2.19 kgf. The exponential function based predictive models may be adopted to describe the single arm carrying strength with reasonable predictive errors. The trend of the carrying strength after carrying a load for a certain period may be employed to describe muscular fatigue for sustained carrying tasks.

  12. A model to estimate aquaculture carrying capacity in three areas of the Philippines

    Directory of Open Access Journals (Sweden)

    Tarzan Legović

    2008-12-01

    Full Text Available A model was developed to estimate the production carrying capacity of water bodies based on nutrient inputs from aquaculture and other sources, flushing rates, and the risk of algal blooms for three different areas of the Philippines – Bolinao (marine site, Dagupan (brackishwater site and Taal Lake (freshwater site. The results suggest that aquaculture production in the Taal Lake was greater than the sustainable carrying capacity. Aquaculture structures in Bolinao were close to carrying capacity during average tidal exchange but greater than the carrying capacity during low tidal exchange and no winds.Aquaculture production in the Dagupan estuary has not overcome its carrying capacity even during low flow. However, during very low flow and no tidal flushing, carrying capacity has been overcome.

  13. First Identification of a Patient Colonized With Klebsiella pneumoniae Carrying blaNDM-1 in Taiwan

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    Hua-Shin Wu

    2010-11-01

    Full Text Available New Delhi metallo-β-lactamase 1 (NDM-1 is a novel type of metallo-β-lactamase (MBL. Enterobacteriaceae carrying this NDM-1 encoding gene, blaNDM-1, have been identified worldwide. Bacteria carrying blaNDM-1 are not only resistant to carbapenem, but also highly resistant to many classes of antibiotics, which indicate the importance of prompt identification of these bacteria and implementation of strict infection control measures to prevent their transmission. Here, we report the first identification and management of a patient colonized with Klebsiella pneumoniae carrying blaNDM-1 in Taiwan, who returned from New Delhi where he had been hospitalized for a gun-shot injury.

  14. Quantifying spatially derived carrying capacity occupation: Framework for characterisation modelling and application to terrestrial acidification

    DEFF Research Database (Denmark)

    Bjørn, Anders; Margni, M.; Bulle, C.

    *year. This metric resembles that of the ecological footprint method and may be compared to the availability of land or water. The framework was applied to the terrestrial acidification impact category. The geochemical steady-state model PROFILE was used to quantify carrying capacities as deposition levels......The popularity of the ecological footprint method and the planetary boundaries concept shows an increasing interest among decision makers in comparing environmental impacts to carrying capacities of natural systems. Recently carrying capacity-based normalisation references were developed for impact...

  15. Estimating the carrying capacity of green mussel cultivation by using net nutrient removal model.

    Science.gov (United States)

    Srisunont, Chayarat; Babel, Sandhya

    2016-11-15

    This study aims to evaluate the nutrient removal potential and carrying capacity of green mussel cultivation by using the mass balance model. The developed model takes into consideration the green mussel growth rate, density and chlorophyll a concentration. The data employed in this study were based on culture conditions at Sriracha Fisheries Research Station, Thailand. Results show that net nutrient removal by green mussel is 3302, 380, and 124mg/year/indv for carbon, nitrogen, and phosphorus respectively. The carrying capacity of green mussel cultivation was found to be 300indv/m 2 based on chlorophyll a concentration which will not release phosphorus in the water environment beyond the standard (45μg-PO 4 -3 -P/L). Higher chlorophyll a concentration results in lowered green mussel carrying capacity. This model can assist farm operators with possible management strategies for a sustainable mussel cultivation and protection of the marine environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Forewarning Model of Regional Water Resources Carrying Capacity Based on Combination Weights and Entropy Principles

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    Rongxing Zhou

    2017-10-01

    Full Text Available As a new development form for evaluating the regional water resources carrying capacity, forewarning regional water resources of their carrying capacities is an important adjustment and control measure for regional water security management. Up to now, most research on this issue have been qualitative analyses, with a lack of quantitative research. For this reason, an index system for forewarning regional water resources of their carrying capacities and grade standards, has been established in Anhui Province, China, in this paper. Subjective weights of forewarning indices can be calculated using a fuzzy analytic hierarchy process, based on an accelerating genetic algorithm, while objective weights of forewarning indices can be calculated by using a projection pursuit method, based on an accelerating genetic algorithm. These two kinds of weights can be combined into combination weights of forewarning indices, by using the minimum relative information entropy principle. Furthermore, a forewarning model of regional water resources carrying capacity, based on entropy combination weight, is put forward. The model can fully integrate subjective and objective information in the process of forewarning. The results show that the calculation results of the model are reasonable and the method has high adaptability. Therefore, this model is worth studying and popularizing.

  17. MODELLING CARRYING CAPACITY FOR THE THANDA PRIVATE GAME RESERVE, SOUTH AFRICA USING LANDSAT 8 MULTISPECTRAL DATA

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    Z. Oumar

    2017-11-01

    Full Text Available Rangelands which consist of grasslands, shrublands and savannahs are used by wildlife for habitat and are the main source of forage for livestock. The assessment and monitoring of rangeland condition is one of the most important factors for rangeland scientists in order to calculate the carrying capacity of livestock with consideration for coexisting wildlife. This study assessed the potential of Landsat 8 multispectral bands and broadband vegetation indices to model woody vegetation parameters such as tree equivalents (TE and total leaf mass (LMASS for the Thanda Private Game Reserve using partial least squares regression (PLSR. The PLSR model predicted TE with an R2 value of 0.76 and a root mean square error (RMSE of 1411 TE/ha using an independent test dataset. LMASS was predicted with an R2 value of 0.67 and a RMSE of 853 kg/ha on an independent test dataset. The predictive models were then inverted to map TE and LMASS over the study area. The modelled TE and LMASS layers were integrated with conventional grazing and browse capacity models to map carrying capacity for the Game Reserve. The study indicates the potential of Landsat 8 multispectral data in carrying capacity modelling. The result is significant for rangeland monitoring in Southern Africa using remote sensing technologies.

  18. [Evaluation and improvement in the information of the patients who carry out a digestive endoscopy].

    Science.gov (United States)

    Baños Madrid, R; Ramón Esparza, T; Serrano Jiménez, A; Alajarín Cervera, M; Alberca de Las Parras, F; Molina Martínez, J

    2005-09-01

    The information is an important part of the attendance process though in occasions it can be inadequate or deficient. We detect an opportunity of improvement in the inadequate information of the patients who carry out an endoscopia. The aim is to evaluate and to improve the quality of the information. We realize the first evaluation with 100 patients proceeding from consultations, detecting ignorance of the technology. Actions of improvement are applied, for 4 months, to realize the second evaluation, with the same number of patients and to evaluate improvement with regard to the situation of item. A deficit of information has been detected in the moment to indicate the endoscopia (little information contributed by the doctor prescriptor and in an important number of cases informed assent was not contributed) and after realizing the test, not contributing recommendations. We prioritize our action to this level with measures of improvement and after a new evaluation, a significant improvement decides in these situations. The studies of qualit level allow us to detect deficit situations and to improve situations in the services of health.

  19. Train Headway Models and Carrying Capacity of Super-Speed Maglev System

    Science.gov (United States)

    He, Shiwei; Song, Rui; Eastham, Tony

    Train headway models are established by analyzing the operation of the Transrapid Super-speed Maglev System (TSMS). The variation in the minimum allowable headway for trains of different speeds and consists is studied under various operational constraints. A potential Beijing-Shanghai Maglev line is used as an illustration to undertake capacity analyses with the model and methods. The example shows that the headway models for analyzing the carrying capacity of Maglev systems are very useful for the configurational design of this new transport system.

  20. Long-term weight-loss in gastric bypass patients carrying melanocortin 4 receptor variants.

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    Bryn S Moore

    Full Text Available The melanocortin 4 receptor (MC4R critically regulates feeding and satiety. Rare variants in MC4R are predominantly found in obese individuals. Though some rare variants in MC4R discovered in patients have defects in localization, ligand binding and signaling to cAMP, many have no recognized defects.In our cohort of 1433 obese subjects that underwent Roux-en-Y Gastric Bypass (RYGB surgery, we found fifteen variants of MC4R. We matched rare variant carriers to patients with the MC4R reference alleles for gender, age, starting BMI and T2D to determine the variant effect on weight-loss post-RYGB. In vitro, we determined expression of mutant receptors by ELISA and western blot, and cAMP production by microscopy.While carrying a rare MC4R allele is associated with obesity, carriers of rare variants exhibited comparable weight-loss after RYGB to non-carriers. However, subjects carrying three of these variants, V95I, I137T or L250Q, lost less weight after surgery. In vitro, the R305Q mutation caused a defect in cell surface expression while only the I137T and C326R mutations showed impaired cAMP signaling. Despite these apparent differences, there was no correlation between in vitro signaling and pre- or post-surgery clinical phenotype.These data suggest that subtle differences in receptor signaling conferred by rare MC4R variants combined with additional factors predispose carriers to obesity. In the absence of complete MC4R deficiency, these differences can be overcome by the powerful weight-reducing effects of bariatric surgery. In a complex disorder such as obesity, genetic variants that cause subtle defects that have cumulative effects can be overcome after appropriate clinical intervention.

  1. Hierarchical population model with a carrying capacity distribution for bacterial biofilms

    Science.gov (United States)

    Indekeu, J. O.; Sznajd-Weron, K.

    2003-12-01

    In order to describe biological colonies with a conspicuous hierarchical structure, a time- and space-discrete model for the growth of a rapidly saturating local biological population N(x,t) is derived from a hierarchical random deposition process previously studied in statistical physics. Two biologically relevant parameters, the probabilities of birth, B, and of death, D, determine the carrying capacity K. Due to the randomness the population depends strongly on position x and there is a distribution of carrying capacities, Π(K). This distribution has self-similar character owing to the exponential slowing down of the growth, assumed in this hierarchical model. The most probable carrying capacity and its probability are studied as a function of B and D. The effective growth rate decreases with time, roughly as in a Verhulst process. The model is possibly applicable, for example, to bacteria forming a “towering pillar” biofilm, a structure poorly described by standard Eden or diffusion-limited-aggregation models. The bacteria divide on randomly distributed nutrient-rich regions and are exposed to a random local bactericidal agent (antibiotic spray). A gradual overall temperature or chemical change away from optimal growth conditions reduces bacterial reproduction, while biofilm development degrades antimicrobial susceptibility, causing stagnation into a stationary state.

  2. Impaired replication stress response in cells from immunodeficiency patients carrying Cernunnos/XLF mutations.

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    Michal Schwartz

    Full Text Available Non-Homologous End Joining (NHEJ is one of the two major pathways of DNA Double Strand Breaks (DSBs repair. Mutations in human NHEJ genes can lead to immunodeficiency due to its role in V(DJ recombination in the immune system. In addition, most patients carrying mutations in NHEJ genes display developmental anomalies which are likely the result of a general defect in repair of endogenously induced DSBs such as those arising during normal DNA replication. Cernunnos/XLF is a recently identified NHEJ gene which is mutated in immunodeficiency with microcephaly patients. Here we aimed to investigate whether Cernunnos/XLF mutations disrupt the ability of patient cells to respond to replication stress conditions. Our results demonstrate that Cernunnos/XLF mutated cells and cells downregulated for Cernunnos/XLF have increased sensitivity to conditions which perturb DNA replication. In addition, under replication stress, these cells exhibit impaired DSB repair and increased accumulation of cells in G2/M. Moreover Cernunnos/XLF mutated and down regulated cells display greater chromosomal instability, particularly at fragile sites, under replication stress conditions. These results provide evidence for the role of Cernunnos/XLF in repair of DSBs and maintenance of genomic stability under replication stress conditions. This is the first study of a NHEJ syndrome showing association with impaired cellular response to replication stress conditions. These findings may be related to the clinical features in these patients which are not due to the V(DJ recombination defect. Additionally, in light of the emerging important role of replication stress in the early stages of cancer development, our findings may provide a mechanism for the role of NHEJ in preventing tumorigenesis.

  3. Noise-Induced Transitions in a Population Growth Model Based on Size-Dependent Carrying Capacity

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    Neeme Lumi

    2014-01-01

    Full Text Available The stochastic dynamics of a population growth model with size-dependent carrying capacity is considered. The effect of a fluctuating environment on population growth is modeled as a multiplicative dichotomous noise. At intermediate values of population size the deterministic counterpart of the model behaves similarly to the Von Foerster model for human population, but at small and very large values of population size substantial differences occur. In the stochastic case, an exact analytical solution for the stationary probability distribution is found. It is established that variation of noise correlation time can cause noise-induced transitions between three different states of the system characterized by qualitatively different behaviors of the probability distributions of the population size. Also, it is shown that, in some regions of the system parameters, variation of the amplitude of environmental fluctuations can induce single unidirectional abrupt transitions of the mean population size.

  4. System dynamics model of Suzhou water resources carrying capacity and its application

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    Li Cheng

    2010-06-01

    Full Text Available A model of Suzhou water resources carrying capacity (WRCC was set up using the method of system dynamics (SD. In the model, three different water resources utilization programs were adopted: (1 continuity of existing water utilization, (2 water conservation/saving, and (3 water exploitation. The dynamic variation of the Suzhou WRCC was simulated with the supply-decided principle for the time period of 2001 to 2030, and the results were characterized based on socio-economic factors. The corresponding Suzhou WRCC values for several target years were calculated by the model. Based on these results, proper ways to improve the Suzhou WRCC are proposed. The model also produced an optimized plan, which can provide a scientific basis for the sustainable utilization of Suzhou water resources and for the coordinated development of the society, economy, and water resources.

  5. [Simulation and prediction of water environmental carrying capacity in Liaoning Province based on system dynamics model].

    Science.gov (United States)

    Wang, Jian; Li, Xue-liang; Li, Fa-yun; Bao, Hong-xu

    2009-09-01

    By the methods of system dynamics, a water environmental carrying capacity (WECC) model was constructed, and the dynamic trend of the WECC in Liaoning Province was simulated by using this model, in combining with analytical hierarchy process (AHP) and the vector norm method. It was predicted that under the conditions of maintaining present development schemes, the WECC in this province in 2000-2050 would be decreased year after year. Only increasing water resources supply while not implementing scientific and rational management of water environment could not improve the regional WECC, and the integration of searching for new and saving present water resources with controlling wastewater pollution and reducing sewage discharge would be the only effective way to improve the WECC and the coordinated development of economy, society, and environment in Liaoning.

  6. Induced pluripotent stem cells (iPSCs derived from cerebrotendinous xanthomatosis (CTX patient's fibroblasts carrying a R395S mutation

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    Philip Höflinger

    2016-09-01

    Full Text Available Induced pluripotent stem cells (iPSCs were generated from dermal fibroblasts from a 60-year-old cerebrotendinous xanthomatosis (CTX patient, carrying a homozygous mutation c. [1183C>A]; p. R395S in CYP27A1. Episomal plasmids encoding the pluripotency genes OCT4, SOX2, KLF4, L-MYC and LIN28 were introduced via electroporation. The generated line iPS-CTX-R395S has no sign of plasmid integration or chromosomal aberration and retained the mutation site in CYP27A1. Furthermore, iPSCs express pluripotency markers and are able to differentiate in all germ layers in vitro. The generated line may be a useful tool for disease modelling of CTX.

  7. Evaluation of the Township Proper Carrying Capacity over Qinghai-Tibet plateau by CASA model

    Science.gov (United States)

    Wu, Chengyong; Cao, Guangchao; Xue, Huaju; Jiang, Gang; Wang, Qi; Yuan, Jie; Chen, Kelong

    2018-01-01

    The existing study of proper carrying capacity (PCC) has mostly focused on province or county administrative units, which can only macroscopically master the quantitative characteristics of PCC, but could not effectively take some animal husbandry management measures that are pertinent and operational. At town-scale, this paper used CASA model to estimate the PCC in Mongolian Autonomous County of Henan, Qinghai province, China,with serious grassland degeneration that mainly caused by overgrazing. The results showed that the PCC throughout the County was 950,417 sheep unit. For the township, the PCC of Saierlong and Duosong were the largest (247,100 sheep unit) and the smallest (82,016 sheep unit) respectively. This study will provide reference data for developing sustainable development of town-scale pasture policies and also will help to evaluate the health status of the alpine grassland ecosystem on Qinghai-Tibet plateau.

  8. Modelling PM 10 concentrations and carrying capacity associated with woodheater emissions in Launceston, Tasmania

    Science.gov (United States)

    Luhar, Ashok K.; Galbally, Ian E.; Keywood, Melita

    Launceston is one of the Australian cities most affected by particle pollution due to the use of woodheaters in the winter months, with frequent exceedences of the national standard, the National Environment Protection Measure for Ambient Air Quality (or Air NEPM in short), of 50 micrograms per cubic metre for daily PM 10 (particulate matter with an aerodynamic diameter of 10 μm or less). The main objective of the present study was to determine the woodheater carrying capacity for Launceston—the number of woodheaters that can operate in the city without exceeding the Air NEPM. For this purpose, a prognostic meteorological and air pollution model called TAPM is used, coupled to a gridded woodheater PM 10 emissions inventory. The latter was derived using information on dwelling density, the percentage of dwellings with woodheaters, woodheater emission rates and their diurnal and seasonal variations, and the proportions of compliant/non-compliant woodheaters and open fireplaces. The model simulations are performed for the year 1998, and the concentrations are scaled for previous and subsequent years using trends in woodheater numbers and types. The modelled number of exceedences of the Air NEPM for the period 1997-2004 is in good agreement with the observations. The modelling indicates that the PM 10 Air NEPM would be met in Launceston when the total number of woodheaters is 20% of the total number of dwellings, of which 76%, 18%, 6% would be compliant woodheaters, non-compliant woodheaters and open fireplaces, respectively. With the present trends in the regional woodheater profile, this should occur in the year 2007.

  9. Evaluating vacquinol-1 in rats carrying glioblastoma models RG2 and NS1.

    Science.gov (United States)

    Ahlstedt, Jonatan; Förnvik, Karolina; Zolfaghari, Shaian; Kwak, Dongoh; Hammarström, Lars G J; Ernfors, Patrik; Salford, Leif G; Redebrandt, Henrietta Nittby

    2018-02-02

    Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor, and available experimental and routine therapies result in limited survival benefits. A vulnerability of GBM cells to catastrophic vacuolization and cell death, a process termed methuosis, induced by Vacquinol-1 (VQ-1) has been described earlier. In the present study, we investigate the efficacy of VQ-1 treatment in two syngeneic rat GBM models, RG2 and NS1. VQ-1 treatment affected growth of both RG2 and NS1 cells in vitro . Intracranially, significant reduction in RG2 tumor size was observed, although no effect was seen on overall survival. No survival advantage or effect on tumor size was seen in animals carrying the NS1 models compared to untreated controls. Furthermore, immunological staining of FOXP3, CD4 and CD8 showed no marked difference in immune cell infiltrate in tumor environment following treatment. Taken together, a survival advantage of VQ-1 treatment alone could not be demonstrated here, even though some effect upon tumor size was seen. Staining for immune cell markers did not indicate that VQ-1 either reduced or increased host anti-tumor immune response.

  10. Arterial tree anomalies in patients with clubfoot: an investigation carried out at Soba University Hospital.

    Science.gov (United States)

    Shaheen, Samir; Bahar, Mustafa E H; Mohammed, Almigdad H A; Elbadri, Sara F A; Johari, Ashok

    2018-01-01

    Vascular deficiencies and reduced perfusion of the anterior tibial artery and the dorsalis pedis artery were suggested as causes of congenital talipes equino varus (CTEV). In this study, we assessed the prevalence of arterial abnormalities in patients with CTEV (50 patients; 74 feet) compared with a normal control group (16 patients; 32 feet) by Doppler ultrasound and Ankle Brachial Index. The flow was normal in the control group and was deficient in 39.19% of clubfoot patients. In severe clubfoot cases, the deficiency was found to an extent of 76.67%. In conclusion, the anterior tibial artery and dorsalis pedis artery are deficient in CTEV patients; to avoid postoperative skin sloughing, arterial supply must be protected using a judicious incision.

  11. Homoarginine Associates with Zonulin and Tryptophan - Findings in a High-Risk Cohort of Patients Carrying an AICD.

    Science.gov (United States)

    Mann, Elli; Kluesener, Robert; Boschann, Felix; Ruppert, Jana; Armbruster, Franz P; Meinitzer, Andreas; Melzer, Christoph; Dschietzig, Thomas B

    2017-11-01

    Homoarginine (hArg) is known to have an impact on nitric oxide (NO) metabolism. It seems to increase NO generation and/or availability, thereby enhancing endothelial function. In addition, hArg is connected to energy metabolism since the key enzyme, L-arginine-glycine amidinotransferase (AGAT) for hArg synthesis in the kidneys, is also involved in the synthesis of energy metabolites like guanidinoacetate. Former studies indicate that low levels of hArg are linked to cardiovascular disease and increased all-cause mortality. This study investigated the dependence of plasma hArg on various biochemical and clinical factors in 229 patients carrying an automatic, implantable cardioverter/defibrillator (AICD) using multiple linear regression analysis (Generalized Linear Model, GLM). GLM revealed a highly significant, positive association between hArg and zonulin (p zonulin is a novel finding which may indicate a different meaning of circulating versus local (gut) zonulin. Therefore, further experimental and clinical investigation is needed to explore this association, focusing on possible pathophysiological pathways and the role of circulating zonulin levels in cardiovascular disease. The positive correlation of hArg and Trp also deserves further research because both amino acids might have a protective effect on cardiovascular disease by inhibition of the enzyme alkaline phosphatase. Eventually, our study associates low hArg concentrations with chronic low-grade inflammation and parameters of malnutrition in cardiovascular high-risk patients.

  12. Nursing care for patients carrying indwelling catheter in target vessel for continuous chemotherapy

    International Nuclear Information System (INIS)

    Wen Lihong

    2009-01-01

    Objective: To reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. Methods: (1)To enhance the propaganda,education and guidance to patients. (2) To standardize the nursing care operations. (3) To establish the reasonable care rules and procedures. (4) The nurses should take the daily nursing care,observations and recording work seriously. Results: Through the analysis of a variety of problems occurred in patients with indwelling catheter during the course of continuous chemotherapy the nursing care experience was summed up. Conclusion: Proper and effective care can reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. (authors)

  13. Can the documented patient briefing be carried out with an iPad app?

    Science.gov (United States)

    Schlechtweg, Philipp Martin; Hammon, Matthias; Heberlein, Christian; Giese, David; Uder, Michael; Schwab, Siegfried Alexander

    2013-06-01

    To evaluate the feasibility of an iPad-based documented patient briefing for Magnetic Resonance Imaging (MRI) examinations. A standard briefing sheet and questionnaire for a MRI scan was converted from paper form into an iPad application. Twenty patients, who had been referred for an MRI scan, were briefed about the examination in paper form as well as via the iPad application before performing the MRI scan. Time each patient needed for the briefing and the number of questions that came up were documented. Patients' acceptance of the electronic briefing was assessed using a questionnaire. The mean processing time was 2.36 min (range 0.58 to 09.35 min., standard deviation ±2.05 min) for the paper-based briefing and 4.15 min (range 1.56 to 13.48 min, SD ± 2.36 min) for the app-based briefing. Concerning technical aspects, patients asked two questions during the app-based briefing; no questions arose during the paper-based briefing. Six patients preferred electronic briefing and four patients, the paper-based form. No patient preferred the electronic form with additional multimedial information. Eight participants did not mind which briefing version was used; two participants did not express their preference at all. Our experiences showed that electronic briefing using an iPad is feasible and has the potential to become a user-friendly alternative to the conventional paper-based approach. Owing to the broad range of the results, a follow-up study will seek to determine the influencing factors on processing time and other potential questions.

  14. Three patients with Wolf-Hirschhorn syndrome carrying a satellited chromosome 4p.

    Science.gov (United States)

    Liang, Desheng; Zhou, Zhongmin; Meng, Dahua; Du, Juan; Wen, Juan; Niikawa, Norio; Wu, Lingqian

    2012-07-01

    Wolf-Hirschhorn syndrome (WHS) is caused by a deletion involving the 4p16.3 region. Approximately 70% of WHS patients have a de novo isolated deletion and 22% involve unbalanced translocations. However, WHS with unbalanced rearrangements involving the short arm of an acrocentric chromosome are infrequently reported. Cytogenetic and molecular analyses by using standard G-banding, argyrophilic nucleolar organiser region (Ag-NOR) staining, fluorescence in situ hybridization, and single nucleotide polymorphism array for copy number detection were performed in three patients with WHS phenotype from two Chinese families. A heterozygous 2,767,380-bp terminal 4p deletion was detected in patients 1 and 2 and a heterozygous 5,047,291-bp terminal 4p deletion was detected in patient3. Clinical comparisons among our patients and previously reported cases have been reviewed. Two terminal 4p deletions were identified in three WHS patients with a satellited 4p and an attempt was made to refine the genotypic-phenotypic correlations of the deleted regions. Copyright © 2012 Wiley Periodicals, Inc.

  15. [Are the patients not carrying protections after radical prostatectomy really continent?].

    Science.gov (United States)

    Centi, J; Brakbi, Y; Plainard, X; Romain, J; Gardic, S; Dumas, J-P; Descazeaud, A

    2015-12-01

    To analyse urinary continence and related quality of life in patients not wearing any pad after robotic assisted radical prostatectomy (RARP). Two hundred and sixteen patients operated consecutively by RARP between January 2009 and June 2011 were evaluated by the ICS (International Continence Society) Male Self-questionnaire. The questionnaires were sent by mail and mailed back by patients with a minimum of 14 months following surgery. The ICS questionnaire contains a symptom score (ICS 1) and a quality of life score (ICS 2). Out of 216 sent questionnaires, 145 (67%) were received. The subgroup of 121 patients who replied that they were not wearing any pad was analysed. Fifty-three (43,8%) of them reported not having leakage when coughing or sneezing, 65 (53,7%) reported not having spontaneous leakage, and 102 (84,3%) reported not having leakage when sleeping. The ICS 1 and ICS 2 scores were strongly correlated (Pearson correlation coefficient 0.96). Within a group of patients not wearing any pad following RARP, the continence as assessed by self-questionnaires remains altered. This analysis might help counselling patients who are about to choose a surgical treatment for their prostate cancer. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Clinical Features in Juvenile-Onset Ankylosing Spondylitis Patients Carrying Different B27 Subtypes

    Directory of Open Access Journals (Sweden)

    Yikun Mou

    2015-01-01

    Full Text Available Background. Ankylosing spondylitis (AS is a common rheumatic disease and is characterized by inflammation of the axial skeleton. HLA-B27 is strongly associated with AS. Juvenile-onset AS (JAS with disease onset before 16 years of age differs from adult-onset AS (AAS in many respects. Objective. To compare the clinical features in JAS with different B27 subtypes and analyze the differences between JAS and AAS. Methods. 145 JAS and 360 AAS patients were included. The demographic data, clinical manifestations, laboratory markers, Bath AS indices, and B27 subtypes were recorded. Results. Peripheral arthritis, enthesitis, BASDAI, ESR, and CRP were significantly higher in JAS patients with HLA-B*2704 than those with B27-negative. Enthesitis and ESR were significantly higher in patients with HLA-B*2705 than those with B27-negative. The onset age of HLA-B*2715 group was much earlier than the other groups. The peripheral arthritis, enthesitis, and hip joint involvement in JAS with HLA-B*2704 were significantly higher than those in AAS with HLA-B*2704. Conclusion. JAS with different B27 subtypes had similar features in most of manifestations; JAS and AAS patients with the same subtype could have distinctive courses. Early diagnosis, hip detection, and control of systemic active inflammation in JAS patients will be helpful for improving the prognosis.

  17. [Changes in knowledge and carrying out the advance directives of patients admitted to internal medicine].

    Science.gov (United States)

    Pérez, M; Herreros, B; Martín, M D; Molina, J; Guijarro, C; Velasco, M

    2013-01-01

    Advance directives (ADs), are documents in which patients express in advance that their wishes are fulfilled when they are unable to communicate them. It is unknown whether patients admitted to internal medicine are more aware of and make ADs. To study the changes in the level of knowledge and implementation of AD among patients admitted to an internal medicine department of a hospital in Madrid since a specific regulation to implement them was introduced. A survey was conducted among patients admitted to internal medicine in two periods: 2008 and 2010. A total of 206 surveys were analysed (84 in 2008 and 122 in 2010). The mean age of the patients was 76.8 years, and 51.5% were women. More than two-thirds (69.4%) had a co-morbidity. and 4.4% had a terminal illness, with no statistical differences between the periods. Only 5.3% knew what ADs are, 1 had implemented ADs, and 46.1%, once informed, would like to implement them. There were no differences between 2008 and 2010 as regards knowledge and implementation of AD. In 2010 there was a greater interest to implement them (would like to implement them: 52.5 vs 36.9%), although in 2010 less respondents believe that AD would change the attitude of the doctor (not change the attitude: 92.6 vs. 69%, P<.001). Knowledge and implementation of AD did not change significantly in the years following the regulation (from 2008-2010). In both periods, their knowledge and implementation are scarce. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  18. Carrying Capacity Model Applied to Coastal Ecotourism of Baluran National Park, Indonesia

    Science.gov (United States)

    Armono, H. D.; Rosyid, D. M.; Nuzula, N. I.

    2017-07-01

    The resources of Baluran National Park have been used for marine and coastal ecotourism. The increasing number of visitors has led to the increasing of tourists and its related activities. This condition will cause the degradation of resources and the welfare of local communities. This research aims to determine the sustainability of coastal ecotourism management by calculating the effective number of tourists who can be accepted. The study uses the concept of tourism carrying capacity, consists the ecological environment, economic, social and physical carrying capacity. The results of the combined carrying capacity analysis in Baluran National Park ecotourism shows that the number of 3.288 people per day (151.248 tourists per year) is the maximum number of accepted tourists. The current number of tourist arrivals is only 241 people per day (87.990 tourists per year) which is far below the carrying capacity.

  19. A Turner Syndrome Patient Carrying a Mosaic Distal X Chromosome Marker

    Directory of Open Access Journals (Sweden)

    Roberto L. P. Mazzaschi

    2014-01-01

    Full Text Available A skin sample from a 17-year-old female was received for routine karyotyping with a set of clinical features including clonic seizures, cardiomyopathy, hepatic adenomas, and skeletal dysplasia. Conventional karyotyping revealed a mosaic Turner syndrome karyotype with a cell line containing a small marker of X chromosome origin. This was later confirmed on peripheral blood cultures by conventional G-banding, fluorescence in situ hybridisation and microarray analysis. Similar Turner mosaic marker chromosome cases have been previously reported in the literature, with a variable phenotype ranging from the mild “classic” Turner syndrome to anencephaly, agenesis of the corpus callosum, complex heart malformation, and syndactyly of the fingers and toes. This case report has a phenotype that is largely discordant with previously published cases as it lies at the severe end of the Turner variant phenotype scale. The observed cytogenetic abnormalities in this study may represent a coincidental finding, but we cannot exclude the possibility that the marker has a nonfunctioning X chromosome inactivation locus, leading to functional disomy of those genes carried by the marker.

  20. Carrying Capacity

    DEFF Research Database (Denmark)

    Schroll, Henning; Andersen, Jan; Kjærgård, Bente

    2012-01-01

    A spatial planning act was introduced inIndonesia 1992 and renewed in 2008. It emphasised the planning role of decentralised authorities. The spatial planning act covers both spatial and environmental issues. It defines the concept of carrying capacity and includes definitions of supportive....../cities. Four different sectors (water, food production, waste, and forests) were selected as core areas for decentralised spatial planning. Indicators for SCC and ACC were identified and assessed with regard to relevance and quantifiability. For each of the indicators selected, a legal threshold or guiding...... was introduced inIndonesia 1992 and renewed in 2008. It emphasised the planning role of decentralised authorities. The spatial planning act covers both spatial and environmental issues. It defines the concept of carrying capacity and includes definitions of supportive carrying capacity (SCC) and assimilative...

  1. Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

    Directory of Open Access Journals (Sweden)

    Motomura Takashi

    2012-11-01

    Full Text Available Abstract Background IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined. Methods Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group and 90 who did not (non-Spx group were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15 and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen. Results Sustained virological response (SVR rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3% and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P 3/μl vs 168.7 × 103/μl, P Conclusions IL28B genetic variants correlated with response to PEG-IFN/RBV following splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype.

  2. Effect of laparoscopic splenectomy in patients with Hepatitis C and cirrhosis carrying IL28B minor genotype

    Science.gov (United States)

    2012-01-01

    Background IL28B and ITPA genetic variants are associated with the outcome of pegylated-interferon and ribavirin (PEG-IFN/RBV) therapy. However, the significance of these genetic variants in cirrhotic patients following splenectomy has not been determined. Methods Thirty-seven patients with HCV-induced cirrhosis who underwent laparoscopic splenectomy (Spx group) and 90 who did not (non-Spx group) were genotyped for IL28B and ITPA. The outcome or adverse effects were compared in each group. Interferon-stimulated gene 15 (ISG15) and protein kinase R expression in the spleen was measured using total RNA extracted from exenterate spleen. Results Sustained virological response (SVR) rate was higher in patients carrying IL28B major genotype following splenectomy (50% vs 27.3%) and in patients carrying minor genotype in the Spx group compared to non-Spx group (27.3% vs 3.6%, P splenectomy did not increase hemoglobin (Hb) level, Hb decline tended to be greater in the non-Spx group. In contrast, splenectomy significantly increased platelet count (61.1 × 103/μl vs 168.7 × 103/μl, P splenectomy. Splenectomy improved SVR rate among patients carrying IL28B minor genotype and protected against anemia and thrombocytopenia during the course of PEG-IFN/RBV therapy regardless of ITPA genotype. PMID:23145809

  3. Carrying capacity models should not use fixed prey density thresholds : a plea for using more tools of behavioural ecology

    NARCIS (Netherlands)

    van Gils, JA; Edelaar, P; Escudero, G; Piersma, T

    Earlier studies have developed models of carrying capacity to predict the number of animals a certain area can support. These models assume that resources are not renewed after consumption ('standing stock' models), and that the initial number of prey and the rate of prey consumption determine the

  4. Presentation of a patient carrying a progressive supra-nuclear paralysis

    International Nuclear Information System (INIS)

    Arredondo Bruce, Alfredo; Huerta Ramírez, Janet; Domínguez Calderón, Tomás; Pérez Zayas, Jesús

    2016-01-01

    The progressive supra-nuclear paralysis (PSP) or Steele-Richardson-Olszewsky’s syndrome is a strange, degenerative illness produced by the deterioration and gradual death of brain selected areas. We present the case of a female patient, aged 80 years, who refers postural instability, frequent falls and cognitive dysfunctions. She also presents stiffness in retrocollis in the back of the neck, fall of eyelids, left hand shaking, dysarthric and incoherent language, and shaking of both hands in coins counting. The cardiovascular examination showed 2nd increased beat, systolic murmur III/IV in mitral focus, AT 160/90 mm of Hg, edemas in both inferior members, hearth frequency of 110 beats/min., and jugular ingurgitation. The rest of the physical examination was normal. The etiologic diagnosis was progressive supranuclear paralysis and dilated cardiomyopathy. The tau protein is important in the maintenance of the neuronal morphology through microtubules formation, the different proportions and locations, causing the Richardson’s syndrome. The most common symptoms of this entity are postural instability and frequent falls, dysarthria, hypokinesia and visual alterations. Magnetic resonance and functional neuroimaging help the diagnosis. (author)

  5. Specifying the Role of Exposure to Violence and Violent Behavior on Initiation of Gun Carrying: A Longitudinal Test of Three Models of Youth Gun Carrying

    Science.gov (United States)

    Spano, Richard; Pridemore, William Alex; Bolland, John

    2012-01-01

    Two waves of longitudinal data from 1,049 African American youth living in extreme poverty are used to examine the impact of exposure to violence (Time 1) and violent behavior (Time 1) on first time gun carrying (Time 2). Multivariate logistic regression results indicate that (a) violent behavior (Time 1) increased the likelihood of initiation of…

  6. A simplified model predicting the weight of the load carrying beam in a wind turbine blade

    DEFF Research Database (Denmark)

    Mikkelsen, Lars Pilgaard

    2016-01-01

    Based on a simplified beam model, the loads, stresses and deflections experienced by a wind turbine blade of a given length is estimated. Due to the simplicity of the model used, the model is well suited for work investigating scaling effects of wind turbine blades. Presently, the model is used t...

  7. Valproate Treatment in an ALS Patient Carrying a c.194G>A Spastin Mutation and SMN2 Homozygous Deletion

    Directory of Open Access Journals (Sweden)

    Lucio Tremolizzo

    2014-01-01

    Full Text Available Here we report the case of an ALS patient found to carry both a novel heterozygous change (c.194G>A within the spastin gene and a homozygous deletion of the SMN2 gene. The patient was started on valproic acid (VPA, 600 mg/die per os considering the capacity of this drug of increasing survival motor neuron through an epigenetic mechanism. Patient clinical course and molecular effects of VPA on skin fibroblasts obtained from the proband are described. This c.194G>A spastin mutation might expand the previously known borders of type 4 spastic paraplegia (SPG4 and we suggest the intriguing possibility that the absence of SMN2 might have acted as a contributory risk factor for starting lower motor neuron damage. Exploring the relationship genocopy-phenocopy in selected ALS patients might represent an interesting strategy for understanding its clinical variability.

  8. A toxicokinetic model for the carry-over of dioxins and PCBs from feed and soil to eggs

    NARCIS (Netherlands)

    Eijkeren, van J.; Zeilmaker, M.; Kan, C.A.; Traag, W.A.; Hoogenboom, L.A.P.

    2006-01-01

    A mathematical model for the kinetics of carry-over of dioxins and dioxin-like PCBs from feed mixed with contaminated oil to eggs has been developed. This model incorporates uptake of the compounds over the gut wall and their subsequent transport by blood, distribution over the body, hepatic

  9. A toxicokinetic model for the carry-over of dioxins and PCBs from feed and soil to eggs.

    NARCIS (Netherlands)

    Eijkeren, Jan C H van; Zeilmaker, Marco J; Kan, C A; Traag, Win A; Hoogenboom, L A P

    2006-01-01

    A mathematical model for the kinetics of carry-over of dioxins and dioxin-like PCBs from feed mixed with contaminated oil to eggs has been developed. This model incorporates uptake of the compounds over the gut wall and their subsequent transport by blood, distribution over the body, hepatic

  10. Integrating remote sensing and conventional grazing/browsing models for modelling carrying capacity in southern African rangelands

    Science.gov (United States)

    Adjorlolo, C.; Botha, J. O.; Mhangara, P.; Mutanga, O.; Odindi, J.

    2014-10-01

    Woody vegetation encroachment into grasslands or bush thickening, a global phenomenon, is transforming the Southern African grassland systems into savanna-like landscapes. Estimation of woody vegetation is important to rangeland scientists and land managers for assessing its impact on grass production and calculating its grazing and browsing capacity. Assessment of grazing and browsing components is often challenging because agro-ecological landscapes of this region are largely characterized by small scale and heterogeneous land-use-land-cover patterns. In this study, we investigated the utility of high spatial resolution remotely sensing data for modelling grazing and browsing capacity at landscape level. Woody tree density or Tree Equivalents (TE) and Total Leaf Mass (LMASS) data were derived using the Biomass Estimation for Canopy Volume (BECVOL) program. The Random Forest (RF) regression algorithm was assessed to establish relationships between these variables and vegetation indices (Simple Ratio and Normalized Difference Vegetation Index), calculated using the red and near infrared bands of SPOT5. The RF analysis predicted LMASS with R2 = 0.63 and a Root Mean Square Error (RMSE) of 1256 kg/ha compared to a mean of 2291kg/ha. TE was predicted with R2 = 0.55 and a RMSE = 1614 TE/ha compared to a mean of 3746 TE/ha. Next, spatial distribution maps of LMASS/ha and TE/ha were derived using separate RF regression models. The resultant maps were then used as input data into conventional grazing and browsing capacity models to calculate grazing and browsing capacity maps for the study area. This study provides a sound platform for integrating currently available and future remote sensing satellite data into rangeland carrying capacity modelling and monitoring.

  11. Model for determining the load or carrying capacity of rivers and riverbanks for recreational use

    Directory of Open Access Journals (Sweden)

    Otero, I.

    2015-12-01

    Full Text Available The aim of this article is to determine the load or functional carrying capacity for the assimilation and recovery of rivers and riverbanks by compiling information on the environment, and to assess the potential for recreation from the environmental and scenic point of view. We set out to find the most significant basis for analysing the pressures limiting carrying capacity and constraining the demand for recreational use. This methodology will help planners and legislators in their decision-making. We also propose a methodology for assessing the recreational use of riverbanks, tested in a number of sites in the Madrid Region, in terms of the satisfaction the activity produces in the users, and the load or carrying capacity of the surrounding environment. A pilot site assessment is presented as a validation of the proposed methodology.El objetivo de este artículo es, determinar la capacidad de carga o acogida funcional, de asimilación y de recuperación de los márgenes y los cursos fluviales mediante la recopilación de información del medio; el potencial recreativo se evalúa además desde un doble punto de vista: ecológico y paisajístico. La forma en que se enfoca el problema y se presenta la metodología y los resultados puede resultar de gran utilidad para planificadores y legisladores. La metodología propuesta para valorar el uso recreativo de los márgenes fluviales, se aplica a una serie de parcelas en la Comunidad de Madrid, teniendo en cuenta la satisfacción que la actividad produce en los usuarios, y la capacidad de carga o acogida del entorno en el que se desarrollan. Como resultado, se presenta la valoración de parcelas piloto, que servirían para validar la metodología propuesta. [fr] Le but de cet article est, déterminer la capacité de charge ou réception fonctionnelle, l’assimilation et rétablissement des marges et les cours de la rivière par le biais de la collecte d’informations de l’environnement: le

  12. Biomechanical modeling and load-carrying simulation of lower limb exoskeleton.

    Science.gov (United States)

    Zhu, Yanhe; Zhang, Guoan; Zhang, Chao; Liu, Gangfeng; Zhao, Jie

    2015-01-01

    This paper introduces novel modern equipment-a lower extremity exoskeleton, which can implement the mutual complement and the interaction between human intelligence and the robot's mechanical strength. In order to provide a reference for the exoskeleton structure and the drive unit, the human biomechanics were modeled and analyzed by LifeModeler and Adams software to derive each joint kinematic parameter. The control was designed to implement the zero-force interaction between human and exoskeleton. Furthermore, simulations were performed to verify the control and assist effect. In conclusion, the system scheme of lower extremity exoskeleton is demonstrated to be feasible.

  13. Patients Carrying 9q31.1-q32 Deletion Share Common Features with Cornelia de Lange Syndrome

    Directory of Open Access Journals (Sweden)

    Ruixue Cao

    2015-01-01

    Full Text Available Background: Cornelia de Lange Syndrome (CdLS is a rare but severe clinically heterogeneous developmental disorder characterized by facial dysmorphia, growth and cognitive retardation, and abnormalities of limb development. Objectives: To determine the pathogenesis of a patient with CdLS. Methods: We studied a patient with CdLS by whole exome sequencing, karyotyping and Agilent CGH Array. The results were confirmed by quantitative real-time PCR analysis of the patient and her parents. Further comparison of our patient and cases with partially overlapping deletions retrieved from the literature and databases was undertaken. Results: Whole exome sequencing had excluded the mutation of cohesion genes such as NIPBL,SMC1A and SMC3. The result of karyotyping showed a deletion of chromosome 9q31.1-q32 and the result of Agilent CGH Array further displayed a 12.01-Mb region of deletion at chromosome bands 9q31.1-q32. Reported cases with the deletion of 9q31.1-q32 share similar features with our CdLS patient. One of the genes in the deleted region, SMC2, belongs to the Structural Maintenance of Chromosomes (SMC family and regulates gene expression and DNA repair. Conclusions: Patients carrying the deletion of 9q31.1-q32 showed similar phenotypes with CdLS.

  14. Modeling and data activities under the IAEA ISAM project. A resume of the activities carried out

    International Nuclear Information System (INIS)

    Torres, C.; Heilbron, P.; Lietava, P.; Little, R.; Yucelf, V.; Volckaert, G.

    2002-01-01

    This paper describes part of the work that was developed in the 3 year Co-ordinated Programme entitled Improvement of Long Term Safety Assessment Methodologies for near surface disposal facilities (ISAM) regarding the modelling and data issues on the safety assessment of near surface disposal facilities for the disposal of low and intermediate radioactive waste. (author)

  15. Methodology to carry out a sensitivity and uncertainty analysis for cross sections using a coupled model Trace-Parcs

    International Nuclear Information System (INIS)

    Reyes F, M. C.; Del Valle G, E.; Gomez T, A. M.; Sanchez E, V.

    2015-09-01

    A methodology was implemented to carry out a sensitivity and uncertainty analysis for cross sections used in a coupled model for Trace/Parcs in a transient of control rod fall of a BWR-5. A model of the reactor core for the neutronic code Parcs was used, in which the assemblies located in the core are described. Thermo-hydraulic model in Trace was a simple model, where only a component type Chan was designed to represent all the core assemblies, which it was within a single vessel and boundary conditions were established. The thermo-hydraulic part was coupled with the neutron part, first for the steady state and then a transient of control rod fall was carried out for the sensitivity and uncertainty analysis. To carry out the analysis of cross sections used in the coupled model Trace/Parcs during the transient, the Probability Density Functions for 22 parameters selected from the total of neutronic parameters that use Parcs were generated, obtaining 100 different cases for the coupled model Trace/Parcs, each one with a database of different cross sections. All these cases were executed with the coupled model, obtaining in consequence 100 different output files for the transient of control rod fall doing emphasis in the nominal power, for which an uncertainty analysis was realized at the same time generate the band of uncertainty. With this analysis is possible to observe the ranges of results of the elected responses varying the selected uncertainty parameters. The sensitivity analysis complements the uncertainty analysis, identifying the parameter or parameters with more influence on the results and thus focuses on these parameters in order to better understand their effects. Beyond the obtained results, because is not a model with real operation data, the importance of this work is to know the application of the methodology to carry out the sensitivity and uncertainty analyses. (Author)

  16. [Measuring water ecological carrying capacity with the ecosystem-service-based ecological footprint (ESEF) method: Theory, models and application].

    Science.gov (United States)

    Jiao, Wen-jun; Min, Qing-wen; Li, Wen-hua; Fuller, Anthony M

    2015-04-01

    Integrated watershed management based on aquatic ecosystems has been increasingly acknowledged. Such a change in the philosophy of water environment management requires recognizing the carrying capacity of aquatic ecosystems for human society from a more general perspective. The concept of the water ecological carrying capacity is therefore put forward, which considers both water resources and water environment, connects socio-economic development to aquatic ecosystems and provides strong support for integrated watershed management. In this paper, the authors proposed an ESEF-based measure of water ecological carrying capacity and constructed ESEF-based models of water ecological footprint and capacity, aiming to evaluate water ecological carrying capacity with footprint methods. A regional model of Taihu Lake Basin was constructed and applied to evaluate the water ecological carrying capacity in Changzhou City which located in the upper reaches of the basin. Results showed that human demand for water ecosystem services in this city had exceeded the supply capacity of local aquatic ecosystems and the significant gap between demand and supply had jeopardized the sustainability of local aquatic ecosystems. Considering aqua-product provision, water supply and pollutant absorption in an integrated way, the scale of population and economy aquatic ecosystems in Changzhou could bear only 54% of the current status.

  17. The Application of a Phosphorus Budget Model Estimating the Carrying Capacity of Kesikköprü Dam Lake

    OpenAIRE

    PULATSÜ, Serap

    2014-01-01

    The aim of this study was to estimate the carrying capacity of Kesikköprü Dam Lake, Ankara, where cage farms for the intensive culture of rainbow trout are located. For this purpose Dillon and Rigler's phosphorus budget model was applied in a series of steps and the carrying capacity of the lake was found to be 3335 tonnes per year. This estimated value was about 10 times higher than the present production level of the lake. It seems possible to orientate the fish culture in cages in...

  18. Molecular genetic and clinical characterization of myotonic dystrophy type 1 patients carrying variant repeats within DMPK expansions.

    Science.gov (United States)

    Pešović, Jovan; Perić, S; Brkušanin, M; Brajušković, G; Rakočević-Stojanović, V; Savić-Pavićević, Dušanka

    2017-12-01

    Myotonic dystrophy type 1 (DM1) is caused by a highly unstable expansion of CTG repeats in the DMPK gene. Its huge phenotypic variability cannot be explained solely by the repeat number. Recently, variant repeats within the DMPK expansions have emerged as potential disease modifiers. The frequency of variant expanded alleles was estimated in 242 DM1 patients from 174 Serbian families using repeat-primed PCR (RP-PCR). The patterns of variant repeats were determined by direct sequencing of RP-PCR or PCR products. PCR-based southern blot was performed to get insight into the intergenerational mutational dynamics of variant expanded alleles. All patients carrying variant repeats were clinically re-examined. Variant repeats were observed in eight patients from five families (2.9%). They were detected only at the 3' end of DMPK expansions. CCG variant repeats were present in seven patients, either as a part of regular runs of CCGCTG hexamer, individual repeats, or CCG blocks. Analyses of three intergenerational transmissions revealed a considerable stability or likely a contraction of variant expanded alleles. Intriguingly, a decrease in age at onset accompanied these transmissions. Overall, patients were characterized by a milder phenotype and/or some atypical symptoms that could be rather clinically suggestive of myotonic dystrophy type 2. In addition, the first case of de novo CTC variant repeat was observed. Variant repeats might explain a part of the phenotypic variability in a small percent of DM1 patients and likely display a stabilizing effect on the meiotic instability of DMPK expanded alleles.

  19. 131I-albumin caused metabolic changes in patients carrying systemic lupus erythematosus with or without nephropathy

    International Nuclear Information System (INIS)

    Cossermelli, W.; Carvalho, N.; Papaleo Netto, M.

    1974-01-01

    Human 131 I-albumin metabolism has been analyzed in 28 female patients carrying systemic lupus erythematosus, 14 out of whom have also presented nephropathy. The hypoalbuminemia common in this type of affection is explained. The results of a comparison made between the two groups, as well as of another comparison of both groups to a normal female individuals one let to the following conclusion: non-significant difference was show relating to restoration and distribution half-life, as well as albumin turn over rate under the two fold comparisons; significative distribution half-life increase in those patients suffering from kidneys disease when compared to normal individuals; non-significative half-life and radioactive albumin turn over rate difference of patients with renal lesion when compared to normal women. The findings allowed the following judgment: if the synthesis and the katabolism are excluded as the main causes of the hypoalbuminemia, the other factors may be a compensation mechanism due to protein alterations like the hypergammaglobulinemia without, however, any sensible loss of the stabilizing and metabolic albumin functions, perhaps due to a possible qualitative change of its molecule [pt

  20. Assessment of antibiotic resistance pattern in Acinetobacter bumannii carrying bla oxA type genes isolated from hospitalized patients

    Directory of Open Access Journals (Sweden)

    Hossein Goudarzi

    2013-11-01

    Full Text Available AbstractPlease cite this article as: Goudarzi H, Douraghi M, Ghalavand Z, Goudarzi M. Assessment of antibiotic resistance pattern in Acinetobacter baumannii carrying bla oxA type genes isolated from hospitalized patients. Novel Biomed 2013;1(2:54-61.Introduction: Acinetobacter baumannii is a Gram-negative coccobacillus and one of the most opportunistic pathogens responsible for serious infections in hospitalized patients.Methods: During a 12 month study, 221 clinical isolates and 22 environmental Acinetobacter baumannii isolates were collected. In vitro susceptibility of Acinetobacter baumannii isolates to 13 antimicrobial agents amikacin; cefepime; ceftazidime; ciprofloxacin; meropenem; piperacillin/tazobactam; sulfamethoxazole/ trimethoprim; imipenem; tigecycline; colistin; gentamycin; ceftriaxone; levofloxacin was performed by the disk diffusion method and Minimum Inhibitory Concentration(MICs of imipenem; levofloxacin and cefepime.was done by the E-test according to Clinical and Laboratory Standards Institute (CLSI criteria. blaOXA-23, blaOXA-24, blaOXA-58, blaOXA-51genes were detected by polymerase chain reaction and sequencing.Results: The result of antimicrobial susceptibility test of clinical isolates by the disk diffusion method revealed that that all strains of Acinetobacter baumannii were resistant to piperacillin/tazobactam. The rates of resistance to the majority of antibiotics tested varied between 69% and 100 %, with the exception of tigecycline and colistin. Of 221 isolates tested 99(44.8% were XDR. All strains carry a blaOXA-51-like gene. blaOXA-23gene was the most prevalence among blaOXA-types.Conclusion: colistin and tigecycline can be effective drugs for treatment of Acinetobacter baumannii infections. Continuous Surveillance for Acinetobacter baumannii multidrug-resistant strains is necessary to prevent the further spread of resistant isolates.

  1. Identification of Anti-tumor Cells Carrying Natural Killer (NK Cell Antigens in Patients With Hematological Cancers

    Directory of Open Access Journals (Sweden)

    Ewelina Krzywinska

    2015-10-01

    Full Text Available Natural killer (NK cells, a cytotoxic lymphocyte lineage, are able to kill tumor cells in vitro and in mouse models. However, whether these cells display an anti-tumor activity in cancer patients has not been demonstrated. Here we have addressed this issue in patients with several hematological cancers. We found a population of highly activated CD56dimCD16+ NK cells that have recently degranulated, evidence of killing activity, and it is absent in healthy donors. A high percentage of these cells expressed natural killer cell p46-related protein (NKp46, natural-killer group 2, member D (NKG2D and killer inhibitory receptors (KIRs and a low percentage expressed NKG2A and CD94. They are also characterized by a high metabolic activity and active proliferation. Notably, we found that activated NK cells from hematological cancer patients have non-NK tumor cell antigens on their surface, evidence of trogocytosis during tumor cell killing. Finally, we found that these activated NK cells are distinguished by their CD45RA+RO+ phenotype, as opposed to non-activated cells in patients or in healthy donors displaying a CD45RA+RO− phenotype similar to naïve T cells. In summary, we show that CD45RA+RO+ cells, which resemble a unique NK population, have recognized tumor cells and degranulate in patients with hematological neoplasias.

  2. [Ecological carrying capacity of Chinese shrimp stock enhancement in Laizhou Bay of East China based on Ecopath model].

    Science.gov (United States)

    Lin, Qun; Li, Xian-sen; Li, Zhong-yi; Jin, Xian-shi

    2013-04-01

    Stock enhancement is an important way of fishery resources conservation, which can increase the high quality fishery resources and improve the fish population structure. The study of ecological carrying capacity is the premise for the scientific implementation of stock enhancement. Based on the survey data of the fishery resources and ecological environment in Laizhou Bay from 2009 to 2010, an Ecopath mass-balance model of the Laizhou Bay ecosystem consisted of 26 functional groups was constructed, and applied to analyze the overall characteristics of the ecosystem, the trophic interrelationships, and the keystone species, and to calculate the ecological carrying capacity of Chinese shrimp enhancement. As for the overall characteristics of the ecosystem, the total primary production/total respiration (TPP/TR) was 1. 53, total primary production/total biomass (TPP/B) was 24.54, Finn' s cycling index was lower (0.07), surplus production was higher (434. 41 t km-2 a-1 ), and system connectance index was lower (0. 29), indicating that this ecosystem was at an early development stage. The analysis on the keystone species showed that Chinese shrimp was not a keystone species of this ecosystem. At present, the biomass of Chinese shrimp in the ecosystem was 0. 1143 t km-2, with a greater potential of continued enhancement. It did not exceed the ecological carrying capacity of 2. 9489 t km-2 when the biomass of the Chinese shrimp was increased by 25. 8 times.

  3. Circulating Microparticles Carry a Functional Endothelial Nitric Oxide Synthase That Is Decreased in Patients With Endothelial Dysfunction

    Science.gov (United States)

    Horn, Patrick; Cortese‐Krott, Miriam Margherita; Amabile, Nicolas; Hundsdörfer, Claas; Kröncke, Klaus‐Dietrich; Kelm, Malte; Heiss, Christian

    2013-01-01

    Background Microparticles (MPs) are circulating membrane particles of less than a micrometer in diameter shed from endothelial and blood cells. Recent literature suggests that MPs are not just functionally inert cell debris but may possess biological functions and mediate the communication between vascular cells. As a significant proportion of MPs originate from platelets and endothelial cells, we hypothesized that MPs may harbor functional enzymes including an endothelial NO synthase (eNOS). Methods and Results Using immunoprecipitation and Western blot analysis, we found that human circulating MPs carry an eNOS. Ca2+ and l‐arginine‐dependent NOS activity of crude enzyme extract from MPs was determined by measuring the conversion of [3H]‐L‐arginine to [3H]‐citrulline and NOS‐dependent nitrite production. NOS‐dependent NO production in intact MPs was assessed by the NO‐specific fluorescent probe MNIP‐Cu. In patients with cardiovascular disease, endothelial dysfunction was associated with an increase in the total number of circulating MPs as well as a significant decrease in the expression and activity of eNOS in MPs. No difference in reactive oxygen species was noted in MPs isolated from either group. Conclusions Our data further support the concept that circulating MPs may not only retain phenotypic markers but also preserve the functionality of enzymes of the cells they originate from, including eNOS. PMID:23525410

  4. Frequency and phenotype of patients carrying TPM2 and TPM3 gene mutations in a cohort of 94 patients with congenital myopathy

    DEFF Research Database (Denmark)

    Citirak, Gülsenay; Witting, Nanna; Duno, Morten

    2014-01-01

    patients carrying the same mutations as found in our study (c.503G>A, and c.502C>T in TPM3, and c.415_417delGAG in TPM2), clinical presentation and muscle morphological findings differed in our patients. Differences included variation in distribution of muscle weakness, presence of scoliosis and ptosis......, physical performance and joint contractures. The variation in clinical profiles emphasizes the phenotypic heterogeneity. However, common features were also present, such as onset of symptoms in infancy or childhood, musculoskeletal deformities and normal or low plasma levels of creatine kinase. One patient...... had nemaline myopathy and fiber size disproportion, while three patients had congenital fiber type disproportion (CFTD) on muscle biopsies. TPM2-related CFTD has only been described in two cases, indicating that mutations in TPM2 are rare causes of CFTD....

  5. Seroprevalence and molecular epidemiology of EAST1 gene-carrying Escherichia coli from diarrheal patients and raw meats.

    Science.gov (United States)

    Sukkua, Kannika; Manothong, Somruthai; Sukhumungoon, Pharanai

    2017-03-31

    Several Escherichia coli pathotypes have been reported in Thailand; however, information on enteroaggregative heat-stable enterotoxin 1 (EAST1)-carrying E. coli (EAST1-EC) is insufficient. Previous reports show that consumption of raw meats causes diarrheagenic E. coli infections. In this study, we investigated the seroprevalence and genetic relationship of EAST1-EC from clinical and raw meat samples. Diarrheal patients and raw meat samples were investigated for the presence of EAST1-EC by performing polymerase chain reaction (PCR) to detect astA. Serotyping, antimicrobial susceptibility tests, and PCR-based phylogenetic group assay were performed. Molecular epidemiology of E. coli strains from clinical and raw meat samples was determined using repetitive element-PCR typing, BOX-PCR, and ERIC2-PCR. Results showed that 11.2% (17/152) of clinical samples and 53.3% (16/30) of raw meat samples had EAST1-EC. In all, 24 and 36 EAST1-EC strains were successfully isolated from 17 clinical and 16 raw meat samples, respectively. These strains had astA but did not possess the indicative genes of other E. coli pathotypes and were therefore classified as EAST1-EC. Most of these strains were multidrug resistant and were classified into nine serogroups. Molecular genotyping showed identical DNA fingerprint among EAST1-EC serotype O15 strains from clinical and raw chicken samples, suggesting that they were derived from the same bacterial clone. Our results indicated a high prevalence of multidrug-resistant EAST1-EC strains in clinical and environmental samples in Thailand belonging to nine serogroups. Moreover, the study highlighted the close association between infections caused by EAST1-EC serotype O15 and raw meat consumption.

  6. Derivation, Characterization, and Neural Differentiation of Integration-Free Induced Pluripotent Stem Cell Lines from Parkinson's Disease Patients Carrying SNCA, LRRK2, PARK2, and GBA Mutations

    DEFF Research Database (Denmark)

    Momcilovic, Olga; Sivapatham, Renuka; Oron, Tal Ronnen

    2016-01-01

    We report generation of induced pluripotent stem cell (iPSC) lines from ten Parkinson's disease (PD) patients carrying SNCA, PARK2, LRRK2, and GBA mutations, and one age-matched control. After validation of pluripotency, long-term genome stability, and integration-free reprogramming, eight...... not be sufficient to determine the cause or mechanism of the disease, and highlights the need to use more focused strategies for large-scale data analysis........ We further examined gene expression in a stress model (MPTP-induced dopaminergic neuronal death) using two clones from the SNCA triplication line, and detected changes in genes associated with mitophagy. Our data suggested that even a well-characterized line of a monogenic disease may...

  7. The 'carry-over' effects of patient self-testing: positive effects on usual care management by an anticoagulation management service.

    LENUS (Irish Health Repository)

    Ryan, Fiona

    2010-11-01

    Patient self-testing (PST) of the international normalised ratio (INR) has a positive effect on anticoagulation control. This study investigated whether the benefits of PST (other than increased frequency of testing, e.g. patient education, empowerment, compliance etc.) could be \\'carried-over\\' into usual care management after a period of home-testing has ceased.

  8. Interleukin 28B Gene Variation at rs12979860 Determines Early Viral Kinetics During Treatment in Patients Carrying Genotypes 2 or 3 of Hepatitis C Virus

    DEFF Research Database (Denmark)

    Lindh, Magnus; Lagging, Martin; Färkkilä, Martti

    2011-01-01

    Single-nucleotide polymorphisms upstream of the interleukin 28B (interferon λ3) gene (IL28B) strongly influence treatment efficacy in patients carrying hepatitis C virus (HCV) of genotype 1. In patients receiving 12 or 24 weeks of interferon-ribavirin therapy for infection with genotype 2 or 3 (n...

  9. Bacteraemia due to meticillin-resistant Staphylococcus aureus carrying the mecC gene in a patient with urothelial carcinoma.

    Science.gov (United States)

    Romero-Gómez, María Pilar; Mora-Rillo, Marta; Lázaro-Perona, Fernando; Gómez-Gil, María Rosa; Mingorance, Jesús

    2013-12-01

    We present a case of bacteraemia due to meticillin-resistant Staphylococcus aureus (MRSA) carrying the mecC gene. The susceptibility to meticillin of Staphylococcus aureus was investigated directly from one blood culture bottle using GenomEra MRSA/SA (Abacus Diagnostica Oy) test. This test identified S. aureus but the presence of the mecA gene result was negative, and the isolate was reported as meticillin-sensitive Staphylococcus aureus (MSSA). Susceptibility studies were done using VITEK 2 AST-P588 susceptibility cards (bioMérieux). The strain was identified as MRSA by the VITEK 2 system, although oxacillin MIC was low (0.5 µg ml(-1)). In view of these results, the isolate was tested for the presence of the mecC gene by a specific PCR and was verified as MRSA carrying mecC. The emergence of this new mecA homologue could have important consequences for the detection of MRSA when routine PCR methods are used as an identification method or provisional detection of MRSA, as in the case reported in this article, because S. aureus carrying the mecC gene will be wrongly diagnosed as meticillin susceptible. Negative results must be interpreted with caution and should be followed by conventional culture, and antimicrobial susceptibility testing or detection of mecC gene by a specific PCR.

  10. Establishment of induced pluripotent stem cell line (ZZUi010-A from an Alzheimer's disease patient carrying an APP gene mutation

    Directory of Open Access Journals (Sweden)

    Zhilei Wang

    2017-12-01

    Full Text Available Alzheimer's disease (AD is one of the most common neurodegenerative disorders. Previous studies have identified mutations in several genes, such as amyloid precursor protein (APP, presenilin-1 (PSEN1, and presenilin-2 (PSEN2, in patients with early-onset (<65 years familial AD. Recently, a patient with an APP gene mutation was identified; the dermal fibroblasts of the patient were obtained and a line of induced pluripotent stem cells (iPSCs was successfully generated using the Sendai-virus (SeV delivery system. The iPSC line will be useful for further study of the pathomechanism and drug screening for AD.

  11. Refinement of genotype-phenotype correlation in 18 patients carrying a 1q24q25 deletion

    DEFF Research Database (Denmark)

    Chatron, Nicolas; Haddad, Véronique; Andrieux, Joris

    2015-01-01

    two familial cases. The patients presented with a characteristic phenotype including mild to moderate intellectual disability (100%), intrauterine (92%) and postnatal (94%) growth retardation, microcephaly (77%), short hands and feet (83%), brachydactyly (70%), fifth finger clinodactyly (78...

  12. Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft

    International Nuclear Information System (INIS)

    Fuster, D.; Lomena, F.; Piera, C.; Setoain, F.J.; Laterza, C.; Herranz, R.; Setoain, J.; Torregrosa, J.V.; Oppenheimer, F.

    2000-01-01

    The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6±12 years). The mean duration of PFS was 35 days (range 7-122). Forty-six of the 91 patients underwent steroid therapy (2- 10 mg/day). Platelet labelling was carried out following Thakur's method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80±0.7, while in patients with non-immunological PFS it was 1.12±0.1 (P 111 In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of 111 In-labelled platelet scintigraphy in detecting immunological PFS. (orig.)

  13. Sensitivity Analysis of the Army Training and Testing Area Carrying Capacity (ATTACC) Model to User-specified Starting Parameters

    National Research Council Canada - National Science Library

    Anderson, Alan

    1999-01-01

    ...) program is a methodology for estimating training and testing land carrying capacity. The methodology is used to determine land rehabilitation and maintenance costs associated with land-based training and other uses...

  14. Patients with genetically heterogeneous synchronous colorectal cancer carry rare damaging germline mutations in immune-related genes

    Science.gov (United States)

    Cereda, Matteo; Gambardella, Gennaro; Benedetti, Lorena; Iannelli, Fabio; Patel, Dominic; Basso, Gianluca; Guerra, Rosalinda F.; Mourikis, Thanos P.; Puccio, Ignazio; Sinha, Shruti; Laghi, Luigi; Spencer, Jo; Rodriguez-Justo, Manuel; Ciccarelli, Francesca D.

    2016-01-01

    Synchronous colorectal cancers (syCRCs) are physically separated tumours that develop simultaneously. To understand how the genetic and environmental background influences the development of multiple tumours, here we conduct a comparative analysis of 20 syCRCs from 10 patients. We show that syCRCs have independent genetic origins, acquire dissimilar somatic alterations, and have different clone composition. This inter- and intratumour heterogeneity must be considered in the selection of therapy and in the monitoring of resistance. SyCRC patients show a higher occurrence of inherited damaging mutations in immune-related genes compared to patients with solitary colorectal cancer and to healthy individuals from the 1,000 Genomes Project. Moreover, they have a different composition of immune cell populations in tumour and normal mucosa, and transcriptional differences in immune-related biological processes. This suggests an environmental field effect that promotes multiple tumours likely in the background of inflammation. PMID:27377421

  15. Dutch myotonic dystrophy type 2 patients and a North-African DM2 family carry the common European founder haplotype

    NARCIS (Netherlands)

    Coenen, M.J.H.; Tieleman, A.A.; Schijvenaars, M.M.V.A.P.; Leferink, M.; Ranum, L.P.; Scheffer, H.; Engelen, B.G.M. van

    2011-01-01

    Myotonic dystrophy type 2 (DM2) is a progressive multisystem disease with muscle weakness and myotonia as main characteristics. The disease is caused by a repeat expansion in the zinc-finger protein 9 (ZNF9) gene on chromosome 3q21. Several reports show that patients from European ancestry share an

  16. MEK inhibition is a promising therapeutic strategy for MLL-rearranged infant acute lymphoblastic leukemia patients carrying RAS mutations.

    Science.gov (United States)

    Kerstjens, Mark; Driessen, Emma M C; Willekes, Merel; Pinhanços, Sandra S; Schneider, Pauline; Pieters, Rob; Stam, Ronald W

    2017-02-28

    Acute lymphoblastic leukemia (ALL) in infants is an aggressive malignancy with a poor clinical outcome, and is characterized by translocations of the Mixed Lineage Leukemia (MLL) gene. Previously, we identified RAS mutations in 14-24% of infant ALL patients, and showed that the presence of a RAS mutation decreased the survival chances even further. We hypothesized that targeting the RAS signaling pathway could be a therapeutic strategy for RAS-mutant infant ALL patients. Here we show that the MEK inhibitors Trametinib, Selumetinib and MEK162 severely impair primary RAS-mutant MLL-rearranged infant ALL cells in vitro. While all RAS-mutant samples were sensitive to MEK inhibitors, we found both sensitive and resistant samples among RAS-wildtype cases. We confirmed enhanced RAS pathway signaling in RAS-mutant samples, but found no apparent downstream over-activation in the wildtype samples. However, we did confirm that MEK inhibitors reduced p-ERK levels, and induced apoptosis in the RAS-mutant MLL-rearranged ALL cells. Finally, we show that MEK inhibition synergistically enhances prednisolone sensitivity, both in RAS-mutant and RAS-wildtype cells. In conclusion, MEK inhibition represents a promising therapeutic strategy for MLL-rearranged ALL patients harboring RAS mutations, while patients without RAS mutations may benefit through prednisolone sensitization.

  17. MEK inhibition is a promising therapeutic strategy for MLL-rearranged infant acute lymphoblastic leukemia patients carrying RAS mutations

    NARCIS (Netherlands)

    Kerstjens, M. (Mark); E.M.C. Driessen; M. Willekes (Merel); Pinhanços, S.S. (Sandra S.); P. Schneider (Pauline); R. Pieters (Rob); R.W. Stam (Ronald)

    2017-01-01

    textabstractAcute lymphoblastic leukemia (ALL) in infants is an aggressive malignancy with a poor clinical outcome, and is characterized by translocations of the Mixed Lineage Leukemia (MLL) gene. Previously, we identified RAS mutations in 14-24% of infant ALL patients, and showed that the presence

  18. Dramatic response after functional hemispherectomy in a patient with epileptic encephalopathy carrying a de novo COL4A1 mutation.

    Science.gov (United States)

    Hino-Fukuyo, Naomi; Kikuchi, Atsuo; Iwasaki, Masaki; Sato, Yuko; Kubota, Yuki; Kobayashi, Tomoko; Nakayama, Tojo; Haginoya, Kazuhiro; Arai-Ichinoi, Natsuko; Niihori, Tetsuya; Sato, Ryo; Suzuki, Tasuku; Kudo, Hiroki; Funayama, Ryo; Nakayama, Keiko; Aoki, Yoko; Kure, Shigeo

    2017-04-01

    We describe the first case of a successful functional hemispherectomy in a patient with epileptic encephalopathy and a de novo collagen type IV alpha 1 (COL4A1) mutation. A 4-year-old girl was COL4A1 mutation-positive and suffered from drug-resistant epilepsy, hemiplegia, and developmental delay. Magnetic resonance imaging detected no porencephaly, and she had no cataract or renal abnormality. Following a presurgical evaluation for epilepsy, she underwent a functional hemispherectomy. She has been seizure free with no intracranial hemorrhage or other perioperative complications. Patients with a COL4A1 mutation have an increased risk for intracranial hemorrhage because of disrupted integrity in the vascular basement membrane due to the mutation. After weighing the risks and benefits to these patients, epilepsy surgery may not be absolutely contraindicated. Furthermore, pediatric neurologists should be aware of an undiagnosed COL4A1 mutation when a patient presents with an unexplained neurological phenotype, such as mild hemiparesis, even in the absence of porencephaly. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  19. Derivation of induced pluripotent stem cells from a familial Alzheimer's disease patient carrying the L282F mutation in presenilin 1

    DEFF Research Database (Denmark)

    Poon, Anna Fong-Yee; Li, Tong; Pires, Carlota

    2016-01-01

    patient carrying a L282F mutation in PSEN1. We transfected skin fibroblasts with episomal iPSC reprogramming vectors targeting human OCT4, SOX2, L-MYC, KLF4, NANOG, LIN28, and short hairpin RNA against TP53. Our hiPSC line, L282F-hiPSC, displayed typical stem cell characteristics with consistent...

  20. Evaluation of quality of life in severely obese patients after bariatric surgery carried out in the public healthcare system.

    Science.gov (United States)

    Khawali, Cristina; Ferraz, Marcos Bosi; Zanella, Maria Tereza; Ferreira, Sandra R G

    2012-02-01

    To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. BMI differed between the pre- and post-surgery groups (52.3 ± 8.3 kg/m(2) vs. 32.5 ± 6.4 kg/m(2), p surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL.

  1. Impact of the CFTR-potentiator ivacaftor on airway microbiota in cystic fibrosis patients carrying a G551D mutation.

    Directory of Open Access Journals (Sweden)

    Cédric Bernarde

    Full Text Available Airway microbiota composition has been clearly correlated with many pulmonary diseases, and notably with cystic fibrosis (CF, an autosomal genetic disorder caused by mutation in the CF transmembrane conductance regulator (CFTR. Recently, a new molecule, ivacaftor, has been shown to re-establish the functionality of the G551D-mutated CFTR, allowing significant improvement in lung function.The purpose of this study was to follow the evolution of the airway microbiota in CF patients treated with ivacaftor, using quantitative PCR and pyrosequencing of 16S rRNA amplicons, in order to identify quantitative and qualitative changes in bacterial communities. Three G551D children were followed up longitudinally over a mean period of more than one year covering several months before and after initiation of ivacaftor treatment.129 operational taxonomy units (OTUs, representing 64 genera, were identified. There was no significant difference in total bacterial load before and after treatment. Comparison of global community composition found no significant changes in microbiota. Two OTUs, however, showed contrasting dynamics: after initiation of ivacaftor, the relative abundance of the anaerobe Porphyromonas 1 increased (p<0.01 and that of Streptococcus 1 (S. mitis group decreased (p<0.05, possibly in relation to the anti-Gram-positive properties of ivacaftor. The anaerobe Prevotella 2 correlated positively with the pulmonary function test FEV-1 (r=0.73, p<0.05. The study confirmed the presumed positive role of anaerobes in lung function.Several airway microbiota components, notably anaerobes (obligate or facultative anaerobes, could be valuable biomarkers of lung function improvement under ivacaftor, and could shed light on the pathophysiology of lung disease in CF patients.

  2. Impaired action potential initiation in GABAergic interneurons causes hyperexcitable networks in an epileptic mouse model carrying a human Na(V)1.1 mutation.

    Science.gov (United States)

    Hedrich, Ulrike B S; Liautard, Camille; Kirschenbaum, Daniel; Pofahl, Martin; Lavigne, Jennifer; Liu, Yuanyuan; Theiss, Stephan; Slotta, Johannes; Escayg, Andrew; Dihné, Marcel; Beck, Heinz; Mantegazza, Massimo; Lerche, Holger

    2014-11-05

    Mutations in SCN1A and other ion channel genes can cause different epileptic phenotypes, but the precise mechanisms underlying the development of hyperexcitable networks are largely unknown. Here, we present a multisystem analysis of an SCN1A mouse model carrying the NaV1.1-R1648H mutation, which causes febrile seizures and epilepsy in humans. We found a ubiquitous hypoexcitability of interneurons in thalamus, cortex, and hippocampus, without detectable changes in excitatory neurons. Interestingly, somatic Na(+) channels in interneurons and persistent Na(+) currents were not significantly changed. Instead, the key mechanism of interneuron dysfunction was a deficit of action potential initiation at the axon initial segment that was identified by analyzing action potential firing. This deficit increased with the duration of firing periods, suggesting that increased slow inactivation, as recorded for recombinant mutated channels, could play an important role. The deficit in interneuron firing caused reduced action potential-driven inhibition of excitatory neurons as revealed by less frequent spontaneous but not miniature IPSCs. Multiple approaches indicated increased spontaneous thalamocortical and hippocampal network activity in mutant mice, as follows: (1) more synchronous and higher-frequency firing was recorded in primary neuronal cultures plated on multielectrode arrays; (2) thalamocortical slices examined by field potential recordings revealed spontaneous activities and pathological high-frequency oscillations; and (3) multineuron Ca(2+) imaging in hippocampal slices showed increased spontaneous neuronal activity. Thus, an interneuron-specific generalized defect in action potential initiation causes multisystem disinhibition and network hyperexcitability, which can well explain the occurrence of seizures in the studied mouse model and in patients carrying this mutation. Copyright © 2014 the authors 0270-6474/14/3414874-16$15.00/0.

  3. The application of mathematical models for the evaluation of radioactive tracer tests carried out in South Africa

    International Nuclear Information System (INIS)

    Snyman, G.C.; Smith, S.W.

    1975-12-01

    The application of mathematical models to evaluate tracer experiments is illustrated by examples of tests done in a variety of industrial plants, using radioactive tracers. Two basic models, the axial mixing model and the perfectly mixed tank model, as well as various applicational techniques, are described. It is concluded that many processes can be simulated to various degrees of accuracy by using the basic models, and that both quantitative and qualitative information can be obtained about the process [af

  4. Clinical and functional characterization of a patient carrying a compound heterozygous pericentrin mutation and a heterozygous IGF1 receptor mutation.

    Directory of Open Access Journals (Sweden)

    Eva Müller

    Full Text Available Intrauterine and postnatal longitudinal growth is controlled by a strong genetic component that regulates a complex network of endocrine factors integrating them with cellular proliferation, differentiation and apoptotic processes in target tissues, particularly the growth centers of the long bones. Here we report on a patient born small for gestational age (SGA with severe, proportionate postnatal growth retardation, discreet signs of skeletal dysplasia, microcephaly and moyamoya disease. Initial genetic evaluation revealed a novel heterozygous IGF1R p.Leu1361Arg mutation affecting a highly conserved residue with the insulin-like growth factor type 1 receptor suggestive for a disturbance within the somatotropic axis. However, because the mutation did not co-segregate with the phenotype and functional characterization did not reveal an obvious impairment of the ligand depending major IGF1R signaling capabilities a second-site mutation was assumed. Mutational screening of components of the somatotropic axis, constituents of the IGF signaling system and factors involved in cellular proliferation, which are described or suggested to provoke syndromic dwarfism phenotypes, was performed. Two compound heterozygous PCNT mutations (p.[Arg585X];[Glu1774X] were identified leading to the specification of the diagnosis to MOPD II. These investigations underline the need for careful assessment of all available information to derive a firm diagnosis from a sequence aberration.

  5. A simple steady-state model for carry-over of aflatoxins from feed to cow's milk.

    NARCIS (Netherlands)

    Eijkeren, Jan C H van; Bakker, Martine I; Zeilmaker, Marco J

    2006-01-01

    A simple steady-state model is derived from two kinetic one-compartment models for the disposition of aflatoxin B1 (AFB1) and aflatoxin M1 (AFM1) in the lactating cow. The model relates daily intake of AFB1 in feed of dairy cattle and the cow's lactation status to resulting concentrations of AFM1 in

  6. Generation of induced pluripotent stem cells (iPSC) from an atrial fibrillation patient carrying a PITX2 p.M200V mutation

    DEFF Research Database (Denmark)

    Mora, Cristina; Serzanti, Marialaura; Giacomelli, Alessio

    2017-01-01

    the molecular mechanisms underlying AF, we reprogrammed to pluripotency polymorphonucleated leukocytes isolated from the blood of a patient carrying a PITX2 p.M200V mutation, using a commercially available non-integrating expression system. The generated iPSCs expressed pluripotency markers and differentiated...... toward cells belonging to the three embryonic germ layers. Moreover, the cells showed a normal karyotype and retained the PITX2 p.M200V mutation....

  7. Generation of induced pluripotent stem cells (iPSC) from an atrial fibrillation patient carrying a KCNA5 p.D322H mutation

    DEFF Research Database (Denmark)

    Mora, Cristina; Serzanti, Marialaura; Giacomelli, Alessio

    2017-01-01

    . To investigate the molecular mechanisms underlying AF, we reprogrammed to pluripotency polymorphonucleated leukocytes isolated from the blood of a patient carrying a KCNA5 p.D322H mutation, using a commercially available non-integrating system. The generated iPSCs expressed pluripotency markers...... and differentiated toward cells belonging to the three embryonic germ layers. Moreover, the cells showed a normal karyotype and retained the p.D322H mutation....

  8. Novel deletion alleles carrying CYP21A1P/A2 chimeric genes in Brazilian patients with 21-hydroxylase deficiency

    Directory of Open Access Journals (Sweden)

    Guerra-Júnior Gil

    2010-06-01

    Full Text Available Abstract Background Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is caused by deletions, large gene conversions or mutations in CYP21A2 gene. The human gene is located at 6p21.3 within a locus containing the genes for putative serine/threonine Kinase RP, complement C4, steroid 21-hydroxylase CYP21 tenascin TNX, normally, in a duplicated cluster known as RCCX module. The CYP21 extra copy is a pseudogene (CYP21A1P. In Brazil, 30-kb deletion forming monomodular alleles that carry chimeric CYP21A1P/A2 genes corresponds to ~9% of disease-causing alleles. Such alleles are considered to result from unequal crossovers within the bimodular C4/CYP21 locus. Depending on the localization of recombination breakpoint, different alleles can be generated conferring the locus high degree of allelic variability. The purpose of the study was to investigate the variability of deleted alleles in patients with 21-hydroxylase deficiency. Methods We used different techniques to investigate the variability of 30-kb deletion alleles in patients with 21-hydroxylase deficiency. Alleles were first selected after Southern blotting. The composition of CYP21A1P/A2 chimeric genes was investigated by ASO-PCR and MLPA analyses followed by sequencing to refine the location of recombination breakpoints. Twenty patients carrying at least one allele with C4/CYP21 30-kb deletion were included in the study. Results An allele carrying a CYP21A1P/A2 chimeric gene was found unusually associated to a C4B/C4A Taq I 6.4-kb fragment, generally associated to C4B and CYP21A1P deletions. A novel haplotype bearing both p.P34L and p.H62L, novel and rare mutations, respectively, was identified in exon 1, however p.P30L, the most frequent pseudogene-derived mutation in this exon, was absent. Four unrelated patients showed this haplotype. Absence of p.P34L in CYP21A1P of normal controls indicated that it is not derived from pseudogene. In addition, the combination of different

  9. Investigating a model for lecturer training that enables lecturers to plan and carry out meaningful e-learning activities

    DEFF Research Database (Denmark)

    Kjær, Christopher; Hansen, Pernille Stenkil; Christensen, Inger-Marie F.

    2014-01-01

    This paper reports on the effect of a lecturer training model in the shape of an e-learning project based on research on adult and work-based learning. A survey was conducted to explore participants’ learning experiences. Findings show high overall satisfaction, motivation and engagement. Suggest....... Suggestions for improvement include better integration of the e-learning project with other lecturer training components, supporting participants in formulating the e-learning project and providing additional opportunities for reflection and feedback....

  10. Intradural spine surgery may not carry an increased risk of shunt revision compared with extradural spine surgery in pediatric patients with myelomeningocele.

    Science.gov (United States)

    Kuhn, Elizabeth N; Hopson, Betsy; Conklin, Michael J; Blount, Jeffrey P

    2018-01-01

    OBJECTIVE Patients with myelomeningocele are often affected by scoliosis and tethered cord syndrome, and frequently require spine surgery. Intradural spine surgeries may carry an inherently higher risk of inducing shunt malfunction due to entry into the subarachnoid space. In this study, the authors sought to compare rates of shunt malfunction after intradural and extradural spine surgeries among pediatric patients with myelomeningocele. METHODS The authors reviewed records of the National Spina Bifida Program Registry for Children's Hospital of Alabama. The Exago reporting function was used to identify patients who had received at least one of the following procedures: shunt revision, tethered cord release (TCR), or spinal fusion for deformity. The registry records were reviewed for all identified patients to determine if a shunt revision was performed within the 1st year after TCR or spinal fusion. RESULTS Final analyses included 117 patients, of whom 39 underwent spinal fusion and 78 underwent TCR. Among patients who underwent spinal fusion, shunt revision was performed within 30 days in 2 patients (5.1%), within 60 days in 2 (5.1%), within 90 days in 4 (10.3%), and within 1 year in 5 (12.8%). Among patients who underwent TCR, shunt revision was performed within 30 days in 7 patients (9.0%), within 60 days in 10 (12.8%), within 90 days in 11 (14.1%), and within 1 year in 17 (21.8%). Using the log-rank test, there was no significant difference in Kaplan-Meier curves between intradural and extradural groups (p = 0.59). CONCLUSIONS In a review of single-institution registry data, the authors found no statistically significant difference in the risk of shunt malfunction after intradural and extradural spine surgeries.

  11. Simplified mathematical models for interpreting the results of tests carried out by labelling the whole piezometric column in water wells

    International Nuclear Information System (INIS)

    Munera, H.A.

    1974-01-01

    Approximate methods used to interpret the results of tests based on radioactive tracer dilution in a single water well by labelling the whole piezometric column are described; these simple mathematical models have been used to obtain semi-quantitative data on the apparent velocity (horizontal) in non-homogeneous aquifers with flow rates of metres daily. Measurements have also been made in a homogeneous aquifer with velocities of centimetres daily. Interpretation is based on determination of the average concentration for the various well zones; this involves recognition of a mean velocity for each region. All the tracer dilution effects that are not due to horizontal or vertical flow between two zones, i.e. convection, artificial mixing, diffusion and so on, are grouped together as a single term, which is taken arbitrarily to be proportional to the difference in concentration between the regions under consideration; its value is obtained from the experimental dilution curve. The model was applied to the solution of the three cases encountered most frequently during our measurements in Colombia: (a) when the well penetrates a permeable zone and adjacent impermeable zone; (b) when the well penetrates a permeable zone contained between impermeable regions; and (c) when the well traverses an aquifer with two adjacent zones of different permeability contained between impermeable zones. The shape of the dilution curve (logarithm of concentration versus time, usually with two or more slopes) is predicted by the model, the approximate nature of which is consistent with the fact that the method of labelling the whole piezometric column is semi-quantitative. The results obtained for measurements made when there are considerable vertical flows are apparently correct, but there is no other experimental measurement available to confirm them. (author) [es

  12. Could the local population of the Lower Rhine delta supply the Roman army? Part 2: Modelling the carrying capacity using archaeological, palaeo-ecological and geomorphological data

    NARCIS (Netherlands)

    van Dinter, M.; Kooistra, L.I.; Dütting, M.K.; van Rijn, P.; Cavallo, C.

    2014-01-01

    In this part two of a diptych of articles, we modelled and quantified the carrying capacity of the landscape and the demand and supply of the Roman army in the western Lower Rhine delta with wood and food in the period A.D. 40 - 140. The absolute volumes of the wood and food were calculated (in m³

  13. Biodistribution of modular nanotransporter carrying Auger electron emitter and targeted at melanoma cells in murine tumor model

    Science.gov (United States)

    Vorontsova, M. S.; Morozova, N. B.; Karmakova, T. A.; Rosenkranz, A. A.; Slastnikova, T. A.; Petriev, V. M.; Smoryzanova, O. A.; Tischenko, V. K.; Yakubovskaya, R. I.; Kaprin, A. D.; Sobolev, A. S.

    2017-09-01

    Recombinant modular nanotransporter containing α-melanocyte-stimulating hormone peptide sequence (MNT-MSH) as a ligand module was designed for nucleus-targeted delivery of cytotoxic agents into melanoma cells. MNT-MSH radiolabeled with Auger electron emitter (111In-NOTA-MNT-MSH) showed a high antitumor efficacy in mice bearing syngeneic melanoma after intratumoral (i.t.) injection. This study is aimed at evaluating the biodistribution of the radioconjugate in melanoma tumor model in vivo. 111In-NOTA-MNT-MSH was administered i.t. in C57Bl/6j mice bearing subcutaneously implanted B16-F1 murine melanoma cells, expressing high levels of MCR1. The tissue uptake of radioactivity was determined ex vivo by γ-counter measurements. The intravenous route of administration did not provide a desirable level of radioactivity accumulation in the tumor, possibly, due to a high uptake of the transporter in liver tissue. After i.t. administration 111In-NOTA-MNT-MSH provided a high local retention of radionuclide, ranged from 400 to 350 %ID/g within at least 48 hours post-injection. MNT containing Auger electron emitter and α-MSH peptide as vector ligand could be a promising basis for radiopharmaceutical preparations intended for melanoma treatment.

  14. Generation of induced pluripotent stem cells (iPSC from an atrial fibrillation patient carrying a PITX2 p.M200V mutation

    Directory of Open Access Journals (Sweden)

    Cristina Mora

    2017-10-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia associated with several cardiac risk factors, but increasing evidences indicated a genetic component. Indeed, genetic variations of the specific PITX2 gene have been identified in patients with early-onset AF. To investigate the molecular mechanisms underlying AF, we reprogrammed to pluripotency polymorphonucleated leukocytes isolated from the blood of a patient carrying a PITX2 p.M200V mutation, using a commercially available non-integrating expression system. The generated iPSCs expressed pluripotency markers and differentiated toward cells belonging to the three embryonic germ layers. Moreover, the cells showed a normal karyotype and retained the PITX2 p.M200V mutation.

  15. Patient-Specific Computational Modeling

    CERN Document Server

    Peña, Estefanía

    2012-01-01

    This book addresses patient-specific modeling. It integrates computational modeling, experimental procedures, imagine clinical segmentation and mesh generation with the finite element method (FEM) to solve problems in computational biomedicine and bioengineering. Specific areas of interest include cardiovascular problems, ocular and muscular systems and soft tissue modeling. Patient-specific modeling has been the subject of serious research over the last seven years and interest in the area is continually growing and this area is expected to further develop in the near future.

  16. Sortilin-Related Receptor Expression in Human Neural Stem Cells Derived from Alzheimer’s Disease Patients Carrying the APOE Epsilon 4 Allele

    Directory of Open Access Journals (Sweden)

    Alen Zollo

    2017-01-01

    Full Text Available Alzheimer’s disease (AD is the most common form of dementia in the elderly; important risk factors are old age and inheritance of the apolipoprotein E4 (APOE4 allele. Changes in amyloid precursor protein (APP binding, trafficking, and sorting may be important AD causative factors. Secretase-mediated APP cleavage produces neurotoxic amyloid-beta (Aβ peptides, which form lethal deposits in the brain. In vivo and in vitro studies have implicated sortilin-related receptor (SORL1 as an important factor in APP trafficking and processing. Recent in vitro evidence has associated the APOE4 allele and alterations in the SORL1 pathway with AD development and progression. Here, we analyzed SORL1 expression in neural stem cells (NSCs from AD patients carrying null, one, or two copies of the APOE4 allele. We show reduced SORL1 expression only in NSCs of a patient carrying two copies of APOE4 allele with increased Aβ/SORL1 localization along the degenerated neurites. Interestingly, SORL1 binding to APP was largely compromised; this could be almost completely reversed by γ-secretase (but not β-secretase inhibitor treatment. These findings may yield new insights into the complex interplay of SORL1 and AD pathology and point to NSCs as a valuable tool to address unsolved AD-related questions in vitro.

  17. GIS and agent based spatial-temporal simulation modeling for assessing tourism social carrying capacity: a study on Mount Emei scenic area, China

    Science.gov (United States)

    Zhang, Renjun

    2007-06-01

    Each scenic area can sustain a specific level of acceptance of tourist development and use, beyond which further development can result in socio-cultural deterioration or a decline in the quality of the experience gained by visitors. This specific level is called carrying capacity. Social carrying capacity can be defined as the maximum level of use (in terms of numbers and activities) that can be absorbed by an area without an unacceptable decline in the quality of experience of visitors and without an unacceptable adverse impact on the society of the area. It is difficult to assess the carrying capacity, because the carrying capacity is determined by not only the number of visitors, but also the time, the type of the recreation, the characters of each individual and the physical environment. The objective of this study is to build a spatial-temporal simulation model to simulate the spatial-temporal distribution of tourists. This model is a tourist spatial behaviors simulator (TSBS). Based on TSBS, the changes of each visitor's travel patterns such as location, cost, and other states data are recoded in a state table. By analyzing this table, the intensity of the tourist use in any area can be calculated; the changes of the quality of tourism experience can be quantized and analyzed. So based on this micro simulation method the social carrying capacity can be assessed more accurately, can be monitored proactively and managed adaptively. In this paper, the carrying capacity of Mount Emei scenic area is analyzed as followed: The author selected the intensity of the crowd as the monitoring Indicators. it is regarded that longer waiting time means more crowded. TSBS was used to simulate the spatial-temporal distribution of tourists. the average of waiting time all the visitors is calculated. And then the author assessed the social carrying capacity of Mount Emei scenic area, found the key factors have impacted on social carrying capacity. The results show that the TSBS

  18. Electroclinical presentation and genotype-phenotype relationships in patients with Unverricht-Lundborg disease carrying compound heterozygous CSTB point and indel mutations.

    Science.gov (United States)

    Canafoglia, Laura; Gennaro, Elena; Capovilla, Giuseppe; Gobbi, Giuseppe; Boni, Antonella; Beccaria, Francesca; Viri, Maurizio; Michelucci, Roberto; Agazzi, Pamela; Assereto, Stefania; Coviello, Domenico A; Di Stefano, Maria; Rossi Sebastiano, Davide; Franceschetti, Silvana; Zara, Federico

    2012-12-01

    Unverricht-Lundborg disease (EPM1A) is frequently due to an unstable expansion of a dodecamer repeat in the CSTB gene, whereas other types of mutations are rare. EPM1A due to homozygous expansion has a rather stereotyped presentation with prominent action myoclonus. We describe eight patients with five different compound heterozygous CSTB point or indel mutations in order to highlight their particular phenotypical presentations and evaluate their genotype-phenotype relationships. We screened CSTB mutations by means of Southern blotting and the sequencing of the genomic DNA of each proband. CSTB messenger RNA (mRNA) aberrations were characterized by sequencing the complementary DNA (cDNA) of lymphoblastoid cells, and assessing the protein concentrations in the lymphoblasts. The patient evaluations included the use of a simplified myoclonus severity rating scale, multiple neurophysiologic tests, and electroencephalography (EEG)-polygraphic recordings. To highlight the particular clinical features and disease time-course in compound heterozygous patients, we compared some of their characteristics with those observed in a series of 40 patients carrying the common homozygous expansion mutation observed at the C. Besta Foundation, Milan, Italy. The eight compound heterozygous patients belong to six EPM1A families (out of 52; 11.5%) diagnosed at the Laboratory of Genetics of the Galliera Hospitals in Genoa, Italy. They segregated five different heterozygous point or indel mutations in association with the common dodecamer expansion. Four patients from three families had previously reported CSTB mutations (c.67-1G>C and c.168+1_18del); one had a novel nonsense mutation at the first exon (c.133C>T) leading to a premature stop codon predicting a short peptide; the other three patients from two families had a complex novel indel mutation involving the donor splice site of intron 2 (c.168+2_169+21delinsAA) and leading to an aberrant transcript with a partially retained intron

  19. Generation of a gene-corrected isogenic control hiPSC line derived from a familial Alzheimer's disease patient carrying a L150P mutation in presenilin 1

    DEFF Research Database (Denmark)

    Poon, Anna Fong-Yee; Schmid, Benjamin; Pires, Carlota

    2016-01-01

    Mutations in the presenilin 1 (PSEN1) gene lead to the most aggressive form of familial Alzheimer's disease (AD). Human induced pluripotent stem cells (hiPSCs) derived from AD patients and subsequently differentiated can be used for disease modeling. We have previously generated a hiPSC line from...

  20. Incidence of Peri-implant Diseases on Implants With and Without Laser-Microgrooved Collar: A 5-Year Retrospective Study Carried Out in Private Practice Patients.

    Science.gov (United States)

    Guarnieri, Renzo; Grande, Maurizio; Zuffetti, Francesco; Testori, Tiziano

    To retrospectively evaluate the incidence of peri-implant mucositis and peri-implantitis around dental implants with the same body design and surface but different collar surface (laser-microgrooved vs not laser-microgrooved) after 5 years of loading in private practice patients. The study was carried out on patients at a private dental clinic enrolled in a periodontal maintenance program, who received at least one implant with a laser-microgrooved collar surface and one implant without a laser-microgrooved collar surface. Clinical variables such as plaque, pocket depth, bleeding on probing, suppuration, and radiographic marginal bone loss at > 5 years around implants were investigated. The correlation between the prevalence of peri-implant mucositis/peri-implantitis and biotype, keratinized tissue width, prosthetic connection type, and prosthetic design type was also analyzed. A total of 166 implants in 74 patients were investigated. At the end of the 5-year follow-up period, 38 implants presented peri-implant mucositis, accounting for 22.8% of the total, affecting a total of 24 patients (32.4%), while 13 implants (7.8%) in 10 patients (13.5%) were diagnosed with peri-implantitis. Sixteen of 82 laser-microgrooved implants (19.5%) and 24 of 84 implants (28.5%) without a laser-microgrooved collar presented peri-implant mucositis, while 3 of 82 (3.6%) of laser-microgrooved implants and 10 of 84 (11.9%) implants without a laser-microgrooved collar demonstrated peri-implantitis. Differences in implant-based incidence of peri-implant diseases between implants with and without a laser-microgrooved collar were statistically significant (P implants with a laser-microgrooved collar, compared with implants without a laser-microgrooved collar, presented a statistically significantly lower incidence of peri-implant diseases.

  1. Detection of the IncX3 plasmid carrying blaKPC-3 in a Serratia marcescens strain isolated from a kidney-liver transplanted patient.

    Science.gov (United States)

    Gona, Floriana; Caio, Carla; Iannolo, Gioacchin; Monaco, Francesco; Di Mento, Giuseppina; Cuscino, Nicola; Fontana, Ignazio; Panarello, Giovanna; Maugeri, Gaetano; Mezzatesta, Maria Lina; Stefani, Stefania; Conaldi, Pier Giulio

    2017-10-01

    Dissemination of resistance to carbapenems among Enterobacteriaceae through plasmids is an increasingly important concern in health care worldwide. Here we report the first description of an IncX3 plasmid carrying the blaKPC-3 gene in a strain of Serratia marcescens isolated from a kidney-liver transplanted patient at the transplantation centre ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy). To localize the transposable element containing the resistance-associated gene Next-Generation Sequencing of the bacterial DNA was performed. S. marcescens was positive for blaKPC-3 and blaSHV-11 genes. The molecular analysis demonstrated that the blaKPC-3 gene of this bacterial strain was located in one copy of the Tn-3-like element Tn4401-a carried in a plasmid that is 53 392 bp in size and showed the typical IncX3 scaffold. Our data demonstrated the presence of a new blaKPC-3 harbouring the IncX3 plasmid in S. marcescens. The possible dissemination among Enterobacteriaceae of this type of plasmid should be monitored and evaluated in terms of clinical risk.

  2. Creating Simulated Microgravity Patient Models

    Science.gov (United States)

    Hurst, Victor; Doerr, Harold K.; Bacal, Kira

    2004-01-01

    The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO).

  3. Generation of human iPSC line from a patient with laterality defects and associated congenital heart anomalies carrying a DAND5 missense alteration

    Directory of Open Access Journals (Sweden)

    Fernando Cristo

    2017-12-01

    Full Text Available A human iPSC line was generated from exfoliated renal epithelial (ERE cells of a patient affected with Congenital Heart Disease (CHD and Laterality Defects carrying tshe variant p.R152H in the DAND5 gene. The transgene-free iPSCs were generated with the human OSKM transcription factor using the Sendai-virus reprogramming system. The established iPSC line had the specific heterozygous alteration, a stable karyotype, expressed pluripotency markers and generated embryoid bodies that can differentiate towards the three germ layers in vitro. This iPSC line offers a useful resource to study the molecular mechanisms of cardiomyocyte proliferation, as well as for drug testing.

  4. Generation of induced pluripotent stem cells (iPSCs from a Bernard–Soulier syndrome patient carrying a W71R mutation in the GPIX gene

    Directory of Open Access Journals (Sweden)

    Lourdes Lopez-Onieva

    2016-05-01

    Full Text Available We generated an induced pluripotent stem cell (iPSC line from a Bernard–Soulier Syndrome (BSS patient carrying the mutation p.Trp71Arg in the GPIX locus (BSS1-PBMC-iPS4F4. Peripheral blood mononuclear cells (PBMCs were reprogrammed using heat sensitive non-integrative Sendai viruses containing the reprogramming factors Oct3/4, SOX2, KLF4 and c-MYC. Successful silencing of the exogenous reprogramming factors was checked by RT-PCR. Characterization of BSS1-PBMC-iPS4F4 included mutation analysis of GPIX locus, Short Tandem Repeats (STR profiling, alkaline phosphatase enzymatic activity, analysis of conventional pluripotency-associated factors at mRNA and protein level and in vivo differentiation studies. BSS1-PBMC-iPS4F4 will provide a powerful tool to study BSS.

  5. Use of the GREAT-ER model to estimate mass fluxes of chemicals, carried into the Western Scheldt estuary from the Rupel basin

    OpenAIRE

    Schowanek, D.

    2002-01-01

    The poster illustrates the application of the GREAT-ER model to estimate the mass flux of chemicals carried from a river basin into an estuary. GREAT-ER (Geo-referenced Regional Exposure Assessment Tool for European Rivers) is a newly developed model (1999) for management and risk assessment of chemicals in river basins (see www.great-er.org). Recently the Rupel basin has been made available for use within GREAT-ER. This now allows to make a reliable estimation of the contribution of pollu...

  6. Assessment of water ecological carrying capacity under the two policies in Tieling City on the basis of the integrated system dynamics model.

    Science.gov (United States)

    Wang, Shuo; Xu, Ling; Yang, Fenglin; Wang, He

    2014-02-15

    Considering the limitation of the traditional method to assess the ecological carrying capacity and the complexity of the water ecological system, we used system dynamics, ANN, and CA-Markov to model a water ecological system. The social component was modeled according to Granger causality test by system dynamics. The natural component consists of the water resource and water environmental capacity, which were forecasted through the prediction of precipitation and change in land use cover. The interaction of the social component and the natural component mainly reflected environmental policies, such as the imposition of an environmental fee and environmental tax based on their values. Simulation results showed the different assessments on water ecological carrying capacity under the two policies. The population grew (2.9 million), and less pollution (86,632.37 t COD and 2854.5 t NH4N) was observed with the imposition of environmental tax compared with the imposition of an environmental fee (2.85 million population, 10,8381 t COD and 3543 t NH4N) at the same GDP level of 585 billion CNY in 2030. According to the causality loop, we discussed the different states under the policies and the reasons that caused the differences in water ecological carrying capacity state. According to game theory, we explained the limitation of the environmental fee policy on the basis of marginal benefit and cost. The externality was cleared up by the environmental tax policy. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Generation of induced pluripotent stem cells (iPSCs) from an Alzheimer's disease patient carrying a M146I mutation in PSEN1

    DEFF Research Database (Denmark)

    Li, Tong; Pires, Carlota; Nielsen, Troels Tolstrup

    2016-01-01

    Skin fibroblasts were obtained from a 46-year-old symptomatic man carrying a M146I mutation in the presenilin 1 gene (PSEN1), responsible for causing Alzheimer's disease (AD). Induced pluripotent stem cells (iPSCs) were derived via transfection with episomal vectors carrying hOCT4, hSOX2, hKLF2, hL-MYC...

  8. Generation of induced pluripotent stem cells (iPSCs) from an Alzheimer's disease patient carrying an A79V mutation in PSEN1

    DEFF Research Database (Denmark)

    Li, Tong; Pires, Carlota; Nielsen, Troels Tolstrup

    2016-01-01

    Skin fibroblasts were obtained from a 48-year-old presymptomatic woman carrying a A79V mutation in the presenilin 1 gene (PSEN1), causing Alzheimer's disease (AD). Induced pluripotent stem cell (iPSCs) were derived via transfection with episomal vectors carrying hOCT4, hSOX2, hKLF2, hL-MYC, hLIN28...

  9. The 22Rv1 prostate cancer cell line carries mixed genetic ancestry: Implications for prostate cancer health disparities research using pre-clinical models.

    Science.gov (United States)

    Woods-Burnham, Leanne; Basu, Anamika; Cajigas-Du Ross, Christina K; Love, Arthur; Yates, Clayton; De Leon, Marino; Roy, Sourav; Casiano, Carlos A

    2017-12-01

    Understanding how biological factors contribute to prostate cancer (PCa) health disparities requires mechanistic functional analysis of specific genes or pathways in pre-clinical cellular and animal models of this malignancy. The 22Rv1 human prostatic carcinoma cell line was originally derived from the parental CWR22R cell line. Although 22Rv1 has been well characterized and used in numerous mechanistic studies, no racial identifier has ever been disclosed for this cell line. In accordance with the need for racial diversity in cancer biospecimens and recent guidelines by the NIH on authentication of key biological resources, we sought to determine the ancestry of 22RV1 and authenticate previously reported racial identifications for four other PCa cell lines. We used 29 established Ancestry Informative Marker (AIM) single nucleotide polymorphisms (SNPs) to conduct DNA ancestry analysis and assign ancestral proportions to a panel of five PCa cell lines that included 22Rv1, PC3, DU145, MDA-PCa-2b, and RC-77T/E. We found that 22Rv1 carries mixed genetic ancestry. The main ancestry proportions for this cell line were 0.41 West African (AFR) and 0.42 European (EUR). In addition, we verified the previously reported racial identifications for PC3 (0.73 EUR), DU145 (0.63 EUR), MDA-PCa-2b (0.73 AFR), and RC-77T/E (0.74 AFR) cell lines. Considering the mortality disparities associated with PCa, which disproportionately affect African American men, there remains a burden on the scientific community to diversify the availability of biospecimens, including cell lines, for mechanistic studies on potential biological mediators of these disparities. This study is beneficial by identifying another PCa cell line that carries substantial AFR ancestry. This finding may also open the door to new perspectives on previously published studies using this cell line. © 2017 Wiley Periodicals, Inc.

  10. Experimental determination and chemical modelling of radiolytic processes at the spent fuel/water interface. Experiments carried out in carbonate solutions in absence and presence of chloride

    Energy Technology Data Exchange (ETDEWEB)

    Bruno, Jordi; Cera, Esther; Grive, Mireia; Duro, Lara [Enviros Spain SL (Spain); Eriksen, Trygve [Royal Inst. of Tech., Stockholm (Sweden). Dept. of Nuclear Chemistry

    2003-01-01

    We report on the recent experimental and modelling results of a research programme that started in 1995. The aim has been to understand the kinetic and thermodynamic processes that control the radiolytic generation of oxidants and reductants at the spent fuel water interface and their consequences for spent fuel matrix stability and radionuclide release. This has been done by carrying out well-controlled dissolution experiments of PWR Ringhals spent fuel fragments in an initially anoxic closed system and by using different solution compositions. Experimental series started with several tests carried out with deionised water as solvent, in a second phase experiments were conducted with 10 mM bicarbonate solutions. New experimental series were set up during the last two years by using the same bicarbonate content in solutions with varying NaCl concentrations in order to ascertain the role of this ligand on the radiolytic products and its consequence for radionuclide release. The selected NaCl concentrations are in the range of 0.1 to 10 mM. Experimental data shows that uranium dissolution at early contact times is controlled by the oxidation of the UO{sub 2} matrix. This process controls the co-dissolution of most of the analysed radionuclides, including Sr, Mo, Tc, Np and surprisingly enough, Cs. In the overall the release rates for U and the matrix associated radionuclides are in the range of 10{sup -6} moles/day with a clear decreasing trend with exposure time and after 2 years the initial release rates have decreased down to 3x10{sup -8} moles/day. The solubility of the released actinides appears to be limited by the formation of An(IV) hydroxide phases, although Np concentrations in solution did not reach solubility levels during the time intervals of the present tests. No secondary solid phase appears to control the solubility of the rest of the elements.

  11. An experimental test of stroke recovery by implanting a hyaluronic acid hydrogel carrying a Nogo receptor antibody in a rat model

    Energy Technology Data Exchange (ETDEWEB)

    Ma Jun [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Tian Weiming [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Hou Shaoping [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Xu Qunyuan [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Spector, Myron [Tissue Engineering, VA Boston Healthcare System, Harvard Medical School, Boston, MA (United States); Cui Fuzhai [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China)

    2007-12-15

    The objective of the study was to determine the effects of a hyaluronic-acid-based (HA-based) hydrogel implant, carrying a polyclonal antibody to the Nogo-66 receptor (NgR), on adult rats that underwent middle cerebral artery occlusion (MCAO). Behavioral tests of a forelimb-reaching task suggested that the disabled function of the impaired forelimb in this stroke model was ameliorated by the implant to a certain extent. These behavioral findings were correlated with immunohistochemical results of investigating the distribution of NgR antibody, neurofilaments (NF) and neuron-specific class III {beta}-tubulin (TuJ1) in the brain sections. The porous hydrogel functioned as a scaffold to deliver the NgR antibody, support cell migration and development. In addition, it was found NF-positive and TuJ1-positive expressions were distributed in the implanted hydrogel. Collectively, the results demonstrate the promise of the HA hydrogel as a scaffold material and the delivery vehicle of the NgR antibody for the repair of defects and the support of neural regeneration in the brain.

  12. A novel animal model of thymic tumour: Development of epithelial thymoma in transgenic rats carrying human T lymphocyte virus type I pX gene

    Science.gov (United States)

    Kikuchi, Kazunori; Ikeda, Hitoshi; Tsuchikawa, Takahiro; Tsuji, Takahiro; Tanaka, Satoshi; Fugo, Kazunori; Sugaya, Toshiaki; Tanaka, Yuetsu; Tateno, Masatoshi; Maruyama, Naoki; Yoshiki, Takashi

    2002-01-01

    The pX region encodes a major product of human T lymphocyte virus type I (HTLV-I) that has been implicated previously in tumour formation. To investigate the pathogenesis of pX gene in lymphoid tissues, we established a series of novel transgenic rats carrying the pX gene under the control of a rat lymphocyte-specific protein tyrosine kinase (p56lck) proximal promoter. The transgene was constructed with the −269 to +26 region of a rat p56lck proximal promoter and the pX cDNA, and was microinjected into fertilized ova of Fischer 344/jcl female rats. Six transgenic lines from 114 pups were established. Integration and expression of the transgene were detected by polymerase chain reaction (PCR) and Southern hybridization or by reverse transcriptase-PCR, northern hybridization, and immunostaining.  Thymic tumours with lethal expansion occurred in 4 of 6 transgenic lines. The tumour consisted of spindle shaped cells. Immunohistochemical and ultra-structural analysis characterized the tumour cells to as epithelial cell type, and in the tumour arose in the medulla. Therefore, the tumour is classified into predominantly epithelial and spindle cell of medullary thymoma (type A of the new World Health Organization classification), as based on the human classification. Tumor occurrence increased in proportion to levels of the pX transcription in the thymus, for each line, and sex distinction was evident regarding rates related to tumour expansion. The transgenic rat model described here is suitable as a model for analysing tumorigenesis in epithelial thymoma occurring in humans. PMID:12641821

  13. Properties of Carry Value Transformation

    Directory of Open Access Journals (Sweden)

    Suryakanta Pal

    2012-01-01

    Full Text Available Carry Value Transformation (CVT is a model of discrete deterministic dynamical system. In the present study, it has been proved that (1 the sum of any two nonnegative integers is the same as the sum of their CVT and XOR values. (2 the number of iterations leading to either CVT=0 or XOR=0 does not exceed the maximum of the lengths of the two addenda expressed as binary strings. A similar process of addition of modified Carry Value Transformation (MCVT and XOR requires a maximum of two iterations for MCVT to be zero. (3 an equivalence relation is shown to exist on Z×Z which divides the CV table into disjoint equivalence classes.

  14. Evaluation of radioprotection conditions and patient dose in thorax exams carried out in a public children's hospital in Belo Horizonte, MG, Brazil

    International Nuclear Information System (INIS)

    Lacerda, Marco A.S.; Silva, Teogenes A. da; Guedes, Elton C.; Khoury, Helen J.; Azevedo, Ana C.P.

    2005-01-01

    We conducted a survey of the conditions of radiation protection, radiographic techniques, dose and risk for pediatric patients undergoing chest X-rays exams in a children's hospital in Belo Horizonte-MG, Brazil. From a total of 125 chest exams (projections AP and PA) were noted the patient data (gender, weight, and age) and parameters of radiographic technique (kV, mAs and distance focus-skin). I was also evaluated the working procedures and the conditions of radiation protection. The values of input air kerma (K a,e ) and effective dose (E) were determined using the DoseCal software developed by Radiological Protection Center of Saint Georges's Hospital in London. With respect to the procedures and conditions for radiation protection, many aspects of Portaria 453 are not considered. The use of radiographic techniques with high values of mAs and low voltage values are not according with the quality criteria adopted by the European Community (EC). The values of Ka for patients aged 1 to 5 years varied between 51 μGy and 64 μGy, below the reference levels proposed by the EC. For patients over 5 years old, the values of Ka were substantially higher than those for other patients. The results allow to conclude that there is a need for optimization of the procedures adopted in order to reduce the dose and the risk to patients

  15. Cognitive and clinical characteristics of patients with amyotrophic lateral sclerosis carrying a C9orf72 repeat expansion: a population-based cohort study.

    LENUS (Irish Health Repository)

    Byrne, Susan

    2012-03-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of upper and lower motor neurons, associated with frontotemporal dementia (FTD) in about 14% of incident cases. We assessed the frequency of the recently identified C9orf72 repeat expansion in familial and apparently sporadic cases of ALS and characterised the cognitive and clinical phenotype of patients with this expansion.

  16. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar H; Køber, Lars

    2008-01-01

    BACKGROUND: Previous studies reveal major differences in the estimated cardiovascular risk in diabetes mellitus, including uncertainty about the risk in young patients. Therefore, large studies of well-defined populations are needed. METHODS AND RESULTS: All residents in Denmark > or = 30 years...... of age were followed up for 5 years (1997 to 2002) by individual-level linkage of nationwide registers. Diabetes patients receiving glucose-lowering medications and nondiabetics with and without a prior myocardial infarction were compared. At baseline, 71 801 (2.2%) had diabetes mellitus and 79 575 (2.......4%) had a prior myocardial infarction. Regardless of age, age-adjusted Cox proportional-hazard ratios for cardiovascular death were 2.42 (95% confidence interval [CI], 2.35 to 2.49) in men with diabetes mellitus without a prior myocardial infarction and 2.44 (95% CI, 2.39 to 2.49) in nondiabetic men...

  17. Therapy-associated myelodysplastic syndrome with monosomy 7 arising in a Muir-Torre Syndrome patient carryingSETBP1mutation.

    Science.gov (United States)

    Ullman, David; Baumgartner, Erin; Wnukowski, Nicholas; Koenig, Gabe; Mikhail, Fady M; Pavlidakey, Peter; Peker, Deniz

    2018-02-01

    Muir-Torre Syndrome (MTS) is a rare hereditary autosomal dominant cancer syndrome and is linked to hereditary non-polyposis colorectal carcinoma (Lynch Syndrome). Individuals develop various skin neoplasms in addition to colorectal, endometrial and upper gastrointestinal malignancies. Therapy-associated myelodysplastic syndrome (T-MDS) is an aggressive hematologic malignancy and is considered a pre-leukemic phase. T-MDS is associated with prior exposure to chemo- and radiotherapy that potentially results in DNA damage. The current case report presents a 74-year-old male MTS patient with prior history of solid tumors and radiation therapy with new onset cytopenia. A subsequent bone marrow biopsy revealed multilineage dysplasia with a high blast count and a diagnosis of high grade T-MDS was rendered. FISH and G-banded karyotype analyses revealed 5q deletion and monosomy 7. This is a unique case of T-MDS arising in the setting of MTS. Secondary malignancies including MDS and acute leukemia may occur in cancer survivors and are often associated with an unfavorable prognosis. This case demonstrates the need to be aware of the risk of secondary hematologic malignancies in cancer patients and a thorough clinical and lab work-up are warranted in patients with persistent or transfusion requiring cytopenia(s).

  18. Immune complexes in chronic Chagas disease patients are formed by exovesicles from Trypanosoma cruzi carrying the conserved MASP N-terminal region

    Science.gov (United States)

    Díaz Lozano, Isabel María; de Pablos, Luis Miguel; Longhi, Silvia Andrea; Zago, María Paola; Schijman, Alejandro Gabriel; Osuna, Antonio

    2017-03-01

    The exovesicles (EVs) are involved in pathologic host-parasite immune associations and have been recently used as biomarkers for diagnosis of infectious diseases. The release of EVs by Trypanosoma cruzi, the causative agent of Chagas disease, has recently been described, with different protein cargoes including the MASP multigene family of proteins MASPs are specific to this parasite and characterized by a conserved C-terminal (C-term) region and an N-terminal codifying for a signal peptide (SP). In this investigation, we identified immature MASP proteins containing the MASP SP in EVs secreted by the infective forms of the parasite. Those EVs are responsible for the formation of immune complexes (ICs) containing anti-MASP SP IgGs in patients with different (cardiac, digestive and asymptomatic) chronic Chagas disease manifestations. Moreover, purified EVs as well as the MASP SP inhibit the action of the complement system and also show a significant association with the humoral response in patients with digestive pathologies. These findings reveal a new route for the secretion of MASP proteins in T. cruzi, which uses EVs as vehicles for immature and misfolded proteins, forming circulating immune complexes. Such complexes could be used in the prognosis of digestive pathologies of clinical forms of Chagas disease.

  19. Generation of a gene-corrected isogenic control cell line from an Alzheimer's disease patient iPSC line carrying a A79V mutation in PSEN1

    DEFF Research Database (Denmark)

    Pires, Carlota; Schmid, Benjamin; Petræus, Carina

    2016-01-01

    mutation in PSEN1 as an in vitro disease model. Here we generated a gene-corrected version from this hiPSC line by substituting the point mutation with the wild-type sequence. The reported A79V-GC-iPSCs line is a very useful resource in combination with the A79V-iPSC line in order to study pathological...

  20. Generation of human induced pluripotent stem cells (EURACi001-A, EURACi002-A, EURACi003-A from peripheral blood mononuclear cells of three patients carrying mutations in the CAV3 gene

    Directory of Open Access Journals (Sweden)

    Viviana Meraviglia

    2018-03-01

    Full Text Available Caveolinopathies are a heterogeneous family of genetic pathologies arising from alterations of the caveolin-3 gene (CAV3, encoding for the isoform specifically constituting muscle caveolae. Here, by reprogramming peripheral blood mononuclear cells, we report the generation of induced pluripotent stem cells (iPSCs from three patients carrying the ΔYTT deletion, T78K and W101C missense mutations in caveolin-3. iPSCs displayed normal karyotypes and all the features of pluripotent stem cells in terms of morphology, specific marker expression and ability to differentiate in vitro into the three germ layers. These lines thus represent a human cellular model to study the molecular basis of caveolinopathies.Resource tableImage 1Unique stem cell lines identifierEURACi001-AEURACi002-AEURACi003-AAlternative names of stem cell linesB2CAV3 (EURACi001-AL1CAV3 (EURACi002-AN1CAV3 (EURACi003-AInstitutionInstitute for Biomedicine, Eurac ResearchContact information of distributorAlessandra Rossini (alessandra.rossini@eurac.eduType of cell linesiPSCsOriginHumanCell sourcePeripheral blood mononuclear cells (PBMCsMethod of reprogrammingElectroporation of episomal vectors (pCXLE hOCT3/4-shp53-F, pCXLE-hSK, and pCXLE-hULMultiline rationaleNon-isogenic cell lines obtained from patients with mutations in the same gene (CAV3Gene modificationNOType of modificationSpontaneous mutationsAssociated diseaseCaveolinopathiesGene/locusHeterozygous CAV3 c.Δ184–192 (EURACi001-AHeterozygous CAV3 c.303 TGG > TGC (EURACi002-AHeterozygous CAV3 c.233 ACG > AAG (EURACi003-AMethod of modificationN/AName of transgene or resistanceN/AInducible/constitutive systemN/ADate archived/stock dateJanuary 2016 (EURACi001-ASeptember 2016 (EURACi002-AMay 2016 (EURACi003-ACell line repository/bankN/AEthical approvalPeripheral blood was collected from patients after signing the informed consent provided by Cell Line and DNA Biobank from Patients Affected by Genetic Diseases, member of the

  1. Estimation of carrying capacity of the Gulf of Kachchh, west coast of India in relation to petroleum hydrocarbon through oil spill modeling

    Digital Repository Service at National Institute of Oceanography (India)

    Vethamony, P.; Babu, M.T.; Reddy, G.S.; Sudheesh, K.; Desa, E.; Zingde, M.D.

    devised to estimate CC using a coupled 2D hydrodynamic - oil spill model. The model was run to assess the dissolution of the oil for various meteorological and oceanographic conditions and oil characteristics. In the case of operational discharge from a...

  2. ISLAMIC CARING MODEL ON INCREASE PATIENT SATISFACTION

    OpenAIRE

    Abdurrouf, Muh.; Nursalam, Nursalam; Purwaningsih, Purwaningsih

    2017-01-01

    Introduction: Patient satisfaction was important aspect that must be considered by health service providers, patients who were not satisfied will leave the hospital and be a competitor's customers so be able caused a decrease in sales of products/services and in turn could reduce and even loss of profit, therefore, the hospital must provided the best service so that it could increase patient satisfaction. The purpose of this study was to exams the effect of Islamic caring model on increase pa...

  3. Patient-specific models of cardiac biomechanics

    Science.gov (United States)

    Krishnamurthy, Adarsh; Villongco, Christopher T.; Chuang, Joyce; Frank, Lawrence R.; Nigam, Vishal; Belezzuoli, Ernest; Stark, Paul; Krummen, David E.; Narayan, Sanjiv; Omens, Jeffrey H.; McCulloch, Andrew D.; Kerckhoffs, Roy C. P.

    2013-07-01

    Patient-specific models of cardiac function have the potential to improve diagnosis and management of heart disease by integrating medical images with heterogeneous clinical measurements subject to constraints imposed by physical first principles and prior experimental knowledge. We describe new methods for creating three-dimensional patient-specific models of ventricular biomechanics in the failing heart. Three-dimensional bi-ventricular geometry is segmented from cardiac CT images at end-diastole from patients with heart failure. Human myofiber and sheet architecture is modeled using eigenvectors computed from diffusion tensor MR images from an isolated, fixed human organ-donor heart and transformed to the patient-specific geometric model using large deformation diffeomorphic mapping. Semi-automated methods were developed for optimizing the passive material properties while simultaneously computing the unloaded reference geometry of the ventricles for stress analysis. Material properties of active cardiac muscle contraction were optimized to match ventricular pressures measured by cardiac catheterization, and parameters of a lumped-parameter closed-loop model of the circulation were estimated with a circulatory adaptation algorithm making use of information derived from echocardiography. These components were then integrated to create a multi-scale model of the patient-specific heart. These methods were tested in five heart failure patients from the San Diego Veteran's Affairs Medical Center who gave informed consent. The simulation results showed good agreement with measured echocardiographic and global functional parameters such as ejection fraction and peak cavity pressures.

  4. An Evaluation of the Instruction Carried out with Printed Laboratory Materials Designed in Accordance with 5E Model: Reflection of Light and Image on a Plane Mirror

    Science.gov (United States)

    Ayvaci, Hakan Sevki; Yildiz, Mehmet; Bakirci, Hasan

    2015-01-01

    This study employed a print laboratory material based on 5E model of constructivist learning approach to teach reflection of light and Image on a Plane Mirror. The effect of the instruction which conducted with the designed print laboratory material on academic achievements of prospective science and technology teachers and their attitudes towards…

  5. "You Know You Are Sick, Why Do You Carry A Pregnancy Again?" Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya.

    Science.gov (United States)

    Onono, Maricianah; Kwena, Zachary; Turan, Janet; Bukusi, Elizabeth A; Cohen, Craig R; Gray, Glenda E

    2015-06-01

    Throughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens. Data were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use. Barriers to women's utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children. The findings of this study suggest that a woman's social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi

  6. Could the local population of the Lower Rhine delta supply the Roman army? Part 2: Modelling the carrying capacity of the delta using archaeological, palaeo-ecological and geomorphological data

    NARCIS (Netherlands)

    Kooistra, L.I.; van Dinter, M.; Dütting, M.K.; van Rijn, P.; Cavallo, C.

    2014-01-01

    In this part two of a diptych of articles, we modelled and quantified the carrying capacity of the landscape and the demand and supply of the Roman army in the western Lower Rhine delta with wood and food in the period A.D.  – . The absolute volumes of the wood and food were calculated (in m

  7. ISLAMIC CARING MODEL ON INCREASE PATIENT SATISFACTION

    Directory of Open Access Journals (Sweden)

    Muh. Abdurrouf

    2017-04-01

    Full Text Available Introduction: Patient satisfaction was important aspect that must be considered by health service providers, patients who were not satisfied will leave the hospital and be a competitor's customers so be able caused a decrease in sales of products/services and in turn could reduce and even loss of profit, therefore, the hospital must provided the best service so that it could increase patient satisfaction. The purpose of this study was to exams the effect of Islamic caring model on increase patient satisfaction.. Method: This study was used pre-experimental design, the respondents were 31 patients in the treatment group assigned Islamic caring and 31 patients with a kontrol group that were not given Islamic caring Inpatient Surgical Sultan Agung Islamic Hospital Semarang by using consecutive sampling techniques, patient satisfaction data collected through questionnaires and analyzed with Mann-Whitney test, as for finding out the Islamic caring for patient satisfaction were analyzed with spearmen's rho test. Result: The results showed that there was a significant influence of Islamic caring for perceived disconfirmation (p=0,000 there was a perceived disconfirmation influence on patient satisfaction significantly (p=0,000, there was a significant influence of Islamic caring for patient satisfaction in the treatment group with a kontrol group (p=0.001. Discussion: Discussion of this study was Islamic caring model effect on the increase perceived disconfirmation and patient satisfaction, Perceived disconfirmation effect on patient satisfaction, patient satisfaction who given Islamic caring was increase, patients given Islamic caring had higher satisfaction levels than patients who not given Islamic caring. Suggestions put forward based on the results of the study of Islamic caring model could be applied in Sultan Agung Islamic Hospital as a model of nursing care, Islamic caring behavior can be learned and improved through training and commitment and

  8. Liposomal Nanoparticles Carrying anti-IL6R Antibody to the Tumour Microenvironment Inhibit Metastasis in Two Molecular Subtypes of Breast Cancer Mouse Models.

    Science.gov (United States)

    Guo, Chunlei; Chen, Yanan; Gao, Wenjuan; Chang, Antao; Ye, Yujie; Shen, Wenzhi; Luo, Yunping; Yang, Shengyong; Sun, Peiqing; Xiang, Rong; Li, Na

    2017-01-01

    Tumour microenvironment (TME) contributes significantly towards potentiating the stemness and metastasis properties of cancer cells. IL6-Stat3 is one of the important cell signaling pathways in mediating the communication between tumour and immune cells. Here, we have systematically developed a novel anti-CD44 antibody-mediated liposomal nanoparticle delivery system loaded with anti-IL6R antibody, which could specifically target the TME of CD44 + breast cancer cells in different mouse models for triple negative and luminal breast cancer. This nanoparticle had an enhanced and specific tumour targeting efficacy with dramatic anti-tumour metastasis effects in syngeneic BALB/c mice bearing 4T1 cells as was in the syngeneic MMTV-PyMT mice. It inhibited IL6R-Stat3 signaling and moderated the TME, characterized by the reduced expression of genes encoding Stat3, Sox2, VEGFA, MMP-9 and CD206 in the breast tissues. Furthermore, this nanoparticle reduced the subgroups of Sox2 + and CD206 + cells in the lung metastatic foci, demonstrating its inhibitory effect on the lung metastatic niche for breast cancer stem cells. Taken together, the CD44 targeted liposomal nanoparticles encapsulating anti-IL6R antibody achieved a significant effect to inhibit the metastasis of breast cancer in different molecular subtypes of breast cancer mouse models. Our results shed light on the application of nanoparticle mediated cancer immune-therapy through targeting TME.

  9. Methodology to carry out a sensitivity and uncertainty analysis for cross sections using a coupled model Trace-Parcs; Metodologia para realizar un analisis de sensibilidad e incertidumbre para las secciones eficaces usando un modelo acoplado TRACE-PARCS

    Energy Technology Data Exchange (ETDEWEB)

    Reyes F, M. C.; Del Valle G, E. [IPN, Escuela Superior de Fisica y Matematicas, Av. IPN s/n, Col. Lindavista, 07738 Ciudad de Mexico (Mexico); Gomez T, A. M. [ININ, Departamento de Sistemas Nucleares, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico); Sanchez E, V., E-mail: rf.melisa@gmail.com [Karlsruhe Institute of Technology, Institute for Neutron Physics and Reactor Technology, Hermann-von-Helmholtz-Platz 1, D-76344 Eggenstein-Leopoldshafen (Germany)

    2015-09-15

    A methodology was implemented to carry out a sensitivity and uncertainty analysis for cross sections used in a coupled model for Trace/Parcs in a transient of control rod fall of a BWR-5. A model of the reactor core for the neutronic code Parcs was used, in which the assemblies located in the core are described. Thermo-hydraulic model in Trace was a simple model, where only a component type Chan was designed to represent all the core assemblies, which it was within a single vessel and boundary conditions were established. The thermo-hydraulic part was coupled with the neutron part, first for the steady state and then a transient of control rod fall was carried out for the sensitivity and uncertainty analysis. To carry out the analysis of cross sections used in the coupled model Trace/Parcs during the transient, the Probability Density Functions for 22 parameters selected from the total of neutronic parameters that use Parcs were generated, obtaining 100 different cases for the coupled model Trace/Parcs, each one with a database of different cross sections. All these cases were executed with the coupled model, obtaining in consequence 100 different output files for the transient of control rod fall doing emphasis in the nominal power, for which an uncertainty analysis was realized at the same time generate the band of uncertainty. With this analysis is possible to observe the ranges of results of the elected responses varying the selected uncertainty parameters. The sensitivity analysis complements the uncertainty analysis, identifying the parameter or parameters with more influence on the results and thus focuses on these parameters in order to better understand their effects. Beyond the obtained results, because is not a model with real operation data, the importance of this work is to know the application of the methodology to carry out the sensitivity and uncertainty analyses. (Author)

  10. An empirical model for salt removal percentage in water under the effect of different current intensities of current carrying coil at different flow rates

    Directory of Open Access Journals (Sweden)

    Rameen S. AbdelHady

    2011-10-01

    Full Text Available The magnetic treatment of hard water is an alternative, simple approach by which the hard water that needs to be treated flows through a magnetic field. This field is created by inducing current in a coil wrapped around a pipe. Consequently some of its properties, such as total dissolved salts (TDS, conductivity (Ec and PH change. The primary purpose of hard water treatment is to decrease TDS in the incoming liquid stream. Using performance data from the application of different magnetic field densities on the different flow levels of water, empirical mathematical models were developed relating the salt removal percentage (SRP to operating flow rate and current of the coil. The obtained experimental results showed that the SRP increased with increasing the current at low flow rates (up to 0.75 ml/s.

  11. Expression Analysis of Hairpin RNA Carrying Sugarcane mosaic virus (SCMV Derived Sequences and Transgenic Resistance Development in a Model Rice Plant

    Directory of Open Access Journals (Sweden)

    Sehrish Akbar

    2017-01-01

    Full Text Available Developing transgenic resistance in monocotyledonous crops against pathogens remains a challenging area of research. Sugarcane mosaic virus (SCMV is a serious pathogen of many monocotyledonous crops including sugarcane. The objective of present study was to analyze transgenic expression of hairpin RNA (hpRNA, targeting simultaneously CP (Coat Protein and Hc-Pro (helper component-proteinase genes of SCMV, in a model rice plant. Conserved nucleotide sequences, exclusive for DAG (Aspartic acid-Alanine-Glycine and KITC (Lycine-Isoleucine-Threonine-Cysteine motifs, derived from SCMV CP and Hc-Pro genes, respectively, were fused together and assembled into the hpRNA cassette under maize ubiquitin promoter to form Ubi-hpCP:Hc-Pro construct. The same CP:Hc-Pro sequence was fused with the β-glucuronidase gene (GUS at the 3′ end under CaMV 35S promoter to develop 35S-GUS:CP:Hc-Pro served as a target reporter gene construct. When delivered into rice callus tissues by particle bombardment, the Ubi-hpCP:Hc-Pro construct induced strong silencing of 35S-GUS:CP:Hc-Pro. Transgenic rice plants, containing Ubi-hpCP:Hc-Pro construct, expressed high level of 21–24 nt small interfering RNAs, which induced specific suppression against GUS:CP:Hc-Pro delivered by particle bombardment and conferred strong resistance to mechanically inoculated SCMV. It is concluded that fusion hpRNA approach is an affordable method for developing resistance against SCMV in model rice plant and it could confer SCMV resistance when transformed into sugarcane.

  12. Generating patient-specific pulmonary vascular models for surgical planning

    Science.gov (United States)

    Murff, Daniel; Co-Vu, Jennifer; O'Dell, Walter G.

    2015-03-01

    Each year in the U.S., 7.4 million surgical procedures involving the major vessels are performed. Many of our patients require multiple surgeries, and many of the procedures include "surgical exploration". Procedures of this kind come with a significant amount of risk, carrying up to a 17.4% predicted mortality rate. This is especially concerning for our target population of pediatric patients with congenital abnormalities of the heart and major pulmonary vessels. This paper offers a novel approach to surgical planning which includes studying virtual and physical models of pulmonary vasculature of an individual patient before operation obtained from conventional 3D X-ray computed tomography (CT) scans of the chest. These models would provide clinicians with a non-invasive, intricately detailed representation of patient anatomy, and could reduce the need for invasive planning procedures such as exploratory surgery. Researchers involved in the AirPROM project have already demonstrated the utility of virtual and physical models in treatment planning of the airways of the chest. Clinicians have acknowledged the potential benefit from such a technology. A method for creating patient-derived physical models is demonstrated on pulmonary vasculature extracted from a CT scan with contrast of an adult human. Using a modified version of the NIH ImageJ program, a series of image processing functions are used to extract and mathematically reconstruct the vasculature tree structures of interest. An auto-generated STL file is sent to a 3D printer to create a physical model of the major pulmonary vasculature generated from 3D CT scans of patients.

  13. Redundancy-Aware Topic Modeling for Patient Record Notes

    Science.gov (United States)

    Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

    2014-01-01

    The clinical notes in a given patient record contain much redundancy, in large part due to clinicians’ documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessement of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community. PMID:24551060

  14. Test of Dignity Model in patient with heart failure.

    Science.gov (United States)

    Bagheri, Hossein; Yaghmaei, Farideh; Ashktorab, Tahereh; Zayeri, Farid

    2016-08-12

    Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers. This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model. The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires. A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9. This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. According to the results, the necessity of using appropriate tools to assess various aspects of patients' dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients' dignity, develop quality of care and treatment, and improve patients' satisfaction. © The Author(s) 2016.

  15. Population growth and earth's human carrying capacity.

    Science.gov (United States)

    Cohen, J E

    1995-07-21

    Earth's capacity to support people is determined both by natural constraints and by human choices concerning economics, environment, culture (including values and politics), and demography. Human carrying capacity is therefore dynamic and uncertain. Human choice is not captured by ecological notions of carrying capacity that are appropriate for nonhuman populations. Simple mathematical models of the relation between human population growth and human carrying capacity can account for faster-than-exponential population growth followed by a slowing population growth rate, as observed in recent human history.

  16. Morphing patient-specific musculoskeletal models

    DEFF Research Database (Denmark)

    Rasmussen, John; Galibarov, Pavel E.; Al-Munajjed, Amir

    or surface scans. Furthermore, we assume that a set of corresponding anatomical landmarks can be identified in the medical imaging data and on the generic musculoskeletal model. A nonlinear transformation, i.e. a morphing, is created by means of radial basis functions that maps points set (i) to point set...... (ii). The morphing is subsequently used to transform parts of the generic musculoskeletal model to a patient-specific version, thus changing bone shapes, muscle insertion points, joint locations and other geometrical properties. Research questions include how to select point sets and whether...... other conditions may require CT or MRI data. The method and its theoretical assumptions, advantages and limitations are presented, and several examples will illustrate morphing to patient-specific models. [1] Carbes S; Tørholm S; Rasmussen, J. A Detailed Twenty-six Segments Kinematic Foot model...

  17. Identification of colorectal cancer patients with tumors carrying the TP53 mutation on the codon 72 proline allele that benefited most from 5-fluorouracil (5-FU) based postoperative chemotherapy

    International Nuclear Information System (INIS)

    Godai, Ten-i; Sakuma, Yuji; Tsuchiya, Eiju; Kameda, Yoichi; Akaike, Makoto; Miyagi, Yohei; Suda, Tetsuji; Sugano, Nobuhiro; Tsuchida, Kazuhito; Shiozawa, Manabu; Sekiguchi, Hironobu; Sekiyama, Akiko; Yoshihara, Mitsuyo; Matsukuma, Shoichi

    2009-01-01

    Although postoperative chemotherapy is widely accepted as the standard modality for Dukes' stage C or earlier stage colorectal cancer (CRC) patients, biomarkers to predict those who may benefit from the therapy have not been identified. Previous in vitro and clinical investigations reported that CRC patients with wild-type p53 gene (TP53)-tumors benefit from 5-fluorouracil (5-FU) based chemotherapy, while those with mutated TP53-tumors do not. However, these studies evaluated the mutation-status of TP53 by immunohistochemistry with or without single-strand conformation polymorphism, and the mutation frequency was different from study to study. In addition, the polymorphic status at p53 codon 72, which results in arginine or proline residues (R72P) and is thought to influence the function of the protein significantly, was not examined. To evaluate the significance of the TP53 mutation as a molecular marker to predict the prognosis of CRC patients, especially those who received postoperative chemotherapy, we examined the mutation by direct sequencing from fresh CRC tumors and evaluated the R72P polymorphism of the mutated TP53 by a combined mutant allele- and polymorphic allele-specific polymerase chain reaction (PCR). The TP53 mutation occurred in 147 (70%) of 211 Japanese CRC tumors. The mutation was observed in 93 (63%) tumors on the R72 allele and in 54 (37%) tumors on the P72 allele. Although the alterations to TP53 have no prognostic significance for CRC patients overall, we found that Dukes' stage C CRC patients who did not receive postoperative chemotherapy and carried the mutated TP53-R72 showed significantly longer survival times than those with the mutated TP53-P72 when evaluated by overall survival (p = 0.012). Using a combined mutant allele- and polymorphic allele-specific PCR, we defined the codon 72 polymorphic status of the TP53 mutated allele in Japanese CRC patients. We raised a possibility that Dukes' stage C colorectal cancer

  18. Identification of colorectal cancer patients with tumors carrying the TP53 mutation on the codon 72 proline allele that benefited most from 5-fluorouracil (5-FU based postoperative chemotherapy

    Directory of Open Access Journals (Sweden)

    Tsuchiya Eiju

    2009-12-01

    Full Text Available Abstract Background Although postoperative chemotherapy is widely accepted as the standard modality for Dukes' stage C or earlier stage colorectal cancer (CRC patients, biomarkers to predict those who may benefit from the therapy have not been identified. Previous in vitro and clinical investigations reported that CRC patients with wild-type p53 gene (TP53-tumors benefit from 5-fluorouracil (5-FU based chemotherapy, while those with mutated TP53-tumors do not. However, these studies evaluated the mutation-status of TP53 by immunohistochemistry with or without single-strand conformation polymorphism, and the mutation frequency was different from study to study. In addition, the polymorphic status at p53 codon 72, which results in arginine or proline residues (R72P and is thought to influence the function of the protein significantly, was not examined. Methods To evaluate the significance of the TP53 mutation as a molecular marker to predict the prognosis of CRC patients, especially those who received postoperative chemotherapy, we examined the mutation by direct sequencing from fresh CRC tumors and evaluated the R72P polymorphism of the mutated TP53 by a combined mutant allele- and polymorphic allele-specific polymerase chain reaction (PCR. Results The TP53 mutation occurred in 147 (70% of 211 Japanese CRC tumors. The mutation was observed in 93 (63% tumors on the R72 allele and in 54 (37% tumors on the P72 allele. Although the alterations to TP53 have no prognostic significance for CRC patients overall, we found that Dukes' stage C CRC patients who did not receive postoperative chemotherapy and carried the mutated TP53-R72 showed significantly longer survival times than those with the mutated TP53-P72 when evaluated by overall survival (p = 0.012. Conclusion Using a combined mutant allele- and polymorphic allele-specific PCR, we defined the codon 72 polymorphic status of the TP53 mutated allele in Japanese CRC patients. We raised a possibility

  19. Patient Perspectives on EMS Alternate Destination Models.

    Science.gov (United States)

    Munjal, Kevin G; Shastry, Siri; Loo, George T; Reid, Daniel; Grudzen, Corita; Shah, Manish N; Chapin, Hugh H; First, Brandon; Sirirungruang, Sasilada; Alpert, Erin; Chason, Kevin; Richardson, Lynne D

    2016-01-01

    Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement. We conducted a cross-sectional study on a convenience sample of patients and caregivers presenting to an urban academic ED between July 2012 and May 2013. Respondents were surveyed on levels of agreement with 13 statements corresponding to various aspects of a proposed patient-centered emergency response system including increased EMS access to healthcare records, shared decision making with the patient and/or primary care physician, transport to alternative destinations, and relative importance of EMS assessment versus transportation. Information on demographic and socioeconomic factors, level of acuity, and EMS utilization history were also determined via survey and chart review. Responses were analyzed descriptively and compared across patient characteristics using chi-square and regression analyses. A total of 621 patients were enrolled. The percentage of patients who agreed or strongly agreed with each of the 13 statements ranged from 48.2 to 93.8%. About 86% agreed with increased EMS access to healthcare records; approximately 72% agreed with coordinating disposition decisions with a primary physician; and about 58% supported transport to alternative destinations for low acuity conditions. No association was found between levels of agreement and the patient's level of acuity or EMS utilization history. Only Black or Hispanic race showed isolated associations with lower rates of agreement with some aspects of an innovative

  20. Modeling Serum Creatinine in Septic ICU Patients

    DEFF Research Database (Denmark)

    De Gaetano, Andrea; Cortese, Giuliana; Pedersen, Morten Gram

    2004-01-01

    Serum creatinine is a metabolite assumed to be constantly produced by the normally functioning muscle mass and is a good measure for monitoring daily renal function in the intensive care unit (ICU). High serum creatinine levels or an abnormal departure from normal pre-disease basal levels....... The present work details the structure of a model describing observed creatinine serum concentration (CSC) variations, depending on the time-varying septic insult to renal function in ICU patients, as well as the estimation of its parameters. CSC determinations were routinely obtained from 12 patients...

  1. Generation of an induced pluripotent stem cell line, IBMS-iPSC-014-05, from a female autosomal dominant polycystic kidney disease patient carrying a common mutation of R803X in PKD2

    Directory of Open Access Journals (Sweden)

    Ming-Ching Ho

    2017-12-01

    Full Text Available Autosomal dominant polycystic kidney disease (ADPKD is one of the most commonly inherited forms of polycystic kidney disease, and is characterized by the growth of numerous cysts in both kidneys. Here we generated an induced pluripotent stem cell (iPSC line from the peripheral blood mononuclear cells (PBMCs of a 63-year-old female ADPKD patient carrying an R803X mutation in the PKD2 gene using the Sendai-virus delivery system. Downstream characterization of these iPSCs showed that they possessed normal karyotyping, were free of genomic integration, retained the disease-causing PKD2 mutation, expressed pluripotency markers and could differentiate into three germ layers.

  2. Model construction of nursing service satisfaction in hospitalized tumor patients.

    Science.gov (United States)

    Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

    2014-01-01

    This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients' expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved.

  3. About rats and jackfruit trees: modeling the carrying capacity of a Brazilian Atlantic Forest spiny-rat Trinomys dimidiatus (Günther, 1877 – Rodentia, Echimyidae – population with varying jackfruit tree (Artocarpus heterophyllus L. abundances

    Directory of Open Access Journals (Sweden)

    JHF Mello

    Full Text Available We carried out a six-year study aimed at evaluating if and how a Brazilian Atlantic Forest small mammal community responded to the presence of the invasive exotic species Artocarpus heterophyllus, the jackfruit tree. In the surroundings of Vila Dois Rios, Ilha Grande, RJ, 18 grids were established, 10 where the jackfruit tree was present and eight were it was absent. Previous results indicated that the composition and abundance of this small mammal community were altered by the presence and density of A. heterophyllus. One observed effect was the increased population size of the spiny-rat Trinomys dimidiatus within the grids where the jackfruit trees were present. Therefore we decided to create a mathematical model for this species, based on the Verhulst-Pearl logistic equation. Our objectives were i to calculate the carrying capacity K based on real data of the involved species and the environment; ii propose and evaluate a mathematical model to estimate the population size of T. dimidiatus based on the monthly seed production of jackfruit tree, Artocarpus heterophyllus and iii determinate the minimum jackfruit tree seed production to maintain at least two T. dimidiatus individuals in one study grid. Our results indicated that the predicted values by the model for the carrying capacity K were significantly correlated with real data. The best fit was found considering 20~35% energy transfer efficiency between trophic levels. Within the scope of assumed premises, our model showed itself to be an adequate simulator for Trinomys dimidiatus populations where the invasive jackfruit tree is present.

  4. How honey bees carry pollen

    Science.gov (United States)

    Matherne, Marguerite E.; Anyanwu, Gabriel; Leavey, Jennifer K.; Hu, David L.

    2017-11-01

    Honey bees are the tanker of the skies, carrying thirty percent of their weight in pollen per foraging trip using specialized orifices on their body. How do they manage to hang onto those pesky pollen grains? In this experimental study, we investigate the adhesion force of pollen to the honeybee. To affix pollen to themselves, honey bees form a suspension of pollen in nectar, creating a putty-like pollen basket that is skewered by leg hairs. We use tensile tests to show that the viscous force of the pollen basket is more than ten times the honeybee's flight force. This work may provide inspiration for the design of robotic flying pollinators.

  5. Loren Shriver carries Olympic torch

    Science.gov (United States)

    1996-01-01

    KSC Shuttle Operations Manager Loren J. Shriver proudly displays the Olympic torch that he carried to the top of Launch Pad 39A as his contribution to the July 7, 1996 KSC Olympic torch relay effort. Nineteen other KSC runners also participated in the relay effort at the Center. The Olympic torch arrived at KSC at 1:40 p.m. and traveled a 20-mile course to the pad and then out to the KSC visitor Center. The Space Shuttle Atlantis is behind Shriver, poised for the STS-79 mission, which will feature the fourth docking of the Shuttle with the Russian Mir space station.

  6. Why do dolphins carry sponges?

    Science.gov (United States)

    Mann, Janet; Sargeant, Brooke L; Watson-Capps, Jana J; Gibson, Quincy A; Heithaus, Michael R; Connor, Richard C; Patterson, Eric

    2008-01-01

    Tool use is rare in wild animals, but of widespread interest because of its relationship to animal cognition, social learning and culture. Despite such attention, quantifying the costs and benefits of tool use has been difficult, largely because if tool use occurs, all population members typically exhibit the behavior. In Shark Bay, Australia, only a subset of the bottlenose dolphin population uses marine sponges as tools, providing an opportunity to assess both proximate and ultimate costs and benefits and document patterns of transmission. We compared sponge-carrying (sponger) females to non-sponge-carrying (non-sponger) females and show that spongers were more solitary, spent more time in deep water channel habitats, dived for longer durations, and devoted more time to foraging than non-spongers; and, even with these potential proximate costs, calving success of sponger females was not significantly different from non-spongers. We also show a clear female-bias in the ontogeny of sponging. With a solitary lifestyle, specialization, and high foraging demands, spongers used tools more than any non-human animal. We suggest that the ecological, social, and developmental mechanisms involved likely (1) help explain the high intrapopulation variation in female behaviour, (2) indicate tradeoffs (e.g., time allocation) between ecological and social factors and, (3) constrain the spread of this innovation to primarily vertical transmission.

  7. Why do dolphins carry sponges?

    Directory of Open Access Journals (Sweden)

    Janet Mann

    Full Text Available Tool use is rare in wild animals, but of widespread interest because of its relationship to animal cognition, social learning and culture. Despite such attention, quantifying the costs and benefits of tool use has been difficult, largely because if tool use occurs, all population members typically exhibit the behavior. In Shark Bay, Australia, only a subset of the bottlenose dolphin population uses marine sponges as tools, providing an opportunity to assess both proximate and ultimate costs and benefits and document patterns of transmission. We compared sponge-carrying (sponger females to non-sponge-carrying (non-sponger females and show that spongers were more solitary, spent more time in deep water channel habitats, dived for longer durations, and devoted more time to foraging than non-spongers; and, even with these potential proximate costs, calving success of sponger females was not significantly different from non-spongers. We also show a clear female-bias in the ontogeny of sponging. With a solitary lifestyle, specialization, and high foraging demands, spongers used tools more than any non-human animal. We suggest that the ecological, social, and developmental mechanisms involved likely (1 help explain the high intrapopulation variation in female behaviour, (2 indicate tradeoffs (e.g., time allocation between ecological and social factors and, (3 constrain the spread of this innovation to primarily vertical transmission.

  8. Novelties that change carrying capacity.

    Science.gov (United States)

    Erwin, Douglas H

    2012-09-01

    Comparative developmental studies have revealed a rich array of details about the patterns and processes of morphological change in animals and increasingly in plants. But, applying these insights to the study of major episodes of evolutionary innovation requires understanding how these novel morphologies become established and sufficiently abundant (either as individuals within a species or as a clade of species) to be preserved in the fossil record, and, in many cases, to influence ecological processes. Evolutionary novelties may: (1) disappear without changing the species; (2) be associated with the generation (through selection or drift) of a new species; and if the latter (3) may or may not become ecologically significant. Only the latter are commonly preserved in the fossil record. These alternatives mirror the distinction among historians of technology between innovation and invention. Here, I argue that specific sorts of evolutionary inventions drive ecological transformation, essentially constructing an environment for themselves and ancillary organisms through ecological spillover effects, increasing the "carrying capacity" of an ecosystem. Copyright © 2011 Wiley Periodicals, Inc.

  9. Patient-Specific Modeling of Intraventricular Hemodynamics

    Science.gov (United States)

    Vedula, Vijay; Marsden, Alison

    2017-11-01

    Heart disease is the one of the leading causes of death in the world. Apart from malfunctions in electrophysiology and myocardial mechanics, abnormal hemodynamics is a major factor attributed to heart disease across all ages. Computer simulations offer an efficient means to accurately reproduce in vivo flow conditions and also make predictions of post-operative outcomes and disease progression. We present an experimentally validated computational framework for performing patient-specific modeling of intraventricular hemodynamics. Our modeling framework employs the SimVascular open source software to build an anatomic model and employs robust image registration methods to extract ventricular motion from the image data. We then employ a stabilized finite element solver to simulate blood flow in the ventricles, solving the Navier-Stokes equations in arbitrary Lagrangian-Eulerian (ALE) coordinates by prescribing the wall motion extracted during registration. We model the fluid-structure interaction effects of the cardiac valves using an immersed boundary method and discuss the potential application of this methodology in single ventricle physiology and trans-catheter aortic valve replacement (TAVR). This research is supported in part by the Stanford Child Health Research Institute and the Stanford NIH-NCATS-CTSA through Grant UL1 TR001085 and partly through NIH NHLBI R01 Grant 5R01HL129727-02.

  10. Examining the Resilience of Crop Production, Livestock Carrying Capacity, and Woodland Density in a Rural Zimbabwean Socio-Ecological System Using Agent-Based Models Representing Human Management Decisions

    Science.gov (United States)

    Eitzel Solera, M. V.; Neves, K.; Veski, A.; Solera, J.; Omoju, O. E.; Mawere Ndlovu, A.; Wilson, K.

    2016-12-01

    As climate change increases the pressures on arid ecosystems by changing timing and amount of rainfall, understanding the ways in which human management choices affect the resilience of these systems becomes key to their sustainability. On marginal farmland in Mazvihwa, Midlands Province, the historical carrying capacity of livestock has been consistently surprisingly high. We explore this phenomenon by building an agent-based model in NetLogo from a wealth of long-term data generated by the community-based participatory research team of The Muonde Trust, a Zimbabwean non-governmental organization. We combine the accumulated results of 35 years of indigenous and local knowledge with national datasets such as rainfall records. What factors keep the carrying capacity high? What management choices can maintain crops, livestock, and woodland at levels necessary for the community's survival? How do these choices affect long-term sustainability, and does increasing resilience at one scale reduce resilience at another scale? We use our agent-based model to explore the feedbacks between crops, livestock, and woodland and the impacts of various human choices as well as temporal and spatial ecological variation. By testing different scenarios, we disentangle the complex interactions between these components. We find that some factors out of the community's control can strongly affect the sustainability of the system through times of drought, and that supplementary feed may maintain livestock potentially at the expense of other resources. The challenges to resilience encountered by the farmers in Mazvihwa are not unique - many indigenous and rural people face drought and the legacies of colonialism, which contribute to lowered resilience to external challenges such as climate change, epidemics, and political instability. Using the agent-based model as a tool for synthesis and exploration initiates discussion about resilience-enhancing management choices for Mazvihwa's farmer-researchers.

  11. Do Salmonella carry spare tyres?

    Science.gov (United States)

    McQuiston, John R; Fields, Patricia I; Tauxe, Robert V; Logsdon, John M

    2008-04-01

    Salmonellae are enterobacteria that have the unique ability to change their flagellar composition by switching expression among two loci that encode the major flagellin protein. This property is not available to all Salmonella, but is species, subspecies and serotype specific. Curiously, the subsequent loss of the second locus in some lineages of Salmonella has apparently been tolerated and, indeed, has led to considerable success for some lineages. We discuss here an evolutionary model for maintenance of this unique function and the possible evolutionary advantages of loss or preservation of this mechanism. We hypothesize that the second flagellin locus is a genetic 'spare tyre' used in particular environmental circumstances.

  12. ETHICAL MODELS OF PHYSICIAN--PATIENT RELATIONSHIP REVISITED WITH REGARD TO PATIENT AUTONOMY, VALUES AND PATIENT EDUCATION.

    Science.gov (United States)

    Borza, Liana Rada; Gavrilovici, Cristina; Stockman, René

    2015-01-01

    The present paper revisits the ethical models of patient--physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician--patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician-patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the informative model excludes physician values from decision making. However, the deliberative model of patient-physician interaction represents an adequate alternative to the two unsatisfactory approaches by promoting shared decision making between the physician and the patient. It has also been suggested that the deliberative model would be ideal for exercising patient autonomy in chronic care and that the ethical role of patient education would be to make the deliberative model applicable to chronic care. In this regard, studies have indicated that the use of decision support interventions might increase the deliberative capacity of chronic patients.

  13. Estoma & câncer retal: revisão de 195 estomas realizados em 380 pacientes portadores de câncer retal Stoma and rectal cancer: review of 195 stomas carried out in 380 patients with rectal cancer

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Gomes da Cruz

    2008-06-01

    estomas executados, assim distribuídas: oito complicações em 146 colostomias terminais (5,5%, uma complicação dentre as 30 colostomias em alça (3,3%, três complicação nas três colostomias duplas (100,0%, duas complicações em 12 ileostomias am alça (16,7% e nenhuma complicação entre as quatro ileostomias terminais. Estenose e prolapso foram as complicações mais comuns (quatro casos de cada.The aim of this report is to analyze 380 patients with rectal cancer with special concern to the 195 stomas carried out with particular reference to temporary and definitive stomas as well as several surgical techniques used and their indications and complications. Three hundred seventy three out of 380 patients underwent surgery (98.2% being 373 tumors resected (91.8%. As far as surgical technique is concerned abdominal rectosigmoidectomy was carried out in 172 of 338 patients who had their tumors removed, being 133 with hand anastomoses (35.0 and 39 with stapled anastomoses (10.3%. Miles procedure was made in 135 (35.5%, local excision in 27 (7.1% and proctocolectomy and end ileostomy in four patients (1.0%. One hundred ninety five of 373 patients who underwent surgical treatment had stomas created in their abdomen (52.3%, being 174 definitive (46.6% and 21 temporary (5.7%. So 174 of the 195 stomas carried out were definitive (89.2% and 21 temporary (10.8%. One hundred and forty six of 195 stomas were end colostomies (39.1%, four end ileostomies (1.1%, 30 loop colostomies (8.0%, three double colostomies (0.8% and 12 loop ileostomies (3.2%. As far as 21 temporary stomas performed in 172 cases of local excision and abdominal rectosigmoidectomy (12.2% are concerned nine were loop colostomy (5.2% and 12 loop ileostomy (7.0%. Sixteen of 21 temporary stomas were made in 133 cases of hand anastomoses, being eight loop colostomies (6.0% and eight loop ileostomies (6.0%; and five in 39 cases of stapled anastomoses, being one loop colostomy (2.6% and four loop ileostomies (10

  14. Modelagem de redes logísticas com custos de inventário calculados a partir da cobertura de estoque Logistic networks modeling with inventory carrying costs calculated using inventory turnover

    Directory of Open Access Journals (Sweden)

    Ricardo Hamad

    2011-01-01

    Full Text Available A consideração dos custos de inventário tem se tornado cada vez mais importante na análise dos trade-offs e na tomada de decisões sobre redes logísticas. O artigo propõe uma metodologia para tratamento do custo de inventário a partir da cobertura de estoque esperada em cada instalação, incorporada na modelagem matemática da localização de fábricas e/ou centros de distribuição em redes logísticas com vários elos, representando uma nova versão do modelo apresentado em Hamad e Gualda (2008. As principais contribuições desta metodologia em relação a outros métodos encontrados na literatura são a facilidade de aplicação do método, a inclusão de restrições ligadas à capacidade de armazenagem e a consideração do custo total de inventário, e não apenas do custo relacionado aos produtos modelados.Inventory carrying cost has become very important in the analysis of the trade-offs and an important component to be considered when taking decisions about a logistic network. This paper proposes a methodology incorporated in a multi-echelon sourcing decision model, to be considered as a new version of the model presented in Hamad, Gualda (2008. It treats the carrying costs using the inventory Days-on-hand estimate in each echelon of the chain (plants and/or Distribution Centers. The main contributions of this methodology compared to other options found in the literature are the simplicity of its application, the consideration of all inventory costs (not only the ones related to the products being modeled and, also, the inclusion of constraints related to warehousing capacity.

  15. Analysis of survival in breast cancer patients by using different parametric models

    Science.gov (United States)

    Enera Amran, Syahila; Asrul Afendi Abdullah, M.; Kek, Sie Long; Afiqah Muhamad Jamil, Siti

    2017-09-01

    In biomedical applications or clinical trials, right censoring was often arising when studying the time to event data. In this case, some individuals are still alive at the end of the study or lost to follow up at a certain time. It is an important issue to handle the censoring data in order to prevent any bias information in the analysis. Therefore, this study was carried out to analyze the right censoring data with three different parametric models; exponential model, Weibull model and log-logistic models. Data of breast cancer patients from Hospital Sultan Ismail, Johor Bahru from 30 December 2008 until 15 February 2017 was used in this study to illustrate the right censoring data. Besides, the covariates included in this study are the time of breast cancer infection patients survive t, age of each patients X1 and treatment given to the patients X2 . In order to determine the best parametric models in analysing survival of breast cancer patients, the performance of each model was compare based on Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC) and log-likelihood value using statistical software R. When analysing the breast cancer data, all three distributions were shown consistency of data with the line graph of cumulative hazard function resembles a straight line going through the origin. As the result, log-logistic model was the best fitted parametric model compared with exponential and Weibull model since it has the smallest value in AIC and BIC, also the biggest value in log-likelihood.

  16. Should women carry their antenatal records?

    OpenAIRE

    Draper, J; Field, S; Thomas, H; Hare, M J

    1986-01-01

    A study of women's views on carrying their medical records during their pregnancy was conducted in Cambridge in 1982. Eighty eight women who were given their full records were compared with a control group of 83 women who carried the traditional cooperation card, both groups answering postal questionnaires about the advantages and disadvantages of carrying their respective records. Most women found advantages in carrying the complete record, although it was too large to carry for practical pu...

  17. BRCAPRO 6.0 Model Validation in Male Patients Presenting for BRCA Testing.

    Science.gov (United States)

    Mitri, Zahi I; Jackson, Michelle; Garby, Carolyn; Song, Juhee; Giordano, Sharon H; Hortobágyi, Gabriel N; Singletary, Claire N; Hashmi, S Shahrukh; Arun, Banu K; Litton, Jennifer K

    2015-06-01

    BRCAPRO is a risk assessment model to estimate the risk of carrying a BRCA mutation. BRCA mutation carriers are at higher risk of developing breast, ovarian, pancreatic, and prostate cancer. BRCAPRO was developed for women and found to be superior to other risk assessment models. The present study evaluated the validity of BRCAPRO at predicting the risk of male patients carrying a BRCA mutation. A total of 146 men who presented for genetic counseling and testing from February1997 to September 2011, and their test results were included in the present study. BRCAPRO risk assessment for all patients was calculated using the BRCAPRO clinical CancerGene assessment software. The mean age at presentation was 57 years. Of the 146 patients, 48 had breast cancer, 18 had pancreatic cancer, 39 had prostate cancer, 27 had other primary cancers, and 37 had no cancer. Fifty patients (34%) tested positive for a BRCA mutation (22 BRCA1, 27 BRCA2, and 1 BRCA1 and BRCA2). The mean BRCAPRO score for all patients was 24.96%. The BRCAPRO score was significantly higher for patients who tested positive for a BRCA mutation (46.19% vs. 13.9%, p BRCA mutation. At a cutoff point of 30.02%, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.74, 0.81, 0.67, and 0.86, respectively. BRCAPRO appears to be a valid risk assessment tool for determining the risk of carrying a BRCA mutation in men. Men carrying genetic mutations in the BRCA gene have a greater risk than the general population of developing certain types of cancer, including breast, pancreatic, and prostate cancer. BRCAPRO is a risk assessment model that predicts the risk of carrying a BRCA mutation. The present study aimed at validating BRCAPRO for use with men seen for genetic counseling, whether affected by cancer or not. The data available for 146 patients revealed that BRCAPRO was effective at identifying patients at risk of BRCA mutation. These findings could help in identifying a subset

  18. Patient-centered care requires a patient-oriented workflow model.

    Science.gov (United States)

    Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

    2013-06-01

    Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

  19. Identifying abnormal connectivity in patients using Dynamic Causal Modelling of fMRI responses.

    Directory of Open Access Journals (Sweden)

    Mohamed L Seghier

    2010-08-01

    Full Text Available Functional imaging studies of brain damaged patients offer a unique opportunity to understand how sensori-motor and cognitive tasks can be carried out when parts of the neural system that support normal performance are no longer available. In addition to knowing which regions a patient activates, we also need to know how these regions interact with one another, and how these inter-regional interactions deviate from normal. Dynamic Causal Modelling (DCM offers the opportunity to assess task-dependent interactions within a set of regions. Here we review its use in patients when the question of interest concerns the characterisation of abnormal connectivity for a given pathology. We describe the currently available implementations of DCM for fMRI responses, varying from the deterministic bilinear models with one-state equation to the stochastic nonlinear models with two-state equations. We also highlight the importance of the new Bayesian model selection and averaging tools that allow different plausible models to be compared at the single subject and group level. These procedures allow inferences to be made at different levels of model selection, from features (model families to connectivity parameters. Following a critical review of previous DCM studies that investigated abnormal connectivity we propose a systematic procedure that will ensure more flexibility and efficiency when using DCM in patients. Finally, some practical and methodological issues crucial for interpreting or generalising DCM findings in patients are discussed.

  20. Energetics of load carrying in Nepalese porters.

    Science.gov (United States)

    Bastien, Guillaume J; Schepens, Bénédicte; Willems, Patrick A; Heglund, Norman C

    2005-06-17

    Nepalese porters routinely carry head-supported loads equal to 100 to 200% of their body weight (Mb) for many days up and down steep mountain footpaths at high altitudes. Previous studies have shown that African women carry head-supported loads of up to 60% of their Mb far more economically than army recruits carrying equivalent loads in backpacks. Here we show that Nepalese porters carry heavier loads even more economically than African women. Female Nepalese porters, for example, carry on average loads that are 10% of their Mb heavier than the maximum loads carried by the African women, yet do so at a 25% smaller metabolic cost.

  1. A pilot survey on the quality of life in respiratory rehabilitation carried out in COPD patients with severe respiratory failure: preliminary data of a novel Inpatient Respiratory Rehabilitation Questionnaire (IRRQ

    Directory of Open Access Journals (Sweden)

    Pasqua Franco

    2012-11-01

    Full Text Available Abstract Background Measuring the state of health is a method for quantifying the impact of an illness on the day-to-day life, health and wellbeing of a patient, providing a quantitative measure of an individual’s quality of life (QoL. QoL expresses patient point of view by a subjective dimension and can express the results of medical intervention. Pulmonary rehabilitation is an essential component in the management of COPD patients, and measuring QoL has become a central focus in the study of this disease. Although nowadays several questionnaires for measuring the QoL in COPD patients are available, there are no questionnaires specifically developed for evaluating QoL in COPD patients undergoing respiratory rehabilitation. The aim of this study was to develop a novel questionnaire for the QoL quantification in COPD patients undergoing in-patient pulmonary rehabilitation program. Methods The questionnaire, administered to COPD patients undergoing long-term oxygen therapy into a respiratory rehabilitation ward, was developed by a simple and graphic layout to be administered to elderly patients. It included one form for admission and another for discharge. It included only tips related to the subjective components of QoL that would be relevant for patient, although likely not strictly related to the respiratory function. A descriptive analysis was performed for the socio-demographic characteristics and both the non-parametric Wilcoxon T-test and the Cronbach’s alpha index were calculated for evaluating the sensitivity of the questionnaire to the effects of respiratory rehabilitation and for identifying its consistency. Results The physical and psychological condition of the 34 COPD patients improved after the rehabilitative treatment and this finding was detected by the questionnaire (overall improvement: 14.2±2.5%, as confirmed by the non-parametric Wilcoxon test (p Conclusions This proposed questionnaire represents a substantial innovation

  2. Local Dynamic Stability Associated with Load Carrying

    Directory of Open Access Journals (Sweden)

    Jian Liu

    2013-03-01

    Conclusion: Current study confirmed the sensitivity of local dynamic stability measure in load carrying situation. It was concluded that load carrying tasks were associated with declined local dynamic stability, which may result in increased risk of fall accident. This finding has implications in preventing fall accidents associated with occupational load carrying.

  3. Queueing network model for obstetric patient flow in a hospital.

    Science.gov (United States)

    Takagi, Hideaki; Kanai, Yuta; Misue, Kazuo

    2016-03-03

    A queueing network is used to model the flow of patients in a hospital using the observed admission rate of patients and the histogram for the length of stay for patients in each ward. A complete log of orders for every movement of all patients from room to room covering two years was provided to us by the Medical Information Department of the University of Tsukuba Hospital in Japan. We focused on obstetric patients, who are generally hospitalized at random times throughout the year, and we analyzed the patient flow probabilistically. On admission, each obstetric patient is assigned to a bed in one of the two wards: one for normal delivery and the other for high-risk delivery. Then, the patient may be transferred between the two wards before discharge. We confirm Little's law of queueing theory for the patient flow in each ward. Next, we propose a new network model of M/G/ ∞ and M/M/ m queues to represent the flow of these patients, which is used to predict the probability distribution for the number of patients staying in each ward at the nightly census time. Although our model is a very rough and simplistic approximation of the real patient flow, the predicted probability distribution shows good agreement with the observed data. The proposed method can be used for capacity planning of hospital wards to predict future patient load in each ward.

  4. Optimising the allocation of groundwater carrying capacity in a data ...

    African Journals Online (AJOL)

    An analysis model of groundwater carrying capacity was then established and is solved with the Lagrange multiplier method. A case study of groundwater resource carrying capacity in 2010 and 2015 in the Yaoba Oasis irrigation district, Alxa Left Prefecture, Inner Mongolia Autonomous Region, China, was performed.

  5. Effect of the patient-to-patient communication model on dysphagia caused by total laryngectomy.

    Science.gov (United States)

    Tian, L; An, R; Zhang, J; Sun, Y; Zhao, R; Liu, M

    2017-03-01

    The study aimed to evaluate the effect of a patient-to-patient communication model on dysphagia in laryngeal cancer patients after total laryngectomy. Sixty-five patients who had undergone total laryngectomy were randomly divided into three groups: a routine communication group, a patient communication group (that received the patient-to-patient communication model) and a physician communication group. Questionnaires were used to compare quality of life and swallowing problems among all patient groups. The main factors causing dysphagia in total laryngectomy patients were related to fear and mental health. The patient communication group had improved visual analogue scale scores at one week after starting to eat. Quality of life in swallowing disorders questionnaire scores were significantly higher in the patient communication and physician communication groups than in the routine communication group. In addition, swallowing problems were much more severe in patients educated to high school level and above than in others. The patient-to-patient communication model can be used to resolve swallowing problems caused by psychological factors in total laryngectomy patients.

  6. Applying Mathematical Models to Surgical Patient Planning

    NARCIS (Netherlands)

    J.M. van Oostrum (Jeroen)

    2009-01-01

    textabstractOn a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient

  7. Hand-carried echocardiography by hospitalists: a randomized trial.

    Science.gov (United States)

    Lucas, Brian P; Candotti, Carolina; Margeta, Bosko; Mba, Benjamin; Kumapley, Rudolf; Asmar, Abdo; Franco-Sadud, Ricardo; Baru, Joshua; Acob, Christine; Borkowsky, Shane; Evans, Arthur T

    2011-08-01

    Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse. We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography. The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, -12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P=.0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography. Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. [Fitness, carrying capacity and competition in an ecosystem].

    Science.gov (United States)

    Wedekind, J; Wöhrmann, K

    1975-01-01

    In this paper a model is introduced in which fitness, carrying capacity and competition are considered. Thereby as well genetic as ecological parameters were assumed to become active. It results from the investigations that: 1. Competition may compensate the influence of genotypic fitness. 2. The carrying capacity has a more important influence on the construction of a population than the genotypic fitness. 3. As well competition as carrying capacity are parameters which do influence not only the size of the populations but also the genotypic construction of the populations. Therefore for a description of populations it is necessary to take into account a polyfactorial system with genotypic fitness, carrying capacity and competition. The model proposed has been compared with those described in the literature. The importance of population fitness and by it the genetic load has been discussed considering ecological parameters such as competition and carrying capacity.

  9. Increased risk of severe fluoropyrimidine-associated toxicity in patients carrying a G to C substitution in the first 28-bp tandem repeat of the thymidylate synthase 2R allele

    NARCIS (Netherlands)

    Meulendijks, Didier; Jacobs, Bart A W; Aliev, Abidin; Pluim, Dick; Van Werkhoven, Erik; Deenen, Maarten J.; Beijnen, Jos H.; Cats, Annemieke; Schellens, Jan H M

    2016-01-01

    The fluoropyrimidines act by inhibiting thymidylate synthase (TS). Recent studies have shown that patients' risk of severe fluoropyrimidine-associated toxicity is affected by polymorphisms in the 5′-untranslated region of TYMS, the gene encoding TS. A G>C substitution in the promoter enhancer region

  10. Measuring Social carrying Capacity: An Exploratory Study

    OpenAIRE

    López-Bonilla, Jesús Manuel; López-Bonilla, Luis Miguel

    2007-01-01

    The tourist carrying capacity commands a growing interest given that it is closely linked with sustainable tourist development. The justification of the utility of this concept is given by means of a simple and efficient methodological proposal, by analysing the social carrying capacity. To this end, an empirical application is carried out in the Western Andalusia. In some of the cases analysed, the satisfaction of the tourist is found to decline when the levels of the tourist use are higher ...

  11. Using the Health Belief Model to explain patient involvement in patient safety.

    Science.gov (United States)

    Bishop, Andrea C; Baker, G Ross; Boyle, Todd A; MacKinnon, Neil J

    2015-12-01

    With the knowledge that patient safety incidents can significantly impact patients, providers and health-care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research. To understand whether patient perceptions of patient safety play a role in patient involvement in factual and challenging patient safety practices and whether the constructs of the Health Belief Model (HBM) help to explain such perceptions. Partial least squares (PLS) analysis of survey data. Four inpatient units located in two tertiary hospitals in Atlantic Canada. Patients discharged from participating units between November 2010 and January 2011. None. A total of 217 of the 587 patient surveys were returned for a final response rate of 37.0%. The PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46 and 42% of the variance, respectively. The results from this study provide evidence for the constructs and relationships set forth by the HBM. Perceptions of patient safety were shown to influence patient likelihood for engaging in selected patient safety practices. While perceptions of barriers and benefits and threats were found to be a contributing factor to patient involvement in patient safety practices, self-efficacy plays an important role as a mediating factor. Overall, the use of the HBM within patient safety provides for increased understanding of how such perceptions can be influenced to improve patient engagement in promoting safer health care. © 2014 John Wiley & Sons Ltd.

  12. DETECTING VESSELS CARRYING MIGRANTS USING MACHINE LEARNING

    Directory of Open Access Journals (Sweden)

    A. Sfyridis

    2017-10-01

    Full Text Available Political instability, conflicts and inequalities result into significant flows of people worldwide, moving to different countries in search of a better life, safety or to be reunited with their families. Irregular crossings into Europe via sea routes, despite not being new, have recently increased together with the loss of lives of people in the attempt to reach EU shores. This highlights the need to find ways to improve the understanding of what is happening at sea. This paper, intends to expand the knowledge available on practices among smugglers and contribute to early warning and maritime situational awareness. By identifying smuggling techniques and based on anomaly detection methods, behaviours of interest are modelled and one class support vector machines are used to classify unlabelled data and detect potential smuggling vessels. Nine vessels are identified as potentially carrying irregular migrants and refugees. Though, further inspection of the results highlights possible misclassifications caused by data gaps and limited knowledge on smuggling tactics. Accepted classifications are considered subject to further investigation by the authorities.

  13. Detecting Vessels Carrying Migrants Using Machine Learning

    Science.gov (United States)

    Sfyridis, A.; Cheng, T.; Vespe, M.

    2017-10-01

    Political instability, conflicts and inequalities result into significant flows of people worldwide, moving to different countries in search of a better life, safety or to be reunited with their families. Irregular crossings into Europe via sea routes, despite not being new, have recently increased together with the loss of lives of people in the attempt to reach EU shores. This highlights the need to find ways to improve the understanding of what is happening at sea. This paper, intends to expand the knowledge available on practices among smugglers and contribute to early warning and maritime situational awareness. By identifying smuggling techniques and based on anomaly detection methods, behaviours of interest are modelled and one class support vector machines are used to classify unlabelled data and detect potential smuggling vessels. Nine vessels are identified as potentially carrying irregular migrants and refugees. Though, further inspection of the results highlights possible misclassifications caused by data gaps and limited knowledge on smuggling tactics. Accepted classifications are considered subject to further investigation by the authorities.

  14. Regression equations for circular CFST columns carrying capacity evaluation

    Directory of Open Access Journals (Sweden)

    Vatulia Glib

    2017-01-01

    Full Text Available Within the last decades, a considerable amount of experimental studies have been carried out by numerous researchers across the world with the purpose to study the carrying capacity of concrete-filled steel tubular (CFST columns and evaluation of their stressed-strained state. The array of the obtained results have allowed designing a mathematical model to determine the maximum carrying capacity value of such constructions using the methods of mathematical statistics. The authors obtained three types of regression equations for short and long circular CFST columns with different geometrical and physical properties under axial compression. Statistical quality of the obtained models was verified by both regression equation quality in general and statistical significance of the equation parameters. The comparison of the obtained carrying capacity values with the results calculated by Eurocode 4 and AIJ methodologies allows making a conclusion on the sufficient calculation accuracy of the designed mathematical models.

  15. Bivalve carrying capacity in coastal ecosystems

    NARCIS (Netherlands)

    Dame, R.F.; Prins, T.C.

    1998-01-01

    carrying capacity of suspension feeding bivalves in 11 coastal and estuarine ecosystems is examined. Bivalve carrying capacity is defined in terms of water mass residence time, primary production time and bivalve clearance time. Turnover times for the 11 ecosystems are compared both two and three

  16. The Concept of Carrying Capacity in Tourism

    Directory of Open Access Journals (Sweden)

    Josef Zelenka

    2014-05-01

    Full Text Available Carrying capacity is often pragmatically, theoretically as well as purely intuitively considered as a concept in the context of tourism sustainability. The carrying capacity application has the greatest potential in protected areas, in frequently visited cultural and natural attractions, and in relation to sustaining of the lifestyle of the local community and tourism destination potential in general. Despite its importance, partial applications, determination of basic theoretical principles, and specifying connection to the other theoretical concepts in tourism (particularly destination life cycle, LAC concept, visitors management, there still is a rightful opinion of some authors suggesting that there is no consistent theory of tourism carrying capacity. This theory would be the base for sophisticated practical carrying capacity applications. This paper is therefore focused on introduction of the theoretical concept of carrying capacity, which can be discussed and possibly further elaborated.

  17. Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

    Science.gov (United States)

    Skriabikova, Olga; Pavlova, Milena; Groot, Wim

    2010-06-01

    This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

  18. Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

    Directory of Open Access Journals (Sweden)

    Olga Skriabikova

    2010-06-01

    Full Text Available This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

  19. Time Ordering in Frontal Lobe Patients: A Stochastic Model Approach

    Science.gov (United States)

    Magherini, Anna; Saetti, Maria Cristina; Berta, Emilia; Botti, Claudio; Faglioni, Pietro

    2005-01-01

    Frontal lobe patients reproduced a sequence of capital letters or abstract shapes. Immediate and delayed reproduction trials allowed the analysis of short- and long-term memory for time order by means of suitable Markov chain stochastic models. Patients were as proficient as healthy subjects on the immediate reproduction trial, thus showing spared…

  20. Detection of the influenza A(H1N1pdm09 virus carrying the K-15E, P83S and Q293H mutations in patients who have undergone bone marrow transplant.

    Directory of Open Access Journals (Sweden)

    Milene Mesquita

    Full Text Available The 2009 pandemic influenza A(H1N1pdm09 virus emerged and caused considerable morbidity and mortality in the third world, especially in Brazil. Although circulating strains of A(H1N1pdm09 are A/California/04/2009-like (CA-04-like viruses, various studies have suggested that some mutations in the viral hemagglutinin (HA may be associated with enhanced severity and fatality. This phenomenon is particularly challenging for immunocompromised individuals, such as those who have undergone bone marrow transplant (BMT, because they are more likely to display worse clinical outcomes to influenza infection than non-immunocompromised individuals. We studied the clinical and viral aspects of post-BMT patients with confirmed A(H1N1pdm09 diagnosis in the largest cancer hospital in Brazil. We found a viral strain with K-15E, P83S and Q293H polymorphisms in the HA, which is presumably more virulent, in these individuals. Despite that, these patients showed only mild symptoms of infection. Our findings complement the discovery of mild cases of infection with the A(H1N1pdm09 virus with the K-15E, P83S and Q293H mutations in Brazil and oppose other studies that have linked these changes with increased disease severity. These results could be important for a better comprehension of the impact of the pandemic influenza in the context of BMT.

  1. Accessing patient-centered care using the advanced access model.

    Science.gov (United States)

    Tantau, Catherine

    2009-01-01

    Waits and delays for healthcare are legendary. These delays are not only frustrating and potentially hazardous for patients and providers but also represent significant cost to office practices. The traditional medical model that defines urgent care versus routine care is a vain and futile attempt to sort demand. This approach is at constant odds with patients' definition of urgency. Trusting patients to determine when and how they want to access care makes sense from a customer service perspective. If approached systematically using the principles of Advanced Access, patient demand patterns can be tracked to forecast demand. These demand patterns become the template for deploying the resources necessary to meet patients' needs. Although not a simple journey, the transformation to Advanced Access provides an entree to patient-centered care where patients can say, "I get exactly the care I want and need, when I want and need it."

  2. Properties of information carrying waves in cosmology

    International Nuclear Information System (INIS)

    O'Shea, E.M.

    2004-01-01

    Recently we studied the effects of information carrying waves propagating through isotropic cosmologies. By information carrying we mean that the waves have an arbitrary dependence on a function. We found that the waves introduce shear and anisotropic stress into the universe. We then constructed explicit examples of pure gravity wave perturbations for which the presence of this anisotropic stress is essential and the null hypersurfaces playing the role of the histories of the wavefronts in the background space-time are shear free. Motivated by this result we now prove that these two properties are true for all information carrying waves in isotropic cosmologies

  3. Gun Carrying by High School Students in Boston, MA: Does Overestimation of Peer Gun Carrying Matter?

    Science.gov (United States)

    Hemenway, David; Vriniotis, Mary; Johnson, Renee M.; Miller, Matthew; Azrael, Deborah

    2011-01-01

    This paper investigates: (1) whether high school students overestimate gun carrying by their peers, and (2) whether those students who overestimate peer gun carrying are more likely to carry firearms. Data come from a randomly sampled survey conducted in 2008 of over 1700 high school students in Boston, MA. Over 5% of students reported carrying a…

  4. Survival prediction model for postoperative hepatocellular carcinoma patients.

    Science.gov (United States)

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

    2017-09-01

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

  5. Blood-CNS Barrier Impairment in ALS Patients versus an Animal Model

    Directory of Open Access Journals (Sweden)

    Svitlana eGarbuzova-Davis

    2014-02-01

    Full Text Available Amyotrophic lateral sclerosis (ALS is a severe neurodegenerative disease with a compli-cated and poorly understood pathogenesis. Recently, alterations in the blood-Central Nervous System barrier (B-CNS-B have been recognized as a key factor possibly aggravating motor neuron damage. The majority of findings on ALS microvascular pathology have been deter-mined in mutant SOD1 rodent models, identifying barrier damage during disease develop-ment which might similarly occur in familial ALS patients carrying the SOD1 mutation. However, our knowledge of B-CNS-B competence in sporadic ALS (SALS has been limited. We recently showed structural and functional impairment in postmortem gray and white mat-ter microvessels of medulla and spinal cord tissue from SALS patients, suggesting pervasive barrier damage. Although numerous signs of barrier impairment (endothelial cell degenera-tion, capillary leakage, perivascular edema, downregulation of tight junction proteins, and microhemorrhages are indicated in both mutant SOD1 animal models of ALS and SALS pa-tients, other pathogenic barrier alterations have as yet only been identified in SALS patients. Pericyte degeneration, perivascular collagen IV expansion, and white matter capillary abnor-malities in SALS patients are significant barrier related pathologies yet to be noted in ALS SOD1 animal models. In the current review, these important differences in blood-CNS barrier damage between ALS patients and animal models, which may signify altered barrier transport mechanisms, are discussed. Understanding discrepancies in barrier condition between ALS patients and animal models may be crucial for developing effective therapies.

  6. Characterization of Cardiac Patients Based on the Synergy Model

    Directory of Open Access Journals (Sweden)

    Tavangar

    2014-10-01

    Full Text Available Background Cardiac patients need comprehensive support due to the adverse effects of this disease on different aspects of their lives. Synergy intervention is a model that focuses on patients' requirements. Objectives This study aimed to determine the eightfold characteristic of cardiac patients based on the synergy model that represent their clinical requirements. Materials and Methods In this descriptive cross-sectional study, 40 cardiac patients hospitalized at the cardiac care unit (CCU of Yazd Afshar Hospital were randomly selected. The data were collected by using a two-part check-list including demographic characteristics and also by studying eight characteristics of patients through interviewing and reviewing their records. The results were analyzed using descriptive statistics such as frequency (percentage and analytical statistics such as Spearman and Mann-Whitney test with the SPSS software, version 18. Results The results showed that among patients' internal characteristics, reversibility (70.6%, vulnerability (68.6%, and predictability (80.4% at level 1 (the minimum score had the highest frequency and stability (49% and complexity (54.9% were at level 3 (average score. Among external characteristics participation in decision-making (80.4% at level 1 had the highest frequency while care (62.7% and recourses (98% were at level 3. Conclusions Ignoring any of the eightfold characteristics based on the synergy model interferes with comprehensive support of cardiac patients. Therefore, it is necessary for professional health practitioners, especially nurses, to consider patients' eightfold characteristics in order to provide quality care.

  7. The effect of manufacturing tolerances on the load carrying capacity ...

    Indian Academy of Sciences (India)

    Abstract. This paper deals with simplified 3D finite element (FE) analysis on the effect of manufacturing tolerances on the load carrying capacity of large diameter bearings based on Hertz theory. The nonlinear connector elements are used to model the rolling elements. This model enables us to evaluate the contact load on ...

  8. Efficient patient modeling for visuo-haptic VR simulation using a generic patient atlas.

    Science.gov (United States)

    Mastmeyer, Andre; Fortmeier, Dirk; Handels, Heinz

    2016-08-01

    This work presents a new time-saving virtual patient modeling system by way of example for an existing visuo-haptic training and planning virtual reality (VR) system for percutaneous transhepatic cholangio-drainage (PTCD). Our modeling process is based on a generic patient atlas to start with. It is defined by organ-specific optimized models, method modules and parameters, i.e. mainly individual segmentation masks, transfer functions to fill the gaps between the masks and intensity image data. In this contribution, we show how generic patient atlases can be generalized to new patient data. The methodology consists of patient-specific, locally-adaptive transfer functions and dedicated modeling methods such as multi-atlas segmentation, vessel filtering and spline-modeling. Our full image volume segmentation algorithm yields median DICE coefficients of 0.98, 0.93, 0.82, 0.74, 0.51 and 0.48 regarding soft-tissue, liver, bone, skin, blood and bile vessels for ten test patients and three selected reference patients. Compared to standard slice-wise manual contouring time saving is remarkable. Our segmentation process shows out efficiency and robustness for upper abdominal puncture simulation systems. This marks a significant step toward establishing patient-specific training and hands-on planning systems in a clinical environment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Integration-free T cell-derived human induced pluripotent stem cells (iPSCs from a patient with recessive dystrophic epidermolysis bullosa (RDEB carrying two compound heterozygous mutations in the COL7A1 gene

    Directory of Open Access Journals (Sweden)

    Munenari Itoh

    2016-07-01

    Full Text Available Expanded human T cells from a Japanese female with recessive dystrophic epidermolysis bullosa (RDBE were used to generate integration-free induced pluripotent stem cells (iPSCs by exogenous expression of four reprogramming factors, OCT3/4, SOX2, cMYC, KLF4, using Sendai virus vector (SeVdp. The authenticity of established iPSC line, RDEB-iPSC26, was confirmed by the expressions of stem cell markers and the differentiation capability into three germ layer. RDEB-iPSC26 may be a useful cell resource for the establishment of in vitro RDEB modeling and the study for developing gene and cell therapy.

  10. A Patient-Specific Airway Branching Model for Mechanically Ventilated Patients

    Directory of Open Access Journals (Sweden)

    Nor Salwa Damanhuri

    2014-01-01

    Full Text Available Background. Respiratory mechanics models have the potential to guide mechanical ventilation. Airway branching models (ABMs were developed from classical fluid mechanics models but do not provide accurate models of in vivo behaviour. Hence, the ABM was improved to include patient-specific parameters and better model observed behaviour (ABMps. Methods. The airway pressure drop of the ABMps was compared with the well-accepted dynostatic algorithm (DSA in patients diagnosed with acute respiratory distress syndrome (ARDS. A scaling factor (α was used to equate the area under the pressure curve (AUC from the ABMps to the AUC of the DSA and was linked to patient state. Results. The ABMps recorded a median α value of 0.58 (IQR: 0.54–0.63; range: 0.45–0.66 for these ARDS patients. Significantly lower α values were found for individuals with chronic obstructive pulmonary disease (P<0.001. Conclusion. The ABMps model allows the estimation of airway pressure drop at each bronchial generation with patient-specific physiological measurements and can be generated from data measured at the bedside. The distribution of patient-specific α values indicates that the overall ABM can be readily improved to better match observed data and capture patient condition.

  11. Sparse Multidimensional Patient Modeling using Auxiliary Confidence Labels.

    Science.gov (United States)

    Heim, Eric; Hauskrecht, Milos

    2015-11-01

    In this work, we focus on the problem of learning a classification model that performs inference on patient Electronic Health Records (EHRs). Often, a large amount of costly expert supervision is required to learn such a model. To reduce this cost, we obtain confidence labels that indicate how sure an expert is in the class labels she provides. If meaningful confidence information can be incorporated into a learning method, fewer patient instances may need to be labeled to learn an accurate model. In addition, while accuracy of predictions is important for any inference model, a model of patients must be interpretable so that clinicians can understand how the model is making decisions. To these ends, we develop a novel metric learning method called Confidence bAsed MEtric Learning (CAMEL) that supports inclusion of confidence labels, but also emphasizes interpretability in three ways. First, our method induces sparsity, thus producing simple models that use only a few features from patient EHRs. Second, CAMEL naturally produces confidence scores that can be taken into consideration when clinicians make treatment decisions. Third, the metrics learned by CAMEL induce multidimensional spaces where each dimension represents a different "factor" that clinicians can use to assess patients. In our experimental evaluation, we show on a real-world clinical data set that our CAMEL methods are able to learn models that are as or more accurate as other methods that use the same supervision. Furthermore, we show that when CAMEL uses confidence scores it is able to learn models as or more accurate as others we tested while using only 10% of the training instances. Finally, we perform qualitative assessments on the metrics learned by CAMEL and show that they identify and clearly articulate important factors in how the model performs inference.

  12. Dynamic Bayesian networks as prognostic models for clinical patient management.

    Science.gov (United States)

    van Gerven, Marcel A J; Taal, Babs G; Lucas, Peter J F

    2008-08-01

    Prognostic models in medicine are usually been built using simple decision rules, proportional hazards models, or Markov models. Dynamic Bayesian networks (DBNs) offer an approach that allows for the incorporation of the causal and temporal nature of medical domain knowledge as elicited from domain experts, thereby allowing for detailed prognostic predictions. The aim of this paper is to describe the considerations that must be taken into account when constructing a DBN for complex medical domains and to demonstrate their usefulness in practice. To this end, we focus on the construction of a DBN for prognosis of carcinoid patients, compare performance with that of a proportional hazards model, and describe predictions for three individual patients. We show that the DBN can make detailed predictions, about not only patient survival, but also other variables of interest, such as disease progression, the effect of treatment, and the development of complications. Strengths and limitations of our approach are discussed and compared with those offered by traditional methods.

  13. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  14. Cognitive Load in Voice Therapy Carry-Over Exercises

    DEFF Research Database (Denmark)

    Iwarsson, Jenny; Morris, David Jackson; Balling, Laura Winther

    2017-01-01

    Purpose The cognitive load generated by online speech production may vary with the nature of the speech task. This article examines 3 speech tasks used in voice therapy carry-over exercises, in which a patient is required to adopt and automatize new voice behaviors, ultimately in daily spontaneous...

  15. How to carry out a clinical audit project

    African Journals Online (AJOL)

    improve patient care and outcomes through systematic review of care against explicit criteria and implementation of change. Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria. ... on admission or perhaps refusal to have the investigations carried out.

  16. Spring assisted cranioplasty: A patient specific computational model.

    Science.gov (United States)

    Borghi, Alessandro; Rodriguez-Florez, Naiara; Rodgers, Will; James, Gregory; Hayward, Richard; Dunaway, David; Jeelani, Owase; Schievano, Silvia

    2018-03-01

    Implantation of spring-like distractors in the treatment of sagittal craniosynostosis is a novel technique that has proven functionally and aesthetically effective in correcting skull deformities; however, final shape outcomes remain moderately unpredictable due to an incomplete understanding of the skull-distractor interaction. The aim of this study was to create a patient specific computational model of spring assisted cranioplasty (SAC) that can help predict the individual overall final head shape. Pre-operative computed tomography images of a SAC patient were processed to extract a 3D model of the infant skull anatomy and simulate spring implantation. The distractors were modeled based on mechanical experimental data. Viscoelastic bone properties from the literature were tuned using the specific patient procedural information recorded during surgery and from x-ray measurements at follow-up. The model accurately captured spring expansion on-table (within 9% of the measured values), as well as at first and second follow-ups (within 8% of the measured values). Comparison between immediate post-operative 3D head scanning and numerical results for this patient proved that the model could successfully predict the final overall head shape. This preliminary work showed the potential application of computational modeling to study SAC, to support pre-operative planning and guide novel distractor design. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

  17. Optimal growth trajectories with finite carrying capacity

    Science.gov (United States)

    Caravelli, F.; Sindoni, L.; Caccioli, F.; Ududec, C.

    2016-08-01

    We consider the problem of finding optimal strategies that maximize the average growth rate of multiplicative stochastic processes. For a geometric Brownian motion, the problem is solved through the so-called Kelly criterion, according to which the optimal growth rate is achieved by investing a constant given fraction of resources at any step of the dynamics. We generalize these finding to the case of dynamical equations with finite carrying capacity, which can find applications in biology, mathematical ecology, and finance. We formulate the problem in terms of a stochastic process with multiplicative noise and a nonlinear drift term that is determined by the specific functional form of carrying capacity. We solve the stochastic equation for two classes of carrying capacity functions (power laws and logarithmic), and in both cases we compute the optimal trajectories of the control parameter. We further test the validity of our analytical results using numerical simulations.

  18. Putting patients first: a novel patient-centered model for medical enterprise success.

    Science.gov (United States)

    Dhawan, Naveen

    2014-01-01

    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

  19. An Optical Carry Chain Fast Adder

    Directory of Open Access Journals (Sweden)

    D. Al-Dabass

    1994-12-01

    Full Text Available A significant problem in Arithmetic Unit design and particularly for systolic arrays remains the speed attainable in achieving high speed addition. The root of the problem is carry propagation and a method is presented which is relatively independent of word length. The problem is addressed by the description of a suggested radical design involving a hybrid optical and electronic approach. The method of carry chain addition through pass gates is explained and a suggested implementation utilising Fabry-Perott resonators, optical waveguides and voltage controlled couplers is described. The design is suitable for n-stage modular expansion.

  20. Parallelization of Reversible Ripple-carry Adders

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal; Axelsen, Holger Bock

    2009-01-01

    The design of fast arithmetic logic circuits is an important research topic for reversible and quantum computing. A special challenge in this setting is the computation of standard arithmetical functions without the generation of \\emph{garbage}. Here, we present a novel parallelization scheme......{O}(m\\cdot k)$. The underlying mechanisms of the parallelization scheme are formally proven correct. We also show designs for garbage-less reversible comparison circuits. We compare the circuit costs of the resulting ripple-block carry adder with known optimized reversible ripple-carry adders in measures...

  1. Abstraction carrying code and resource-awareness

    OpenAIRE

    Hermenegildo, Manuel V.; Albert Albiol, Elvira; López García, Pedro; Puebla Sánchez, Alvaro Germán

    2005-01-01

    Proof-Carrying Code (PCC) is a general approach to mobile code safety in which the code supplier augments the program with a certifícate (or proof). The intended benefit is that the program consumer can locally validate the certifícate w.r.t. the "untrusted" program by means of a certifícate checker—a process which should be much simpler, eíñcient, and automatic than generating the original proof. Abstraction Carrying Code (ACC) is an enabling technology for PCC in which an abstract mod...

  2. Multilevel model based glucose control for type-1 diabetes patients.

    Science.gov (United States)

    Garcia-Gabin, Winston; Jacobsen, Elling W

    2013-01-01

    Diabetes is a disease that involves alterations at multiple biological levels, ranging from intracellular signalling to organ processes. Since glucose homeostasis is the consequence of complex interactions that involve a number of factors, the control of diabetes should be based on a multilevel analysis. In this paper, a novel approach to design of closed-loop glucose controllers based on multilevel models is presented. A control scheme is proposed based on combining a pharmacokinetic/pharmacodynamic model with an insulin signal transduction model for type 1 diabetes mellitus patients. Based on this, an insulin feedback control schemes is designed. Two main advantages of explicitly utilizing information at the intracellular level were obtained. First, significant reduction of hypoglycaemic risk by reducing the undershoot in glucose levels in response to added insulin. Second, robust performance for inter-patient changes, demonstrated through application of the multilevel control strategy to a well established in silico population of diabetic patients.

  3. A communication tool to improve the patient journey modeling process.

    Science.gov (United States)

    Curry, Joanne; McGregor, Carolyn; Tracy, Sally

    2006-01-01

    Quality improvement is high on the agenda of Health Care Organisations (HCO) worldwide. Patient journey modeling is a relatively recent innovation in healthcare quality improvement that models the patient's movement through the HCO by viewing it from a patient centric perspective. Critical to the success of the redesigning care process is the involvement of all stakeholders and their commitment to actively participate in the process. Tools which promote this type of communication are a critical enabler that can significantly affect the overall process redesign outcomes. Such a tool must also be able to incorporate additional factors such as relevant policies and procedures, staff roles, system usage and measurements such as process time and cost. This paper presents a graphically based communication tool that can be used as part of the patient journey modeling process to promote stakeholder involvement, commitment and ownership as well highlighting the relationship of other relevant variables that contribute to the patient's journey. Examples of how the tool has been used and the framework employed are demonstrated via a midwife-led primary care case study. A key contribution of this research is the provision of a graphical communication framework that is simple to use, is easily understood by a diverse range of stakeholders and enables ready recognition of patient journey issues. Results include strong stakeholder buy-in and significant enhancement to the overall design of the future patient journey. Initial results indicate that the use of such a communication tool can improve the patient journey modeling process and the overall quality improvement outcomes.

  4. A statistical analysis based recommender model for heart disease patients.

    Science.gov (United States)

    Mustaqeem, Anam; Anwar, Syed Muhammad; Khan, Abdul Rashid; Majid, Muhammad

    2017-12-01

    An intelligent information technology based system could have a positive impact on the life-style of patients suffering from chronic diseases by providing useful health recommendations. In this paper, we have proposed a hybrid model that provides disease prediction and medical recommendations to cardiac patients. The first part aims at implementing a prediction model, that can identify the disease of a patient and classify it into one of the four output classes i.e., non-cardiac chest pain, silent ischemia, angina, and myocardial infarction. Following the disease prediction, the second part of the model provides general medical recommendations to patients. The recommendations are generated by assessing the severity of clinical features of patients, estimating the risk associated with clinical features and disease, and calculating the probability of occurrence of disease. The purpose of this model is to build an intelligent and adaptive recommender system for heart disease patients. The experiments for the proposed recommender system are conducted on a clinical data set collected and labelled in consultation with medical experts from a known hospital. The performance of the proposed prediction model is evaluated using accuracy and kappa statistics as evaluation measures. The medical recommendations are generated based on information collected from a knowledge base created with the help of physicians. The results of the recommendation model are evaluated using confusion matrix and gives an accuracy of 97.8%. The proposed system exhibits good prediction and recommendation accuracies and promises to be a useful contribution in the field of e-health and medical informatics. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Carrying capacity: maintaining outdoor recreation quality

    Science.gov (United States)

    David W. Lime; George H. Stankey

    1971-01-01

    A discussion of (1) what is meant by the concept of recreational carrying capacity; (2) what is known about capacities in terms of both how resources and experience of visitors are affected by recreational use; and (3) what alternative procedures the administrator can use to manage both resources and visitors for capacity.

  6. Construction of expression vectors carrying mouse peroxisomal ...

    African Journals Online (AJOL)

    The aim of this study was to construct expression vectors carrying mouse peroxisomal protein gene (PEP-cDNA) in prokaryotic and mammalian expression vectors in ... pGEX6p2-PEP and pUcD3-FLAG-PEP constructed vectors were transformed into the one shot TOP10 and JM105 bacterial competent cells, respectively.

  7. Transgenic cassava lines carrying heterologous alternative oxidase ...

    African Journals Online (AJOL)

    Afuape

    2013-07-03

    Jul 3, 2013 ... Organized embryogenic callus development: In our experiment, somatic embryos were developed from leaf lobes collected from transgenic cassava lines carrying the AtAOX1a gene. Immature leaf lobes measuring about 1 to 6 mm obtained from about six weeks old in vitro derived plants were used.

  8. Magnetoacoustic waves in current-carrying plasmas

    International Nuclear Information System (INIS)

    Brennan, M.H.

    1980-04-01

    The results of theoretical and experimental investigations of the characteristics of magnetoacoustic waves in non-uniform, current-carrying plasmas are reviewed. Dissipative MHD and collisionless theories are considered. Also discussed is the use of magnetoacoustic waves in plasma diagnostics and plasma heating

  9. Microfluidic device for carrying out a reaction

    NARCIS (Netherlands)

    Iordanov, V.; Bastemeijer, J.; Bossche, A.; Sarro, P.M.

    2005-01-01

    A device for carrying out a reaction, which device comprises a wafer provided with a group of at least two wells. The wells are thermally separate from each other by means of a groove in a layer of the device, while parts separated by the groove are locally connected by bridges. In this way a device

  10. Transgenic cassava lines carrying heterologous alternative oxidase ...

    African Journals Online (AJOL)

    Messenger RNA was extracted from selected PCR-positive lines for reverse transcription-PCR analysis for gene expression. To screen positive lines for gene function, leaf lobes from two transgenic lines with a line carrying an empty vector and the wild type were subjected to somatic embryogenesis (SE), a known oxidative ...

  11. Development of Oxygen-Carrying Compounds

    Science.gov (United States)

    1942-10-16

    lth-ugh nc suggestion w:.s nude th t the oxygen in tiu compounds night be carried reversibly they c.ppeared worth investig. ting. The - llylamine...revolution every nine- teen minutes. The accompanying diagram ehovs the machine in its first form. The driv~ and Rear reduction mechanism of this

  12. Modeling neurodegenerative diseases with patient-derived induced pluripotent cells

    DEFF Research Database (Denmark)

    Poon, Anna; Zhang, Yu; Chandrasekaran, Abinaya

    2017-01-01

    The rising prevalence of progressive neurodegenerative diseases coupled with increasing longevity poses an economic burden at individual and societal levels. There is currently no effective cure for the majority of neurodegenerative diseases and disease-affected tissues from patients have been...... the opportunity to model disease development, uncover novel mechanisms and test potential therapeutics. Here we review findings from iPSC-based modeling of selected neurodegenerative diseases, including Alzheimer's disease, frontotemporal dementia and spinocerebellar ataxia. Furthermore, we discuss...

  13. The Assessment of Patient Clinical Outcome: Advantages, Models, Features of an Ideal Model

    Directory of Open Access Journals (Sweden)

    Mou’ath Hourani

    2016-06-01

    Full Text Available Background: The assessment of patient clinical outcome focuses on measuring various aspects of the health status of a patient who is under healthcare intervention. Patient clinical outcome assessment is a very significant process in the clinical field as it allows health care professionals to better understand the effectiveness of their health care programs and thus for enhancing the health care quality in general. It is thus vital that a high quality, informative review of current issues regarding the assessment of patient clinical outcome should be conducted. Aims & Objectives: 1 Summarizes the advantages of the assessment of patient clinical outcome; 2 reviews some of the existing patient clinical outcome assessment models namely: Simulation, Markov, Bayesian belief networks, Bayesian statistics and Conventional statistics, and Kaplan-Meier analysis models; and 3 demonstrates the desired features that should be fulfilled by a well-established ideal patient clinical outcome assessment model. Material & Methods: An integrative review of the literature has been performed using the Google Scholar to explore the field of patient clinical outcome assessment. Conclusion: This paper will directly support researchers, clinicians and health care professionals in their understanding of developments in the domain of the assessment of patient clinical outcome, thus enabling them to propose ideal assessment models.

  14. The self-aware diabetic patient software agent model.

    Science.gov (United States)

    Wang, Zhanle; Paranjape, Raman

    2013-11-01

    This work presents a self-aware diabetic patient software agent for representing a human diabetic patient. To develop a 24h, stochastic and self-aware patient agent, we extend the original seminal work of Ackerman et al. [1] in creating a mathematical model of human blood glucose levels in three aspects. (1) We incorporate the stochastic and unpredictable effects of daily living. (2) The Ackerman model is extended into the period of night-time. (3) Patients' awareness of their own conditions is incorporated. Simulation results are quantitatively assessed to demonstrate the effectiveness of lifestyle management, such as adjusting the amount of food consumed, meal schedule, intensity of exercise and level of medication. In this work we show through the simulation that the average blood glucose can be reduced by as much as 51% due to careful lifestyle management. Self monitoring blood glucose is also quantitatively evaluated. The simulation results show that the average blood glucose is further dropped by 25% with the assistance of blood glucose samples. In addition, the blood glucose is perfectly controlled in the target range during the simulation period as a result of joint efforts of lifestyle management and self monitoring blood glucose. This study focuses on demonstrating how human patients' behavior, specifically lifestyle and self monitoring of blood glucose, affects blood glucose controls on a daily basis. This work does not focus on the insulin-glucose interaction of an individual human patient. Our conclusion is that this self-aware patient agent model is capable of adequately representing diabetic patients and of evaluating their dynamic behaviors. It can also be incorporated into a multi-agent system by introducing other healthcare components so that more interesting insights such as the healthcare quality, cost and performance can be observed. © 2013 Published by Elsevier Ltd.

  15. Towards patient specific thermal modelling of the prostate

    Science.gov (United States)

    Van den Berg, Cornelis A. T.; Van de Kamer, Jeroen B.; DeLeeuw, Astrid A. C.; Jeukens, Cécile R. L. P. N.; Raaymakers, Bas W.; van Vulpen, Marco; Lagendijk, Jan J. W.

    2006-02-01

    The application of thermal modelling for hyperthermia and thermal ablation is severely hampered by lack of information about perfusion and vasculature. However, recently, with the advent of sophisticated angiography and dynamic contrast enhanced (DCE) imaging techniques, it has become possible to image small vessels and blood perfusion bringing the ultimate goal of patient specific thermal modelling closer within reach. In this study dynamic contrast enhanced multi-slice CT imaging techniques are employed to investigate the feasibility of this concept for regional hyperthermia treatment of the prostate. The results are retrospectively compared with clinical thermometry data of a patient group from an earlier trial. Furthermore, the role of the prostate vasculature in the establishment of the prostate temperature distribution is studied. Quantitative 3D perfusion maps of the prostate were constructed for five patients using a distributed-parameter tracer kinetics model to analyse dynamic CT data. CT angiography was applied to construct a discrete vessel model of the pelvis. Additionally, a discrete vessel model of the prostate vasculature was constructed of a prostate taken from a human corpse. Three thermal modelling schemes with increasing inclusion of the patient specific physiological information were used to simulate the temperature distribution of the prostate during regional hyperthermia. Prostate perfusion was found to be heterogeneous and T3 prostate carcinomas are often characterized by a strongly elevated tumour perfusion (up to 70-80 ml 100 g-1 min-1). This elevated tumour perfusion leads to 1-2 °C lower tumour temperatures than thermal simulations based on a homogeneous prostate perfusion. Furthermore, the comparison has shown that the simulations with the measured perfusion maps result in consistently lower prostate temperatures than clinically achieved. The simulations with the discrete vessel model indicate that significant pre-heating takes place

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

    Science.gov (United States)

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

    2017-02-03

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

  17. Like an eagle carries its young

    Directory of Open Access Journals (Sweden)

    Hans-Georg Wünch

    2016-07-01

    Full Text Available The picture of an eagle carrying its young on its wings (Dt 32:11 is a powerful and encouraging image of trust and security in God. It is particularly relevant for Western culture, where the eagle is a prominent symbol of power and strength. In recent years, though, the translation of the Hebrew term רֶשֶׁנ as ‘eagle’ has come into question and modern exegetes claim that it is more accurately translated as ‘vulture’. But can this really be a symbol of comfort? Furthermore, do eagles (or vultures even carry their young on their wings? This article intends to shed some light on these questions. Keywords: Old Testament; Deuteronomy; Eagle; Vulture

  18. Proof-Carrying Code with Correct Compilers

    Science.gov (United States)

    Appel, Andrew W.

    2009-01-01

    In the late 1990s, proof-carrying code was able to produce machine-checkable safety proofs for machine-language programs even though (1) it was impractical to prove correctness properties of source programs and (2) it was impractical to prove correctness of compilers. But now it is practical to prove some correctness properties of source programs, and it is practical to prove correctness of optimizing compilers. We can produce more expressive proof-carrying code, that can guarantee correctness properties for machine code and not just safety. We will construct program logics for source languages, prove them sound w.r.t. the operational semantics of the input language for a proved-correct compiler, and then use these logics as a basis for proving the soundness of static analyses.

  19. Comparison of hospital charge prediction models for colorectal cancer patients: neural network vs. decision tree models.

    Science.gov (United States)

    Lee, Seung-Mi; Kang, Jin-Oh; Suh, Yong-Moo

    2004-10-01

    Analysis and prediction of the care charges related to colorectal cancer in Korea are important for the allocation of medical resources and the establishment of medical policies because the incidence and the hospital charges for colorectal cancer are rapidly increasing. But the previous studies based on statistical analysis to predict the hospital charges for patients did not show satisfactory results. Recently, data mining emerges as a new technique to extract knowledge from the huge and diverse medical data. Thus, we built models using data mining techniques to predict hospital charge for the patients. A total of 1,022 admission records with 154 variables of 492 patients were used to build prediction models who had been treated from 1999 to 2002 in the Kyung Hee University Hospital. We built an artificial neural network (ANN) model and a classification and regression tree (CART) model, and compared their prediction accuracy. Linear correlation coefficients were high in both models and the mean absolute errors were similar. But ANN models showed a better linear correlation than CART model (0.813 vs. 0.713 for the hospital charge paid by insurance and 0.746 vs. 0.720 for the hospital charge paid by patients). We suggest that ANN model has a better performance to predict charges of colorectal cancer patients.

  20. Menu variations for diabetes mellitus patients using Goal Programming model

    Science.gov (United States)

    Dhoruri, Atmini; Lestari, Dwi; Ratnasari, Eminugroho

    2017-08-01

    Diabetes mellitus (DM) was a chronic metabolic disease characterized by higher than normal blood glucose level (normal blood glucose level = = 80 -120 mg/dl). In this study, type 2 DM which mostly caused by unhealthy eating habits would be investigated. Related to eating habit, DM patients needed dietary menu planning with an extracare regarding their nutrients intake (energy, protein, fat and carbohydrate). Therefore, the measures taken were by organizing nutritious dietary menu for diabetes mellitus patients. Dietary menu with appropriate amount of nutrients was organized by considering the amount of calories, proteins, fats and carbohydrates. In this study, Goal Programming model was employed to determine optimal dietary menu variations for diabetes mellitus patients by paying attention to optimal expenses. According to the data obtained from hospitals in Yogyakarta, optimal menu variations would be analyzed by using Goal Programming model and would be completed by using LINGO computer program.

  1. “You Know You Are Sick, Why Do You Carry A Pregnancy Again?” Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya

    Science.gov (United States)

    Onono, Maricianah; Kwena, Zachary; Turan, Janet; Bukusi, Elizabeth A; Cohen, Craig R; Gray, Glenda E

    2015-01-01

    Objective Throughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens. Methods Data were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use. Results Barriers to women’s utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children. Conclusion The findings of this study suggest that a woman’s social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the

  2. Random noise characterization on the carrying capacities of a ...

    African Journals Online (AJOL)

    The process of the survival of species dependent on a limited resource in a polluted environment which isnot a new idea can be described by the technique of a mathematical modelling. We have utilised the technique of a numerical simulation to study the impact of environmental random noise on the carrying capacities of ...

  3. Dendrite and spine modifications in autism and related neurodevelopmental disorders in patients and animal models.

    Science.gov (United States)

    Martínez-Cerdeño, Verónica

    2017-04-01

    Dendrites and spines are the main neuronal structures receiving input from other neurons and glial cells. Dendritic and spine number, size, and morphology are some of the crucial factors determining how signals coming from individual synapses are integrated. Much remains to be understood about the characteristics of neuronal dendrites and dendritic spines in autism and related disorders. Although there have been many studies conducted using autism mouse models, few have been carried out using postmortem human tissue from patients. Available animal models of autism include those generated through genetic modifications and those non-genetic models of the disease. Here, we review how dendrite and spine morphology and number is affected in autism and related neurodevelopmental diseases, both in human, and genetic and non-genetic animal models of autism. Overall, data obtained from human and animal models point to a generalized reduction in the size and number, as well as an alteration of the morphology of dendrites; and an increase in spine densities with immature morphology, indicating a general spine immaturity state in autism. Additional human studies on dendrite and spine number and morphology in postmortem tissue are needed to understand the properties of these structures in the cerebral cortex of patients with autism. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 419-437, 2017. © 2016 Wiley Periodicals, Inc.

  4. Original article Rehabilitation model program for seriously ill patients

    Directory of Open Access Journals (Sweden)

    Adrienne Kegye

    2014-10-01

    Full Text Available Background Patients receiving cancer treatment start lifestyle changes mostly at the end of the treatment during the rehabilitation period. Most often, the first step is a dietary change and physical exercises built into the daily routine. Patients who do this in groups led by qualified therapists and based on professional counseling can build more effective and more permanent changes into their life. To develop a complex rehabilitation program which, in the short term, aims to familiarize patients with a lifestyle which harmonizes the physical, mental, spiritual and social spheres of life and, in the long term, to build it into their everyday life in order to ameliorate the physical and mental state and reduce the psychological symptoms and the isolation of patients. The physical component focuses on diet and exercise. The psycho-social-spiritual support focuses on discovering inner sources of strength, developing active coping mechanisms and helping to achieve more open communication. Participants and procedure In February and March 2011, 8 patients treated for malignant tumors participated in the model program. The components of the model program were psychotherapy, physiotherapy, cancer consultation, nutrition counseling, creative activities and walking. Results During the period of the model program the isolation of the patients decreased and their social support and ability of coping with the illness ameliorated. They reported an ease in anxiety and depression in their everyday activities. According to feedback, their communication with each other, with the staff and with their relatives became more open. Altogether this had advantageous effects on the functioning of the ward and the mood of the staff. Conclusions The rehabilitation program confirmed that beside individual psycho-social support, beneficial and economic psycho-social support can be provided for the patients in group form along with the most effective assignment of the

  5. Patient perceptions of a pharmacy star rating model.

    Science.gov (United States)

    Warholak, Terri L; Patel, Mira; Rosenthal, Meagen; West-Strum, Donna; Ettienne, Earl B; Nunlee-Bland, Gail; Nau, David; Hincapie, Ana L

    To identify patients' understanding of what constitutes a "quality pharmacy" and to obtain their feedback regarding the development and use of the pharmacy star rating model, a pharmacy-specific aggregate performance score based on the Centers for Medicare and Medicaid Services' Medicare Star Rating. Prospective cross-sectional study. Focus groups were conducted in Arizona, California, Mississippi, Maryland, and the District of Columbia, and one-on-one interviews were conducted in Indiana. Eligible patients were required to routinely use a community pharmacy. Consumer insights on their experiences with their pharmacies and their input on the pharmacy star rating model were attained. Key themes from the focus groups and interviews were obtained through the use of qualitative data analyses. Forty-nine subjects from 5 states and DC participated in 6 focus groups and 4 one-on-one interviews. Eighty-eight percent of participants reported currently taking at least 1 medication, and 87% reported having at least 1 health condition. The 7 themes identified during qualitative analysis included patient care, relational factors for choosing a pharmacy, physical factors for choosing a pharmacy, factors related to use of the pharmacy star rating model, reliability of the pharmacy star rating model, trust in pharmacists, and measures of pharmacy quality. Most participants agreed that the ratings would be useful and could aid in selecting a pharmacy, especially if they were moving to a new place or if they were dissatisfied with their current pharmacy. Pharmacy quality measures are new to patients. Therefore, training and education will need to be provided to patients, as pharmacies begin to offer additional clinical services, such as medication therapy management and diabetes education. The use of the pharmacy star rating model was dependent on the participants' situation when choosing a pharmacy. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc

  6. Patient Specific Modeling of Head-Up Tilt

    DEFF Research Database (Denmark)

    Williams, Nakeya; Wright, Andrew; Mehlsen, Jesper

    2014-01-01

    blood pressure. The model contains five compartments representing arteries and veins in the upper and lower body of the systemic circulation, as well as the left ventricle facilitating pumping of the heart. A physiologically based sub-model describes gravitational effects on pooling of blood during......Short term cardiovascular responses to head-up tilt (HUT) experiments involve complex cardiovascular regulation in order to maintain blood pressure at homeostatic levels. This manuscript presents a patient specific compartmental model developed to predict dynamic changes in heart rate and arterial...... that it is possible to estimate a subset of model parameters that allows prediction of observed changes in arterial blood pressure. Furthermore, the model adequately predicts arterial and venous blood pressures, as well as cardiac output in compartments for which data are not available....

  7. Correlates of gun-carrying among adolescents in south Louisiana.

    Science.gov (United States)

    McNabb, S J; Farley, T A; Powell, K E; Rolka, H R; Horan, J M

    1996-01-01

    In the majority of episodes of fatal interpersonal violence, the weapon used is a firearm. Amid frequent reports of youths carrying weapons, including firearms, we conducted a case-control study to identify risk factors for being charged with gun-carrying and gun-carrying, per se, among adolescents in Jefferson Parish, Louisiana. Cases were defined as incidents of gun-carrying among adolescents juvenile court from January 1, 1992, through April 15, 1993. For each case, we randomly drew three age-, gender-, and school-matched control subjects from the enrollment rosters of the Jefferson Parish public schools and administered a questionnaire. The data set comprised 38 case subjects and 103 matched control subjects. Thirty (29%) control subjects reported gun-carrying. Both case subjects and gun-carrying control subjects reported self-defense (40%) as the main reason for gun-carrying. Most case subjects (25 [66%]) were African Americans, but only 8 (27%) gun-carrying and 27 (37%) non-gun-carrying control subjects were African Americans. Case subjects were significantly more likely than gun-carrying control subjects to report being African American (odds ratio [OR] = 5.3, 95% confidence intervals [CI] = 1.6, 17.5). In crude analyses, case subjects were more likely than non-gun-carrying control subjects to report adult-male unemployment among households with adult men, to foresee a likelihood to be shot in school, to have seen a shooting, to use marijuana, to watch television > 6 hours per day, and to be African American. After the effect estimates were adjusted in conditional logistic regression modeling, case subjects were more likely than non-gun-carrying control subjects to report adult-male unemployment among households with adult men, using marijuana, and watching television > 6 hours per day (OR = 8.6, 95% CI = 1.2, 61,2; OR = 11.7, 95% CI = 2, 70.2; and OR = 6.5, 95% CI = 0.8, 51.9, respectively). Gun-carrying control subjects were significantly more likely than

  8. Effect of Continuous Care model on lifestyle modification in patients with hypertension: Randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Afsane Shahrani

    2016-07-01

    Full Text Available Hypertension is the most important modifiable cardiovascular disease. One of the main factors affecting the risk of hypertension is people’s lifestyle, for which appropriate changes in lifestyle-related factors creating cardiovascular risks need to be developed through new and effective approaches in long-term. Follow-up is an important tool for active participation in treatment and behavior changes; therefore, the present study aimed to evaluate the effect of continuous care model on the lifestyle of patients with hypertension. In this two-stage clinical trial, two groups of 64 patients with hypertension at the Isfahan Hypertension Center were selected through simple sampling, who hold the study criteria. The samples were randomly divided into two groups of 32 people as the experimental and control groups. The continuous care in the test group was carried out in the form of a four-stage program including orientation, sensitization, control and evaluation for 3 months. The control patients received usual care. Two questionnaires were employed to collect demographic data and lifestyle inventory data for hypertension used in two stages of pre- and post-intervention. Data were analyzed using descriptive statistics and statistical tests such as chisquare, Mann-Whitney, independent and paired t-test and analysis of covariance by SPSS version 20. Statistical tests showed no significant differences between the mean scores of two groups in life style dimensions before the intervention. After the intervention, however, the mean scores of lifestyle and its dimensions were significantly higher in the test group than those in the control group (p <0.001 According to the results, it can be concluded that applying continuous care model has significantly been effective in lifestyle modification of patients with high blood pressure. Training the patients and strengthening by repetition, monitoring and management of nurses can be important factors in promoting

  9. Development of pellet chain for charge carrying

    International Nuclear Information System (INIS)

    Chung, K.H.; Ko, S.K.; Choi, B.H.; Hong, J.H.

    1988-01-01

    This paper reports on the development of pellet chain and charge induction components which are used for charge carrying in electrostatic accelerators. It has very simple structure, and its fabrication cost is low. As the results of the test, first, mechanical vibration is reduced for operation and torsional stress due to belt twisting is removed completely. Second, after insertion of the material with high dielectric constant in charge induction assembly, the capacitance between pellets and inductor is increased. Third, for measurement of the life time of chain, it is continuously on the operation

  10. Can we measure carrying capacity with foraging behavior?

    Science.gov (United States)

    Morris, Douglas W; Mukherjee, Shomen

    2007-03-01

    Carrying capacity is one of the most important, yet least understood and rarely estimated, parameters in population management and modeling. A simple behavioral metric of carrying capacity would advance theory, conservation, and management of biological populations. Such a metric should be possible because behavior is finely attuned to variation in environment including population density. We connect optimal foraging theory with population dynamics and life history to develop a simple model that predicts this sort of adaptive density-dependent change in food consumption. We then confirm the model's unexpected and manifold predictions with field experiments. The theory predicts reproductive thresholds that alter the marginal value of energy as well as the value of time. Both effects cause a pronounced discontinuity in quitting-harvest rate that we revealed with foraging experiments. Red-backed voles maintained across a range of high densities foraged at a lower density-dependent rate than the same animals exposed to low-density treatments. The change in harvest rate is diagnostic of populations that exceed their carrying capacity. Ecologists, conservation biologists, and wildlife managers may thus be able to use simple and efficient foraging experiments to estimate carrying capacity and habitat quality.

  11. Dataset in support of the generation of Niemann-Pick disease Type C1 patient-specific iPS cell lines carrying the novel NPC1 mutation c.1180T>C or the prevalent c.3182T>C mutation – Analysis of pluripotency and neuronal differentiation

    Directory of Open Access Journals (Sweden)

    Franziska Peter

    2017-06-01

    Full Text Available Data presented in this article demonstrate the generation and characterization of two novel Niemann-Pick disease Type C1 (NPC1 patient-specific induced pluripotent stem cell (iPSC lines, related to the research article Trilck et al. (Diversity of Glycosphingolipid GM2 and Cholesterol Accumulation in NPC1 Patient-Specific iPSC-Derived Neurons; Brain Res.; 2017; 1657:52-61. doi: 10.1016/j.brainres.2016.11.031. For reprogramming fibroblasts, carrying the novel homozygous mutation c.1180T>C and the prevalent homozygous mutation c.3182T>C, were used. Reprogramming into patient-specific iPSCs was induced by retroviral transduction of the transcription factors Sox2, Klf4, Oct4 and c-Myc, and confirmed according to their pluripotency. The iPSCs were subsequently differentiated into neural progenitor cells, which were terminally differentiated into functional neurons and glial cells. The generation of these cell lines provides further valuable tools to investigate pathogenic mechanism of NPC1 in human neuronal cells carrying different NPC1 mutations.

  12. A Model to Identify Sarcopenia in Patients With Cirrhosis.

    Science.gov (United States)

    Tandon, Puneeta; Low, Gavin; Mourtzakis, Marina; Zenith, Laura; Myers, Robert P; Abraldes, Juan G; Shaheen, Abdel Aziz M; Qamar, Hina; Mansoor, Nadia; Carbonneau, Michelle; Ismond, Kathleen; Mann, Sumeer; Alaboudy, Alshimaa; Ma, Mang

    2016-10-01

    The severe depletion of muscle mass at the third lumbar vertebral level (sarcopenia) is a marker of malnutrition and is independently associated with mortality in patients with cirrhosis. Instead of monitoring sarcopenia by cross-sectional imaging, we investigated whether ultrasound-based measurements of peripheral muscle mass, measures of muscle function, along with nutritional factors, are associated with severe loss of muscle mass. We performed a prospective study of 159 outpatients with cirrhosis (56% male; mean age, 58 ± 10 years; mean model for end-stage liver disease score, 10 ± 3; 60% Child-Pugh class A) evaluated at the Cirrhosis Care Clinic at the University of Alberta Hospital from March 2011 through September 2012. Lumbar skeletal muscle indices were determined by computed tomography or magnetic resonance imaging. We collected clinical data and data on patients' body composition, nutrition, and thigh muscle thickness (using ultrasound analysis). We also measured mid-arm muscle circumference, mid-arm circumference, hand grip, body mass index, and serum level of albumin; patients were evaluated using the subjective global assessment scale. Findings from these analyses were compared with those from cross-sectional imaging, for each sex, using logistic regression analysis. Based on cross-sectional imaging analysis, 43% of patients had sarcopenia (57% of men and 25% of women). Results from the subjective global assessment, serum level of albumin, and most nutritional factors were significantly associated with sarcopenia. We used multivariate analysis to develop a model to identify patients with sarcopenia, and developed a nomogram based on body mass index and thigh muscle thickness for patients of each sex. Our model identified men with sarcopenia with an area under the receiver operating characteristic curve value of 0.78 and women with sarcopenia with an area under the receiver operating characteristic curve value of 0.89. In a prospective study of

  13. Cryptococcus neoformans carried by Odontomachus bauri ants

    Directory of Open Access Journals (Sweden)

    Mariana Santos de Jesus

    2012-06-01

    Full Text Available Cryptococcus neoformans is the most common causative agent of cryptococcosis worldwide. Although this fungus has been isolated from a variety of organic substrates, several studies suggest that hollow trees constitute an important natural niche for C. neoformans. A previously surveyed hollow of a living pink shower tree (Cassia grandis positive for C. neoformans in the city of Rio de Janeiro, Brazil, was chosen for further investigation. Odontomachus bauri ants (trap-jaw ants found inside the hollow were collected for evaluation as possible carriers of Cryptococcus spp. Two out of 10 ants were found to carry phenoloxidase-positive colonies identified as C. neoformans molecular types VNI and VNII. The ants may have acted as a mechanical vector of C. neoformans and possibly contributed to the dispersal of the fungi from one substrate to another. To the best of our knowledge, this is the first report on the association of C. neoformans with ants of the genus Odontomachus.

  14. Azobenzene derivatives carrying a nitroxide radical.

    Science.gov (United States)

    Nakatsuji, Shin'ichi; Fujino, Masahiro; Hasegawa, Satoko; Akutsu, Hiroki; Yamada, Jun-ichi; Gurman, Vladimir S; Kh Vorobiev, Andrey

    2007-03-16

    Several trans-azobenzene derivatives carrying a nitroxide (aminoxyl) radical (2a, 6a-12a) were prepared, and their photoisomerization reactions to the corresponding cis-isomers were investigated. Although no fruitful results could be obtained for the photoisomerizations of the derivatives with para-subsituents (9a-12a), the unsubstututed derivatives at the para-position (2a, 6a, 7a, 8a) were found to show photoisomerizations by irradiation to give the corresponding cis-isomers (2b, 6b, 7b, 8b), being isolated as relatively stable solid materials, and the change of the intermolecular magnetic interactions was apparently observed by the structural change for each photochromic couple.

  15. Fatigue in fibromyalgia: a conceptual model informed by patient interviews

    DEFF Research Database (Denmark)

    Humphrey, Louise; Arbuckle, Rob; Mease, Philip

    2010-01-01

    Fatigue is increasingly recognized as an important symptom in fibromyalgia (FM). Unknown however is how fatigue is experienced by individuals in the context of FM. We conducted qualitative research in order to better understand aspects of fatigue that might be unique to FM as well as the impact...... it has on patients' lives. The data obtained informed the development of a conceptual model of fatigue in FM....

  16. Diagnosing perforated appendicitis in pediatric patients: a new model.

    Science.gov (United States)

    van den Bogaard, Veerle A B; Euser, Sjoerd M; van der Ploeg, Tjeerd; de Korte, Niels; Sanders, Dave G M; de Winter, Derek; Vergroesen, Diederik; van Groningen, Krijn; de Winter, Peter

    2016-03-01

    Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children. Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation. In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%. This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Kottalanka Srikanth

    2017-07-01

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

  18. 3D Modelling and Printing Technology to Produce Patient-Specific 3D Models.

    Science.gov (United States)

    Birbara, Nicolette S; Otton, James M; Pather, Nalini

    2017-11-10

    A comprehensive knowledge of mitral valve (MV) anatomy is crucial in the assessment of MV disease. While the use of three-dimensional (3D) modelling and printing in MV assessment has undergone early clinical evaluation, the precision and usefulness of this technology requires further investigation. This study aimed to assess and validate 3D modelling and printing technology to produce patient-specific 3D MV models. A prototype method for MV 3D modelling and printing was developed from computed tomography (CT) scans of a plastinated human heart. Mitral valve models were printed using four 3D printing methods and validated to assess precision. Cardiac CT and 3D echocardiography imaging data of four MV disease patients was used to produce patient-specific 3D printed models, and 40 cardiac health professionals (CHPs) were surveyed on the perceived value and potential uses of 3D models in a clinical setting. The prototype method demonstrated submillimetre precision for all four 3D printing methods used, and statistical analysis showed a significant difference (pprinted models, particularly using multiple print materials, were considered useful by CHPs for preoperative planning, as well as other applications such as teaching and training. This study suggests that, with further advances in 3D modelling and printing technology, patient-specific 3D MV models could serve as a useful clinical tool. The findings also highlight the potential of this technology to be applied in a variety of medical areas within both clinical and educational settings. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  19. Pilot Study of a Patient-Centered Radiology Process Model.

    Science.gov (United States)

    Swan, J Shannon; Furtado, Vanessa F; Keller, Lisa A; Lotti, Judith Borsody; Saltalamacchia, Catherine A; Lennes, Inga T; Salazar, Gloria M

    2017-02-01

    The Radiology Process Model (RPM) was previously described in terms of its conceptual basis and proposed survey items. The current study describes the first pilot application of the RPM in the field and the results of initial psychometric analysis. We used an Institutional Review Board-approved pilot RPM survey in 100 patients having outpatient interventional radiology procedures. The 24 survey items had 4 or 5 levels of severity. We assessed for missing data, items that patients found confusing, any suggestions by patients for additional items and clarity of items from patient feedback. Factor analysis was performed and internal consistency measured. Construct validity was assessed by correlation of patient responses to the items as a summated scale with a visual analog scale (VAS) they completed indicating their interventional radiology experience. The visual analog scale and the RPM summated scale were strongly correlated (r = 0.7). Factor analysis showed four factors: interactions with facility and doctors/staff, time-sensitive aspects, pain, and anxiety. The items showed high internal consistency (alpha: 0.86) as a group and approximately 0.7 to 0.9 by the factors. Analysis shows that two items could be deleted (cost and communication between radiologist and referrers). Revision of two items and potential addition of others are discussed. The RPM shows initial evidence of psychometric validity and internal consistency reliability. Minor changes are anticipated before wider use. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Comparison of hospital charge prediction models for gastric cancer patients: neural network vs. decision tree models.

    Science.gov (United States)

    Wang, Jing; Li, Man; Hu, Yun-tao; Zhu, Yu

    2009-09-14

    In recent years, artificial neural network is advocated in modeling complex multivariable relationships due to its ability of fault tolerance; while decision tree of data mining technique was recommended because of its richness of classification arithmetic rules and appeal of visibility. The aim of our research was to compare the performance of ANN and decision tree models in predicting hospital charges on gastric cancer patients. Data about hospital charges on 1008 gastric cancer patients and related demographic information were collected from the First Affiliated Hospital of Anhui Medical University from 2005 to 2007 and preprocessed firstly to select pertinent input variables. Then artificial neural network (ANN) and decision tree models, using same hospital charge output variable and same input variables, were applied to compare the predictive abilities in terms of mean absolute errors and linear correlation coefficients for the training and test datasets. The transfer function in ANN model was sigmoid with 1 hidden layer and three hidden nodes. After preprocess of the data, 12 variables were selected and used as input variables in two types of models. For both the training dataset and the test dataset, mean absolute errors of ANN model were lower than those of decision tree model (1819.197 vs. 2782.423, 1162.279 vs. 3424.608) and linear correlation coefficients of the former model were higher than those of the latter (0.955 vs. 0.866, 0.987 vs. 0.806). The predictive ability and adaptive capacity of ANN model were better than those of decision tree model. ANN model performed better in predicting hospital charges of gastric cancer patients of China than did decision tree model.

  1. Comparison of hospital charge prediction models for gastric cancer patients: neural network vs. decision tree models

    Directory of Open Access Journals (Sweden)

    Hu Yun-tao

    2009-09-01

    Full Text Available Abstract Background In recent years, artificial neural network is advocated in modeling complex multivariable relationships due to its ability of fault tolerance; while decision tree of data mining technique was recommended because of its richness of classification arithmetic rules and appeal of visibility. The aim of our research was to compare the performance of ANN and decision tree models in predicting hospital charges on gastric cancer patients. Methods Data about hospital charges on 1008 gastric cancer patients and related demographic information were collected from the First Affiliated Hospital of Anhui Medical University from 2005 to 2007 and preprocessed firstly to select pertinent input variables. Then artificial neural network (ANN and decision tree models, using same hospital charge output variable and same input variables, were applied to compare the predictive abilities in terms of mean absolute errors and linear correlation coefficients for the training and test datasets. The transfer function in ANN model was sigmoid with 1 hidden layer and three hidden nodes. Results After preprocess of the data, 12 variables were selected and used as input variables in two types of models. For both the training dataset and the test dataset, mean absolute errors of ANN model were lower than those of decision tree model (1819.197 vs. 2782.423, 1162.279 vs. 3424.608 and linear correlation coefficients of the former model were higher than those of the latter (0.955 vs. 0.866, 0.987 vs. 0.806. The predictive ability and adaptive capacity of ANN model were better than those of decision tree model. Conclusion ANN model performed better in predicting hospital charges of gastric cancer patients of China than did decision tree model.

  2. The logistic model-generated carrying capacities for wild herbivores ...

    African Journals Online (AJOL)

    Jesse

    These equations are quadratic production functions without intercept. Multiplying out these equations yield their equivalent counterpart, also production functions without intercept (equations. 6c), as follows: ∑. -. = +. +. -. = 1. 1. 2. 1 n j jt it ij it i it i it. HH. H. H. Y λ δ β. These equations are then solved for the first order ...

  3. Voltage-carrying states in superconducting microstrips

    International Nuclear Information System (INIS)

    Stuivinga, M.E.C.

    1983-01-01

    When the critical current is exceeded in a superconducting microstrip, voltage-carrying states with a resistance significantly below the normal state resistance can occur. Phase-slip centers (PSC) appear at about the critical temperature. These are successive local voltage units which manifest themselves as strip-like increments in voltage in the I-V characteristic. For temperatures off the critical temperature the PSC regime degenerates into a region of normal material, a so-called hot spot. These two phenomena, PSC and hot spots, form the subject of this thesis. To gain a better understanding of the phase-slip center process, an experiment was designed to measure local values of the quasi-particle and pair potential. The results of local potential and gap measurements at a PSC in aluminium are presented and discussed. Special attention is paid to pair-breaking interactions which can shorten the relaxation time. A non-linear differential equation is derived which describes the development of a PSC into a normal hot spot under the influence of Joule heating. It incorporates the temperature rise due to the dissipative processes occurring in the charge imbalance tails. Numerical solutions are presented for a set of parameters, including those for aluminium and tin. Subsequently, they are compared with experiments. (Auth.)

  4. On Kolmogorov Complexity and the Costs of Carrying out Strategies

    OpenAIRE

    Justin Smith

    2000-01-01

    It is common to model costs of carrying out strategies in games in relation to the complexity, in some sense, of the strategies. We show a particularly general definition of complexity for this purpose, one that subsumes many alternatives as special cases. We explore how this definition can be used and developed, and illustrate with applications to the analysis of two player finite repeated games.

  5. Increasing Patient-Clinician Concordance About Medical Error Disclosure Through the Patient TIPS Model.

    Science.gov (United States)

    Martinez, William; Browning, David; Varrin, Pamela; Sarnoff Lee, Barbara; Bell, Sigall K

    2017-05-10

    To test whether an educational model involving patients and family members (P/F) in medical error disclosure training for interprofessional clinicians can narrow existing gaps between clinician and P/F views about disclosure. Parallel presurveys/postsurveys using Likert scale questions for clinicians and P/F. Baseline surveys were completed by 91% (50/55) of clinicians who attended the workshops and 74% (65/88) of P/F from a hospital patient and family advisory council. P/F's baseline views about disclosure were significantly different from clinicians' in 70% (7/10) of the disclosure expectation items and 100% (3/3) of the disclosure vignette items. For example, compared with clinicians, P/F more strongly agreed that "patients want to know all the details of what happened" and more strongly disagreed that "patients find explanation(s) more confusing than helpful." In the medication error vignette, compared with clinicians, P/F more strongly agreed that the error should be disclosed and that the patient would want to know and more strongly disagreed that disclosure would do more harm than good (all P medical error disclosure and brings patient and clinicians views closer together.

  6. Different Ways of Carrying Bags in Mental Retarded Students

    Directory of Open Access Journals (Sweden)

    Saideh-Sadat Mortazavi

    2012-10-01

    Full Text Available School as an educational and social center is linked with various aspects of child’s growth. The impact of objects, tools, and lifestyle on the development of human performance is not hidden from anyone [1].Tasell Lauri, the head of Cairo Praktive in Australia, in a paper warned parents about bags as a tool that students carry every day, and he is believes that many spinal disorders in adults is caused by childhood trauma. Studies on children and patients with special needs and such as myelomenangocele, cerebral palsy, and neurofibromatosis precisely show abnormal growth of spinal disorders, muscle imbalance, wrong posture [2]. Carrying stationery in an inappropriate tool can cause irreversible effects.

  7. A phase II evaluation of the potent, highly selective PARP inhibitor veliparib in the treatment of persistent or recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in patients who carry a germline BRCA1 or BRCA2 mutation - An NRG Oncology/Gynecologic Oncology Group study.

    Science.gov (United States)

    Coleman, Robert L; Sill, Michael W; Bell-McGuinn, Katherine; Aghajanian, Carol; Gray, Heidi J; Tewari, Krishnansu S; Rubin, Steven C; Rutherford, Thomas J; Chan, John K; Chen, Alice; Swisher, Elizabeth M

    2015-06-01

    Veliparib is a potent small molecule inhibitor of PARP-1/2, which is cytotoxic in tumor cells with deficiencies in BRCA1 or BRCA2. We studied the clinical activity and toxicity of veliparib in ovarian cancer patients carrying a germline BRCA1 or BRCA2 mutation (gBRCA). Eligibility included three or fewer prior chemotherapy regimens, measurable disease and no prior use of a PARP inhibitor. Veliparib was administered at 400mg orally BID with one cycle being 28days. The two-stage Simon design was capable of detecting a 25% response probability with 90% power while controlling alpha=10% (at a 10% assumed null response probability). The median age of the 50 eligible patients was 57years (range 37-94) and 14, 18, and 18 patients had 1, 2, and 3 prior therapies respectively. Thirty patients (60%) were platinum-resistant. The median number of cycles administered was 6 (1-27). There was one grade 4 thrombocytopenia. Grade 3 adverse events were: fatigue (n=3), nausea (2), leukopenia (1), neutropenia (1), dehydration (1), and ALT (1). Grade 2 events >10% were: nausea (46%), fatigue (26%), vomiting (18%), and anemia (14%). The proportion responding was 26% (90% CI: 16%-38%, CR: 2, PR: 11); for platinum-resistant and platinum-sensitive patients the proportion responding was 20% and 35%, respectively. The most common reason for treatment discontinuation was progression (62%). Twenty-nine patients are alive; two with SD remain on veliparib. The median PFS is 8.18months. The single agent efficacy and tolerability of veliparib for BRCA mutation-associated recurrent ovarian cancer warrants further investigation. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Modelling Transcapillary Transport of Fluid and Proteins in Hemodialysis Patients.

    Directory of Open Access Journals (Sweden)

    Mauro Pietribiasi

    Full Text Available The kinetics of protein transport to and from the vascular compartment play a major role in the determination of fluid balance and plasma refilling during hemodialysis (HD sessions. In this study we propose a whole-body mathematical model describing water and protein shifts across the capillary membrane during HD and compare its output to clinical data while evaluating the impact of choosing specific values for selected parameters.The model follows a two-compartment structure (vascular and interstitial space and is based on balance equations of protein mass and water volume in each compartment. The capillary membrane was described according to the three-pore theory. Two transport parameters, the fractional contribution of large pores (αLP and the total hydraulic conductivity (LpS of the capillary membrane, were estimated from patient data. Changes in the intensity and direction of individual fluid and solute flows through each part of the transport system were analyzed in relation to the choice of different values of small pores radius and fractional conductivity, lymphatic sensitivity to hydraulic pressure, and steady-state interstitial-to-plasma protein concentration ratio.The estimated values of LpS and αLP were respectively 10.0 ± 8.4 mL/min/mmHg (mean ± standard deviation and 0.062 ± 0.041. The model was able to predict with good accuracy the profiles of plasma volume and serum total protein concentration in most of the patients (average root-mean-square deviation < 2% of the measured value.The applied model provides a mechanistic interpretation of fluid transport processes induced by ultrafiltration during HD, using a minimum of tuned parameters and assumptions. The simulated values of individual flows through each kind of pore and lymphatic absorption rate yielded by the model may suggest answers to unsolved questions on the relative impact of these not-measurable quantities on total vascular refilling and fluid balance.

  9. A Causal Model for Fluctuating Sugar Levels in Diabetes Patients

    Directory of Open Access Journals (Sweden)

    Kinzang Chhogyal

    2012-09-01

    Full Text Available Background Causal models of physiological systems can be immensely useful in medicine as they may be used for both diagnostic and therapeutic reasoning. Aims In this paper we investigate how an agent may use the theory of belief change to rectify simple causal models of changing blood sugar levels in diabetes patients. Method We employ the semantic approach to belief change together with a popular measure of distance called Dalal distance between different state descriptions in order to implement a simple application that simulates the effectiveness of the proposed method in helping an agent rectify a simple causal model. Results Our simulation results show that distance-based belief change can help in improving the agent’s causal knowledge. However, under the current implementation there is no guarantee that the agent will learn the complete model and the agent may at times get stuck in local optima. Conclusion Distance-based belief change can help in refining simple causal models such as the example in this paper. Future work will include larger state-action spaces, better distance measures and strategies for choosing actions.

  10. A causal model for fluctuating sugar levels in diabetes patients.

    Science.gov (United States)

    Chhogyal, Kinzang; Nayak, Abhaya; Schwitter, Rolf; Sattar, Abdul

    2012-01-01

    Causal models of physiological systems can be immensely useful in medicine as they may be used for both diagnostic and therapeutic reasoning. In this paper we investigate how an agent may use the theory of belief change to rectify simple causal models of changing blood sugar levels in diabetes patients. We employ the semantic approach to belief change together with a popular measure of distance called Dalal distance between different state descriptions in order to implement a simple application that simulates the effectiveness of the proposed method in helping an agent rectify a simple causal model. Our simulation results show that distance-based belief change can help in improving the agent's causal knowledge. However, under the current implementation there is no guarantee that the agent will learn the complete model and the agent may at times get stuck in local optima. Distance-based belief change can help in refining simple causal models such as the example in this paper. Future work will include larger state-action spaces, better distance measures and strategies for choosing actions.

  11. Biofouling control using microparticles carrying a biocide.

    Science.gov (United States)

    Ferreira, C; Rosmaninho, R; Simoes, M; Pereira, M C; Bastos, M M S M; Nunes, O C; Coelho, M; Melo, L F

    2010-01-01

    This study presents a new technological approach to minimize the use of antimicrobial (AMB) agents and their deleterious effects, based on the principle of drug-delivery systems whereby the AMB chemicals are transported on microparticles. The efficacy of microparticles carrying the quaternary ammonium compound (QAC), benzyldimethyldodecyl ammonium chloride (BDMDAC), was assessed against Pseudomonas fluorescens in both the planktonic and the biofilm state. The microparticles were prepared using a layer-by-layer (LBL) self-assembly technique. Oppositely charged molecules of polyethyleneimine (PEI), sodium polystyrene sulfonate (PSS), and BDMDAC were assembled on polystyrene (PS) cores. BDMDAC-coated particles were observed by CryoSEM and their composition analyzed by X-ray microanalysis. Zeta potential measurements indicated that changes in surface charge were compatible with a BDMDAC/particle interaction. This biocidal carrier structure had significant stability, verified by the release of only 15% of the BDMDAC when immersed in water for 18 months. Biocidal carrier activity was evaluated by determining the survival ratio of P. fluorescens planktonic and biofilm cells after different exposure periods to BDMDAC-coated particles. Tests with biofilm cells were also performed with the free QAC. An efficient AMB effect (minimum bactericidal concentration) against suspended cells was found for a concentration of 9.2 mg l(-1) of BDMDAC on coated particles after incubation for 30 min and 6.5 mg l(-1) of BDMDAC on coated particles after 60 min. Exposure of biofilms to PS-PEI/PSS/BDMDAC (0.87 mg l(-1)) resulted in a decrease in viability of 60.5% and 66.5% of the total biofilm population for 30 and 60 min exposure times, respectively. Exposure for 60 min to 6.33 mg l(-1) and 11.75 mg l(-1) of BDMDAC in PS-PEI/PSS/BDMDAC particles promoted inactivation of 80.6% and 87.2% of the total population, respectively. The AMB effects obtained with the application of free BDMDAC were

  12. Risk models for patients with localised renal cell carcinoma.

    Science.gov (United States)

    Velis, J M; Ancizu, F J; Hevia, M; Merino, I; García, A; Doménech, P; Algarra, R; Tienza, A; Pascual, J I; Robles, J E

    2017-11-01

    We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. BRCA1 and BRCA2 mutation predictions using the BRCAPRO and Myriad models in Korean ovarian cancer patients.

    Science.gov (United States)

    Eoh, Kyung Jin; Park, Ji Soo; Park, Hyung Seok; Lee, Seung-Tae; Han, Jeongwoo; Lee, Jung-Yun; Kim, Sang Wun; Kim, Sunghoon; Kim, Young Tae; Nam, Eun Ji

    2017-04-01

    To evaluate the predictive efficacies including sensitivity and positive predictive value of the genetic risk prediction model BRCAPRO and the Myriad BRCA risk calculator in Korean ovarian cancer patients. Individuals undergoing genetic testing for BRCA mutations from November 2010-August 2016 were recruited from the Department of Obstetrics and Gynecology at a single institute in Korea. The observed BRCA1 and BRCA2 mutation statuses were compared with the predicted carrier probabilities using BRCAPRO and the Myriad BRCA risk calculator. Two hundred thirty-two patients were recruited, of whom 99.1% (230/232) were of Korean ethnicity. Of the 232 individuals, 206 and 26 had ovarian and double primary breast/ovarian cancer, respectively. Thirty-six individuals had a family history of breast/ovarian cancer in first-degree relatives. Fifty-seven patients (24.6%) tested positive for BRCA mutation (41 BRCA1, 16 BRCA2). The mean BRCAPRO and Myriad scores for all patients were 6.4% and 7.7%, respectively. The scores were significantly higher for patients with positive BRCA mutation status (29.0% vs. 6.1%, Pmodels to predict the risk of carrying a BRCA mutation. Both models overestimated the mutation probability in patients with a family history of breast/ovarian cancer (1.55-fold and 1.50-fold, respectively) and underestimated the probability in patients without a family history (both, 0.54-fold). BRCAPRO and Myriad seem to be acceptable risk assessment tools for determining the risk of carrying BRCA mutations in Korean ovarian cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Patient-Specific Deep Architectural Model for ECG Classification

    Directory of Open Access Journals (Sweden)

    Kan Luo

    2017-01-01

    Full Text Available Heartbeat classification is a crucial step for arrhythmia diagnosis during electrocardiographic (ECG analysis. The new scenario of wireless body sensor network- (WBSN- enabled ECG monitoring puts forward a higher-level demand for this traditional ECG analysis task. Previously reported methods mainly addressed this requirement with the applications of a shallow structured classifier and expert-designed features. In this study, modified frequency slice wavelet transform (MFSWT was firstly employed to produce the time-frequency image for heartbeat signal. Then the deep learning (DL method was performed for the heartbeat classification. Here, we proposed a novel model incorporating automatic feature abstraction and a deep neural network (DNN classifier. Features were automatically abstracted by the stacked denoising auto-encoder (SDA from the transferred time-frequency image. DNN classifier was constructed by an encoder layer of SDA and a softmax layer. In addition, a deterministic patient-specific heartbeat classifier was achieved by fine-tuning on heartbeat samples, which included a small subset of individual samples. The performance of the proposed model was evaluated on the MIT-BIH arrhythmia database. Results showed that an overall accuracy of 97.5% was achieved using the proposed model, confirming that the proposed DNN model is a powerful tool for heartbeat pattern recognition.

  15. [Preoperative predictive model for biochemical recurrence in patients with localized prostate cancer treated with radical prostatectomy].

    Science.gov (United States)

    Molina Escudero, Roberto; Herranz Amo, Felipe; Paez Borda, Alvaro; Hernández Fernández, Carlos

    2013-01-01

    To identify pre-prostatectomy clinical prognostic factors for biochemical recurrence (BR) and to create a predictive model for BR based or predictive clinical variables prior to radical prostatectomy (RP). a retrospective case-records study of patients with clinically localized prostate cancer treated with RPas monotherapy pN0-pNx and monitored at least for 12 months between 1996 and 2007. We considered BR the PSA persistence or elevation after RP greater than 0.4 ng/ml. The clinical variables analyzed were PSA, clinical stage and Gleason score from the biopsy (GS). Univariate and multivariate analysis were carried out using the chi squared test and logistic regression to determine the variables associated with BR. In order to estimate BR based on the variables identified we developed a mathematical model and designed an Excel spreadsheet to apply it. Calibration and discrimination were performed using the Hosmer-Lemeshow test and an ROC curve determining the area under the curve. We included 627 patients. The mean age was 64 years with a mean follow- up of 87 months. The mean PSA was 8 ng/ml. 68.6% of patients had a PSA ≤ 10 ng/ml, 53,1% had a GS ≤ 6 and 61,7% had a clinical stage of cT1a-c. BR was observed in 204 (32,5%) patients, 39 due to biochemical persistence. The mean time to BR was 28 months with 89,7% of instances occurring in the first 8 years. On the multivariate analysis, PSA and GS were independent predictors of BR ( p=0.001), while the cT2c stage had a tendency towards statistical significance ( p=0.06). The three variables were included in the equation for the model with different specific weight. Specificity was 93.6%, sensitivity was 36.8% and an overall precision of 75.1%. The model had a predictive capacity of 73% and a p-value < 0.001. PSA and GS are independent prognostic clinical variables associated with BR-free survival. The predictive model developed allows the risk of BR to be estimated with 73% reliability.

  16. Nonlinear vibration of an axially loaded beam carrying rigid bodies

    Directory of Open Access Journals (Sweden)

    O. Barry

    2016-12-01

    Full Text Available This paper investigates the nonlinear vibration due to mid-plane stretching of an axially loaded simply supported beam carrying multiple rigid masses. Explicit expressions and closed form solutions of both linear and nonlinear analysis of the present vibration problem are presented for the first time. The validity of the analytical model is demonstrated using finite element analysis and via comparison with the result in the literature. Parametric studies are conducted to examine how the nonlinear frequency and frequency response curve are affected by tension, rotational inertia, and number of intermediate rigid bodies.

  17. Personalized predictive modeling for patients with Alzheimer's disease using an extension of Sullivan's life table model.

    Science.gov (United States)

    Stallard, Eric; Kinosian, Bruce; Stern, Yaakov

    2017-09-20

    Alzheimer's disease (AD) progression varies substantially among patients, hindering calculation of residual total life expectancy (TLE) and its decomposition into disability-free life expectancy (DFLE) and disabled life expectancy (DLE) for individual patients with AD. The objective of the present study was to assess the accuracy of a new synthesis of Sullivan's life table (SLT) and longitudinal Grade of Membership (L-GoM) models that estimates individualized TLEs, DFLEs, and DLEs for patients with AD. If sufficiently accurate, such information could enhance the quality of important decisions in AD treatment and patient care. We estimated a new SLT/L-GoM model of the natural history of AD over 10 years in the Predictors 2 Study cohort: N = 229 with 6 fixed and 73 time-varying covariates over 21 examinations covering 11 measurement domains including cognitive, functional, behavioral, psychiatric, and other symptoms/signs. Total remaining life expectancy was censored at 10 years. Disability was defined as need for full-time care (FTC), the outcome most strongly associated with AD progression. All parameters were estimated via weighted maximum likelihood using data-dependent weights designed to ensure that the estimates of the prognostic subtypes were of high quality. Goodness of fit was tested/confirmed for survival and FTC disability for five relatively homogeneous subgroups defined to cover the range of patient outcomes over the 21 examinations. The substantial heterogeneity in initial patient presentation and AD progression was captured using three clinically meaningful prognostic subtypes and one terminal subtype exhibiting highly differentiated symptom severity on 7 of the 11 measurement domains. Comparisons of the observed and estimated survival and FTC disability probabilities demonstrated that the estimates were accurate for all five subgroups, supporting their use in AD life expectancy calculations. Mean 10-year TLE differed widely across subgroups

  18. Multiscale modeling and surgical planning for single ventricle heart patients

    Science.gov (United States)

    Marsden, Alison

    2011-11-01

    Single ventricle heart patients are among the most challenging for pediatric cardiologists to treat, and typically undergo a palliative course of three open-heart surgeries starting immediately after birth. We will present recent tools for modeling blood flow in single ventricle heart patients using a multiscale approach that couples a 3D Navier-Stokes domain to a 0D closed loop lumped parameter network comprised of circuit elements. This coupling allows us to capture the effect of changes in local geometry, such as shunt sizes, on global circulatory dynamics, such as cardiac output. A semi-implicit numerical method is formulated to solve the coupled system in which flow and pressure information is passed between the two domains at the inlets and outlets of the model. A finite element method with outflow stabilization is applied in the 3D Navier-Stokes domain, and the LPN system of ordinary differential equations is solved numerically using a Runge-Kutta method. These tools are coupled via automated scripts to a derivative-free optimization method. Optimization is used to systematically explore surgical designs using clinically relevant cost functions for two stages of single ventricle repair. First, we will present results from optimization of the first stage Blalock Taussig Shunt. Second, we will present results from optimization of a new Y-graft design for the third stage of single ventricle repair called the Fontan surgery. The Y-graft is shown, in simulations, to successfully improve hepatic flow distribution, a known clinical problem. Preliminary clinical experience with the Y-graft will be discussed.

  19. Leader communication approaches and patient safety: An integrated model.

    Science.gov (United States)

    Mattson, Malin; Hellgren, Johnny; Göransson, Sara

    2015-06-01

    Leader communication is known to influence a number of employee behaviors. When it comes to the relationship between leader communication and safety, the evidence is more scarce and ambiguous. The aim of the present study is to investigate whether and in what way leader communication relates to safety outcomes. The study examines two leader communication approaches: leader safety priority communication and feedback to subordinates. These approaches were assumed to affect safety outcomes via different employee behaviors. Questionnaire data, collected from 221 employees at two hospital wards, were analyzed using structural equation modeling. The two examined communication approaches were both positively related to safety outcomes, although leader safety priority communication was mediated by employee compliance and feedback communication by organizational citizenship behaviors. The findings suggest that leader communication plays a vital role in improving organizational and patient safety and that different communication approaches seem to positively affect different but equally essential employee safety behaviors. The results highlights the necessity for leaders to engage in one-way communication of safety values as well as in more relational feedback communication with their subordinates in order to enhance patient safety. Copyright © 2015 Elsevier Ltd. and National Safety Council. Published by Elsevier Ltd. All rights reserved.

  20. ”How do the patients and their close relatives experience The Coordinated Investigation Model of Dementia in the North Denmark Region?”

    DEFF Research Database (Denmark)

    Hulgaard, Hanne; Ottesen, Aase Marie

    How do the patients and their close relatives experience The Coordinated Investigation Model of Dementia in the North Denmark Region? The aim of the project was to investigate how the patients and their close relatives experienced the investigation and the subsequent social medicine intervention......, and to give recommendations based on the results. The project is based on qualitative interviews with 11 families. Background The Coordinated Investigation Model of Dementia implies that the primary investigation is carried out in the primary sector by a general practitioner in cooperation with a local...... dementia nurse in accordance to a specified procedure. Further investigation may hereafter be carried out by specialists in the secondary sector. Especially after The Coordinated Investigation Model was evaluated in 2005 and found useful from a professional point of view, we found it relevant...

  1. Wall Shear Stress Distribution in a Patient-Specific Cerebral Aneurysm Model using Reduced Order Modeling

    Science.gov (United States)

    Han, Suyue; Chang, Gary Han; Schirmer, Clemens; Modarres-Sadeghi, Yahya

    2016-11-01

    We construct a reduced-order model (ROM) to study the Wall Shear Stress (WSS) distributions in image-based patient-specific aneurysms models. The magnitude of WSS has been shown to be a critical factor in growth and rupture of human aneurysms. We start the process by running a training case using Computational Fluid Dynamics (CFD) simulation with time-varying flow parameters, such that these parameters cover the range of parameters of interest. The method of snapshot Proper Orthogonal Decomposition (POD) is utilized to construct the reduced-order bases using the training CFD simulation. The resulting ROM enables us to study the flow patterns and the WSS distributions over a range of system parameters computationally very efficiently with a relatively small number of modes. This enables comprehensive analysis of the model system across a range of physiological conditions without the need to re-compute the simulation for small changes in the system parameters.

  2. Factors affecting patients' online health information-seeking behaviours: The role of the Patient Health Engagement (PHE) Model.

    Science.gov (United States)

    Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Riva, Giuseppe

    2017-10-01

    To identify the variables affecting patients' online health information-seeking behaviours by examining the relationships between patient participation in their healthcare and online health information-seeking behaviours. A cross-sectional survey of Italian chronic patients (N=352) was conducted on patient's online health information-seeking behaviours and patient participation-related variables. Structural equation modeling analysis was conducted to test the hypothesis. This study showed how the healthcare professionals' ability to support chronic patients' autonomy affect patients' participation in their healthcare and patient's online health information-seeking behaviours. However, results do not confirm that the frequency of patients' online health-information seeking behavior has an impact on their adherence to medical prescriptions. Assuming a psychosocial perspective, we have discussed how patients' engagement - conceived as the level of their emotional elaboration of the health condition - affects the patients' ability to search for and manage online health information. To improve the effectiveness of patients' online health information-seeking behaviours and to enhance the effectiveness of technological interventions in this field, healthcare providers should target assessing and improving patient engagement and patient empowerment in their healthcare. It is important that health professionals acknowledge patients' online health information-seeking behaviours that they discuss the information offered by patients and guide them to reliable and accurate web sources. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Emergence of Klebsiella pneumoniae ST273 Carrying blaNDM-7and ST656 Carrying blaNDM-1in Manila, Philippines.

    Science.gov (United States)

    Chou, Andrew; Roa, Marylette; Evangelista, Michael A; Sulit, Arielle Kae; Lagamayo, Evelina; Torres, Brian C; Klinzing, David C; Daroy, Maria Luisa G; Navoa-Ng, Josephine; Sucgang, Richard; Zechiedrich, Lynn

    2016-10-01

    We sought to determine the epidemiology of carbapenem-resistant Enterobacteriaceae and to investigate the emergence of carbapenem-resistant Klebsiella pneumoniae in two teaching hospitals in Manila, Philippines. We screened 364 Enterobacteriaceae for carbapenem resistance between 2012 and 2013 and detected four carbapenem-resistant K. pneumoniae isolates from three different patients. We used whole genome sequencing to determine the antibiotic resistance profiles and confirmed the presence of carbapenemase genes by multiplex PCR. We used multilocus sequence typing and PCR-based replicon typing to genetically characterize the carbapenem-resistant isolates. The carbapenemase gene bla NDM was detected in K. pneumoniae isolates from two patients. The first patient had ventilator-associated pneumonia and lumbar shunt infection from K. pneumoniae ST273 carrying bla NDM-7 . The second patient had asymptomatic genitourinary colonization with K. pneumoniae ST656 carrying bla NDM-1 . The third patient had a gluteal abscess with K. pneumoniae ST1 that did not carry a carbapenemase gene, but did carry bla DHA-1 , bla OXA-1 , and bla SHV-1 . In this study, we report the first cases of bla NDM -carrying pathogens in the Philippines and add to the growing evidence of the worldwide spread of ST273 and NDM-7, a more efficient carbapenem hydrolyzer than NDM-1.

  4. Performance of Disease-Specific Scoring Models in Intensive Care Patients with Severe Liver Diseases.

    Science.gov (United States)

    El-Ghannam, Maged T; Hassanien, Moataz H; El-Talkawy, Mohamed D; Saleem, Abdel Aziz A; Sabry, Amal I; Abu Taleb, Hoda M

    2017-06-01

    Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt's annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources. Over one year, a total of 777 patients with End Stage Liver Disease (ESLD) due to HCV infection were included in this retrospective non-randomized human study. All statistical analyses were performed by the statistical software SPSS version 22.0 (SPSS, Chicago, IL, USA). Child Turcotte Pugh (CTP) score, MELD score, MELD-Na, MESO, iMELD, Refit MELD and Refit MELD-Na were calculated on ICU admission. ICU admission was mainly due to Gastrointestinal (GI) bleeding and Hepatic Encephalopathy (HE). Overall mortality was 27%. Age and sex showed no statistical difference between survivors and non survivors. Significantly higher mean values were observed for all models among individuals who died compared to survivors. MELD-Na was the most specific compared to the other scores. MELD-Na was highly predictive of mortality at an optimized cut-off value of 20.4 (AURC=0.789±0.03-CI 95%=0.711-0.865) while original MELD was highly predictive of mortality at an optimized cut-off value of 17.4 (AURC=0.678±0.01-CI 95%=0.613-0.682) denoting the importance of adding serum sodium to the original MELD. INR, serum creatinine, bilirubin, white blood cells count and hyponatremia were significantly higher in non survivors compared to survivors, while hypoalbuminemia showed no statistical difference. The advent of Hepatorenal Syndrome (HRS) and Spontaneous

  5. Validation of existing prognostic models in patients with early-stage cervical cancer

    NARCIS (Netherlands)

    Biewenga, Petra; van der Velden, Jacobus; Mol, Ben Willem J.; Stalpers, Lukas J. A.; Schilthuis, Marten S.; van der Steeg, Jan Willem; Burger, Matthé P. M.; Buist, Marrije R.

    2009-01-01

    Objective. Models that predict survival and recurrence in patients with early-stage cervical cancer are important tools in patient management, We validated 12 existing prognostic models in an independent population of patients with early-stage cervical cancer. Materials and Methods. We searched the

  6. Complicações pós-operatórias precoces de trabeculectomia com mitomicina, em pacientes portadores de glaucoma primário de ângulo aberto Precocious postoperative complications of mitomicina trabeculectomy, in carrying patients with primary open angle glaucoma

    Directory of Open Access Journals (Sweden)

    Gustavvo Carneiro Vilasboas Gutemberg

    2010-04-01

    ção, diminuindo assim a morbidade e a chance de falência cirúrgica a longo prazo.OBJECTIVE: To evaluate the joined precocious complications in surgeries of mitomycin trabeculectomy, carried through in residence service-school, aiming at better perfectioning in the technique and postoperative accompaniment of the patients. METHODS: Retrospective study by means of record analysis. The patients evaluated amount sex, age and race. Was included patients with primary of angle open glaucoma and submitted the mitomycin trabeculectomy. A total of 43 patients had been analyzed, 25 were male and 18 female; 19 were black, and the age ranged of 51 the 82 years (average 68 years. The patients were evaluated in first and seventh postoperative days, or if necessary before first week. The complications in had been registered it and were: bleb leaking, shallow anterior chamber, atalamy; hifema, choroidal detachment. RESULTS: The age average was of 68 years, 58.1% of the patients (25 in the total was male and 44.1% were black. The Bleb leaking was the most frequent complication, representing 25.56% of surgeries and 36.66% of all the complications (11 patients. Shallow anterior chamber was observed in 17.5% of surgeries and 22.5% of complications (seven patients. Choroidal detachment was present in 14.6% of patients and 19.3% of the complications in 1a week ( seven patients. Atalamy was found in three patients, represented of 6.97% of patients and 9.67% of the complications. Hifema also was observed in three patients, being all found they in the Immediate Postoperative CONCLUSION: The frequency of complications found in this work this inside of the limits observed in literature. Quantify the percentage of postoperative complications during the first week is of fundamental importance for improvements in intra operative and standardization of the behaviors front to each complication, standardization of behavior in response to each complication, thus reducing the morbidity and chance of surgical

  7. Necking down of sausages in current-carrying plasma pinches

    Energy Technology Data Exchange (ETDEWEB)

    Trubnikov, B.A.; Zhdanov, S.K.

    1986-07-01

    The evolution of long-wave perturbations is shown to be equivalent, for various unstable media, to the dynamics of a gas with a negative adiabatic index ..gamma... This evolution is described (for various values at N) by the quasi-Chaplygin system of equations Several examples of such media are considered, including a ''Chaplygin gas'' (N = 3), drops on a ceiling or ''solitons which have broken'' (N = 0), necks in a current-carrying plasma pinch with a skin effect, for both incompressible and compressible models (N = 2), and the breakup of liquid jets into drops (N = 3/2). A principle for selecting evolutionary solutions corresponding to the absence of perturbations in the limit t ..-->.. -infinity is formulated. In the cases N = 0 and N = 2, a hodograph transformation reduces system (1) to a magnetostatic equation (..delta..A)/sub phi/ = -(4..pi../c)j/sub phi/ and all the instability modes are equivalent to multipoles of circular currents which are localized on a circle. Exact solutions are given for periodic and isolated (localized) perturbations. The breakup of a medium into distinct blobs, in particular, the rupture of necks in a current-carrying plasma pinch, is demonstrated.

  8. Necking down of sausages in current-carrying plasma pinches

    International Nuclear Information System (INIS)

    Trubnikov, B.A.; Zhdanov, S.K.

    1986-01-01

    The evolution of long-wave perturbations is shown to be equivalent, for various unstable media, to the dynamics of a gas with a negative adiabatic index γ. This evolution is described (for various values at N) by the quasi-Chaplygin system of equations Several examples of such media are considered, including a ''Chaplygin gas'' (N = 3), drops on a ceiling or ''solitons which have broken'' (N = 0), necks in a current-carrying plasma pinch with a skin effect, for both incompressible and compressible models (N = 2), and the breakup of liquid jets into drops (N = 3/2). A principle for selecting evolutionary solutions corresponding to the absence of perturbations in the limit t → -∞ is formulated. In the cases N = 0 and N = 2, a hodograph transformation reduces system (1) to a magnetostatic equation (ΔA)/sub phi/ = -(4π/c)j/sub phi/ and all the instability modes are equivalent to multipoles of circular currents which are localized on a circle. Exact solutions are given for periodic and isolated (localized) perturbations. The breakup of a medium into distinct blobs, in particular, the rupture of necks in a current-carrying plasma pinch, is demonstrated

  9. Usefulness Of Three-Dimensional Printing Models for Patients with Stoma Construction

    OpenAIRE

    Tominaga, Tetsuro; Takagi, Katsunori; Takeshita, Hiroaki; Miyamoto, Tomo; Shimoda, Kozue; Matsuo, Ayano; Matsumoto, Keitaro; Hidaka, Shigekazu; Yamasaki, Naoya; Sawai, Terumitsu; Nagayasu, Takeshi

    2016-01-01

    The use of patient-specific organ models in three-dimensional printing systems could be helpful for the education of patients and medical students. The aim of this study was to clarify whether the use of patient-specific stoma models is helpful for patient education. From January 2014 to September 2014, 5 patients who underwent colorectal surgery and for whom a temporary or permanent stoma had been created were involved in this study. Three-dimensional stoma models and three-dimensional face ...

  10. Predicting stretcher carriage: Investigating variations in bilateral carry tests.

    Science.gov (United States)

    Beck, Ben; Middleton, Kane J; Carstairs, Greg L; Billing, Daniel C; Caldwell, Joanne N

    2016-07-01

    Carrying a casualty on a stretcher is a critical task within military and emergency service occupations. This study evaluated the impact of manipulating carry speed and the object type in bilateral carries on the ability to predict performance and reflect the physical and physiological requirements of a unilateral stretcher carry. We demonstrated that three task-related predictive tests; a jerry can carry performed at 4.5 km h(-1)or 5.0 km h(-1) and a kettle-bell carry performed at 5.0 km h(-1) were strongly predictive of the physical and physiological demands of an individual participating as part of a four-person stretcher carry team. Therefore, bilateral predictive assessments have the utility for predicting the suitability of employees to effectively and safely conduct a four-person unilateral stretcher carry. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  11. Complicações dos estomas em câncer colorretal: revisão de 21 complicações em 276 estomas realizados em 870 pacientes portadores de câncer colorretal Complications of stomas in colorectal cancer: review of 21 complications in 276 stomas carried out in 870 patients with colorectal cancer

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Gomes da Cruz

    2008-03-01

    of the anus. In 490 cases (53.1% cancer were localized in the colon and in 380 (41.2% in the rectum. The aim of this report is to study these 870 patients bearing colorectal cancer analyzing, specially, the 276 stomas carried out (31.7%, classifying them in temporary and definitive, describing their modalities and indications as well as their complications and surgical techniques used to approach them. Operability rate was 98.1% (853 patients, being 90.6% (778 patients the incidence of resected tumors. The most used surgical techniques to approach the disease were abdominal colon resection with anastomoses (617 cases, 70.9% and abdominoperineal resection (15.5%. Stomas were made in 276 patients (31.7%, being 73 temporary (8.4% and 203 definitive (23.3%. End colostomy was the most common type of stoma carried out (181 cases, 21.2%. Loop ileostomy was the most common temporary stoma (33 cases, 3.9% and end colostomy the most common definitive stoma (156 cases, 18.3%. Incidence of complications was 7.6% (21 cases, and loop colostomy and loop ileostomy the stomas with the highest incidence of complications: 9.1% each. End ileostomy did not show any complication. The most frequent complication was stoma prolapse (six cases, necrosis (five cases and stenosis (five cases. The main procedures for surgical approach were pericolostomy incision with correction of the stoma (12 cases and laparotomy and colectomy making a new stoma (five cases.

  12. External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites.

    Science.gov (United States)

    Guardiola, Jordi; Baliellas, Carme; Xiol, Xavier; Fernandez Esparrach, Glòria; Ginès, Pere; Ventura, Pere; Vazquez, Santiago

    2002-09-01

    Cirrhotic patients with refractory ascites (RA) have a poor prognosis, although individual survival varies greatly. A model that could predict survival for patients with RA would be helpful in planning treatment. Moreover, in cases of potential liver transplantation, a model of these characteristics would provide the bases for establishing priorities of organ allocation and the selection of patients for a living donor graft. Recently, we developed a model to predict survival of patients with RA. The aim of this study was to establish its generalizability for predicting the survival of patients with RA. The model was validated by assessing its performance in an external cohort of patients with RA included in a multicenter, randomized, controlled trial that compared large-volume paracentesis and peritoneovenous shunt. The values for actual and model-predicted survival of three risk groups of patients, established according to the model, were compared graphically and by means of the one-sample log-rank test. The model provided a very good fit to the survival data of the three risk groups in the validation cohort. We also found good agreement between the survival predicted from the model and the observed survival when patients treated with peritoneovenous shunt and with paracentesis were considered separately. Our survival model can be used to predict the survival of patients with RA and may be a useful tool in clinical decision making, especially in deciding priority for liver transplantation.

  13. Estimation and Determination of Carrying Capacity in Loblolly Pine

    OpenAIRE

    Yang, Sheng-I

    2016-01-01

    Stand carrying capacity is the maximum size of population for a species under given environmental conditions. Site resources limit the maximum volume or biomass that can be sustained in forest stands. This study was aimed at estimating and determining the carrying capacity in loblolly pine. Maximum stand basal area (BA) that can be sustained over a long period of time can be regarded as a measure of carrying capacity. To quantify and project stand BA carrying capacity, one approach is to use ...

  14. 46 CFR 111.105-35 - Vessels carrying coal.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Vessels carrying coal. 111.105-35 Section 111.105-35...-GENERAL REQUIREMENTS Hazardous Locations § 111.105-35 Vessels carrying coal. (a) The following are Class II, Division 1, (Zone 10 or Z) locations on a vessel that carries coal: (1) The interior of each coal...

  15. An integrative model of patient-centeredness - a systematic review and concept analysis.

    Directory of Open Access Journals (Sweden)

    Isabelle Scholl

    Full Text Available Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results.Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness.4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59% contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care.The proposed integrative model of patient-centeredness allows different stakeholders to speak

  16. From Finite Element Meshes to Clouds of Points: A Review of Methods for Generation of Computational Biomechanics Models for Patient-Specific Applications.

    Science.gov (United States)

    Wittek, Adam; Grosland, Nicole M; Joldes, Grand Roman; Magnotta, Vincent; Miller, Karol

    2016-01-01

    It has been envisaged that advances in computing and engineering technologies could extend surgeons' ability to plan and carry out surgical interventions more accurately and with less trauma. The progress in this area depends crucially on the ability to create robustly and rapidly patient-specific biomechanical models. We focus on methods for generation of patient-specific computational grids used for solving partial differential equations governing the mechanics of the body organs. We review state-of-the-art in this area and provide suggestions for future research. To provide a complete picture of the field of patient-specific model generation, we also discuss methods for identifying and assigning patient-specific material properties of tissues and boundary conditions.

  17. Patient-centred management in idiopathic pulmonary fibrosis: similar themes in three communication models.

    Science.gov (United States)

    Wuyts, Wim A; Peccatori, Fedro A; Russell, Anne-Marie

    2014-06-01

    The progressive and highly variable course of idiopathic pulmonary fibrosis (IPF) can present patients and their families with various challenges at different points of the disease. Structured communication between the healthcare professional and the patient is vital to ensure the best possible support and treatment for the patient. While research in this area has been limited, an increasing number of studies are emerging that support the role of communication in patients with debilitating and fatal lung diseases. Communication models used in other conditions that share many challenges with IPF, such as cancer, provide important insights for developing specifically designed patient support and communications models in IPF. Three communication models will be described: 1) the patient-centred care model (for oncology); 2) the three pillars of care model (for IPF); and 3) the Brompton model of care (for interstitial lung disease). Themes common to all three models include comprehensive patient education, encouraged patient participation and an accessible healthcare system, all supported by a collaborative provider-patient relationship. The development of effective communication skills is an on-going process and it is recommended to examine communication models used in other chronic diseases. ©ERS 2014.

  18. Effect of Da-Cheng-Qi Decoction on Pancreatitis-Associated Intestinal Dysmotility in Patients and in Rat Models

    Directory of Open Access Journals (Sweden)

    Jianlei Zhao

    2015-01-01

    Full Text Available The impairment of intestinal motility and related infectious complications are the predominant clinical phenomenon in patients with severe acute pancreatitis (SAP. We aimed to investigate the effects of Da-Cheng-Qi decoction (DCQD on the gastrointestinal injury in SAP patients and the potential mechanism involved in rats. DCQD was enema administered to 70 patients for 7 days in West China Hospital. Mortality and organ failure during admission were observed and blood samples for laboratory analysis were collected. We also experimentally examined plasma inflammatory cytokines in rat serum and carried the morphometric studies of the gut. Intestinal propulsion index and serum and tissue vasoactive intestinal peptide (VIP were also detected. Though DCQD did not affect the overall incidence of organ failure, it shortened the average time of paralytic intestinal obstruction and decreased the morbidity of infectious complications in patients with SAP. Compared with untreated rats, the DCQD lowered the levels of proinflammatory cytokine and decreased the mean pathological intestinal lesion scores. The VIP level in intestinal tissue or serum in DCQD group was obviously lowered and intestinal propulsion index was significantly improved. In conclusion, DCQD has good effect on pancreatitis-associated intestinal dysmotility in patients and in rat models.

  19. Effect of da-cheng-qi decoction on pancreatitis-associated intestinal dysmotility in patients and in rat models.

    Science.gov (United States)

    Zhao, Jianlei; Zhong, Cejun; He, Zhiyu; Chen, Guangyuan; Tang, Wenfu

    2015-01-01

    The impairment of intestinal motility and related infectious complications are the predominant clinical phenomenon in patients with severe acute pancreatitis (SAP). We aimed to investigate the effects of Da-Cheng-Qi decoction (DCQD) on the gastrointestinal injury in SAP patients and the potential mechanism involved in rats. DCQD was enema administered to 70 patients for 7 days in West China Hospital. Mortality and organ failure during admission were observed and blood samples for laboratory analysis were collected. We also experimentally examined plasma inflammatory cytokines in rat serum and carried the morphometric studies of the gut. Intestinal propulsion index and serum and tissue vasoactive intestinal peptide (VIP) were also detected. Though DCQD did not affect the overall incidence of organ failure, it shortened the average time of paralytic intestinal obstruction and decreased the morbidity of infectious complications in patients with SAP. Compared with untreated rats, the DCQD lowered the levels of proinflammatory cytokine and decreased the mean pathological intestinal lesion scores. The VIP level in intestinal tissue or serum in DCQD group was obviously lowered and intestinal propulsion index was significantly improved. In conclusion, DCQD has good effect on pancreatitis-associated intestinal dysmotility in patients and in rat models.

  20. Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model.

    Science.gov (United States)

    Moore, Jennifer E; Titler, Marita G; Kane Low, Lisa; Dalton, Vanessa K; Sampselle, Carolyn M

    2015-01-01

    In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process. Published by Elsevier Inc.

  1. Generating unique IDs from patient identification data using security models.

    Science.gov (United States)

    Mohammed, Emad A; Slack, Jonathan C; Naugler, Christopher T

    2016-01-01

    The use of electronic health records (EHRs) has continued to increase within healthcare systems in the developed and developing nations. EHRs allow for increased patient safety, grant patients easier access to their medical records, and offer a wealth of data to researchers. However, various bioethical, financial, logistical, and information security considerations must be addressed while transitioning to an EHR system. The need to encrypt private patient information for data sharing is one of the foremost challenges faced by health information technology. We describe the usage of the message digest-5 (MD5) and secure hashing algorithm (SHA) as methods for encrypting electronic medical data. In particular, we present an application of the MD5 and SHA-1 algorithms in encrypting a composite message from private patient information. The results show that the composite message can be used to create a unique one-way encrypted ID per patient record that can be used for data sharing. The described software tool can be used to share patient EMRs between practitioners without revealing patients identifiable data.

  2. Improving Patient Flow Utilizing a Collaborative Learning Model.

    Science.gov (United States)

    Tibor, Laura C; Schultz, Stacy R; Cravath, Julie L; Rein, Russell R; Krecke, Karl N

    2016-01-01

    This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague.

  3. Usefulness Of Three-Dimensional Printing Models for Patients with Stoma Construction

    Directory of Open Access Journals (Sweden)

    Tetsuro Tominaga

    2016-04-01

    Full Text Available The use of patient-specific organ models in three-dimensional printing systems could be helpful for the education of patients and medical students. The aim of this study was to clarify whether the use of patient-specific stoma models is helpful for patient education. From January 2014 to September 2014, 5 patients who underwent colorectal surgery and for whom a temporary or permanent stoma had been created were involved in this study. Three-dimensional stoma models and three-dimensional face plates were created. The patients’ ages ranged from 59 to 81 years. Four patients underwent stoma construction because of rectal cancer, and 1 underwent stoma construction because of colon stenosis secondary to recurrent cancer. All patients were educated about their stoma and potential stoma-associated problems using three-dimensional stoma models, and all practiced cutting face plates using three-dimensional face plates. The models were also used during medical staff conferences to discuss current issues. All patients understood their problems and finally became self-reliant. The recent availability of three-dimensional printers has enabled the creation of many organ models, and full-scale stoma and face plate models are now available for patient education on cutting an appropriately individualized face plate. Thus, three-dimensional printers could enable fewer skin problems than are currently associated with daily stomal care.

  4. Methods to assess performance of models estimating risk of death in intensive care patients: a review.

    Science.gov (United States)

    Cook, D A

    2006-04-01

    Models that estimate the probability of death of intensive care unit patients can be used to stratify patients according to the severity of their condition and to control for casemix and severity of illness. These models have been used for risk adjustment in quality monitoring, administration, management and research and as an aid to clinical decision making. Models such as the Mortality Prediction Model family, SAPS II, APACHE II, APACHE III and the organ system failure models provide estimates of the probability of in-hospital death of ICU patients. This review examines methods to assess the performance of these models. The key attributes of a model are discrimination (the accuracy of the ranking in order of probability of death) and calibration (the extent to which the model's prediction of probability of death reflects the true risk of death). These attributes should be assessed in existing models that predict the probability of patient mortality, and in any subsequent model that is developed for the purposes of estimating these probabilities. The literature contains a range of approaches for assessment which are reviewed and a survey of the methodologies used in studies of intensive care mortality models is presented. The systematic approach used by Standards for Reporting Diagnostic Accuracy provides a framework to incorporate these theoretical considerations of model assessment and recommendations are made for evaluation and presentation of the performance of models that estimate the probability of death of intensive care patients.

  5. A Baseline Patient Model to Support Testing of Medical Cyber-Physical Systems.

    Science.gov (United States)

    Silva, Lenardo C; Perkusich, Mirko; Almeida, Hyggo O; Perkusich, Angelo; Lima, Mateus A M; Gorgônio, Kyller C

    2015-01-01

    Medical Cyber-Physical Systems (MCPS) are currently a trending topic of research. The main challenges are related to the integration and interoperability of connected medical devices, patient safety, physiologic closed-loop control, and the verification and validation of these systems. In this paper, we focus on patient safety and MCPS validation. We present a formal patient model to be used in health care systems validation without jeopardizing the patient's health. To determine the basic patient conditions, our model considers the four main vital signs: heart rate, respiratory rate, blood pressure and body temperature. To generate the vital signs we used regression models based on statistical analysis of a clinical database. Our solution should be used as a starting point for a behavioral patient model and adapted to specific clinical scenarios. We present the modeling process of the baseline patient model and show its evaluation. The conception process may be used to build different patient models. The results show the feasibility of the proposed model as an alternative to the immediate need for clinical trials to test these medical systems.

  6. Model-based optimal PEEP in mechanically ventilated ARDS patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Sundaresan Ashwath

    2011-07-01

    Full Text Available Abstract Background The optimal level of positive end-expiratory pressure (PEEP is still widely debated in treating acute respiratory distress syndrome (ARDS patients. Current methods of selecting PEEP only provide a range of values and do not provide unique patient-specific solutions. Model-based methods offer a novel way of using non-invasive pressure-volume (PV measurements to estimate patient recruitability. This paper examines the clinical viability of such models in pilot clinical trials to assist therapy, optimise patient-specific PEEP, assess the disease state and response over time. Methods Ten patients with acute lung injury or ARDS underwent incremental PEEP recruitment manoeuvres. PV data was measured at increments of 5 cmH2O and fitted to the recruitment model. Inspiratory and expiratory breath holds were performed to measure airway resistance and auto-PEEP. Three model-based metrics are used to optimise PEEP based on opening pressures, closing pressures and net recruitment. ARDS status was assessed by model parameters capturing recruitment and compliance. Results Median model fitting error across all patients for inflation and deflation was 2.8% and 1.02% respectively with all patients experiencing auto-PEEP. In all three metrics' cases, model-based optimal PEEP was higher than clinically selected PEEP. Two patients underwent multiple recruitment manoeuvres over time and model metrics reflected and tracked the state or their ARDS. Conclusions For ARDS patients, the model-based method presented in this paper provides a unique, non-invasive method to select optimal patient-specific PEEP. In addition, the model has the capability to assess disease state over time using these same models and methods.

  7. Evaluation of remifentanil sevoflurane response surface models in patients emerging from anesthesia: Model improvement using effect-site sevoflurane concentrations

    Science.gov (United States)

    Johnson, Ken B.; Syroid, Noah D.; Gupta, Dhanesh K.; Manyam, Sandeep C.; Pace, Nathan L.; LaPierre, Cris D.; Egan, Talmage D.; White, Julia L.; Tyler, Diane; Westenskow, Dwayne R.

    2009-01-01

    Introduction We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness (ROR) during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non steady state conditions, accounting for the lag time between effect site (Ce) and end tidal (ET) sevoflurane concentrations would improve predictions. Methods Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET based and a Ce based prediction. Similarly two predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared to observations with graphical and temporal analyses. Results While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (≥ 99%). However, following termination of the anesthetic, models exhibited a wide range of predictions at emergence (1% to 97%). Although wide, the Ce based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET based predictions. For the ET based model, 45% of the patients awoke within 2 minutes of the 50% model predicted probability of unresponsiveness; 65% awoke within 4 minutes. For the Ce based model, 45% of the patients awoke within 1 minute of the 50% model predicted probability of unresponsiveness; 85% awoke within 3.2 minutes. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce and ET based models. Discussion Results confirmed in part our study hypothesis; accounting

  8. The relationship between blood pressure and the structures of Pender's health promotion model in rural hypertensive patients.

    Science.gov (United States)

    Kamran, Aziz; Azadbakht, Leila; Sharifirad, Gholamreza; Mahaki, Behzad; Mohebi, Siamak

    2015-01-01

    Perception is the most important predictor of behavior and there is a strong relation and correlation between behavior and believes. Thus, to improve self-care behaviors of patients, it is required to fully understand their perceptions about behavior. This paper aimed to assess the prediction power of health promotion model of systolic blood pressure (SBP) as the result of self-care behavior in rural hypertensive. This cross-sectional study has been carried out through random multistage sampling on 671 rural patients under the coverage of health center of Ardebil city in 2013. Data were collected through reliable and valid questionnaire based on the health promotion model in eight sectors. For data analysis, Pearson correlation statistical tests, multivariate linear regression, ANOVA and independent t-test were used and for confirmatory factor analysis, SPSS 18 and AMOS 18 (SPSS Inc., Chicago, IL, USA) were used. The results showed significant negative correlation between self-efficacy, perceived benefits, situational influences, affects related to behavior and commitment to action structures with SBP and showed a positive significant correlation between perceived barriers and SBP. Furthermore, age and body mass had direct significant relation with SBP. The age of patients showed inverse significant correlation with self-efficacy, perceived benefits, affects related to behavior, interpersonal influences and commitment and showed a direct significant correlation with perceived barriers, means that by increase of age, the perceived barriers also increased. The structures of health promotion model have in overall the prediction power of 71.4% of SBP changes. The diet perceptions of patients, the same as health promotion model, has good predictive power of SBP, especially the structures of perceived benefits and self-efficacy have inverse meaningful relation with systole blood pressure and predicted a higher percentage of this variable.

  9. Methods and Models for Capacity and Patient Flow Analysis in Hospital Sector

    DEFF Research Database (Denmark)

    Kozlowski, Dawid

    qualified decision-making and planning in light of structural changes faced by the acute hospital units in Denmark. The tool is aimed to support effective capacity management and constant enhancement of the quality of patient care and patient satisfaction at the emergency departments, to be brought about...... by an improved patient flow. The specially developed structure of the model facilitates its reuse at different units, with no advanced modelling skills required in day-to-day use. This feature amplifies the usefulness of DES in conducting comprehensive patient flow analyses at any department with emergency...... patients and constitutes one of the very few examples of the reuse modelling within healthcare sector. This thesis also investigates the process of elective patient treatment in Denmark which is governed by the maximum waiting time policy. Introduced in Denmark in 2002, it entitles patients to treatment...

  10. Healthcare model with use of information and communication technology for patients with chronic disease.

    Science.gov (United States)

    Lisiecka-Biełanowicz, Mira; Wawrzyniak, Zbigniew

    2016-07-15

    The healthcare system is positioned in the patient's environment and works with other determinants of the treatment. Patient care requires a whole system compatible to the needs of organizational and technical solutions. The purpose of this study is to present a new model of patient-oriented care, in which the use of information and communication technology (ICT) can improve the effectiveness of healthcare for patients with chronic diseases. The study material is the process of healthcare for chronically ill patients. Knowledge of the circumstances surrounding ecosystem and of the patients' needs, taking into account the fundamental healthcare goals allows us to build a new models of care, starting with the economic assumptions. The method used is modeling the construction of efficient healthcare system with the patient-centered model using ICT tools. We present a new systemic concept of building patient's environment in which he is the central figure of the healthcare organization - so called patient centered system. The use of ICT in the model of chronic patient's healthcare can improve the effectiveness of this kind of care. The concept is a vision to making wide platform of information management in chronic disease in a real environment ecosystem of patient using ICT tools. On the basis of a systematic approach to the model of chronic disease, and the knowledge of the patient itself, a model of the ecosystem impacts and interactions through information feedback and the provision of services can be constructed. ICT assisted techniques will increase the effectiveness of patient care, in which nowadays information exchange plays a key role.

  11. A Centerline Based Model Morphing Algorithm for Patient-Specific Finite Element Modelling of the Left Ventricle.

    Science.gov (United States)

    Behdadfar, S; Navarro, L; Sundnes, J; Maleckar, M; Ross, S; Odland, H H; Avril, S

    2017-09-20

    Hexahedral automatic model generation is a recurrent problem in computer vision and computational biomechanics. It may even become a challenging problem when one wants to develop a patient-specific finite-element (FE) model of the left ventricle (LV), particularly when only low resolution images are available. In the present study, a fast and efficient algorithm is presented and tested to address such a situation. A template FE hexahedral model was created for a LV geometry using a General Electric (GE) ultrasound (US) system. A system of centerline was considered for this LV mesh. Then, the nodes located over the endocardial and epicardial surfaces are respectively projected from this centerline onto the actual endocardial and epicardial surfaces reconstructed from a patient's US data. Finally, the position of the internal nodes is derived by finding the deformations with minimal elastic energy. This approach was applied to eight patients suffering from congestive heart disease. A FE analysis was performed to derive the stress induced in the LV tissue by diastolic blood pressure on each of them. Our model morphing algorithm was applied successfully and the obtained meshes showed only marginal mismatches when compared to the corresponding US geometries. The diastolic FE analyses were successfully performed in seven patients to derive the distribution of principal stresses. The original model morphing algorithm is fast and robust with low computational cost. This low cost model morphing algorithm may be highly beneficial for future patient-specific reduced-order modelling of the LV with potential application to other crucial organs.

  12. Training to Increase Safe Tray Carrying Among Cocktail Servers

    OpenAIRE

    Scherrer, Megan D; Wilder, David A

    2008-01-01

    We evaluated the effects of training on proper carrying techniques among 3 cocktail servers to increase safe tray carrying on the job and reduce participants' risk of developing musculoskeletal disorders. As participants delivered drinks to their tables, their finger, arm, and neck positions were observed and recorded. Each participant received individual safety training that focused on proper carrying positions and techniques after baseline data were collected. A multiple baseline design acr...

  13. A Modified Integrated Genetic Model for Risk Prediction in Younger Patients with Acute Myeloid Leukemia.

    Science.gov (United States)

    Sloan, Caroline E; Luskin, Marlise R; Boccuti, Anne M; Sehgal, Alison R; Zhao, Jianhua; Daber, Robert D; Morrissette, Jennifer J D; Luger, Selina M; Bagg, Adam; Gimotty, Phyllis A; Carroll, Martin

    2016-01-01

    Although cytogenetics-based prognostication systems are well described in acute myeloid leukemia (AML), overall survival (OS) remains highly variable within risk groups. An integrated genetic prognostic (IGP) model using cytogenetics plus mutations in nine genes was recently proposed for patients ≤60 years to improve classification. This model has not been validated in clinical practice. We retrospectively studied 197 patients with newly diagnosed de novo AML. We compared OS curves among the mutational profiles defined by the IGP model. The IGP model assigned patients with intermediate cytogenetics as having favorable, intermediate or unfavorable mutational profiles. The IGP model reassigned 50 of 137 patients with intermediate cytogenetics to favorable or unfavorable mutational profiles. Median OS was 2.8 years among 14 patients with intermediate cytogenetics and favorable mutational profiles (mutant NPM1 and mutant IDH1 or IDH2) and 1.3 years among patients with intermediate mutational profiles. Among patients with intermediate cytogenetics labeled as having unfavorable mutational profiles, median OS was 0.8 years among 24 patients with FLT3-ITD positive AML and high-risk genetic changes (trisomy 8, TET2 and/or DNMT3A) and 1.7 years among 12 patients with FLT3-ITD negative AML and high-risk mutations (TET2, ASXL1 and/or PHF6). OS for patients with intermediate cytogenetics and favorable mutational profiles was similar to OS for patients with favorable cytogenetics (p = 0.697) and different from patients with intermediate cytogenetics and intermediate mutational profiles (p = 0.028). OS among patients with FLT3-ITD positive AML and high-risk genetic changes was similar to patients with unfavorable cytogenetics (p = 0.793) and different from patients with intermediate IGP profile (p = 0.022). Patients with FLT3-ITD negative AML and high-risk mutations, defined as 'unfavorable' in the IGP model, had OS similar to patients with intermediate IGP profile (p = 0

  14. A Modified Integrated Genetic Model for Risk Prediction in Younger Patients with Acute Myeloid Leukemia.

    Directory of Open Access Journals (Sweden)

    Caroline E Sloan

    Full Text Available Although cytogenetics-based prognostication systems are well described in acute myeloid leukemia (AML, overall survival (OS remains highly variable within risk groups. An integrated genetic prognostic (IGP model using cytogenetics plus mutations in nine genes was recently proposed for patients ≤60 years to improve classification. This model has not been validated in clinical practice.We retrospectively studied 197 patients with newly diagnosed de novo AML. We compared OS curves among the mutational profiles defined by the IGP model. The IGP model assigned patients with intermediate cytogenetics as having favorable, intermediate or unfavorable mutational profiles. The IGP model reassigned 50 of 137 patients with intermediate cytogenetics to favorable or unfavorable mutational profiles. Median OS was 2.8 years among 14 patients with intermediate cytogenetics and favorable mutational profiles (mutant NPM1 and mutant IDH1 or IDH2 and 1.3 years among patients with intermediate mutational profiles. Among patients with intermediate cytogenetics labeled as having unfavorable mutational profiles, median OS was 0.8 years among 24 patients with FLT3-ITD positive AML and high-risk genetic changes (trisomy 8, TET2 and/or DNMT3A and 1.7 years among 12 patients with FLT3-ITD negative AML and high-risk mutations (TET2, ASXL1 and/or PHF6. OS for patients with intermediate cytogenetics and favorable mutational profiles was similar to OS for patients with favorable cytogenetics (p = 0.697 and different from patients with intermediate cytogenetics and intermediate mutational profiles (p = 0.028. OS among patients with FLT3-ITD positive AML and high-risk genetic changes was similar to patients with unfavorable cytogenetics (p = 0.793 and different from patients with intermediate IGP profile (p = 0.022. Patients with FLT3-ITD negative AML and high-risk mutations, defined as 'unfavorable' in the IGP model, had OS similar to patients with intermediate IGP profile (p

  15. Patient-specific 3D printed model in delineating brain glioma and surrounding structures in a pediatric patient

    OpenAIRE

    Ivan Lau; Andrew Squelch; Yung Liang Wan; Alex Mun-Chung Wong; Werner Ducke; Zhonghua Sun

    2017-01-01

    Background and Objectives: Three-dimensional (3D) printing has been increasingly used in medicine with applications in the diagnostic assessment of disease extent, medical education and training, preoperative planning, and surgical simulation. The use of 3D printing in brain tumors is very limited. In this study, we presented our preliminary experience of creating patient-specific 3D printed model of a brain tumor in a pediatric patient and demonstrated the feasibility of using 3D printing in...

  16. Organization and carrying out the triathlon competitions in Ukraine

    Directory of Open Access Journals (Sweden)

    Volodymyr Vodlozerov

    2016-02-01

    Full Text Available Purpose: the aim is analyzing of system of organization and carrying out the triathlon competitions in Ukraine in accordance with rules of triathlon international federation. Material & Methods: comparative analysis of process of organization and carrying out the triathlon competitions in the world and Ukraine was carried out on basis of specialist literature studying, normative base of sports organizations (triathlon federation. Results: inconsistencies were identified in competitions carried out in cold season, particularity of triathlon that intends overcoming the combined distance without time durations between stages. Conclusions: recommendation in eliminate inconsistencies that affect to performance of triathlon competitions in Ukraine was suggested.

  17. Engaging patients and consumers in research evidence: Applying the conceptual model of patient and family engagement.

    Science.gov (United States)

    Carman, Kristin L; Workman, Thomas A

    2017-01-01

    This essay discusses applying the Conceptual Framework for Patient and Family Engagement to partnerships with patients and consumers to increase their use of research evidence in healthcare decisions. The framework's foundational principles hold that engagement occurs on a continuum across all levels of healthcare-from direct care to policymaking-with patients and healthcare professionals working in full partnership and sharing responsibility for achieving a safe, high-quality, efficient, and patient-centered healthcare system. Research evidence can serve as a critical decision-making tool in partnerships between patients and health professionals. However, as the framework suggests, without patient and consumer engagement in the design, planning, interpretation, and dissemination of research findings, it is unlikely that the broader consumer population will find research evidence useful, much less use it, to guide their healthcare decisions. Understanding what factors influence patient and consumer engagement can lead to effective strategies that enable meaningful partnerships between patients and researchers. Understanding patient and consumer perspectives of research evidence is critical to engaging them in meaningful partnerships that produce actionable research findings that they can in turn use in partnership with health professionals to improve their own health and the healthcare system as a whole. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease : Are Current Models Suitable to Evaluate Personalized Medicine?

    NARCIS (Netherlands)

    Hoogendoorn, Martine; Feenstra, Talitha L; Asukai, Yumi; Briggs, Andrew H; Borg, Sixten; Dal Negro, Roberto W; Hansen, Ryan N; Jansson, Sven-Arne; Leidl, Reiner; Risebrough, Nancy; Samyshkin, Yevgeniy; Wacker, Margarethe E; Rutten-van Mölken, Maureen P M H

    2016-01-01

    OBJECTIVES: To assess how suitable current chronic obstructive pulmonary disease (COPD) cost-effectiveness models are to evaluate personalized treatment options for COPD by exploring the type of heterogeneity included in current models and by validating outcomes for subgroups of patients. METHODS: A

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

    Science.gov (United States)

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

    2012-08-07

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

  20. The Population Growth and Carrying Capacity in Semarang City

    Science.gov (United States)

    Hariyanto; Hadi, Sudharto P.; Buchori, Imam

    2018-02-01

    Population growth and development of city activities take some lands to carry them. As a result, land use competition happens among persons, society or sector. Land necessity for settlement, industry, or sector has taken over farm land, therefore farm land has been converted intensively and massively. Chronologically, population growth will cause land necessity increase. Unproductive land, especially farm land will be converted. Furthermore, farm land conversion will cause carrying capacity change. Carrying capacity has certain bio capacity. With the population growth, it will increase resource consumption; on the other side, farm land conversion will decrease carrying capacity. The objective of the study is to know about the influence of population growth towards carrying capacity (bio capacity) in Semarang city. Land consumption per capita is indeed influenced by city population, the higher the population is, the lower the land consumption per capita. With the population growth, it will influence carrying capacity. Carrying capacity here is the ratio of area to population. Analytical descriptive method is applied in the study with all sub-districts in Semarang city as the analysis unit. Population here is sub-district area and population per sub-district in Semarang city. Population growth data period is from 2000 until 2015. Main variables of the study are area per sub-district, population, population growth, carrying capacity. Result of the study shows significant influence of carrying capacity decrease, especially some outskirts in Semarang city. This condition happens because the outskirts in Semarang city tend to have dense population growth. Range of carrying capacity in Semarang city is from 0,007 to 0,117 of 0 to 1. Almost all sub-districts in Semarang city show miserable condition, except Mijen and Tugu. The conclusion of the study is that population will decrease carrying capacity. Therefore, the government should control population growth by paying

  1. The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections.

    Science.gov (United States)

    Tängdén, T; Ramos Martín, V; Felton, T W; Nielsen, E I; Marchand, S; Brüggemann, R J; Bulitta, J B; Bassetti, M; Theuretzbacher, U; Tsuji, B T; Wareham, D W; Friberg, L E; De Waele, J J; Tam, V H; Roberts, Jason A

    2017-07-01

    Critically ill patients with severe infections are at high risk of suboptimal antimicrobial dosing. The pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobials in these patients differ significantly from the patient groups from whose data the conventional dosing regimens were developed. Use of such regimens often results in inadequate antimicrobial concentrations at the site of infection and is associated with poor patient outcomes. In this article, we describe the potential of in vitro and in vivo infection models, clinical pharmacokinetic data and pharmacokinetic/pharmacodynamic models to guide the design of more effective antimicrobial dosing regimens. Individualised dosing, based on population PK models and patient factors (e.g. renal function and weight) known to influence antimicrobial PK, increases the probability of achieving therapeutic drug exposures while at the same time avoiding toxic concentrations. When therapeutic drug monitoring (TDM) is applied, early dose adaptation to the needs of the individual patient is possible. TDM is likely to be of particular importance for infected critically ill patients, where profound PK changes are present and prompt appropriate antibiotic therapy is crucial. In the light of the continued high mortality rates in critically ill patients with severe infections, a paradigm shift to refined dosing strategies for antimicrobials is warranted to enhance the probability of achieving drug concentrations that increase the likelihood of clinical success.

  2. Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders.

    Science.gov (United States)

    Barros, Jorge; Morales, Susana; Echávarri, Orietta; García, Arnol; Ortega, Jaime; Asahi, Takeshi; Moya, Claudia; Fischman, Ronit; Maino, María P; Núñez, Catalina

    2017-01-01

    To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one's own capacities and coping abilities. These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

  3. The role of patients' explanatory models and daily-lived experience in hypertension self-management.

    Science.gov (United States)

    Bokhour, Barbara G; Cohn, Ellen S; Cortés, Dharma E; Solomon, Jeffrey L; Fix, Gemmae M; Elwy, A Rani; Mueller, Nora; Katz, Lois A; Haidet, Paul; Green, Alexander R; Borzecki, Ann M; Kressin, Nancy R

    2012-12-01

    Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts. This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors. Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers. PARTICIPANTS (OR PATIENTS OR SUBJECTS): African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure. We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors. Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management. Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.

  4. Care model for patients with phenylketonuria (PKU in Argentina

    Directory of Open Access Journals (Sweden)

    Ana Chiesa

    2014-07-01

    1,300,000 subjects tested. Nutritional treatment consists of a diet restricted in phenylanine (Phe and free of animal food, it is started in all children whose serum Phe levels are above 6 mg/dL, low tyrosine (Tyr concentration, and a Phe to Tyr ratio >3, although patients between 2 to 6 mg/dL are closely followed. Periodic blood Phe quantification and dietetic instructions to the patient are required in order to keep Phe levels in a safe range that preserves nervous system maturing, and prevention of mental retardation which is inherent to non-treated disease. Educational activities constitute the core of the teamwork; they are destined to achieve the best psycho-social integration of the patient to society. Patients’ mothers are trained to follow dietetic quantities of Phe following the “Practical guidance for phenylketonuric patients’ nutrition”. Diet compliance is a complex process which should be evaluated in individual and familiar context in order to identify the need for extra medical support; adolescents are the most vulnerable age population. It has been noted that late diagnosed patients who were given the adequate proposed treatment improved in terms of neurological symptoms, behavioral issues as well as in their potential for rehabilitation.

  5. Variability of four-dimensional computed tomography patient models

    NARCIS (Netherlands)

    Sonke, Jan-Jakob; Lebesque, Joos; van Herk, Marcel

    2008-01-01

    PURPOSE: To quantify the interfractional variability in lung tumor trajectory and mean position during the course of radiation therapy. METHODS AND MATERIALS: Repeat four-dimensional (4D) cone-beam computed tomography (CBCT) scans (median, nine scans/patient) routinely acquired during the course of

  6. An evidence-based patient-centered method makes the biopsychosocial model scientific.

    Science.gov (United States)

    Smith, Robert C; Fortin, Auguste H; Dwamena, Francesca; Frankel, Richard M

    2013-06-01

    To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. Engel's BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. 25 CFR 23.51 - Grant carry-over authority.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Grant carry-over authority. 23.51 Section 23.51 Indians... Uniform Grant Administration Provisions and Requirements § 23.51 Grant carry-over authority. Unless... two years beyond the initial grant funding period and must be utilized only for the intent, purpose...

  8. 46 CFR 98.30-3 - Vessels carrying MPTs.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Vessels carrying MPTs. 98.30-3 Section 98.30-3 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS SPECIAL... Vessels carrying MPTs. Each MPT on a vessel to which this part applies must bear, on a metal or other...

  9. 46 CFR 111.105-45 - Vessels carrying agricultural products.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Vessels carrying agricultural products. 111.105-45... ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Hazardous Locations § 111.105-45 Vessels carrying agricultural products. (a) The following areas are Class II, Division 1, (Zone 10 or Z) locations on vessels...

  10. Ecological Carrying Capacity of Saanane Island Proposed National ...

    African Journals Online (AJOL)

    The study on ecological carrying capacity of Saanane Island aimed at assessing stocking capacity of the island to provide guidance to the introduction of animals to enhance its ecological value and tourism potential. To evaluate the ecological carrying capacity of the Island, wet and dry season data were collected in 2014 ...

  11. Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

    2013-04-01

    To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

  12. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

    Science.gov (United States)

    Chiew, Yeong Shiong; Pretty, Christopher; Docherty, Paul D; Lambermont, Bernard; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

    2015-01-01

    Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV), but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs)) model that can be used in spontaneously breathing patients to determine their respiratory mechanics. A time-varying respiratory elastance model is developed with a negative elastic component (E(demand)), to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS) and Neurally Adjusted Ventilatory Assist (NAVA) are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs) of every breathing cycle for each patient at different ventilation modes are presented for comparison. At the start of every breathing cycle initiated by patient, E(drs) is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS) severity indicator. The E(drs) model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  13. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

    Directory of Open Access Journals (Sweden)

    Yeong Shiong Chiew

    Full Text Available BACKGROUND: Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV, but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs model that can be used in spontaneously breathing patients to determine their respiratory mechanics. METHODS: A time-varying respiratory elastance model is developed with a negative elastic component (E(demand, to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS and Neurally Adjusted Ventilatory Assist (NAVA are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs of every breathing cycle for each patient at different ventilation modes are presented for comparison. RESULTS: At the start of every breathing cycle initiated by patient, E(drs is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS severity indicator. CONCLUSION: The E(drs model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  14. Nursing research on a first aid model of double personnel for major burn patients.

    Science.gov (United States)

    Wu, Weiwei; Shi, Kai; Jin, Zhenghua; Liu, Shuang; Cai, Duo; Zhao, Jingchun; Chi, Cheng; Yu, Jiaao

    2015-03-01

    This study explored the effect of a first aid model employing two nurses on the efficient rescue operation time and the efficient resuscitation time for major burn patients. A two-nurse model of first aid was designed for major burn patients. The model includes a division of labor between the first aid nurses and the re-organization of emergency carts. The clinical effectiveness of the process was examined in a retrospective chart review of 156 cases of major burn patients, experiencing shock and low blood volume, who were admitted to the intensive care unit of the department of burn surgery between November 2009 and June 2013. Of the 156 major burn cases, 87 patients who received first aid using the double personnel model were assigned to the test group and the 69 patients who received first aid using the standard first aid model were assigned to the control group. The efficient rescue operation time and the efficient resuscitation time for the patients were compared between the two groups. Student's t tests were used to the compare the mean difference between the groups. Statistically significant differences between the two groups were found on both measures (P's first aid model based on scientifically validated procedures and a reasonable division of labor can shorten the efficient rescue operation time and the efficient resuscitation time for major burn patients. Given these findings, the model appears to be worthy of clinical application.

  15. The flexible application of carrying capacity in ecology

    Directory of Open Access Journals (Sweden)

    Eric J. Chapman

    2018-01-01

    Full Text Available Carrying capacity encompasses a broad collection of approaches used to better understand biotic interactions in ecosystems and is often applied with no explicit regard to its historical origin. In this paper, we reviewed the primary literature to examine how carrying capacity is applied in ecology. We focused our review on ecosystem studies—studies that frame their results at the ecosystem level—published after the 1950s and highlight emerging trends of this concept. We found that while carrying capacity offers some underlying commonalities, a wide range of definitions and approaches hinders a unified framework to better understand biotic ecosystem interactions. Not surprisingly, these studies most often use K—the number of individuals that the environment “can support” in a given area—to define carrying capacity, despite considerable ambiguity and uncertainty in this approach. Furthermore, the studies that we reviewed spanned several levels of ecological organization: molecules to communities and up to landscapes. To add further complexity, it is not clear whether carrying capacity was intended as a dynamic concept subject to temporal variability as it was often applied in the reviewed studies. We found that carrying capacity is most often applied to studies in conservation biology, rangeland and wildlife management, aquaculture, and fisheries biology. We explore ecosystem level responses to implications of “carrying capacity” overshoot and discuss proposed mechanisms that govern ecosystem carrying capacity. We discuss the usefulness of the concept and end with suggestions to improve carrying capacity's general application in ecosystem studies. Keywords: Carrying capacity, Conservation biology, Ecosystems, Ecosystem management, Natural resources

  16. The NEAT Predictive Model for Survival in Patients with Advanced Cancer.

    Science.gov (United States)

    Zucker, Amanda; Tsai, Chiaojung Jillian; Loscalzo, John; Calves, Pedro; Kao, Johnny

    2018-01-24

    We previously developed a model to more accurately predict life expectancy for stage IV cancer patients referred to radiation oncology. The goals of this study are to validate this model and to compare competing published models. From May 2012 to March 2015, 280 consecutive patients with stage IV cancer were prospectively evaluated by a single radiation oncologist. Patients were separated into training, validation and combined sets. The NEAT model evaluated number of active tumors ("N"), Eastern Cooperative Oncology Group (ECOG) performance status ("E"), albumin ("A") and primary tumor site ("T"). The Odette Cancer Center model validated performance status, bone only metastases and primary tumor site. The Harvard TEACHH model investigated primary tumor type, performance status, age, prior chemotherapy courses, liver metastases, and hospitalization within 3 months. Cox multivariable analyses and logistical regression were utilized to compare model performance. Number of active tumors, performance status, albumin, primary tumor site, prior hospitalization within the last 3 months and liver metastases predicted overall survival on uinvariate and multivariable analysis (pNEAT model separated patients into 4 prognostic groups with median survivals of 24.9, 14.8, 4.0, and 1.2 months, respectively (pNEAT model had a C-index of 0.76 with a Nagelkerke's R2 of 0.54 suggesting good discrimination, calibration and total performance. The NEAT model warrants further investigation as a clinically useful approach to predict survival in patients with stage IV cancer.

  17. A model for predicting skin dose received by patients from an x-ray ...

    African Journals Online (AJOL)

    We have done this by modifying a model for predicting skin dose derived by Edmonds for a triple-phase generator. Results for 100 patients based on the triple-phase generator output show a reasonable average agreement (»1%) between our present model and the Edmonds's model. Although our earlier estimated ...

  18. Predictive models of adjuvant chemotherapy for patients with stage ii colorectal cancer: A retrospective study.

    Science.gov (United States)

    Wei, Bo; Zheng, Xiao-Ming; Lei, Pu-Run; Huang, Yong; Zheng, Zong-Heng; Chen, Tu-Feng; Huang, Jiang-Long; Fang, Jia-Feng; Liang, Cheng-Hua; Wei, Hong-Bo

    2017-09-05

    It remains controversial whether patients with Stage II colorectal cancer would benefit from adjuvant chemotherapy after radical resection. The aim of this study was to establish two mathematical models to identify the suitable patients for adjuvant chemotherapy. The current study comprised of two steps. In the first step, 353 patients with Stage II colorectal cancer who underwent surgical procedures at the Third Affiliated Hospital of Sun Yat-sen University between June 2006 and December 2015 were entered and followed up for 6-120 months. Their clinical data were collected and enrolled into the database. We established two mathematical models by univariate and multivariate Cox regression analysis to identify the target patients; in the second step, 230 patients under the same standard between January 2012 and December 2016 were entered and followed up for 3-62 months to verify the two models' validation. In the first step, totally 340 surgical patients with Stage II colorectal cancer were finally enrolled in this study. Statistical analysis showed that tumor differentiation (TD) (P models: (1) OS risk score = 1.116 × TD + 2.202 × LVI + 3.676 × UPM + 1.438 × LN - 0.493; (2) DFS risk score = 0.789 × TD + 2.074 × LVI + 3.183 × UPM + 1.329 × LN - 0.432. According to the models and cutoff points [(0.07, 1.33) and (-0.04, 1.30), respectively], patients can be divided into three groups: low-risk, moderate-risk, and high-risk. Moreover, the high-risk group patients could benefit from adjuvant chemotherapy. In the second step, totally 221 patients were finally used to verify the models' validation. The results proved that the models were accurate and feasible (Ppredictive models, patients with Stage II colorectal cancer in the high-risk group are strongly recommended for adjuvant chemotherapy, thus facilitating the individualized and precise treatment.

  19. Development of a home-based telehealthcare model for improving the effectiveness of the chronic care of stroke patients

    Directory of Open Access Journals (Sweden)

    Yen-Hung Kuo

    2012-01-01

    Full Text Available This study describes the development of an information technology (IT-mediated home-based healthcare model designed to improve the effectiveness of caring for stroke patients who require chronic, home care. This model was evaluated at Kaohsiung Medical Hospital in Taiwan between 2005 and 2008; 84 newly diagnosed stroke patients diagnosed as the chronic covalence stage were enrolled for preliminary testing of this model. These patients required 24-hour in-home monitoring of their health status and emergency call service. Over the course of the study, 15 emergency transfers were carried out, and the acute stroke patients were sent to the emergency care within 26 minutes, on average. This system helped physicians, patients, and their families to more efficiently detect the occurrence of recurrent stroke. In addition, we found a statistically significant finding (p < 0.001 that daily blood pressure (BP monitoring increased from 45.5% in the initial month of the study to 76% after 3–10 months of intervention. Meanwhile, the proportion of patients with an abnormal BP rate decreased from 20.5% in the initial month of the study to 10.9% after 3–10 months of intervention. This suggests that this model helped to improve patient behavior and their ability to care for themselves. This is the first study to develop an IT-mediated, home-based healthcare model in Taiwan. This model integrates both healthcare and clinical services and is capable of enhancing the effectiveness of the care provided to patients with chronic diseases, especially those in situations where self-care is essential for disease management.

  20. Estimating landscape carrying capacity through maximum clique analysis

    Science.gov (United States)

    Donovan, Therese; Warrington, Greg; Schwenk, W. Scott; Dinitz, Jeffrey H.

    2012-01-01

    Habitat suitability (HS) maps are widely used tools in wildlife science and establish a link between wildlife populations and landscape pattern. Although HS maps spatially depict the distribution of optimal resources for a species, they do not reveal the population size a landscape is capable of supporting--information that is often crucial for decision makers and managers. We used a new approach, "maximum clique analysis," to demonstrate how HS maps for territorial species can be used to estimate the carrying capacity, N(k), of a given landscape. We estimated the N(k) of Ovenbirds (Seiurus aurocapillus) and bobcats (Lynx rufus) in an 1153-km2 study area in Vermont, USA. These two species were selected to highlight different approaches in building an HS map as well as computational challenges that can arise in a maximum clique analysis. We derived 30-m2 HS maps for each species via occupancy modeling (Ovenbird) and by resource utilization modeling (bobcats). For each species, we then identified all pixel locations on the map (points) that had sufficient resources in the surrounding area to maintain a home range (termed a "pseudo-home range"). These locations were converted to a mathematical graph, where any two points were linked if two pseudo-home ranges could exist on the landscape without violating territory boundaries. We used the program Cliquer to find the maximum clique of each graph. The resulting estimates of N(k) = 236 Ovenbirds and N(k) = 42 female bobcats were sensitive to different assumptions and model inputs. Estimates of N(k) via alternative, ad hoc methods were 1.4 to > 30 times greater than the maximum clique estimate, suggesting that the alternative results may be upwardly biased. The maximum clique analysis was computationally intensive but could handle problems with < 1500 total pseudo-home ranges (points). Given present computational constraints, it is best suited for species that occur in clustered distributions (where the problem can be

  1. Concordant but Varied Phenotypes among Duchenne Muscular Dystrophy Patient-Specific Myoblasts Derived using a Human iPSC-Based Model

    Directory of Open Access Journals (Sweden)

    In Young Choi

    2016-06-01

    Full Text Available Duchenne muscular dystrophy (DMD remains an intractable genetic disease. Althogh there are several animal models of DMD, there is no human cell model that carries patient-specific DYSTROPHIN mutations. Here, we present a human DMD model using human induced pluripotent stem cells (hiPSCs. Our model reveals concordant disease-related phenotypes with patient-dependent variation, which are partially reversed by genetic and pharmacological approaches. Our “chemical-compound-based” strategy successfully directs hiPSCs into expandable myoblasts, which exhibit a myogenic transcriptional program, forming striated contractile myofibers and participating in muscle regeneration in vivo. DMD-hiPSC-derived myoblasts show disease-related phenotypes with patient-to-patient variability, including aberrant expression of inflammation or immune-response genes and collagens, increased BMP/TGFβ signaling, and reduced fusion competence. Furthermore, by genetic correction and pharmacological “dual-SMAD” inhibition, the DMD-hiPSC-derived myoblasts and genetically corrected isogenic myoblasts form “rescued” multi-nucleated myotubes. In conclusion, our findings demonstrate the feasibility of establishing a human “DMD-in-a-dish” model using hiPSC-based disease modeling.

  2. Doctor-patient relationships in general practice--a different model.

    Science.gov (United States)

    Kushner, T

    1981-09-01

    Philosophical concerns cannot be excluded from even a cursory examination of the physician-patient relationship. Two possible alternatives for determining what this relationship entails are the teleological (outcome) approach vs the deontological (process) one. Traditionally, this relationship has been structured around the 'clinical model' which views the physician-patient relationship in teleological terms. Data on the actual content of general medical practice indicate the advisability of reassessing this relationship, and suggest that the 'clinical model' may be too limiting, and that a more appropriate basis for the physician-patient relationship is one described in this paper as the 'relational model'.

  3. US Public Opinion on Carrying Firearms in Public Places.

    Science.gov (United States)

    Wolfson, Julia A; Teret, Stephen P; Azrael, Deborah; Miller, Matthew

    2017-06-01

    To estimate US public opinion, overall and by gun ownership status, about the public places where legal gun owners should be allowed to carry firearms. We fielded an online survey among 3949 adults, including an oversample of gun owners and veterans, in April 2015. We used cross-tabulations with survey weights to generate nationally representative estimates. Fewer than 1 in 3 US adults supported gun carrying in any of the specified venues. Support for carrying in public was consistently higher among gun owners than among non-gun owners. Overall, support for carrying in public was lowest for schools (19%; 95% confidence interval [CI] = 16.7, 21.1), bars (18%; 95% CI = 15.9, 20.6), and sports stadiums (17%; 95% CI = 15.0, 19.5). Most Americans, including most gun owners, support restricting public places legal gun owners can carry firearms. These views contrast sharply with the current trend in state legislatures of expanding where, how, and by whom guns can be carried in public. Recent state laws and proposed federal legislation that would force states to honor out-of-state concealed carry permits are out of step with American public opinion.

  4. A 10-year prognostic model for patients with suspected angina attending a chest pain clinic.

    Science.gov (United States)

    Sekhri, Neha; Perel, Pablo; Clayton, Tim; Feder, Gene S; Hemingway, Harry; Timmis, Adam

    2016-06-01

    Diagnostic models used in the management of suspected angina provide no explicit information about prognosis. We present a new prognostic model of 10-year coronary mortality in patients presenting for the first time with suspected angina to complement the Diamond-Forrester diagnostic model of disease probability. A multicentre cohort of 8762 patients with suspected angina was followed up for a median of 10 years during which 233 coronary deaths were observed. Developmental (n=4412) and validation (n=4350) prognostic models based on clinical data available at first presentation showed good performance with close agreement and the final model utilised all 8762 patients to maximise power. The prognostic model showed strong associations with coronary mortality for age, sex, chest pain typicality, smoking status, diabetes, pulse rate, and ECG findings. Model discrimination was good (C statistic 0.83), patients in the highest risk quarter accounting for 173 coronary deaths (10-year risk of death: 8.7%) compared with a total of 60 deaths in the three lower risk quarters. When the model was simplified to incorporate only Diamond-Forrester factors (age, sex and character of symptoms) it underestimated coronary mortality risk, particularly in patients with reversible risk factors. For the first time in patients with suspected angina, a prognostic model is presented based on simple clinical factors available at the initial cardiological assessment. The model discriminated powerfully between patients at high risk and lower risk of coronary death during 10-year follow-up. Clinical utility was reflected in the prognostic value it added to the updated Diamond-Forrester diagnostic model of disease probability. 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/

  5. Mechanisms of Therapy Resistance in Patient-Derived Xenograft Models of BRCA1-Deficient Breast Cancer.

    Science.gov (United States)

    Ter Brugge, Petra; Kristel, Petra; van der Burg, Eline; Boon, Ute; de Maaker, Michiel; Lips, Esther; Mulder, Lennart; de Ruiter, Julian; Moutinho, Catia; Gevensleben, Heidrun; Marangoni, Elisabetta; Majewski, Ian; Józwiak, Katarzyna; Kloosterman, Wigard; van Roosmalen, Markus; Duran, Karen; Hogervorst, Frans; Turner, Nick; Esteller, Manel; Cuppen, Edwin; Wesseling, Jelle; Jonkers, Jos

    2016-11-01

    Although BRCA1-deficient tumors are extremely sensitive to DNA-damaging drugs and poly(ADP-ribose) polymerase (PARP) inhibitors, recurrences do occur and, consequently, resistance to therapy remains a serious clinical problem. To study the underlying mechanisms, we induced therapy resistance in patient-derived xenograft (PDX) models of BRCA1-mutated and BRCA1-methylated triple-negative breast cancer. A cohort of 75 mice carrying BRCA1-deficient breast PDX tumors was treated with cisplatin, melphalan, nimustine, or olaparib, and treatment sensitivity was determined. In tumors that acquired therapy resistance, BRCA1 expression was investigated using quantitative real-time polymerase chain reaction and immunoblotting. Next-generation sequencing, methylation-specific multiplex ligation-dependent probe amplification (MLPA) and Target Locus Amplification (TLA)-based sequencing were used to determine mechanisms of BRCA1 re-expression in therapy-resistant tumors. BRCA1 protein was not detected in therapy-sensitive tumors but was found in 31 out of 42 resistant cases. Apart from previously described mechanisms involving BRCA1-intragenic deletions and loss of BRCA1 promoter hypermethylation, a novel resistance mechanism was identified in four out of seven BRCA1-methylated PDX tumors that re-expressed BRCA1 but retained BRCA1 promoter hypermethylation. In these tumors, we found de novo gene fusions that placed BRCA1 under the transcriptional control of a heterologous promoter, resulting in re-expression of BRCA1 and acquisition of therapy resistance. In addition to previously described clinically relevant resistance mechanisms in BRCA1-deficient tumors, we describe a novel resistance mechanism in BRCA1-methylated PDX tumors involving de novo rearrangements at the BRCA1 locus, demonstrating that BRCA1-methylated breast cancers may acquire therapy resistance via both epigenetic and genetic mechanisms. © The Author 2016. Published by Oxford University Press. All rights reserved

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

    Science.gov (United States)

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

    2017-04-05

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

  7. Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication.

    Science.gov (United States)

    Öhlén, J; Carlsson, G; Jepsen, A; Lindberg, I; Friberg, F

    2016-06-01

    In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication. A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model. The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated. The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient's way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care

  8. Knowledge-based IMRT planning for individual liver cancer patients using a novel specific model.

    Science.gov (United States)

    Yu, Gang; Li, Yang; Feng, Ziwei; Tao, Cheng; Yu, Zuyi; Li, Baosheng; Li, Dengwang

    2018-03-27

    The purpose of this work is to benchmark RapidPlan against clinical plans for liver Intensity-modulated radiotherapy (IMRT) treatment of patients with special anatomical characteristics, and to investigate the prediction capability of the general model (Model-G) versus our specific model (Model-S). A library consisting of 60 liver cancer patients with IMRT planning was used to set up two models (Model-S, Model-G), using the RapidPlan knowledge-based planning system. Model-S consisted of 30 patients with special anatomical characteristics where the distance from planning target volume (PTV) to the right kidney was less than three centimeters and Model-G was configurated using all 60 patients in this library. Knowledge-based IMRT plans were created for the evaluation group formed of 13 patients similar to those included in Model-S by Model-G, Model-S and manually (M), named RPG-plans, RPS-plans and M-plans, respectively. The differences in the dose-volume histograms (DVHs) were compared, not only between RP-plans and their respective M-plans, but also between RPG-plans and RPS-plans. For all 13 patients, RapidPlan could automatically produce clinically acceptable plans. Comparing RP-plans to M-plans, RP-plans improved V 95% of PTV and had greater dose sparing in the right kidney. For the normal liver, RPG-plans delivered similar doses, while RPS-plans delivered a higher dose than M-plans. With respect to RapidPlan models, RPS-plans had better conformity index (CI) values and delivered lower doses to the right kidney V 20Gy and maximizing point doses to spinal cord, while delivering higher doses to the normal liver. The study shows that RapidPlan can create high-quality plans, and our specific model can improve the CI of PTV, resulting in more sparing of OAR in IMRT for individual liver cancer patients.

  9. Mathematical Models of Androgen Resistance in Prostate Cancer Patients under Intermittent Androgen Suppression Therapy

    Directory of Open Access Journals (Sweden)

    Javier Baez

    2016-11-01

    Full Text Available Predicting the timing of a castrate resistant prostate cancer is critical to lowering medical costs and improving the quality of life of advanced prostate cancer patients. We formulate, compare and analyze two mathematical models that aim to forecast future levels of prostate-specific antigen (PSA. We accomplish these tasks by employing clinical data of locally advanced prostate cancer patients undergoing androgen deprivation therapy (ADT. While these models are simplifications of a previously published model, they fit data with similar accuracy and improve forecasting results. Both models describe the progression of androgen resistance. Although Model 1 is simpler than the more realistic Model 2, it can fit clinical data to a greater precision. However, we found that Model 2 can forecast future PSA levels more accurately. These findings suggest that including more realistic mechanisms of androgen dynamics in a two population model may help androgen resistance timing prediction.

  10. A Knowledge-Constrained Access Control Model for Protecting Patient Privacy in Hospital Information Systems.

    Science.gov (United States)

    Zhang, Runtong; Chen, Donghua; Shang, Xiaopu; Zhu, Xiaomin; Liu, Kecheng

    2017-04-24

    Current access control mechanisms of the hospital information system can hardly identify the real access intention of system users. A relaxed access control increases the risk of compromise of patient privacy. To reduce unnecessary access of patient information by hospital staff, this paper proposes a Knowledge-Constrained Role-Based Access Control (KC-RBAC) model in which a variety of medical domain knowledge is considered in access control. Based on the proposed Purpose Tree and knowledge-involved algorithms, the model can dynamically define the boundary of access to the patient information according to the context, which helps protect patient privacy by controlling access. Compared with the Role-Based Access Control model, KC-RBAC can effectively protect patient information according to the results of the experiments.

  11. Parameter estimation in six numerical models of transperitoneal transport of potassium in patients undergoing peritoneal dialysis

    DEFF Research Database (Denmark)

    Graff, J; Fugleberg, S; Joffe, P

    1995-01-01

    The mechanisms of transperitoneal potassium transport during peritoneal dialysis were evaluated by validation of different mathematical models. The models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport....... Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The validation procedure demonstrated that models including both diffusive and non-lymphatic convective solute transport were superior to the other models. Lymphatic convective solute transport was not identifiable...

  12. Estimating the recreational carrying capacity of a lowland river section.

    Science.gov (United States)

    Lorenz, Stefan; Pusch, Martin T

    2012-01-01

    Recreational boating represents a major human use of inland waters in many regions. However, boating tourism may affect the ecological integrity of surface waters in multiple ways. In particular, surface waves produced by boating may disturb freshwater invertebrates, such as interrupting the filtration activity of benthic mussels. As mussels may significantly contribute to self-purification, disturbance may have crucial impacts on water quality, and thus on water tourism. In this paper we calculate the carrying capacity of a river section for sustainable boating tourism based on the preservation of water quality. This approach is complemented by spatial and social approaches for carrying capacity estimates. The ecological carrying capacity significantly decreases with lower water levels during summer. Hence, the analysis of variables that influence the river's carrying capacity allows the formation of recommendations for management measures that integrate social, touristic and ecological aspects.

  13. Hand Sanitizers Carry Unproven Claims to Prevent MRSA Infections

    Science.gov (United States)

    ... For Consumers Home For Consumers Consumer Updates Hand Sanitizers Carry Unproven Claims to Prevent MRSA Infections Share ... Flickr. Subscribe: FDA Consumer Health Information Some hand sanitizers and antiseptic products come with claims that they ...

  14. Optimising the allocation of groundwater carrying capacity in a data ...

    African Journals Online (AJOL)

    2009-08-26

    scarce region, Oasis irrigation district. Introduction. The concept of carrying ... a united definition of WRCC. Though different researchers .... data and the mining of useful information implied in the data, a new evaluation criterion of ...

  15. 46 CFR 122.340 - Vessels carrying vehicles.

    Science.gov (United States)

    2010-10-01

    ... vehicles freely in the event of fire or other disaster. The decks, where necessary, must be distinctly... smoking or carrying of lighted or smoldering pipes, cigars, cigarettes, or similar items in the deck area...

  16. 46 CFR 185.340 - Vessels carrying vehicles.

    Science.gov (United States)

    2010-10-01

    ... and away from the vehicles freely in the event of fire or other disaster. The decks, where necessary... precautions to prevent smoking or carrying of lighted or smoldering pipes, cigars, cigarettes, or similar...

  17. Foreign exchange predictability and the carry trade: a decomposition approach

    Czech Academy of Sciences Publication Activity Database

    Anatolyev, Stanislav; Gospodinov, N.; Jamali, I.; Liu, X.

    2017-01-01

    Roč. 42, June (2017), s. 199-211 ISSN 0927-5398 Institutional support: RVO:67985998 Keywords : exchange rate forecasting * carry trade * return decomposition Subject RIV: AH - Economics OBOR OECD: Finance Impact factor: 0.979, year: 2016

  18. Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test.

    Science.gov (United States)

    Dou, Kaili; Yu, Ping; Deng, Ning; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

    2017-12-06

    Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use

  19. Analyzing changes in productivity and carrying capacity under planned grazing in Madiama Commune, Mali (West Africa)

    OpenAIRE

    Badini, Oumar; Stockle, C.; Jones, J.; Bostick, M.; Kodio, Amadou; Keita, Moussa

    2004-01-01

    This presentation addresses the problems of overgrazing and degradation of pasture land. Policies that can increase pasture productivity and improve the carrying capacity and soil quality of pastures are assessed using CropSyst simulation modeling. Optimal grazing intensity and intervals (rotational grazing) are evaluated and discussed, based on model analysis from the Madiama commune in Mali (West Africa). ME (Management Entity)

  20. Assessment of feeding value of vegetable-carried pineapple fruit ...

    African Journals Online (AJOL)

    This study compared the sun-drying characteristics of five blends each (w/w; 1:1, 1:1.5, 1:2, 1:2.5, 1:3) of wheat offal-carried pineapple waste (WO:PW) and brewers' dried grains-carried pineapple waste (BDG:PW), assessed the blends for their nutrient contents and the feeding value of the optimum blends with Red Sokoto ...

  1. Estimation of carrying angle based on CT images in preoperative surgical planning for cubitus deformities.

    Science.gov (United States)

    Park, Shinsuk; Kim, Eugene

    2009-12-01

    Conventionally, the carrying angle of the elbow is measured using simple two-dimensional radiography or goniometry, which has questionable reliability. This study proposes a novel method for estimating carrying angles using computed tomography that can enhance the reliability of the angle measurement. Data of CT scans from 25 elbow joints were processed to build segmented three-dimensional models. The cross-sectional centerlines of the ulna and the humerus were traced from the 3D models, and the angle between 2 vectors formed from the centerlines of the humerus and the ulna was defined as the "three-dimensional carrying angle." These angles were compared with those measured by simple radiograph. Two cases of angular deformity were underwent surgery based on this preoperative surgical planning, and the postoperative 3D carrying angles were evaluated using the proposed method. The mean value of the calculated three-dimensional carrying angle was 20.7 degrees +/-3.61, while it was 16.3 degrees +/-3.21 based on simple radiography without statistical difference. Based on the 3D carrying angle estimations, 2 surgical cases of cubitus deformities were planned by comparison with the normal contra-lateral elbow. Postoperative angle estimations confirmed that the corrected angles were nearly identical to the planned angles for both cases. The results of this study showed that the carrying angle can be accurately estimated using three-dimensional CT and that the proposed method is useful in evaluating deformities of the elbow with high reliability.

  2. The effect of the training program on the quality of life in patients with asthma based on the Precede model in Ahvaz, Iran.

    Science.gov (United States)

    Nejad, Mina Motaghi; Nejad, Ghodratollah Shakeri; Tavakol, Heshmatollah; Cheraghi, Maria

    2017-06-01

    The aim of the study was to determine the effect of the training program based on the Precede model and its main components on improving the quality of life in patients with asthma. It was a randomized quasi-experimental study done on 120 patients with asthma who were referred to the Imam Khomeini hospital in Ahvaz who were selected using the convenience sampling method and were randomly divided into intervention and control groups. The data collection tool consisted of two questionnaires. The first questionnaire evaluated the quality of life in patients with asthma and the other one was developed by the researcher based on the structures of the Precede model. Training intervention was conducted during four sessions twice a week and each session was carried out for an hour based on the structures of the Precede model. In order to achieve the results, SPSS software, even t -test, and χ 2 were used. The results showed that after the training intervention in the experimental group, the mean scores of predisposing factors ( p quality of life in two groups after the intervention ( p quality of life of patients in the experimental group was improved after the training intervention. The design and implementation of the training program based on the Precede model can have a positive effect on the improvement of quality of life in patients with asthma.

  3. Prediction Model and Risk Stratification Tool for Survival in Patients With CKD

    Directory of Open Access Journals (Sweden)

    Alexander S. Goldfarb-Rumyantzev

    2018-03-01

    Conclusion: The risk stratification tool and prediction model of 2-year mortality demonstrated good performance and may be used in clinical practice to quantify the risk of death for individual patients with CKD.

  4. Organization-and-technological model of medical care delivered to patients with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Popova Y.V.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  5. Organization-and-technological model of medical care delivered to patients with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Kiselev A.R.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with arterial hypertension based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  6. Organization-and-technological model of medical care delivered to patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Kiselev A.R.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with chronic heart failure based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  7. Using competing risks model and competing events in outcome of pulmonary tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Mehdi Kazempour Dizaji

    2016-01-01

    Conclusions: Use of competing risks model with competing events can provide a better way to understand the associated risk factors co-related with outcome of the pulmonary TB process, especially among DR-TB patients.

  8. An emergency department patient flow model based on queueing theory principles.

    Science.gov (United States)

    Wiler, Jennifer L; Bolandifar, Ehsan; Griffey, Richard T; Poirier, Robert F; Olsen, Tava

    2013-09-01

    The objective was to derive and validate a novel queuing theory-based model that predicts the effect of various patient crowding scenarios on patient left without being seen (LWBS) rates. Retrospective data were collected from all patient presentations to triage at an urban, academic, adult-only emergency department (ED) with 87,705 visits in calendar year 2008. Data from specific time windows during the day were divided into derivation and validation sets based on odd or even days. Patient records with incomplete time data were excluded. With an established call center queueing model, input variables were modified to adapt this model to the ED setting, while satisfying the underlying assumptions of queueing theory. The primary aim was the derivation and validation of an ED flow model. Chi-square and Student's t-tests were used for model derivation and validation. The secondary aim was estimating the effect of varying ED patient arrival and boarding scenarios on LWBS rates using this model. The assumption of stationarity of the model was validated for three time periods (peak arrival rate = 10:00 a.m. to 12:00 p.m.; a moderate arrival rate = 8:00 a.m. to 10:00 a.m.; and lowest arrival rate = 4:00 a.m. to 6:00 a.m.) and for different days of the week and month. Between 10:00 a.m. and 12:00 p.m., defined as the primary study period representing peak arrivals, 3.9% (n = 4,038) of patients LWBS. Using the derived model, the predicted LWBS rate was 4%. LWBS rates increased as the rate of ED patient arrivals, treatment times, and ED boarding times increased. A 10% increase in hourly ED patient arrivals from the observed average arrival rate increased the predicted LWBS rate to 10.8%; a 10% decrease in hourly ED patient arrivals from the observed average arrival rate predicted a 1.6% LWBS rate. A 30-minute decrease in treatment time from the observed average treatment time predicted a 1.4% LWBS. A 1% increase in patient arrivals has the same effect on LWBS rates as a 1

  9. Decision-tree model of treatment-seeking behaviors after detecting symptoms by Korean stroke patients.

    Science.gov (United States)

    Oh, Hyo-Sook; Park, Hyeoun-Ae

    2006-06-01

    This study was performed to develop and test a decision-tree model of treatment-seeking behaviors about when Korean patients visit a doctor after experiencing stroke symptoms. The study used methodological triangulation. The model was developed based on qualitative data collected from in-depth interviews with 18 stroke patients. The model was tested using quantitative data collected from interviews and a structured questionnaire involving 150 stroke patients. The predictability of the decision-tree model was quantified as the proportion of participants who followed the pathway predicted by the model. Decision outcomes of the model were categorized into immediate and delayed treatment-seeking behavior. The model was influenced by lowered consciousness, social-group influences, perceived seriousness of symptoms, past history of hypertension or stroke, and barriers to hospital visits. The predictability of the model was found to be 90.7%. The results from this study can help healthcare personnel understand the education needs of stroke patients regarding treatment-seeking behaviors, and hence aid in the development of educational strategies for stroke patients.

  10. Bilinear models for inter- and intra-patient variation of the prostate

    International Nuclear Information System (INIS)

    Jeong, Y; Radke, R J; Lovelock, D M

    2010-01-01

    We propose bilinear models for capturing and effectively decoupling the expected shape variations of an organ both across the patient population and within a specific patient. Bilinear models have been successfully introduced in other areas of computer vision, but they have rarely been used in medical imaging applications. Our particular interest is in modeling the shape variation of the prostate for potential use in radiation therapy treatment planning. Using a dataset of 204 prostate shapes contoured from CT imagery of 12 different patients, we build bilinear models and show that they can fit both training and testing shapes accurately. We also show how the bilinear model can adapt to a new patient using only a few example shapes, producing a patient-specific model that also reflects expected content variation learnt from a broader population. Finally, we evaluate the training and testing projection error, adaptation performance and image segmentation accuracy of the bilinear model compared to linear principal component analysis and hierarchical point distribution models with the same number of parameters.

  11. Integrated Coastal Zone Planning Based on Environment Carrying Capacity Analysis

    Science.gov (United States)

    Miharja, M.; Arsallia, S.

    2017-07-01

    Coastal zone is a crucial area in terms of planning development. It holds high economic value, which affect to increasing number of inhabitants living in the area. As a result, this condition influences environmental degradation. Thus, in every attempt towards coastal zone development, it is crucial to always refer to environment carrying capacity. Carrying capacity is the limit of a certain coastal zone capability to support all human created activities, in which all ecological performances are maintained at sustainable level. The failure to establish strong and clear method and regulation on carrying capacity analysis will lead to a very risky coastal zone development, which in turn would threat the area’s sustainability. This paper discusses method for analysing carrying capacity of coastal zone as important input for the area development plan. Two key parameters, i.e. land and clean water carrying capacities are discussed to form carrying capacity analytical method. Furthermore, an empirical data of Ambon Bay, Moluccas Province, is used to illustrate the operationalization of the method.

  12. Carrying capacity: the tradition and policy implications of limits

    Directory of Open Access Journals (Sweden)

    Virginia Deane Abernethy

    2001-01-01

    Full Text Available ABSTRACT: Within just the last few centuries, science and technology have enlarged human capabilities and population size until humans now take, for their own use, nearly half of the Earth's net terrestrial primary production. An ethical perspective suggests that potentials to alter, or further increase, humanity's use of global resources should be scrutinized through the lenses of self-interested foresightedness and respect for non-human life. Without overtly invoking ethics, studies of the carrying capacity achieve just this objective. Carrying capacity is an ecological concept that expresses the relationship between a population and the natural environment on which it depends for ongoing sustenance. Carrying capacity assumes limits on the number of individuals that can be supported at a given level of consumption without degrading the environment and, therefore, reducing future carrying capacity. That is, carrying capacity addresses long-term sustainability. Worldviews differ in the importance accorded to the carrying capacity concept. This paper addresses three worldviews - ecological, romantic, and entrepreneurial - and explores the ethics and the policy implications of their contrasting perspectives.

  13. Building new roles and relationships in research: a model of patient engagement research.

    Science.gov (United States)

    Marlett, Nancy; Shklarov, Svetlana; Marshall, Deborah; Santana, Maria Jose; Wasylak, Tracy

    2015-05-01

    Patient engagement is influenced by institutional ideologies, professional attitudes and patient readiness to accept new, engaged roles. This article provides an opportunity to consider a new role for patients who are trained to conduct patient experience research using qualitative methods. The emergence of the role of patient engagement researcher was studied using a grounded theory with 21 patients over one-year internship and 125 research participants. Data were collected using tape recordings, field notes and student assignments. These were analyzed using open and selective coding, memoing, categorizing themes. Patients' education level (from high school to PhD), cultural background (immigrant experience, seniors), employment (employed full or part time, receiving disability benefits or retired), age (late 30 s-75) and gender (17 women and four men) were diverse. Main categories (emancipating patient experience; qualifying for research; leading sitting down; working data together; seeding change) are organized by the dialectic of co-creation as the roles of patient and researcher merge. A theoretical model is proposed. The theoretical model provides a glimpse into the process of merging two distinct roles of patient and researcher and in the process unleashes a force for change. The emergence of a dialectic from polar opposite roles is difficult to locate in health or other institutions where power differentials exist but there are indications that this new role might become a template for other merged roles in patient-led medical teams.

  14. A new model to estimate prognosis in patients with hepatocellular carcinoma after Yttrium-90 radioembolization.

    Science.gov (United States)

    Weng, Zhihong; Ertle, Judith; Zheng, Shaoping; Lauenstein, Thomas; Mueller, Stefan; Bockisch, Andreas; Gerken, Guido; Yang, Dongliang; Schlaak, Joerg F

    2013-01-01

    The current prognostic model to estimate the survival in hepatocellular carcinoma (HCC) patients treated with transarterial hepatic selective internal radiotherapy (SIRT) is not fully characterized. The aim of this study was to establish a new scoring model including assessment of both tumor responses and therapy-induced systemic changes in HCC patients to predict survival at an early time point post-SIRT. Between 2008 and 2012, 149 HCC patients treated with SIRT were included into this study. CT images and biomarkers in blood tested at one month post-SIRT were analyzed and correlated with clinical outcome. Tumor responses were assessed by RECIST 1.1, mRECIST, and Choi criteria. Kaplan-Meier methods were used to estimate survival curves. Cox regression was used in uni- and multivariable survival analyses and in the establishment of a prognostic model. A multivariate proportional hazards model was created based on the tumor response, the number of tumor nodules, the score of the model for end stage liver disease (MELD), and the serum C-reactive protein levels which were independent predictors of survival in HCC patients at one month post-SIRT. This prognostic model accurately differentiated the outcome of patients with different risk scores in this cohort (P<0.001). The model also had the ability to assign a predicted survival probability for individual patients. A new model to predict survival of HCC patients mainly based on tumor responses and therapy-induced systemic changes provides reliable prognosis and accurately discriminates the survival at an early time point after SIRT in these patients.

  15. A new model to estimate prognosis in patients with hepatocellular carcinoma after Yttrium-90 radioembolization.

    Directory of Open Access Journals (Sweden)

    Zhihong Weng

    Full Text Available AIMS: The current prognostic model to estimate the survival in hepatocellular carcinoma (HCC patients treated with transarterial hepatic selective internal radiotherapy (SIRT is not fully characterized. The aim of this study was to establish a new scoring model including assessment of both tumor responses and therapy-induced systemic changes in HCC patients to predict survival at an early time point post-SIRT. METHODS AND MATERIALS: Between 2008 and 2012, 149 HCC patients treated with SIRT were included into this study. CT images and biomarkers in blood tested at one month post-SIRT were analyzed and correlated with clinical outcome. Tumor responses were assessed by RECIST 1.1, mRECIST, and Choi criteria. Kaplan-Meier methods were used to estimate survival curves. Cox regression was used in uni- and multivariable survival analyses and in the establishment of a prognostic model. RESULTS: A multivariate proportional hazards model was created based on the tumor response, the number of tumor nodules, the score of the model for end stage liver disease (MELD, and the serum C-reactive protein levels which were independent predictors of survival in HCC patients at one month post-SIRT. This prognostic model accurately differentiated the outcome of patients with different risk scores in this cohort (P<0.001. The model also had the ability to assign a predicted survival probability for individual patients. CONCLUSIONS: A new model to predict survival of HCC patients mainly based on tumor responses and therapy-induced systemic changes provides reliable prognosis and accurately discriminates the survival at an early time point after SIRT in these patients.

  16. Fatal cardiovascular risk assessment with SCORE model in type 2 diabetes patients from Republic of Macedonia

    OpenAIRE

    Smokovski, Ivica; Milenkovic, Tatjana

    2013-01-01

    Aim: Assessment of 10-year fatal cardiovascular risk (%) with SCORE model in patients with type 2 diabetes mellitus (DM) from Republic of Macedonia, adjusted for diabetic population. Methods and materials: Observational, cross-sectional study of cohort of 1,404 type 2 DM aged 25 to 65 years, without cardiovascular disease or cancer. 10-year fatal cardiovascular risk (%) with SCORE model was calculated for every patient, taking in consideration the increased relative risk of DM compared to non...

  17. Use of Game Theory to model patient engagement after surgery: a qualitative analysis.

    Science.gov (United States)

    Castellanos, Stephen A; Buentello, Gerardo; Gutierrez-Meza, Diana; Forgues, Angela; Haubert, Lisa; Artinyan, Avo; Macdonald, Cameron L; Suliburk, James W

    2018-01-01

    Patient engagement is challenging to define and operationalize. Qualitative analysis allows us to explore patient perspectives on this topic and establish themes. A game theoretic signaling model also provides a framework through which to further explore engagement. Over a 6-mo period, thirty-eight interviews were conducted within 6 wk of discharge in patients undergoing thyroid, parathyroid, or colorectal surgery. Interviews were transcribed, anonymized, and analyzed using the NVivo 11 platform. A signaling model was then developed depicting the doctor-patient interaction surrounding the patient's choice to reach out to their physician with postoperative concerns based upon the patient's perspective of the doctor's availability. This was defined as "engagement". We applied the model to the qualitative data to determine possible causations for a patient's engagement or lack thereof. A private hospital's and a safety net hospital's populations were contrasted. The private patient population was more likely to engage than their safety-net counterparts. Using our model in conjunction with patient data, we determined possible etiologies for this engagement to be due to the private patient's perceived probability of dealing with an available doctor and apparent signals from the doctor indicating so. For the safety-net population, decreased access to care caused them to be less willing to engage with a doctor perceived as possibly unavailable. A physician who understands these Game Theory concepts may be able to alter their interactions with their patients, tailoring responses and demeanor to fit the patient's circumstances and possible barriers to engagement. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Multilevel latent class casemix modelling: a novel approach to accommodate patient casemix

    Directory of Open Access Journals (Sweden)

    Forman David

    2011-03-01

    Full Text Available Abstract Background Using routinely collected patient data we explore the utility of multilevel latent class (MLLC models to adjust for patient casemix and rank Trust performance. We contrast this with ranks derived from Trust standardised mortality ratios (SMRs. Methods Patients with colorectal cancer diagnosed between 1998 and 2004 and resident in Northern and Yorkshire regions were identified from the cancer registry database (n = 24,640. Patient age, sex, stage-at-diagnosis (Dukes, and Trust of diagnosis/treatment were extracted. Socioeconomic background was derived using the Townsend Index. Outcome was survival at 3 years after diagnosis. MLLC-modelled and SMR-generated Trust ranks were compared. Results Patients were assigned to two classes of similar size: one with reasonable prognosis (63.0% died within 3 years, and one with better prognosis (39.3% died within 3 years. In patient class one, all patients diagnosed at stage B or C died within 3 years; in patient class two, all patients diagnosed at stage A, B or C survived. Trusts were assigned two classes with 51.3% and 53.2% of patients respectively dying within 3 years. Differences in the ranked Trust performance between the MLLC model and SMRs were all within estimated 95% CIs. Conclusions A novel approach to casemix adjustment is illustrated, ranking Trust performance whilst facilitating the evaluation of factors associated with the patient journey (e.g. treatments and factors associated with the processes of healthcare delivery (e.g. delays. Further research can demonstrate the value of modelling patient pathways and evaluating healthcare processes across provider institutions.

  19. Application of a model of social information processing to nursing theory: how nurses respond to patients.

    Science.gov (United States)

    Sheldon, Lisa Kennedy; Ellington, Lee

    2008-11-01

    This paper is a report of a study to assess the applicability of a theoretical model of social information processing in expanding a nursing theory addressing how nurses respond to patients. Nursing communication affects patient outcomes such as anxiety, adherence to treatments and satisfaction with care. Orlando's theory of nursing process describes nurses' reactions to patients' behaviour as generating a perception, thought and feeling in the nurse and then action by the nurse. A model of social information processing describes the sequential steps in the cognitive processes used to respond to social cues and may be useful in describing the nursing process. Cognitive interviews were conducted in 2006 with a convenience sample of 5 nurses in the United States of America. The data were interpreted using the Crick and Dodge model of social information processing. Themes arising from cognitive interviews validated concepts of the nursing theory and the constructs of the model of social information processing. The interviews revealed that the support of peers was an additional construct involved in the development of communication skills, creation of a database and enhancement of self-efficacy. Models of social information processing enhance understanding of the process of how nurses respond to patients and further develop nursing theories further. In combination, the theories are useful in developing research into nurse-patient communication. Future research based on the expansion of nursing theory may identify effective and culturally appropriate nurse response patterns to specific patient interactions with implications for nursing care and patient outcomes.

  20. Quantification of metoprolol beta 2-adrenoceptor antagonism in asthmatic patients by pharmacokinetic-pharmacodynamic modelling

    NARCIS (Netherlands)

    Braat, M. C.; Jonkers, R. E.; van Boxtel, C. J.

    1992-01-01

    An integrated pharmacokinetic-pharmacodynamic model was used to quantify the beta 2-blocking activity of metoprolol in seven asthmatic patients. The patients received a subcutaneous dose of terbutaline on two consecutive days. On day 1 they were pretreated with placebo and on day 2 with metoprolol

  1. Change for the better: an innovative model of care delivering positive patient and workforce outcomes.

    Science.gov (United States)

    Cann, Tina; Gardner, Anne

    2012-01-01

    To evaluate patient and workforce outcomes following the implementation of the Practice Partnership Model of Care. Pre-test-post-test design. A 29-bed surgical ward at a tertiary-level regional hospital. Summary de-identified data from all patients and ward nursing staff in the study period. The Practice Partnership Model of Care has four main components: working in partnership; clinical handover at the bedside; comfort rounds; and environmental modifications. These reflect patient-centered and quality focused initiatives and use a total quality improvement framework that aims to transform care at the bedside. Patient outcomes: changes in patient safety (measured by numbers of medication errors and patient falls); satisfaction with care (use of the call bell system, number of complaints and compliments). Workforce outcomes: changes in staff satisfaction (measured through staff sick leave). A statistically significant reduction in use of nurse call bells (p=<0.001) post-implementation. Medication errors and patient falls reduced, with an overall reduction of 4% in staff sick leave. The Practice Partnership Model of Care positively affected patient and workforce outcomes, suggesting further exploration of this model in other hospital contexts is warranted.

  2. Development and validation of a prognostic model for recurrent glioblastoma patients treated with bevacizumab and irinotecan

    DEFF Research Database (Denmark)

    Urup, Thomas; Dahlrot, Rikke Hedegaard; Grunnet, Kirsten

    2016-01-01

    BACKGROUND: Predictive markers and prognostic models are required in order to individualize treatment of recurrent glioblastoma (GBM) patients. Here, we sought to identify clinical factors able to predict response and survival in recurrent GBM patients treated with bevacizumab (BEV) and irinotecan...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    PURPOSE: Ventilator-associated pneumonia (VAP) is a common and serious complication in patients requiring mechanical ventilation in the intensive care unit. The aims of this study were to identify models used to predict mortality in VAP patients and to assess their prognostic accuracy. METHODS...

  4. Patient neglect in healthcare institutions: a systematic review and conceptual model

    Science.gov (United States)

    2013-01-01

    Background Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. Method The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. Results Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. Conclusion A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and

  5. Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

    Science.gov (United States)

    Chen, Judy T.; LaLopa, Joseph

    2008-01-01

    Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

  6. The Partnering with Patients Model of Nursing Interventions: A First Step to a Practice Theory.

    Science.gov (United States)

    Moyle, Wendy; Rickard, Claire M; Chambers, Suzanne K; Chaboyer, Wendy

    2015-04-24

    The development of a body of knowledge, gained through research and theory building, is one hallmark of a profession. This paper presents the "Partnering with Patients Model of Nursing Interventions", providing direction towards how complex nursing interventions can be developed, tested and subsequently adopted into practice. Coalescence of understanding of patient-centred care, the capabilities approach and the concept of complex healthcare interventions led to the development of the model assumptions and concepts. Application of the model to clinical practice is described, including presentation of a case study, and areas for future research including understanding both patients' and nurses' perceptions and experiences when the model is in use, and testing the effect of nursing interventions based on the model are recommended.

  7. 3D-Printed Models of Cleft Lip and Palate for Surgical Training and Patient Education.

    Science.gov (United States)

    Chou, Pang-Yun; Hallac, Rami R; Shih, Ellen; Trieu, Jenny; Penumatcha, Anjani; Das, Priyanka; Meyer, Clark A; Seaward, James R; Kane, Alex A

    2018-03-01

    Sculpted physical models and castings of the anatomy of cleft lip and palate are used for parent, patient, and trainee education of cleft lip and palate conditions. In this study, we designed a suite of digital 3-dimensional (3D) models of cleft lip and palate anatomy with additive manufacturing techniques for patient education. CT scans of subjects with isolated cleft palate, unilateral and bilateral cleft lip and palate, and a control were obtained. Soft tissue and bony structures were segmented and reconstructed into digital 3D models. The oral soft tissues overlying the cleft palate were manually molded with silicone putty and scanned using CT to create digital 3D models. These were then combined with the original model to integrate with segmentable soft tissues. Bone and soft tissues were 3D printed in different materials to mimic the rigidity/softness of the relevant anatomy. These models were presented to the parents/patients at our craniofacial clinic. Visual analog scale (VAS) surveys were obtained pertaining to the particular use of the models, to ascertain their value in parental education. A total of 30 parents of children with cleft conditions completed VAS evaluations. The models provided the parents with a better understanding of their child's condition with an overall evaluation score of 9.35 ± 0.5. We introduce a suite of 3D-printed models of cleft conditions that has a useful role in patient, parental, and allied health education with highly positive feedback.

  8. Effectiveness of cognitive behavioral therapy based on the pain sustainment/exacerbation model in patients with tension-type headache: a pilot study.

    Science.gov (United States)

    Motoya, Ryo; Oda, Keiko; Ito, Eiji; Ichikawa, Masahiro; Sato, Taku; Watanabe, Tadashi; Sakuma, Jun; Saito, Kiyoshi; Niwa, Shin-Ichi; Yabe, Hirooki

    2014-01-01

    The purpose of this study was to carry out a program of Cognitive Behavioral Therapy (CBT) based on the pain sustainment/exacerbation model for tension-type headache (TTH) patients and to examine the effectiveness as a pilot study. The participants were 4 TTH patients who consulted the outpatient clinic of a university hospital. It consisted of 4 individualized sessions as CBT program (including psychological education, self-monitoring, relaxation technique, cognitive restricting and exposure), and a follow-up examination was carried out 1 month after its completion. The sessions, each of which was 60 minutes long, were executed at weekly intervals. As a result, the score of the Pain Catastrophizing Scale (PCS) decreased after program compared with before program in all patients. The score of escape/avoidance was also reduced at the post-program and follow-up (1 month later) compared with the score of pre-program in patients except Case 2, in whom the score was 0 throughout the study. The degree of the Headache Impact Test (HIT-6) improved by program and changed to "mild" or "none" in all participants. These findings show that in patients with TTH this short CBT program has effect on pain catastrophizing, escape/avoidance and daily disability.

  9. Development and Validation of a Mortality Prediction Model for Patients Receiving 14 Days of Mechanical Ventilation.

    Science.gov (United States)

    Hough, Catherine L; Caldwell, Ellen S; Cox, Christopher E; Douglas, Ivor S; Kahn, Jeremy M; White, Douglas B; Seeley, Eric J; Bangdiwala, Shrikant I; Rubenfeld, Gordon D; Angus, Derek C; Carson, Shannon S

    2015-11-01

    The existing risk prediction model for patients requiring prolonged mechanical ventilation is not applicable until after 21 days of mechanical ventilation. We sought to develop and validate a mortality prediction model for patients earlier in the ICU course using data from day 14 of mechanical ventilation. Multicenter retrospective cohort study. Forty medical centers across the United States. Adult patients receiving at least 14 days of mechanical ventilation. None. Predictor variables were measured on day 14 of mechanical ventilation in the development cohort and included in a logistic regression model with 1-year mortality as the outcome. Variables were sequentially eliminated to develop the ProVent 14 model. This model was then generated in the validation cohort. A simplified prognostic scoring rule (ProVent 14 Score) using categorical variables was created in the development cohort and then tested in the validation cohort. Model discrimination was assessed by the area under the receiver operator characteristic curve. Four hundred ninety-one patients and 245 patients were included in the development and validation cohorts, respectively. The most parsimonious model included age, platelet count, requirement for vasopressors, requirement for hemodialysis, and nontrauma admission. The area under the receiver operator characteristic curve for the ProVent 14 model using continuous variables was 0.80 (95% CI, 0.76-0.83) in the development cohort and 0.78 (95% CI, 0.72-0.83) in the validation cohort. The ProVent 14 Score categorized age at 50 and 65 years old and platelet count at 100×10(9)/L and had similar discrimination as the ProVent 14 model in both cohorts. Using clinical variables available on day 14 of mechanical ventilation, the ProVent 14 model can identify patients receiving prolonged mechanical ventilation with a high risk of mortality within 1 year.

  10. A structured patient identification model for medication therapy management services in a community pharmacy.

    Science.gov (United States)

    Pagano, Gina M; Groves, Brigid K; Kuhn, Catherine H; Porter, Kyle; Mehta, Bella H

    To describe the development and implementation of a structured patient identification model for medication therapy management (MTM) services within traditional dispensing activities of a community pharmacy to facilitate pharmacist-provided completion of MTM services. A daily clinical opportunity report was developed as a structured model to identify MTM opportunities daily for all MTM-eligible patients expecting to pick up a prescription. Pharmacy staff was trained and the standardized model was implemented at study sites. One hundred nineteen grocery store-based community pharmacies throughout Ohio, West Virginia, and Michigan. A structured patient identification model in a community pharmacy consists of reviewing a clinical opportunity report, identifying interventions for MTM-eligible patients, and possibly collaborating with an interdisciplinary team. This model allows pharmacists to increase MTM cases performed by providing a structured process for identifying MTM-eligible patients and completing MTM services. The development and implementation of a structured patient identification model in the community pharmacy was completed and consists of pharmacists reviewing a clinical opportunity report to identify MTM opportunities and perform clinical interventions for patients. In a 3-month pre- and post-implementation comparison, there was a 49% increase in the number of MTM services provided by pharmacists (P < 0.001). A structured patient identification model in the community pharmacy was associated with an increase in the amount of MTM services provided by pharmacists. This method could be a useful tool at a variety of community pharmacies to solve challenges associated with MTM completion. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  11. Carrying capacity of water resources in Bandung Basin

    Science.gov (United States)

    Marganingrum, D.

    2018-02-01

    The concept of carrying capacity is widely used in various sectors as a management tool for sustainable development processes. This idea has also been applied in watershed or basin scale. Bandung Basin is the upstream of Citarum watershed known as one of the national strategic areas. This area has developed into a metropolitan area loaded with various environmental problems. Therefore, research that is related to environmental carrying capacity in this area becomes a strategic issue. However, research on environmental carrying capacity that has been done in this area is still partial either in water balance terminology, land suitability, ecological footprint, or balance of supply and demand of resources. This paper describes the application of the concept of integrated environmental carrying capacity in order to overcome the increasing complexity and dynamic environmental problems. The sector that becomes the focus of attention is the issue of water resources. The approach method to be carried out is to combine the concept of maximum balance and system dynamics. The dynamics of the proposed system is the ecological dynamics and population that cannot be separated from one another as a unity of the Bandung Basin ecosystem.

  12. [Ecological carrying capacity and Chongming Island's ecological construction].

    Science.gov (United States)

    Wang, Kaiyun; Zou, Chunjing; Kong, Zhenghong; Wang, Tianhou; Chen, Xiaoyong

    2005-12-01

    This paper overviewed the goals of Chongming Island's ecological construction and its background, analyzed the current eco-economic status and constraints of the Island, and put forward some scientific issues on its ecological construction. It was suggested that for the resources-saving and sustainable development of the Island, the researches on its ecological construction should be based on its ecological carrying capacity, fully take the regional characteristics into consideration, and refer the successful development modes at home and abroad. The carrying capacity study should ground on systemic and dynamic views, give a thorough evaluation of the Island's present carrying capacity, simulate its possible changes, and forecast its demands and risks. Operable countermeasures to promote the Island's carrying capacity should be worked out, new industry structure, population scale, and optimized distribution projects conforming to regional carrying capacity should be formulated, and effective ecological security alarming and control system should be built, with the aim of providing suggestions and strategic evidences for the decision-making of economic development and sustainable environmental resources use of the region.

  13. Construction of a novel lentiviral vector carrying human B-domain ...

    African Journals Online (AJOL)

    ... integration were detected in all cell lines after transfection. A novel lentiviral vector carrying human FVIII³BD was constructed, which was able to transfect different mammalian cell types accompanied by high-level activity. This lentiviral vector may provide a theoretical basis for the gene therapy of patients with hemophilia ...

  14. Test-retest reliability of lifting and carrying in a 2-day functional capacity evaluation

    NARCIS (Netherlands)

    Reneman, MF; Dijkstra, PU; Westmaas, M; Goeken, LNH; Göeken, L.N.H.

    2002-01-01

    The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using

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

    Science.gov (United States)

    Sharafoddini, Anis; Dubin, Joel A

    2017-01-01

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

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  17. Comparison of models for predicting outcomes in patients with coronary artery disease focusing on microsimulation

    Directory of Open Access Journals (Sweden)

    Masoud Amiri

    2012-01-01

    Full Text Available Background: Physicians have difficulty to subjectively estimate the cardiovascular risk of their patients. Using an estimate of global cardiovascular risk could be more relevant to guide decisions than using binary representation (presence or absence of risk factors data. The main aim of the paper is to compare different models of predicting the progress of a coronary artery diseases (CAD to help the decision making of physician. Methods: There are different standard models for predicting risk factors such as models based on logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. Each model has its own application which can or cannot use by physicians to make a decision on treatment of each patient. Results: There are five main common models for predicting of outcomes, including models based on logistic regression model (for short-term outcomes, Cox regression model (for intermediate-term outcomes, dynamic logistic regression model, and simulation models such as Markov and microsimulation models (for long-term outcomes. The advantages and disadvantages of these models have been discussed and summarized. Conclusion: Given the complex medical decisions that physicians face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, physicians may potentially benefit from a clinical decision support system that accounts for all these considerations. The microsimulation model could provide cardiologists, researchers, and medical students a user-friendly software, which can be used as an intelligent interventional simulator.

  18. Establishment and characterization of uterine sarcoma and carcinosarcoma patient-derived xenograft models

    NARCIS (Netherlands)

    Cuppens, Tine; Depreeuw, Jeroen; Annibali, Daniela; Thomas, Debby; Hermans, Els; Gommé, Ellen; Trinh, Xuan Bich; Debruyne, David; Moerman, Philippe; Lambrechts, Diether; Amant, Frédéric

    2017-01-01

    Uterine sarcomas (US) and carcinosarcomas (CS) are rare, aggressive cancers. The lack of reliable preclinical models hampers the search for new treatment strategies and predictive biomarkers. To this end, we established and characterized US and CS patient-derived xenograft (PDX) models. Tumor

  19. Patient-Derived Xenograft Models : An Emerging Platform for Translational Cancer Research

    NARCIS (Netherlands)

    Hidalgo, Manuel; Amant, Frederic; Biankin, Andrew V.; Budinska, Eva; Byrne, Annette T.; Caldas, Carlos; Clarke, Robert B.; de Jong, Steven; Jonkers, Jos; Maelandsmo, Gunhild Mari; Roman-Roman, Sergio; Seoane, Joan; Trusolino, Livio; Villanueva, Alberto

    Recently, there has been an increasing interest in the development and characterization of patient-derived tumor xenograft (PDX) models for cancer research. PDX models mostly retain the principal histologic and genetic characteristics of their donor tumor and remain stable across passages. These

  20. The Effect of Partnership Care Model on Mental Health of Patients with Thalassemia Major.

    Science.gov (United States)

    Shamsi, Afzal; Amiri, Fardin; Ebadi, Abbas; Ghaderi, Musab

    2017-01-01

    Thalassemia major has become a public health problem worldwide, particularly in developing and poor countries, while the role of educating the family and community has not been considered enough in patients' care. This study examines the impact of partnership care model on mental health of patients with beta-thalassemia major. This experimental study, with pretest and posttest design, was performed on patients with beta-thalassemia major in Jiroft city. 82 patients with beta-thalassemia major were allocated randomly into two groups of intervention (41 patients) and control ( n = 41) groups. Mental health of the participants was measured using the standard questionnaire GHQ-28 before and after intervention in both groups. The intervention was applied to the intervention group for 6 months, based on the partnership care model. There were significant differences between the scores of mental health and its subscales between two groups after the intervention ( P partnership care model on mental health of patients with beta-thalassemia major; thus, implementation of this model is suggested for the improvement of mental health of patients with beta-thalassemia major.

  1. The Impact of Information Culture on Patient Safety Outcomes. Development of a Structural Equation Model.

    Science.gov (United States)

    Jylhä, Virpi; Mikkonen, Santtu; Saranto, Kaija; Bates, David W

    2017-03-08

    An organization's information culture and information management practices create conditions for processing patient information in hospitals. Information management incidents are failures that could lead to adverse events for the patient if they are not detected. To test a theoretical model that links information culture in acute care hospitals to information management incidents and patient safety outcomes. Reason's model for the stages of development of organizational accidents was applied. Study data were collected from a cross-sectional survey of 909 RNs who work in medical or surgical units at 32 acute care hospitals in Finland. Structural equation modeling was used to assess how well the hypothesized model fit the study data. Fit indices indicated a good fit for the model. In total, 18 of the 32 paths tested were statistically significant. Documentation errors had the strongest total effect on patient safety outcomes. Organizational guidance positively affected information availability and utilization of electronic patient records, whereas the latter had the strongest total effect on the reduction of information delays. Patient safety outcomes are associated with information management incidents and information culture. Further, the dimensions of the information culture create work conditions that generate errors in hospitals.

  2. Social networks enabled coordination model for cost management of patient hospital admissions.

    Science.gov (United States)

    Uddin, Mohammed Shahadat; Hossain, Liaquat

    2011-09-01

    In this study, we introduce a social networks enabled coordination model for exploring the effect of network position of "patient," "physician," and "hospital" actors in a patient-centered care network that evolves during patient hospitalization period on the total cost of coordination. An actor is a node, which represents an entity such as individual and organization in a social network. In our analysis of actor networks and coordination in the healthcare literature, we identified that there is significant gap where a number of promising hospital coordination model have been developed (e.g., Guided Care Model, Chronic Care Model) for the current healthcare system focusing on quality of service and patient satisfaction. The health insurance dataset for total hip replacement (THR) from hospital contribution fund, a prominent Australian Health Insurance Company, are analyzed to examine our proposed coordination model. We consider network attributes of degree, connectedness, in-degree, out-degree, and tie strength to measure network position of actors. To measure the cost of coordination for a particular hospital, average of total hospitalization expenses for all THR hospital admissions is used. Results show that network positions of "patient," "physician," and "hospital" actors considering all hospital admissions that a particular hospital has have effect on the average of total hospitalization expenses of that hospital. These results can be used as guidelines to set up a cost-effective healthcare practice structure for patient hospitalization expenses. © 2011 National Association for Healthcare Quality.

  3. The illness/non-illness model: hypnotherapy for physically ill patients.

    Science.gov (United States)

    Navon, Shaul

    2014-07-01

    This article proposes a focused, novel sub-set of the cognitive behavioral therapy approach to hypnotherapy for physically ill patients, based upon the illness/non-illness psychotherapeutic model for physically ill patients. The model is based on three logical rules used in differentiating illness from non-illness: duality, contradiction, and complementarity. The article discusses the use of hypnotic interventions to help physically ill and/or disabled patients distinguish between illness and non-illness in their psychotherapeutic themes and attitudes. Two case studies illustrate that patients in this special population group can be taught to learn the language of change and to use this language to overcome difficult situations. The model suggests a new clinical mode of treatment in which individuals who are physically ill and/or disabled are helped in coping with actual motifs and thoughts related to non-illness or non-disability.

  4. Combined Population Dynamics and Entropy Modelling Supports Patient Stratification in Chronic Myeloid Leukemia

    Science.gov (United States)

    Brehme, Marc; Koschmieder, Steffen; Montazeri, Maryam; Copland, Mhairi; Oehler, Vivian G.; Radich, Jerald P.; Brümmendorf, Tim H.; Schuppert, Andreas

    2016-04-01

    Modelling the parameters of multistep carcinogenesis is key for a better understanding of cancer progression, biomarker identification and the design of individualized therapies. Using chronic myeloid leukemia (CML) as a paradigm for hierarchical disease evolution we show that combined population dynamic modelling and CML patient biopsy genomic analysis enables patient stratification at unprecedented resolution. Linking CD34+ similarity as a disease progression marker to patient-derived gene expression entropy separated established CML progression stages and uncovered additional heterogeneity within disease stages. Importantly, our patient data informed model enables quantitative approximation of individual patients’ disease history within chronic phase (CP) and significantly separates “early” from “late” CP. Our findings provide a novel rationale for personalized and genome-informed disease progression risk assessment that is independent and complementary to conventional measures of CML disease burden and prognosis.

  5. Clinical diagnosis and treatment of a patient with low back pain using the patient response model: A case report.

    Science.gov (United States)

    Robinson, Michael

    2016-05-01

    The medical management of low back pain (LBP) can be approached in a multitude of ways. Classification via subgrouping is increasingly common in orthopedic literature. Clinical diagnosis and treatment of LBP using the patient response model (PRM) can assist clinicians in hypothesizing the origin of pain and providing beneficial interventions unlike the widely used pathoanatomical model. This case report involved a 52-year-old female with sudden onset of right-sided LBP that radiated to the foot. These symptoms were accompanied by occasional paresthesias in bilateral lower extremities. Magnetic resonance imaging (MRI) confirmed disc bulges at levels T11-T12 and T12-L1. On the first of seven visits, she reported 9/10 on the Numeric Pain Rating Scale (NPRS), scored a 24/50 on the modified Oswestry disability index (mODI), and demonstrated lumbar flexion range of motion (ROM) of 10°. Using the PRM, the patient was classified as an extension responder and was instructed to perform 10 repetitions of standing lumbar extension every 2 waking hours. After 4 weeks of therapy, the patient reported a 1/10 pain localized to the low back, scored 20/50 on the mODI, and improved flexion ROM to 45°. Classification using the PRM yielded positive outcomes with this patient's symptoms and daily function.

  6. Evaluation of carrying capacity and territorial environmental sustainability

    Directory of Open Access Journals (Sweden)

    Giuseppe Ruggiero

    2012-09-01

    Full Text Available Land use has a great impact on environmental quality, use of resources, state of ecosystems and socio-economic development. Land use can be considered sustainable if the environmental pressures of human activities do not exceed the ecological carrying capacity. A scientific knowledge of the capability of ecosystems to provide resources and absorb waste is a useful and innovative means of supporting territorial planning. This study examines the area of the Province of Bari to estimate the ecosystems’ carrying capacity, and compare it with the current environmental pressures exerted by human activities. The adapted methodology identified the environmentally sustainable level for one province.

  7. General relativistic galvano-gravitomagnetic effect in current carrying conductors

    International Nuclear Information System (INIS)

    Ahmedov, B.J.

    1998-11-01

    The analogy between general relativity and electromagnetism suggests that there is a galvano-gravitomagnetic effect, which is the gravitational analogue of the Hall effect. This new effect takes place when a current carrying conductor is placed in a gravitomagnetic field and the conduction electrons moving inside the conductor are deflected transversally with respect to the current flow. In connection with this galvano-gravitomagnetic effect, we explore the possibility of using current carrying conductors for detecting the gravitomagnetic field of the Earth. (author)

  8. Carry trade as a speculative investment strategy in Serbia

    Directory of Open Access Journals (Sweden)

    Bungin Sanja

    2012-12-01

    Full Text Available This paper is analyses causes and the consequences of a speculative investment carry trade strategy in the exchange market in Serbia. The presence of such type of investor is related to high yields of risk free securities denominated in dinars, as well as the perception of future movements of dinar exchange rate related to currency that serves as source of investment. The consequences of carry trade may significantly influence exchange rate movements when monetary policy has limited facilities to combat negative and sudden shocks.

  9. Evaluation of radioprotection conditions and patient dose in thorax exams carried out in a public children's hospital in Belo Horizonte, MG, Brazil; Avaliacao das condicoes de radioprotecao e dose paciente em exames de torax realizados em um hospital publico infantil de Belo Horizonte, MG

    Energy Technology Data Exchange (ETDEWEB)

    Lacerda, Marco A.S.; Silva, Teogenes A. da; Guedes, Elton C. [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Khoury, Helen J. [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Azevedo, Ana C.P. [Fundacao Oswaldo Cruz (ENSP-CESTEH), Rio de Janeiro, RJ (Brazil)

    2005-07-01

    We conducted a survey of the conditions of radiation protection, radiographic techniques, dose and risk for pediatric patients undergoing chest X-rays exams in a children's hospital in Belo Horizonte-MG, Brazil. From a total of 125 chest exams (projections AP and PA) were noted the patient data (gender, weight, and age) and parameters of radiographic technique (kV, mAs and distance focus-skin). I was also evaluated the working procedures and the conditions of radiation protection. The values of input air kerma (K{sub a,e}) and effective dose (E) were determined using the DoseCal software developed by Radiological Protection Center of Saint Georges's Hospital in London. With respect to the procedures and conditions for radiation protection, many aspects of Portaria 453 are not considered. The use of radiographic techniques with high values of mAs and low voltage values are not according with the quality criteria adopted by the European Community (EC). The values of Ka for patients aged 1 to 5 years varied between 51 {mu}Gy and 64 {mu}Gy, below the reference levels proposed by the EC. For patients over 5 years old, the values of Ka were substantially higher than those for other patients. The results allow to conclude that there is a need for optimization of the procedures adopted in order to reduce the dose and the risk to patients.

  10. Development of patient specific cardiovascular models predicting dynamics in response to orthostatic stress challenges

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2013-01-01

    Physiological realistic models of the controlled cardiovascular system are constructed and validated against clinical data. Special attention is paid to the control of blood pressure, cerebral blood flow velocity, and heart rate during postural challenges, including sit-to-stand and head-up tilt....... This study describes development of patient specific models, and how sensitivity analysis and nonlinear optimization methods can be used to predict patient specific characteristics when analyzed using experimental data. Finally, we discuss how a given model can be used to understand physiological changes...

  11. Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review.

    Science.gov (United States)

    Henry, Stephen G; Matthias, Marianne S

    2018-02-01

    Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research. © 2018 American Academy of Pain Medicine. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  12. Assessing overall patient satisfaction in inflammatory bowel disease using structural equation modeling.

    Science.gov (United States)

    Soares, João-Bruno; Marinho, Ana S; Fernandes, Dália; Moreira Gonçalves, Bruno; Camila-Dias, Cláudia; Gonçalves, Raquel; Magro, Fernando

    2015-08-01

    Structural equation modeling (SEM) is a very popular data-analytic technique for the evaluation of customer satisfaction. We aimed to measure the overall satisfaction of inflammatory bowel disease (IBD) patients with healthcare in Portugal and to define its main determinants using SEM. The study included three steps: (i) specification of a patient satisfaction model that included the following dimensions: Image, Expectations, Facilities, Admission process, Assistant staff, Nursing staff, Medical staff, Treatment, Inpatient care, Outpatient care, Overall quality, Overall satisfaction, and Loyalty; (ii) sample survey from 2000 patients, members of the Portuguese Association of the IBD; and (iii) estimation of the satisfaction model using partial least squares (XLSTAT-PLSPM). We received 498 (25%) valid questionnaires from 324 (66%) patients with Crohn's disease and 162 (33%) patients with ulcerative colitis. Our model provided a substantial explanation for Overall satisfaction (R=0.82). The mean index of overall satisfaction was 74.4 (0-100 scale). The main determinants of Overall satisfaction were the Image (β=0.26), Outpatient care (β=0.23), and Overall quality (β=0.21), whose mean indices were 83, 75, and 81, respectively. Facilities and Inpatient care were the variables with a significant impact on Overall satisfaction and the worst mean indices. SEM is useful for the evaluation of IBD patient satisfaction. The Overall satisfaction of IBD patients with healthcare in Portugal is good, but to increase it, IBD services need to focus on the improvement of Outpatient care, Facilities, and Inpatient care. Our model could be a matrix for a global model of IBD patient satisfaction.

  13. The effect of improved modelling of plasma clearance in paediatric patients with expanded body spaces on estimation of the glomerular filtration rate

    International Nuclear Information System (INIS)

    Perkinson, A S; Evans, C J; Burniston, M T; Smye, S W

    2010-01-01

    The glomerular filtration rate (GFR) is used clinically to assess renal function. The most accurate estimation technique is tracer clearance where deterministic compartment pharmacokinetic models are most widely used. The aim of this study was to assess the viability of alternative pharmacokinetic models to describe tracer clearance, and in turn, measure GFR. This study was carried out on 126 clearance datasets obtained from 44 patients with large solid tumours; these were fitted to four pharmacokinetic models with superiority of model determined by Akaike Information Criteria. A fractal model was found to be superior to the best deterministic compartment model (70% of datasets, P < 0.0020) as was a gamma-distributed residence time model (93% of datasets, P < 0.0020); both models also gave greater mean weighted coefficients of determination than deterministic compartment models. These results suggest that gamma-distributed residence time and fractal models better describe tracer clearance than deterministic compartment models and therefore should allow more accurate estimation of GFR

  14. Utilization of a mental health collaborative care model among patients who require interpreter services.

    Science.gov (United States)

    Njeru, Jane W; DeJesus, Ramona S; St Sauver, Jennifer; Rutten, Lila J; Jacobson, Debra J; Wilson, Patrick; Wieland, Mark L

    2016-01-01

    Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice. This was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not. Of the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]). Within primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among

  15. Adverse risk: a 'dynamic interaction model of patient moving and handling'.

    Science.gov (United States)

    Griffiths, Howard

    2012-09-01

    The aim of the present study was to examine patient adverse events associated with sub-optimal patient moving and handling. Few studies have examined the patient's perspective on adverse risk during manual handling episodes. A narrative review was undertaken to develop the 'Dynamic Interaction Model of Patient Moving and Handling' in an orthopaedic rehabilitation setting, using peer-reviewed publications published in English between 1992 and 2010. Five predominant themes emerged from the narrative review: 'patient's need to know about analgesics prior to movement/ambulation'; 'comfort care'; 'mastery of and acceptance of mobility aids/equipment'; 'psychological adjustment to fear of falling'; and 'the need for movement to prevent tissue pressure damage'. Prevalence of discomfort, pain, falls, pressure sores together with a specific Direct Instrument Nursing Observation (DINO) tool enable back care advisers to measure quality of patient manual handling. Evaluation of patients' use of mobility aids together with fear of falling may be important in determining patients' recovery trajectory. Clinical governance places a responsibility on nurse managers to consider quality of care for their service users. 'Dynamic Interaction Model of Nurse-Patient Moving and Handling' provides back care advisers, clinical risk managers and occupational health managers with an alternative perspective to clinical risk and occupational risk. © 2011 Blackwell Publishing Ltd.

  16. Host antitumor resistance improved by the macrophage polarization in a chimera model of patients with HCC.

    Science.gov (United States)

    Asai, Akira; Tsuchimoto, Yusuke; Ohama, Hideko; Fukunishi, Shinya; Tsuda, Yasuhiro; Kobayashi, Makiko; Higuchi, Kazuhide; Suzuki, Fujio

    2017-01-01

    Despite major advances in curative and palliative approaches, hepatocellular carcinoma (HCC) is still the third leading cause of cancer-related death worldwide. M1 macrophages (Mϕ) play a key role in host antitumor defenses in HCC. In our study, CD14 + cells were isolated from the peripheral blood of four groups of HCC patients (group-1, patients with stage 0 HCC; group-2, patients with stage A HCC; group-3, patients with stage B HCC; and group-4, patients with stage C HCC) and characterized phenotypically. Then, CD14 + cells from group-2 and group-3 HCC patients were induced to polarize and tested for their antitumor abilities in a chimera model of HCC patients. Human HCCs (HepG2 solid tumors) grew in a chimera model of group-3 patients (group-3 HCC chimeras) but not in a chimera model of group-2 patients (group-2 HCC chimeras). In response to HCC antigens, the majority of CD14 + cells from group-2 patients (group-2 CD14 + cells) switched to the M1 phenotype (IL-12 + IL-10 - iNOS + cells), whereas the majority of CD14 + cells from group-3 patients (group-3 CD14 + cells) did not switch to the M1 phenotype and continued to express M2b phenotypic properties (IL-12 - IL-10 + CCL1 + iNOS - cells). Group-3 CD14 + cells showed M1Mϕ polarization after treatment with CCL1 antisense oligodeoxynucleotide (ODN). Therefore, our study indicates that anti-HCC defenses of group-3 HCC chimeras are improved after CCL1 antisense ODN treatment.

  17. Moderating Nutritious Habits in Psychiatric Patients Using Transtheoretical Model of Change and Counseling.

    Science.gov (United States)

    Anastopoulou, Konstantina; Fradelos, Evangelos C; Misouridou, Evdokia; Kourakos, Michael; Berk, Aristea; Papathanasiou, Ioanna V; Kleisiaris, Christos; Zyga, Sofia

    2017-01-01

    Motivational Interviewing provides the opportunity to health professionals to have an effective strategy to increase the level of readiness to change health behaviors. Along with the Transtheoretical Model (Stages of Change Model) compose the theoretical base of intervention in psychiatry settings. This study was aimed to change nutritious behavior of psychiatric patients using a specific Model of Change and Counseling implementing a health education program. A quasi-experimental design was adopted on a random sample of 60 psychiatric patients at Military Hospital of Athens. Patients were divided into two groups as follows; (a) Intervention Group (four sessions of counseling and encouraging motivation for modification of their nutritious habits), and (b) Control Group (simple information sessions about the principles of healthy alimentation). The mean age of Intervention Group (IG) was 43.9 ± 9.5 and Control Group (CG) 46.1 ± 9.1, ranging from 40 to 55 years old. Also, 26.7% of the participants were female, 23.3% were married and, 10% divorced. Our analyses showed that IG patients were significantly loss weight post-intervention compared to CG patients. Specifically, IG patients were significantly moderated the intake of starchy foods in every meal (p < 0.001) and the intake of fruits and vegetables (p < 0.001). Similarly, IG patients were moderated the intake of low fat dairy foods while they changed the full fat dairy foods with low fat (p < 0.001). Also important, IG patients showed significant enhance (80%) regarding drugs compliance, suggesting that 34% of the CG patients often forgot to take their medication. Finally, IG patients reported a positive attitude towards moderating unhealthy nutritious behaviors (p = 0.032). Our results confirms that health educational and promotional Interventions may change behavior of psychiatric patients and thus may positively influence their nutritious habits.

  18. Modeling the oxygen uptake kinetics during exercise testing of patients with chronic obstructive pulmonary diseases using nonlinear mixed models

    DEFF Research Database (Denmark)

    Baty, Florent; Ritz, Christian; van Gestel, Arnoldus

    2016-01-01

    BACKGROUND: The six-minute walk test (6MWT) is commonly used to quantify exercise capacity in patients with several cardio-pulmonary diseases. Oxygen uptake ([Formula: see text]O2) kinetics during 6MWT typically follow 3 distinct phases (rest, exercise, recovery) that can be modeled by nonlinear...... regression. Simultaneous modeling of multiple kinetics requires nonlinear mixed models methodology. To the best of our knowledge, no such curve-fitting approach has been used to analyze multiple [Formula: see text]O2 kinetics in both research and clinical practice so far. METHODS: In the present study, we...... describe functionality of the R package medrc that extends the framework of the commonly used packages drc and nlme and allows fitting nonlinear mixed effects models for automated nonlinear regression modeling. The methodology was applied to a data set including 6MWT [Formula: see text]O2 kinetics from 61...

  19. Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.

    Science.gov (United States)

    Islam, R; Weir, C; Del Fiol, G

    2016-01-01

    Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

  20. Structural model for quality of life of patients with chronic cardiovascular disease in Korea.

    Science.gov (United States)

    Han, Kuem Sun; Lee, Sook Ja; Park, Eun Sook; Park, Young-Joo; Cheol, Kang Hyun

    2005-01-01

    Health promotion among those with chronic illness has been proposed as a strategy to contain health care cost and enhance quality of life (QOL), but little research has been done in Korea on QOL focused on health promotion of patients with chronic cardiovascular disease (CCVD). This study was designed to estimate a structural model to represent the QOL of patients with CCVD, on the basis of a literature review and Pender's health promotion model (HPM). Data were collected by questionnaire from 436 patients with CCVD in a university hospital in Seoul from August 2001 to July 2002. Data analysis included descriptive statistics and covariance structural analysis. As the fit of the hypothetical model to the data was only moderate, it was modified by excluding 10 paths and including free parameters. The modified model with path showed a good fit to the empirical data (chi = 508.12, p = .001, GFI = .95, AGFI = .93, NFI = .98, NNFI = .98, RMSEA = .04). Health-promoting behavior (HPB) and self-efficacy were found to have a significant direct effect on QOL. Health perception, self-esteem, perceived barriers to action, and preference were found to have indirect effects on QOL. The variables of this model explain 63% of the variance in QOL. The modified model is considered appropriate to explain and predict QOL of patients with CCVD. Therefore, it can effectively be used as a reference model for further studies and to suggest directions in nursing practice.

  1. Occurrence of Enterobacter hormaechei carrying blaNDM-1 and blaKPC-2 in China.

    Science.gov (United States)

    Yang, Biwei; Feng, Yu; McNally, Alan; Zong, Zhiyong

    2018-02-01

    Three carbapenem-resistant clinical isolates of the Enterobacter cloacae complex (ECC) were recovered from different patients in a hospital. All 3 isolates carried 2 carbapenemase genes bla KPC-2 and bla NDM-1 . A study was performed to characterize their relatedness and to investigate possible links among the patients. Whole genome sequencing revealed that the isolates were Enterobacter hormaechei and belonged to ST177 of the ECC. There were 19-142 single nucleotide polymorphisms (SNPs) between the isolates, suggesting that the isolates were likely from a central reservoir, which might have existed for some time. bla KPC-2 and bla NDM-1 were carried on 2 different IncF-type plasmids in the isolates. The 3 bla NDM-1 -carrying plasmids were almost identical and were self-transmissible, while the bla KPC-2 -carrying plasmids were only transmissible in the presence of the bla NDM-1 -carrying plasmid. The source of and direct links among them were not identified, suggesting a hospital transmission of a common multidrug resistant strain. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Assessment of CT dose to the fetus and pregnant female patient using patient-specific computational models.

    Science.gov (United States)

    Xie, Tianwu; Poletti, Pierre-Alexandre; Platon, Alexandra; Becker, Christoph D; Zaidi, Habib

    2018-03-01

    This work provides detailed estimates of the foetal dose from diagnostic CT imaging of pregnant patients to enable the assessment of the diagnostic benefits considering the associated radiation risks. To produce realistic biological and physical representations of pregnant patients and the embedded foetus, we developed a methodology for construction of patient-specific voxel-based computational phantoms based on existing standardised hybrid computational pregnant female phantoms. We estimated the maternal absorbed dose and foetal organ dose for 30 pregnant patients referred to the emergency unit of Geneva University Hospital for abdominal CT scans. The effective dose to the mother varied from 1.1 mSv to 2.0 mSv with an average of 1.6 mSv, while commercial dose-tracking software reported an average effective dose of 1.9 mSv (range 1.7-2.3 mSv). The foetal dose normalised to CTDI vol varies between 0.85 and 1.63 with an average of 1.17. The methodology for construction of personalised computational models can be exploited to estimate the patient-specific radiation dose from CT imaging procedures. Likewise, the dosimetric data can be used for assessment of the radiation risks to pregnant patients and the foetus from various CT scanning protocols, thus guiding the decision-making process. • In CT examinations, the absorbed dose is non-uniformly distributed within foetal organs. • This work reports, for the first time, estimates of foetal organ-level dose. • The foetal brain and skeleton doses present significant correlation with gestational age. • The conceptus dose normalised to CTDI vol varies between 0.85 and 1.63. • The developed methodology is adequate for patient-specific CT radiation dosimetry.

  3. The Effect of Orem's Self-Care Model on Quality of Life in Patients with Migraine: a Randomized Clinical Trial.

    Science.gov (United States)

    Mahmoudzadeh Zarandi, Fatemeh; Raiesifar, Afsaneh; Ebadi, Abbas

    2016-03-01

    Many aspects of the lives of migraineurs are commonly affected by the condition, including occupational affairs, social and family life, responsibilities and ultimately the quality of life. This study was designed to determine the effect of orem's self-care nursing model on quality of life in patients with a migraine. This study was carried out in Tehran, Iran. According to the pre-post design of the randomized clinical trial, 88 patients were selected. After obtaining approval from the ethics committee of the Baqiyatallah Medical Sciences University's Research Deputy; Patients who signed the informed consent aged 20-55 years and without any more disease or disability affecting the quality of life were selected and randomly assigned to a group. Data collection tools were a demographic questionnaire, general health survey short form (SF36), and Orem cognition form and self-care checklist. Self-care model were held as four 30-45 minutes training sessions based on self-care deficit needs for the experimental group. The quality of life scores was measured in two stages, before and three months after intervention then were compared in both groups. Data were analyzed with statistical software SPSS and use of descriptive analysis tests, Chi-square, Mann-Whitney u and Wilcoxon. The final analysis was performed on 43 experimental and 40 controls. No significant difference was detected in the two groups in terms of demographic variables (P>0.05). All dimensions of quality of life including physical functioning, physical role limitation, body pain, general health, vitality, social functioning and emotional role limitation and mental health in the experimental group showed a significant increase after intervention compared to the control group (Pmodel improves function and overall quality of life and reduces the high cost of a migraine and migraine-related disability to individuals and society.

  4. Development of heavy load carrying vehicle for nuclear power station

    International Nuclear Information System (INIS)

    Terabayashi, Yasuharu; Oono, Hiroo; Aizu, Takao; Kawaguchi, Kaname; Yamanaka, Masayuki; Hirobe, Tamio; Inagaki, Yoshiaki.

    1985-01-01

    In nuclear power stations, in order to carry out sound and stable operation, the routine inspection and regular inspection of machinery and equipment are performed, therefore, the transportation of heavy things is frequently carried out. Especially, the transportation of heavy things over the steps of passages and stairs requires much labor. Therefore, Chubu Electric Power Co., Inc. and Chubu Plant Service Co., Ltd. carried out the research on the development of a vehicle for transporting heavy components of nuclear power plants. In this research, it was aimed at developing a vehicle which can carry heavy components and get over a step, climb and descend stairs, and run through a narrow passage having many curves as well as running on flat ground. For this purpose, the actual state of the transportation of heavy things was investigated during the regular inspection of a nuclear power station, and on the basis of this results, a prototype vehicle was made and tested. Thereafter, a transporting vehicle of actual scale was made and tested. The investigation of actual state and the examination of the fundamental concept, the design, trial manufacture and verifying test are reported. (Kako, I.)

  5. The KB WOT Fisheries Programme carried out in 2015

    NARCIS (Netherlands)

    Damme, van C.J.G.; Verver, S.W.

    2017-01-01

    The KB WOT Fisheries programme is established to maintain and develop the expertise needed to carry out the statutory obligations of the Netherlands in fisheries monitoring and advice. It is also a flexible program which responds to changes over time in WOT requirements, fisheries management and

  6. Application of Load Carrying Sandwich Elements in Wind Turbine Blades

    DEFF Research Database (Denmark)

    Jensen, Jacob Fisker; Schultz, Jacob Pagh; Berggreen, Carl Christian

    2005-01-01

    The present work investigates the possibilities and drawbacks when applying sandwich as opposed to single skin composites in the flanges of the load carrying spar in a future 180 m wind turbine rotor. FEA is applied to investigate two basic designs with single skin and sandwich flanges respectively...

  7. Charges and Fields in a Current-Carrying Wire

    Science.gov (United States)

    Redzic, Dragan V.

    2012-01-01

    Charges and fields in a straight, infinite, cylindrical wire carrying a steady current are determined in the rest frames of ions and electrons, starting from the standard assumption that the net charge per unit length is zero in the lattice frame and taking into account a self-induced pinch effect. The analysis presented illustrates the mutual…

  8. Carrying capacity of Chaetoceros gracilis in Homa Lagoon and the ...

    African Journals Online (AJOL)

    The possibility for nutrient limitation to affect C. gracilis was assessed from two different ecosystems (Izmir Bay and Homa Lagoon). Our goal was to determine the growth rate of all nutrients and the maximum levels of the C. gracilis phytoplankton biomass (the maximum biomass carrying capacity) on the extent of its full ...

  9. Anthelmintic activity procedure The anthelmintic assay was carried ...

    Indian Academy of Sciences (India)

    Indian adult earthworms Pheretima posthuma. The worms were procured from local supplier at Shimoga at the time of carrying out the experiment. The worms were washed with normal saline to remove all fecal matter used for the anthelmintic study. The earthworms of 4 -6 cm in length and 0.3-0.4 cm in width were used for ...

  10. Stress Carry-Over and College Student Health Outcomes

    Science.gov (United States)

    Pedersen, Daphne E.

    2012-01-01

    Objective: Using a stress carry-over perspective, this study examines the relationship between stress stemming from school and family domains and physical and mental health outcomes. Methods: The study sample included 268 undergraduate men and women from a Midwestern university. Participants completed an anonymous online questionnaire. OLS…

  11. Foreign exchange predictability and the carry trade: a decomposition approach

    Czech Academy of Sciences Publication Activity Database

    Anatolyev, Stanislav; Gospodinov, N.; Jamali, I.; Liu, X.

    2017-01-01

    Roč. 42, June (2017), s. 199-211 ISSN 0927-5398 Institutional support: Progres-Q24 Keywords : exchange rate forecasting * carry trade * return decomposition Subject RIV: AH - Economics OBOR OECD: Finance Impact factor: 0.979, year: 2016

  12. El naturalismo americano: Theodore Dreiser y Sister Carrie

    Directory of Open Access Journals (Sweden)

    Dolores G. ALONSO MULAS

    2009-08-01

    Full Text Available Para situar a un escritor, como Theodore Dreiser, y especialmente su novela Sister Carrie dentro de un movimiento literario y de una etapa determinada de la historia americana, es necesario dar un breve repaso al naturalismo, llegado a América a través de Stephen Crane

  13. Carrying capacity of a heterogeneous lake for migrating swans

    NARCIS (Netherlands)

    Gyimesi, A.

    2010-01-01

    One way to express the value of a natural habitat is its capacity to harbour a particular target species. In the case of migratory birds, the cumulative number of birds that can be accommodated at a site for a given period of time (‘bird-days’) became an accepted currency for this carrying capacity.

  14. An apparatus for carrying and transporting a product

    NARCIS (Netherlands)

    Van Ostayen, R.A.J.; Munnig Schmidt, R.H.; Hong, P.V.

    2014-01-01

    An apparatus for carrying and transporting a product, comprising a conveyor having a surface, which surface is during use directed towards the product and is provided with inlet openings and outlet openings for a medium for supporting and providing the product with traction, wherein the surface is

  15. An Actor-Partner Interdependence Model of Acquired Brain Injury Patient Impairments and Caregiver Psychosocial Functioning

    DEFF Research Database (Denmark)

    Perrin, Paul B; Norup, Anne; Caracuel, Alfonso

    2017-01-01

    . METHOD: A sample of 968 individuals with ABI and their caregivers (n = 1,936) from 4 countries completed the European Brain Injury Questionnaire, a measure of ABI impairments and caregiver psychosocial functioning in the context of providing care for the person with ABI. RESULTS: An APIM with all......OBJECTIVE: The purpose of this study was to use actor-partner interdependence modeling (APIM) to examine the simultaneous effects of both acquired brain injury (ABI) patient and caregiver ratings of patient impairments on both patient and caregiver ratings of caregiver psychosocial dysfunction...... adequate or good fit indices found that patient ratings of their own impairments in the domains of social disadaptation and depression were uniquely and positively associated with patient ratings of caregiver psychosocial dysfunction, yet none of the patient ratings of their own impairments were uniquely...

  16. Patient-specific pediatric silicone heart valve models based on 3D ultrasound

    Science.gov (United States)

    Ilina, Anna; Lasso, Andras; Jolley, Matthew A.; Wohler, Brittany; Nguyen, Alex; Scanlan, Adam; Baum, Zachary; McGowan, Frank; Fichtinger, Gabor

    2017-03-01

    PURPOSE: Patient-specific heart and valve models have shown promise as training and planning tools for heart surgery, but physically realistic valve models remain elusive. Available proprietary, simulation-focused heart valve models are generic adult mitral valves and do not allow for patient-specific modeling as may be needed for rare diseases such as congenitally abnormal valves. We propose creating silicone valve models from a 3D-printed plastic mold as a solution that can be adapted to any individual patient and heart valve at a fraction of the cost of direct 3D-printing using soft materials. METHODS: Leaflets of a pediatric mitral valve, a tricuspid valve in a patient with hypoplastic left heart syndrome, and a complete atrioventricular canal valve were segmented from ultrasound images. A custom software was developed to automatically generate molds for each valve based on the segmentation. These molds were 3D-printed and used to make silicone valve models. The models were designed with cylindrical rims of different sizes surrounding the leaflets, to show the outline of the valve and add rigidity. Pediatric cardiac surgeons practiced suturing on the models and evaluated them for use as surgical planning and training tools. RESULTS: Five out of six surgeons reported that the valve models would be very useful as training tools for cardiac surgery. In this first iteration of valve models, leaflets were felt to be unrealistically thick or stiff compared to real pediatric leaflets. A thin tube rim was preferred for valve flexibility. CONCLUSION: The valve models were well received and considered to be valuable and accessible tools for heart valve surgery training. Further improvements will be made based on surgeons' feedback.

  17. [Application of 3D soft print models of the kidney for treatment of patients with localized cancer of the kidney (a pilot study)].

    Science.gov (United States)

    Alyaev, Yu G; Sirota, E S; Bezrukov, E A; Fiev, D N; Bukatov, M D; Letunovskii, A V; Byadretdinov, I Sh

    2017-12-01

    To evaluate the possibility of using 3D-printing in the management of patients with localized kidney cancer. The study comprised five patients with localized kidney cancer who were treated at the Urology Clinic of the I.M. Sechenov First Moscow State Medical University from January 2016 to April 2017. Along with the standard examination, the patients underwent multispiral computed tomography (MSCT) to produce patient-specific 3D-printed models of the kidney tumors using 3D modeling and 3D printing. To evaluate the effectiveness of using 3D-printed models, two-stage preoperative planning was conducted, and five surgeons were surveyed using a four-question multiple choice questionnaire. At the first stage, the planning of operations was carried out based on MSCT findings. At the second stage, the surgeons were given patient-specific soft 3D models of the kidney with a tumor for preoperative training. After preoperative training, patients underwent laparoscopic resection of the kidney with a tumor. According to the survey results, each of the participating surgeons at least once changed surgical plan based on data obtained with 3D printed models of the kidney with the tumor. The implementation of preoperative training using 3D printed models of the kidney turned out to be effective. All patients underwent laparoscopic surgery performed by a single surgeon with extensive experience in this type of surgery. The mean operative time was 187 minutes. All operations were performed with main renal artery occlusion. The men warm ischemia time was 19.5 minutes and the mean blood loss was 170 ml. There were no conversions to open surgery and organ-removing operations. There were no postoperative complications or deaths. All surgical margins were negative. Morphological examination showed that four patients had renal cell carcinoma one patient had the oncocytoma. The study demonstrated the promise of using 3D printing for preoperative planning and surgical performance due to a

  18. State Gun Law Environment and Youth Gun Carrying in the United States.

    Science.gov (United States)

    Xuan, Ziming; Hemenway, David

    2015-11-01

    Gun violence and injuries pose a substantial threat to children and youth in the United States. Existing evidence points to the need for interventions and policies for keeping guns out of the hands of children and youth. (1) To examine the association between state gun law environment and youth gun carrying in the United States, and (2) to determine whether adult gun ownership mediates this association. This was a repeated cross-sectional observational study design with 3 years of data on youth gun carrying from US states. The Youth Risk Behavior Survey comprises data of representative samples of students in grades 9 to 12 from biennial years of 2007, 2009, and 2011. We hypothesized that states with more restrictive gun laws have lower rates of youth gun carrying, and this association is mediated by adult gun ownership. State gun law environment as measured by state gun law score. Youth gun carrying was defined as having carried a gun on at least 1 day during the 30 days before the survey. In the fully adjusted model, a 10-point increase in the state gun law score, which represented a more restrictive gun law environment, was associated with a 9% decrease in the odds of youth gun carrying (adjusted odds ratio [AOR], 0.91 [95% CI, 0.86-0.96]). Adult gun ownership mediated the association between state gun law score and youth gun carrying (AOR, 0.94 [ 95% CI, 0.86-1.01], with 29% attenuation of the regression coefficient from -0.09 to -0.07 based on bootstrap resampling). More restrictive overall gun control policies are associated with a reduced likelihood of youth gun carrying. These findings are relevant to gun policy debates about the critical importance of strengthening overall gun law environment to prevent youth gun carrying.

  19. Strategic level proton therapy patient admission planning: a Markov decision process modeling approach.

    Science.gov (United States)

    Gedik, Ridvan; Zhang, Shengfan; Rainwater, Chase

    2017-06-01

    A relatively new consideration in proton therapy planning is the requirement that the mix of patients treated from different categories satisfy desired mix percentages. Deviations from these percentages and their impacts on operational capabilities are of particular interest to healthcare planners. In this study, we investigate intelligent ways of admitting patients to a proton therapy facility that maximize the total expected number of treatment sessions (fractions) delivered to patients in a planning period with stochastic patient arrivals and penalize the deviation from the patient mix restrictions. We propose a Markov Decision Process (MDP) model that provides very useful insights in determining the best patient admission policies in the case of an unexpected opening in the facility (i.e., no-shows, appointment cancellations, etc.). In order to overcome the curse of dimensionality for larger and more realistic instances, we propose an aggregate MDP model that is able to approximate optimal patient admission policies using the worded weight aggregation technique. Our models are applicable to healthcare treatment facilities throughout the United States, but are motivated by collaboration with the University of Florida Proton Therapy Institute (UFPTI).

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

    Science.gov (United States)

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

    2018-03-01

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

  1. A METHOD OF SECURITY SCANNING OF CARRY-ON ITEMS, AND A CARRY-ON ITEMS SECURITY SCANNING SYSTEM

    DEFF Research Database (Denmark)

    2017-01-01

    A security scanning system (1) comprises a first stage module (3) having at least one X-ray source (6) and at least three first detectors (7) that are line-shaped and arranged in mutually different orientations and have at least dual energy resolution. A group of carry-on items (4) on a carrier...... are scanned simultaneously in the first stage module solely by transmission contrast radiography generating projections of two-dimensional image data. A processing device (9) reconstructs a 3D representation of the carry-on items and analyzes the 3D representation to determine whether further scanning...

  2. Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders

    Directory of Open Access Journals (Sweden)

    Jorge Barros

    Full Text Available Objective: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM analysis. Methods: A study of 707 Chilean mental health patients (with and without suicide risk was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79. Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one’s own capacities and coping abilities. Conclusion: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

  3. Risk assessment models to evaluate the necessity of prostate biopsies in North Chinese patients with 4-50 ng/mL PSA.

    Science.gov (United States)

    Zhao, Jing; Liu, Shuai; Gao, Dexuan; Ding, Sentai; Niu, Zhihong; Zhang, Hui; Huang, Zhilong; Qiu, Juhui; Li, Qing; Li, Ning; Xie, Fang; Cui, Jilei; Lu, Jiaju

    2017-02-07

    Prostate-specific antigen (PSA) is widely used for prostate cancer screening, but low specificity results in high false positive rates of prostate biopsies. To develop new risk assessment models to overcome the diagnostic limitation of PSA and reduce unnecessary prostate biopsies in North Chinese patients with 4-50 ng/mL PSA. A total of 702 patients in seven hospitals with 4-10 and 10-50 ng/mL PSA, respectively, who had undergone transrectal ultrasound-guided prostate biopsies, were assessed. Analysis-modeling stage for several clinical indexes related to prostate cancer and renal function was carried out. Multiple logistic regression analyses were used to develop new risk assessment models of prostate cancer for both PSA level ranges 4-10 and 10-50 ng/mL. External validation stage of the new models was performed to assess the necessity of biopsy. The new models for both PSA ranges performed significantly better than PSA for detecting prostate cancers. Both models showed higher areas under the curves (0.937 and 0.873, respectively) compared with PSA alone (0.624 and 0.595), at pre-determined cut-off values of 0.1067 and 0.6183, respectively. Patients above the cut-off values were recommended for immediate biopsy, while the others were actively observed. External validation of the models showed significantly increased detection rates for prostate cancer (4-10 ng/mL group, 39.29% vs 17.79%, p=0.006; 10-50 ng/mL group, 71.83% vs 50.0%, p=0.015). We developed risk assessment models for North Chinese patients with 4-50 ng/mL PSA to reduce unnecessary prostate biopsies and increase the detection rate of prostate cancer.

  4. The Partnering with Patients Model of Nursing Interventions: A First Step to a Practice Theory

    Science.gov (United States)

    Moyle, Wendy; Rickard, Claire M.; Chambers, Suzanne K.; Chaboyer, Wendy

    2015-01-01

    The development of a body of knowledge, gained through research and theory building, is one hallmark of a profession. This paper presents the “Partnering with Patients Model of Nursing Interventions”, providing direction towards how complex nursing interventions can be developed, tested and subsequently adopted into practice. Coalescence of understanding of patient-centred care, the capabilities approach and the concept of complex healthcare interventions led to the development of the model assumptions and concepts. Application of the model to clinical practice is described, including presentation of a case study, and areas for future research including understanding both patients’ and nurses’ perceptions and experiences when the model is in use, and testing the effect of nursing interventions based on the model are recommended. PMID:27417760

  5. Translational mixed-effects PKPD modelling of recombinant human growth hormone - from hypophysectomized rat to patients

    DEFF Research Database (Denmark)

    Thorsted, Anders; Thygesen, Peter; Agersø, Henrik

    2016-01-01

    and validated through simulations relative to patient data. KEY RESULTS: The final model described rhGH PK as a two compartmental model with parallel linear and non-linear elimination terms, parallel first-order absorption with a total s.c. bioavailability of 87% in rats. Induction of IGF-1 was described...... by an indirect response model with stimulation of kin and related to rhGH exposure through an Emax relationship. Increase in bodyweight was directly linked to individual concentrations of IGF-1 by a linear relation. The scaled model provided robust predictions of human systemic PK of rhGH, but exposure following...... a clinically relevant biomarker, IGF-1, to a primary clinical end-point, growth/bodyweight gain. Scaling of the model parameters provided robust predictions of the human PKPD in growth hormone-deficient patients including variability....

  6. Examining the link between patient satisfaction and adherence to HIV care: a structural equation model.

    Directory of Open Access Journals (Sweden)

    Bich N Dang

    Full Text Available INTRODUCTION: Analogous to the business model of customer satisfaction and retention, patient satisfaction could serve as an innovative, patient-centered focus for increasing retention in HIV care and adherence to HAART, and ultimately HIV suppression. OBJECTIVE: To test, through structural equation modeling (SEM, a model of HIV suppression in which patient satisfaction influences HIV suppression indirectly through retention in HIV care and adherence to HAART. METHODS: We conducted a cross-sectional study of adults receiving HIV care at two clinics in Texas. Patient satisfaction was based on two validated items, one adapted from the Consumer Assessment of Healthcare Providers and Systems survey ("Would you recommend this clinic to other patients with HIV? and one adapted from the Delighted-Terrible Scale, ("Overall, how do you feel about the care you got at this clinic in the last 12 months?". A validated, single-item question measured adherence to HAART over the past 4 weeks. Retention in HIV care was based on visit constancy in the year prior to the survey. HIV suppression was defined as plasma HIV RNA <48 copies/mL at the time of the survey. We used SEM to test hypothesized relationships. RESULTS: The analyses included 489 patients (94% of eligible patients. The patient satisfaction score had a mean of 8.5 (median 9.2 on a 0- to 10- point scale. A total of 46% reported "excellent" adherence, 76% had adequate retention, and 70% had HIV suppression. In SEM analyses, patient satisfaction with care influences retention in HIV care and adherence to HAART, which in turn serve as key determinants of HIV suppression (all p<.0001. CONCLUSIONS: Patient satisfaction may have direct effects on retention in HIV care and adherence to HAART. Interventions to improve the care experience, without necessarily targeting objective clinical performance measures, could serve as an innovative method for optimizing HIV outcomes.

  7. Developing and Validating a Survival Prediction Model for NSCLC Patients Through Distributed Learning Across 3 Countries.

    Science.gov (United States)

    Jochems, Arthur; Deist, Timo M; El Naqa, Issam; Kessler, Marc; Mayo, Chuck; Reeves, Jackson; Jolly, Shruti; Matuszak, Martha; Ten Haken, Randall; van Soest, Johan; Oberije, Cary; Faivre-Finn, Corinne; Price, Gareth; de Ruysscher, Dirk; Lambin, Philippe; Dekker, Andre

    2017-10-01

    Tools for survival prediction for non-small cell lung cancer (NSCLC) patients treated with chemoradiation or radiation therapy are of limited quality. In this work, we developed a predictive model of survival at 2 years. The model is based on a large volume of historical patient data and serves as a proof of concept to demonstrate the distributed learning approach. Clinical data from 698 lung cancer patients, treated with curative intent with chemoradiation or radiation therapy alone, were collected and stored at 2 different cancer institutes (559 patients at Maastro clinic (Netherlands) and 139 at Michigan university [United States]). The model was further validated on 196 patients originating from The Christie (United Kingdon). A Bayesian network model was adapted for distributed learning (the animation can be viewed at https://www.youtube.com/watch?v=ZDJFOxpwqEA). Two-year posttreatment survival was chosen as the endpoint. The Maastro clinic cohort data are publicly available at https://www.cancerdata.org/publication/developing-and-validating-survival-prediction-model-nsclc-patients-through-distributed, and the developed models can be found at www.predictcancer.org. Variables included in the final model were T and N category, age, performance status, and total tumor dose. The model has an area under the curve (AUC) of 0.66 on the external validation set and an AUC of 0.62 on a 5-fold cross validation. A model based on the T and N category performed with an AUC of 0.47 on the validation set, significantly worse than our model (PLearning the model in a centralized or distributed fashion yields a minor difference on the probabilities of the conditional probability tables (0.6%); the discriminative performance of the models on the validation set is similar (P=.26). Distributed learning from federated databases allows learning of predictive models on data originating from multiple institutions while avoiding many of the data-sharing barriers. We believe that

  8. Validation of multivariable models for predicting tooth loss in periodontitis patients.

    Science.gov (United States)

    Schwendicke, F; Schmietendorf, E; Plaumann, A; Sälzer, S; Dörfer, C E; Graetz, C

    2018-04-03

    A large number of multivariable models which associate independent variables with the outcome tooth loss exist. Directly or indirectly, these make predictions as to the relative risk of tooth loss. We aimed to validate six of these prediction models. We applied each model, if needed after adaptions, in a cohort of 301 compliant periodontitis patients who had been under supportive periodontal treatment (SPT) in a university setting over 21.7±5.6 years. The models employed a range of tooth-level and patient-level parameters. Model accuracy, i.e. the ability to rightly predict tooth loss during SPT using baseline parameters, was investigated by the area under the receiver-operating-characteristics curve (AUC). Most models showed low accuracy (AUC ranged between 0.52 and 0.67). The classification model from Avila et al. (2009), expressing the risk of tooth loss in five grades, was most accurate (mean AUC: 0.67, 95%CI: 0.65/0.69). When applying this model, the risk of false-positively predicting tooth loss was high, except when the highest grade (i.e. a tooth being considered as having a hopeless prognosis) was used. In this case, the specificity was 84% and the sensitivity 46%. Predicting tooth loss in this specific cohort of periodontitis patients was only limitedly possible. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Can Mathematical Models Predict the Outcomes of Prostate Cancer Patients Undergoing Intermittent Androgen Deprivation Therapy?

    Science.gov (United States)

    Everett, R. A.; Packer, A. M.; Kuang, Y.

    Androgen deprivation therapy is a common treatment for advanced or metastatic prostate cancer. Like the normal prostate, most tumors depend on androgens for proliferation and survival but often develop treatment resistance. Hormonal treatment causes many undesirable side effects which significantly decrease the quality of life for patients. Intermittently applying androgen deprivation in cycles reduces the total duration with these negative effects and may reduce selective pressure for resistance. We extend an existing model which used measurements of patient testosterone levels to accurately fit measured serum prostate specific antigen (PSA) levels. We test the model's predictive accuracy, using only a subset of the data to find parameter values. The results are compared with those of an existing piecewise linear model which does not use testosterone as an input. Since actual treatment protocol is to re-apply therapy when PSA levels recover beyond some threshold value, we develop a second method for predicting the PSA levels. Based on a small set of data from seven patients, our results showed that the piecewise linear model produced slightly more accurate results while the two predictive methods are comparable. This suggests that a simpler model may be more beneficial for a predictive use compared to a more biologically insightful model, although further research is needed in this field prior to implementing mathematical models as a predictive method in a clinical setting. Nevertheless, both models are an important step in this direction.

  10. Validation of a model to predict all-cause in-hospital mortality in vascular surgical patients.

    Science.gov (United States)

    Biccard, B M; Pooran, R R

    2008-01-01

    To develop and validate a pre- and postoperative model of all-cause in-hospital mortality in South African vascular surgical patients. We carried out a retrospective cohort study. A multivariate analysis using binary logistic regression was conducted on a derivation cohort using clinical, physiological and surgical data. Interaction and colinearity between covariates were investigated. The models were validated using the Homer-Lemeshow goodness-of-fit test. Independent predictors of in-hospital mortality in the pre-operative model were: (1) age (per one-year increase) [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.0-1.06), (2) creatinine > 180 micromol.l(-1) (OR 6.43, 95% CI: 3.482-11.86), (3) chronic beta-blocker therapy (OR 2.48, 95% CI: 1.38-4.48), and (4) absence of chronic statin therapy (OR 2.81, 95% CI: 1.15-6.83). Independent predictors of mortality in the postoperative model were: (1) age (per one-year increase) (OR 1.05, 95% CI: 1.02-1.09), (2) creatinine > 180 micromol.l(-1) (OR 5.08, 95% CI: 2.50-10.31), (3) surgery out of hours without statin therapy (OR 8.27, 95% CI: 3.36-20.38), (4) mean daily postoperative heart rate (HR) (OR 1.02, 95% CI: 1.0-1.04), (5) mean daily postoperative HR in the presence of a mean daily systolic blood pressure of less than 100 beats per minute or above 179 mmHg (OR 1.02, 95% CI: 1.01-1.03) and (6) mean daily postoperative HR associated with withdrawal of chronic beta-blockade (OR 1.02, 95% CI: 1.01-1.03). Both models were validated. The pre-operative model may predict the risk of in-hospital mortality associated with vascular surgery. The postoperative model may identify patients whose risk increases as a result of surgical or physiological factors.

  11. Prediction of warfarin maintenance dose in Han Chinese patients using a mechanistic model based on genetic and non-genetic factors.

    Science.gov (United States)

    Lu, Yuan; Yang, Jinbo; Zhang, Haiyan; Yang, Jin

    2013-07-01

    Many attempts have been made to predict the warfarin maintenance dose in patients beginning warfarin therapy using a descriptive model based on multiple linear regression. Here we report the first attempt to develop a comprehensive mechanistic model integrating in vitro-in vivo extrapolation (IVIVE) with a pharmacokinetic-pharmacodynamic model to predict the warfarin maintenance dose in Han Chinese patients. The model incorporates demographic factors [sex, age, body weight (BW)] and the genetic polymorphisms of cytochrome P450 (CYP) 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1). Information on the various factors, mean warfarin daily dose and International Normalized Ratio (INR) was available for a cohort of 197 Han Chinese patients. Based on in vitro enzyme kinetic parameters for S-warfarin metabolism, demographic data for Han Chinese and some scaling factors, the S-warfarin clearance (CL) was predicted for patients in the cohort with different CYP2C9 genotypes using IVIVE. The plasma concentration of S-warfarin after a single oral dose was simulated using a one-compartment pharmacokinetic model with first-order absorption and a lag time and was combined with a mechanistic coagulation model to simulate the INR response. The warfarin maintenance dose was then predicted based on the demographic data and genotypes of CYP2C9 and VKORC1 for each patient and using the observed steady-state INR (INRss) as a target value. Finally, sensitivity analysis was carried out to determine which factor(s) affect the warfarin maintenance dose most strongly. The predictive performance of this mechanistic model is not inferior to that of our previous descriptive model. There were significant differences in the mean warfarin daily dose in patients with different CYP2C9 and VKORC1 genotypes. Using IVIVE, the predicted mean CL of S-warfarin for patients with CYP2C9*1/*3 (0.092 l/h, n = 11) was 57 % less than for those with wild-type *1/*1 (0.215 l/h, n

  12. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures.

    Science.gov (United States)

    Rettmann, Maryam E; Holmes, David R; Kwartowitz, David M; Gunawan, Mia; Johnson, Susan B; Camp, Jon J; Cameron, Bruce M; Dalegrave, Charles; Kolasa, Mark W; Packer, Douglas L; Robb, Richard A

    2014-02-01

    In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamic in vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration

  13. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Rettmann, Maryam E., E-mail: rettmann.maryam@mayo.edu; Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A. [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Kwartowitz, David M. [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States); Gunawan, Mia [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States); Johnson, Susan B.; Packer, Douglas L. [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States); Dalegrave, Charles [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil); Kolasa, Mark W. [David Grant Medical Center, Fairfield, California 94535 (United States)

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

  14. Health care competition, strategic mission, and patient satisfaction: research model and propositions.

    Science.gov (United States)

    Rivers, Patrick A; Glover, Saundra H

    2008-01-01

    In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. A literature review was conducted. A total of 50 items of literature related to the subject were reviewed. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

  15. Three-dimensional patient-specific cardiac model for surgical planning in Nikaidoh procedure.

    Science.gov (United States)

    Valverde, Israel; Gomez, Gorka; Gonzalez, Antonio; Suarez-Mejias, Cristina; Adsuar, Alejandro; Coserria, Jose Felix; Uribe, Sergio; Gomez-Cia, Tomas; Hosseinpour, Amir Reza

    2015-04-01

    To explore the use of three-dimensional patient-specific cardiovascular models using rapid prototyping techniques (fused deposition modelling) to improve surgical planning in patients with complex congenital heart disease. Rapid prototyping techniques are used to print accurate three-dimensional replicas of patients' cardiovascular anatomy based on magnetic resonance images using computer-aided design systems. Models are printed using a translucent polylactic acid polymer. As a proof of concept, a model of the heart of a 1.5-year-old boy with transposition of the great arteries, ventricular septal defect and pulmonary stenosis was constructed to help planning the surgical correction. The cardiac model allowed the surgeon to evaluate the location and dimensions of the ventricular septal defect as well as its relationship with the aorta and pulmonary artery. Cardiovascular models constructed by rapid prototyping techniques are extremely helpful for planning corrective surgery in patients with complex congenital malformations. Therefore they may potentially reduce operative time and morbi-mortality.

  16. Identifying the Basal Ganglia network model markers for medication-induced impulsivity in Parkinson's disease patients.

    Science.gov (United States)

    Balasubramani, Pragathi Priyadharsini; Chakravarthy, V Srinivasa; Ali, Manal; Ravindran, Balaraman; Moustafa, Ahmed A

    2015-01-01

    Impulsivity, i.e. irresistibility in the execution of actions, may be prominent in Parkinson's disease (PD) patients who are treated with dopamine precursors or dopamine receptor agonists. In this study, we combine clinical investigations with computational modeling to explore whether impulsivity in PD patients on medication may arise as a result of abnormalities in risk, reward and punishment learning. In order to empirically assess learning outcomes involving risk, reward and punishment, four subject groups were examined: healthy controls, ON medication PD patients with impulse control disorder (PD-ON ICD) or without ICD (PD-ON non-ICD), and OFF medication PD patients (PD-OFF). A neural network model of the Basal Ganglia (BG) that has the capacity to predict the dysfunction of both the dopaminergic (DA) and the serotonergic (5HT) neuromodulator systems was developed and used to facilitate the interpretation of experimental results. In the model, the BG action selection dynamics were mimicked using a utility function based decision making framework, with DA controlling reward prediction and 5HT controlling punishment and risk predictions. The striatal model included three pools of Medium Spiny Neurons (MSNs), with D1 receptor (R) alone, D2R alone and co-expressing D1R-D2R. Empirical studies showed that reward optimality was increased in PD-ON ICD patients while punishment optimality was increased in PD-OFF patients. Empirical studies also revealed that PD-ON ICD subjects had lower reaction times (RT) compared to that of the PD-ON non-ICD patients. Computational modeling suggested that PD-OFF patients have higher punishment sensitivity, while healthy controls showed comparatively higher risk sensitivity. A significant decrease in sensitivity to punishment and risk was crucial for explaining behavioral changes observed in PD-ON ICD patients. Our results highlight the power of computational modelling for identifying neuronal circuitry implicated in learning, and its

  17. [Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders].

    Science.gov (United States)

    Espaulella-Panicot, Joan; Molist-Brunet, Núria; Sevilla-Sánchez, Daniel; González-Bueno, Javier; Amblàs-Novellas, Jordi; Solà-Bonada, Núria; Codina-Jané, Carles

    Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. 3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

    Science.gov (United States)

    Dhou, Salam; Hurwitz, Martina; Mishra, Pankaj; Cai, Weixing; Rottmann, Joerg; Li, Ruijiang; Williams, Christopher; Wagar, Matthew; Berbeco, Ross; Ionascu, Dan; Lewis, John H.

    2015-01-01

    3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we develop and perform initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and use these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparing to ground truth digital and physical phantom images. The performance of 4DCBCT- and 4DCT- based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms, and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. PMID:25905722

  19. 3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

    International Nuclear Information System (INIS)

    Dhou, S; Hurwitz, M; Cai, W; Rottmann, J; Williams, C; Wagar, M; Berbeco, R; Lewis, J H; Mishra, P; Li, R; Ionascu, D

    2015-01-01

    3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we developed and performed initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and used these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparison to ground truth digital and physical phantom images. The performance of 4DCBCT-based and 4DCT-based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. (paper)

  20. Positive and Negative Relationship between Anxiety and Depression of Patients in Pain: A Bifactor Model Analysis

    Science.gov (United States)

    li, Wen; Shang, Wen; Yan, Ming; Miao, Danmin; Zhang, Huiming

    2012-01-01

    Background The relationship between anxiety and depression in pain patients has not been clarified comprehensively. Previous research has identified a common factor in anxiety and depression, which may explain why depression and anxiety are strongly correlated. However, the specific clinical features of anxiety and depression seem to pull in opposite directions. Objective The purpose of this study is to develop a statistical model of depression and anxiety, based on data from pain patients using Hospital Anxiety and Depression Scale (HADS). This model should account for the positive correlation between depression and anxiety in terms of a general factor and also demonstrate a latent negative correlation between the specific factors underlying depression and anxiety. Methods The anxiety and depression symptoms of pain patients were evaluated using the HADS and the severity of their pain was assessed with the visual analogue scale (VAS). We developed a hierarchical model of the data using an IRT method called bifactor analysis. In addition, we tested this hierarchical model with model fit comparisons with unidimensional, bidimensional, and tridimensional models. The correlations among anxiety, depression, and pain severity were compared, based on both the bidimensional model and our hierarchical model. Results The bidimensional model analysis found that there was a large positive correlation between anxiety and depression (r = 0.638), and both scores were significantly positively correlated with pain severity. After extracting general factor of distress using bifactor analysis, the specific factors underlying anxiety and depression were weakly but significantly negatively correlated (r = −0.245) and only the general factor was significantly correlated with pain severity. Compared with the three first-order models, the bifactor hierarchical model had the best model fit. Conclusion Our results support the hypothesis that apart from distress, anxiety and

  1. Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

    Directory of Open Access Journals (Sweden)

    Marta Carrara

    2015-01-01

    Full Text Available We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients.

  2. A framework for different levels of integration of computational models into web-based virtual patients.

    Science.gov (United States)

    Kononowicz, Andrzej A; Narracott, Andrew J; Manini, Simone; Bayley, Martin J; Lawford, Patricia V; McCormack, Keith; Zary, Nabil

    2014-01-23

    Virtual patients are increasingly common tools used in health care education to foster learning of clinical reasoning skills. One potential way to expand their functionality is to augment virtual patients' interactivity by enriching them with computational models of physiological and pathological processes. The primary goal of this paper was to propose a conceptual framework for the integration of computational models within virtual patients, with particular focus on (1) characteristics to be addressed while preparing the integration, (2) the extent of the integration, (3) strategies to achieve integration, and (4) methods for evaluating the feasibility of integration. An additional goal was to pilot the first investigation of changing framework variables on altering perceptions of integration. The framework was constructed using an iterative process informed by Soft System Methodology. The Virtual Physiological Human (VPH) initiative has been used as a source of new computational models. The technical challenges associated with development of virtual patients enhanced by computational models are discussed from the perspectives of a number of different stakeholders. Concrete design and evaluation steps are discussed in the context of an exemplar virtual patient employing the results of the VPH ARCH project, as well as improvements for future iterations. The proposed framework consists of four main elements. The first element is a list of feasibility features characterizing the integration process from three perspectives: the computational modelling researcher, the health care educationalist, and the virtual patient system developer. The second element included three integration levels: basic, where a single set of simulation outcomes is generated for specific nodes in the activity graph; intermediate, involving pre-generation of simulation datasets over a range of input parameters; advanced, including dynamic solution of the model. The third element is the

  3. Carrying guns in public: legal and public health implications.

    Science.gov (United States)

    Vernick, Jon S

    2013-03-01

    In District of Columbia v. Heller, the U.S. Supreme Court ruled that the Second Amendment protects an individual's right to own handguns in the home for protection, invalidating a Washington, D.C. law banning most handgun possession. The Heller decision, however, provided lower courts with little guidance regarding how to judge the constitutionality of gun laws other than handgun bans. Nevertheless, lower courts have upheld the vast majority of federal, state, and local gun laws challenged since Heller. One area in which some lower courts have disagreed has been the constitutionality of laws regulating the ability to carry firearms in public. This issue may be the next to be addressed by the Supreme Court under its evolving Second Amendment jurisprudence. Courts should carefully consider the negative public health and safety implications of gun carrying in public as they weigh the constitutionality of these laws. © 2013 American Society of Law, Medicine & Ethics, Inc.

  4. Experiments on criticality carried out from 1975 till 1980

    International Nuclear Information System (INIS)

    Heinicke, W.; Tischer, A.; Weber, W.J.

    1981-11-01

    The report on hand includes the experiments on criticality published from 1975 till 1980. About 90 experiments with the most important related data are listed. They are capable of being called up, with the data base system KRITEXP, by 14 different descriptors or printed in any arrangement or order. This is the basis for a global or purposeful verification of the calculating method for criticality safety. The proof of reliability of the calculations for the criticality analysis are immediately relevant for the licencing procedure under atomic law for all plants of the nuclear fuel cycle where nuclear fuels are handled. Since no criticality experiments are being carried out in the Federal Republic of Germany, the data collection on hand will help to fill this gap with regard to the assessment of experiments carried out in other countries. (orig.) [de

  5. Parallel Optimization of a Reversible (Quantum) Ripple-Carry Adder

    DEFF Research Database (Denmark)

    Thomsen, Michael Kirkedal; Axelsen, Holger Bock

    2008-01-01

    ) ripple-carry adder. We optimize this design with a novel parallelization scheme wherein m parallel k-bit CDKM-adders are combined to form a reversible mk-bit ripple-block carry adder with logic depth O(m+k) for a minimal logic depth O(\\sqrt{mk}), thus improving on the mk-bit CDKM-adder logic depth O......(mk). We also show designs for garbage-less reversible set-less-than circuits. We compare the circuit costs of the CDKM and parallel adder in measures of circuit delay, width, gate and transistor count, and find that the parallelized adder offers significant speedups at realistic word sizes with modest...... parallelization overhead....

  6. Exercise effects in a virtual type 1 diabetes patient: Using stochastic differential equations for model extension

    DEFF Research Database (Denmark)

    Duun-Henriksen, Anne Katrine; Schmidt, S.; Nørgaard, K.

    2013-01-01

    The use of virtual patients for in silico testing of control algorithms for an artificial pancreas is growing. It is an easy, fast and low-cost alternative to pre-clinical testing. To simulate the everyday life of a type 1 diabetes (T1D) patient a simulator must be able to take into account...... physical activity. Exercise constitutes a substantial challenge to closed-loop control of T1D. The effects are many and depend on intensity and duration and may be delayed by several hours. In this study, we use a model for the glucoregulatory system based on the minimal model and a previously published...... on clinical data from a study including exercise bouts of 20 minutes performed on 12 T1D patients treated with continuous subcutaneous insulin infusion. The predictive abilities of the model are investigated. In conclusion, this study illustrates the advantages of using SDEs in the development of an extended...

  7. Patient Derived Xenograft Models: An Emerging Platform for Translational Cancer Research

    Science.gov (United States)

    Hidalgo, Manuel; Amant, Frederic; Biankin, Andrew V.; Budinská, Eva; Byrne, Annette T.; Caldas, Carlos; Clarke, Robert B.; de Jong, Steven; Jonkers, Jos; Mælandsmo, Gunhild Mari; Roman-Roman, Sergio; Seoane, Joan; Trusolino, Livio; Villanueva, Alberto

    2014-01-01

    Recently, there has been increasing interest in the development and characterization of patient derived tumor xenograft (PDX) models for cancer research. PDX models mostly retain the principal histological and genetic characteristics of their donor tumor and remain stable across passages. These models have been shown to be predictive of clinical outcomes and are being used for preclinical drug evaluation, biomarker identification, biological studies, and personalized medicine strategies. This paper summarizes the current state of the art in this field including methodological issues, available collections, practical applications, challenges and shortcoming, and future directions, and introduces a European consortium of PDX models. PMID:25185190

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

    Science.gov (United States)

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

    2018-01-01

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

  9. An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement.

    Science.gov (United States)

    Png, Chien Yi M; Tadros, Rami O; Beckerman, William E; Han, Daniel K; Tardiff, Melissa L; Torres, Marielle R; Marin, Michael L; Faries, Peter L

    2017-09-01

    Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs. 895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables. Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033). Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. MATHEMATICAL MODEL FOR THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN PATIENTS

    OpenAIRE

    Dr. T. Geetha; K. Balamurugan

    2016-01-01

    In this paper we use mathematical model for the application of The Renin-Angiotensin-Aldosterone system the difference of sleep related activity of the RAAS between depressed patients and healthy controls. We studied the nocturnal plasma concentration of ACTH, cortisol, renin and aldosterone, and sleep EEG in 7 medication free patients with depression. The huge increase in aldosterone in depressed subjects compared to controls and the unchanged cross correlation between the time course of noc...

  11. New Delivery Model for Rising-Risk Patients: The Forgotten Lot?

    Science.gov (United States)

    Cheung, Lauren; Norden, Justin; Harrington, Robert A; Desai, Sumbul A

    2017-08-01

    Shared-risk models encourage providers to engage young patients early. Telemedicine may be well suited for younger, healthier patients although it is unclear how best to incorporate telemedicine into routine clinical care. We test the assumptions surrounding the use of telemedicine, younger and rising-risk patients, and primary care in ClickWell Care (CWC), a care model developed at our institution for our own accountable care organization. CWC's team of physicians and wellness coaches work together to provide comprehensive primary care through in-person, phone, and video visits. This study examines usage of the clinic over its initial year in operation. 1,464 unique patients conducted a total of 3,907 visits. 2,294 (58.7%) visits were completed virtually (1,382 [35.4%] by phone and 912 [23.3%] by video). Patients were more inclined to see the physician in-person for a new visit (1,065 visits [70.5%] vs. 362 [24%] phone and 83 [6%] video) and more likely to see the physician virtually for a return visit (606 [43.2%] phone and 249 [17.7%] video vs. 548 [39.1%] in-person), a statistically significant difference (X 2  = 306.7, p < 0.00001). This new care model successfully engaged a younger population of patients. However, our data suggest young patients may not be inclined to establish care with a primary care physician virtually and, in fact, choose an initial in-person touch point, although many are willing to conduct return visits virtually. This new model of care could have a large impact on how care is delivered to low- and rising-risk patients.

  12. Time Dynamic Modeling and Inference Approaches for Outcomes in Patients on Dialysis

    OpenAIRE

    Estes, Jason

    2015-01-01

    In the first chapter of this work, we characterize the dynamics of cardiovascular event risk trajectories for patients on dialysis while conditioning on survival status via multiple time indices: (1) time since the start of dialysis, (2) time since the pivotal initial infection-related hospitalization and (3) the patient's age at the start of dialysis. This is achieved by using a new class of generalized multiple-index varying coefficient (GM-IVC) models utilizing a multiplicative structure a...

  13. Gluteus medius and thigh muscles electromyography during load carrying walking

    Directory of Open Access Journals (Sweden)

    Petr Šťastný

    2015-11-01

    Full Text Available This study compares the electromyographic (EMG peak amplitude changes of gluteus medius (Gmed, vastus medialis (VMO, vastus lateralis (VL and biceps femoris (BF during load carrying walking due to the increased load. The percentage of maximum isometric voluntary contractions (%MVIC of both limbs and 3D kinematic of lower limbs were detected on eighteen resistance-trained men (mean age ± SD, 31 ± 3.4 years while carrying loads of 25, 50 and 75% of their body mass (BM. The repeated measurement ANOVA was used to evaluate the differences in muscles %MVIC and 3D kinematics at all load conditions. Significant differences were found for Gmed %MVIC (F3,99 = 19.8, p < 0.001. Gmed activity was significantly different between load carrying walking with 25% of BM (mean ± SD, 20 ± 12%MVIC, 50% of BM (32 ± 17%MVIC and 75% of BM (45 ± 26%MVIC condition. Differences were found in hip flexion at Gmed EMG peak (F3,96 = 14, p < 0.001, between 25% of BM (18 ± 11° and 50% of BM (29 ± 7°. No significant differences were found for thigh muscles, when thigh muscle activity did not exceed 30%MVIC even at 75% of BM condition. Load carrying walking is an exercise which activates Gmed more than thigh muscles. This exercise increases the Gmed activity along with increased loads and it should be regarded as a complex Gmed strengthening exercise. This exercise is recommended for strengthening the Gmed with low activation of VL and VMO.

  14. Digitization Projects Carried out by the Mathematical Institute Belgrade

    OpenAIRE

    Ognjanovič, Zoran; Mijajlovič, Žarco

    2004-01-01

    In this paper some current digitization projects carried out by the Mathematical Institute of Serbian Academy of Science and Arts Belgrade and the Faculty of Mathematics Belgrade are described. The projects concern developing of a virtual library of retro-digitized books and an Internet data base and presentation of electronic editions of some leading Serbian journals in science and arts, and the work on the South-Eastern European Digitization Initiative (SEEDI).

  15. Hydrodynamic pressure, carrying capacities, friction forces in biobearing gap.

    Science.gov (United States)

    Wierzcholski, Krzysztof Ch

    2009-01-01

    The present paper deals with the calculations of the pressure distributions, carrying capacities and friction forces derivations in a super- thin layer of biological synovial fluid inside the slide biobearing gap limited by a spherical, conical, cylindrical, parabolic, hyperbolic bone heads. There are also described unsteady and random flow conditions of the bio-bearing lubrication with the changes of the dynamic viscosity of the synovial fluid in the gap height in general.

  16. The calming effect of maternal carrying in different mammalian species

    Directory of Open Access Journals (Sweden)

    Gianluca eEsposito

    2015-04-01

    Full Text Available Attachment theory postulates that mothers and their infants possess some basic physiological mechanisms that favour their dyadic interaction and bonding. Many studies have focused on the maternal physiological mechanisms that promote attachment (e.g. mothers’ automatic responses to infant faces and/or cries, and relatively less have examined infant physiology. Thus, the physiological mechanisms regulating infant bonding behaviors remain largely undefined. This review elucidates some of the neurobiological mechanisms governing social bonding and cooperation in humans by focusing on maternal carrying and its beneficial effect on mother-infant interaction in mammalian species (e.g. in humans, big cats and rodents. These studies show that infants have a specific calming response to maternal carrying. A human infant carried by his/ her walking mother exhibits a rapid heart rate decrease, and immediately stops voluntary movement and crying compared to when he/ she is held in a sitting position. Furthermore, strikingly similar responses were identified in mouse rodents, who exhibit immobility, diminished ultra-sonic vocalizations and heart rate. In general, the studies described in the current review demonstrate the calming effect of maternal carrying to be comprised of a complex set of behavioral and physiological components, each of which has a specific postnatal time window and is orchestrated in a well-matched manner with the maturation of the infants. Such reactions could have been evolutionarily adaptive in mammalian mother-infant interactions. The findings have implications for parenting practices in developmentally normal populations. In addition, we propose that infants’ physiological response may be useful in clinical assessments as we discuss possible implications on early screening for child psychopathology (e.g. Autism Spectrum Disorders, and Perinatal Brain Disorders.

  17. Superpositions of light fields carrying orbital angular momentum

    CSIR Research Space (South Africa)

    Dudley, Angela L

    2012-01-01

    Full Text Available OF LIGHT FIELDS CARRYING ORBITAL ANGULAR MOMENTUM By Angela Dudley A thesis submitted in fulfilment of the academic requirements for the PhD degree of Science in the School of Chemistry and Physics, University of KwaZulu-Natal, Durban... this dissertation for submission. _________________________________ Prof Andrew Forbes On this_______day of____________________________2012 iv Declaration 2 - Plagiarism I, ???????????????. declare that 1...

  18. Plant Agricultural Streptomycin Formulations Do Not Carry Antibiotic Resistance Genes▿

    OpenAIRE

    Rezzonico, Fabio; Stockwell, Virginia O.; Duffy, Brion

    2009-01-01

    Streptomycin is used in plant agriculture for bacterial disease control, particularly against fire blight in pome fruit orchards. Concerns that this may increase environmental antibiotic resistance have led to bans or restrictions on use. Experience with antibiotic use in animal feeds raises the possible influence of formulation-delivered resistance genes. We demonstrate that agricultural streptomycin formulations do not carry producer organism resistance genes. By using an optimized extracti...

  19. Patient-specific induced pluripotent stem cells in neurological disease modeling: the importance of nonhuman primate models

    Directory of Open Access Journals (Sweden)

    Qiu Z

    2013-07-01

    Full Text Available Zhifang Qiu,1,2 Steven L Farnsworth,2 Anuja Mishra,1,2 Peter J Hornsby1,21Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA; 2Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USAAbstract: The development of the technology for derivation of induced pluripotent stem (iPS cells from human patients and animal models has opened up new pathways to the better understanding of many human diseases, and has created new opportunities for therapeutic approaches. Here, we consider one important neurological disease, Parkinson's, the development of relevant neural cell lines for studying this disease, and the animal models that are available for testing the survival and function of the cells, following transplantation into the central nervous system. Rapid progress has been made recently in the application of protocols for neuroectoderm differentiation and neural patterning of pluripotent stem cells. These developments have resulted in the ability to produce large numbers of dopaminergic neurons with midbrain characteristics for further study. These cells have been shown to be functional in both rodent and nonhuman primate (NHP models of Parkinson's disease. Patient-specific iPS cells and derived dopaminergic neurons have been developed, in particular from patients with genetic causes of Parkinson's disease. For complete modeling of the disease, it is proposed that the introduction of genetic changes into NHP iPS cells, followed by studying the phenotype of the genetic change in cells transplanted into the NHP as host animal, will yield new insights into disease processes not possible with rodent models alone.Keywords: Parkinson's disease, pluripotent cell differentiation, neural cell lines, dopaminergic neurons, cell transplantation, animal models

  20. Apollo 11 Astronaut Aldrin Carries Equipment on Lunar Surface

    Science.gov (United States)

    1969-01-01

    The first manned lunar landing mission, Apollo 11, launched from the Kennedy Space Center (KSC) in Florida via the Marshall Space Flight Center (MSFC) developed Saturn V launch vehicle on July 16, 1969 and safely returned to Earth on July 24, 1969. Aboard the space craft were astronauts Neil A. Armstrong, commander; Michael Collins, Command Module (CM) pilot; and Edwin E. (Buzz) Aldrin Jr., Lunar Module (LM) pilot. The CM, piloted by Michael Collins, remained in a parking orbit around the Moon, while the LM, named 'Eagle'', carrying astronauts Armstrong and Aldrin, landed on the Moon in the Sea of Tranquility. During 2½ hours of surface exploration, the crew set up experiments, collected 47 pounds of lunar surface material for analysis back on Earth, planted the U.S Flag, and left a message for all mankind. In this photograph, Aldrin walks past some rocks, easily carrying scientific equipment which would have been too heavy to carry on Earth. The two packages made up the Early Apollo Scientific Experiment Package (EASEP) on Apollo 11. On the left is the Passive Seismic Experiment Package (PSEP) and on the right is the Laser Ranging Retroreflector (LRR).

  1. Magnetohydrodynamic sausage waves in current-carrying coronal tubes

    Science.gov (United States)

    Bahari, Karam

    2017-09-01

    Magnetohydrodynamic (MHD) sausage waves in a coronal loop consisting of a core with longitudinal magnetic field and a current-carrying annulus with azimuthal magnetic field in the presence of plasma pressure are studied. As the plasma pressure is introduced to the loop a narrow band of infinite slow waves appear in the dispersion diagram, and the oscillation frequency of the fast sausage waves increases. In the loops with thinner annulus, more fast sausage waves with higher radial mode numbers are supported by the loop, and the fast sausage waves have smaller cut off wave numbers. The eigenfunction of the long wavelength fast sausage wave supported by the current-carrying loop, in the case of low density contrast, is similar to the eigenfunction of the slow sausage wave in a straight homogeneous loop with the maximum frequency of the frequency band. Other slow sausage waves both in a straight homogeneous loop and a current-carrying loop do not perturb the surrounding environment substantially.

  2. [The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

    Science.gov (United States)

    Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

    2014-06-01

    Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  3. Integrated clinical and specialty pharmacy practice model for management of patients with multiple sclerosis.

    Science.gov (United States)

    Hanson, Rebekah L; Habibi, Mitra; Khamo, Nehrin; Abdou, Sherif; Stubbings, JoAnn

    2014-03-15

    An integrated clinical and specialty pharmacy practice model for the management of patients with multiple sclerosis (MS) is described. Specialty medications, such as disease-modifying therapies (DMTs) used to treat MS, are costly and typically require special administration, handling, and storage. DMTs are associated with high rates of nonadherence and may have associated safety risks. The University of Illinois Hospital and Health Sciences System developed an MS pharmacy practice model that sought to address the many challenges of coordinating care with multiple entities outside the health system. Several key features of the integrated model include a dedicated clinical pharmacist on the MS specialty team, an integrated specialty pharmacy service, direct access to the electronic medical record, and face-to-face interaction with patients. Through the active involvement of the neurology clinical pharmacist and an onsite specialty pharmacy service, targeted assessments and medication and disease education are provided to the patient before DMT initiation and maintained throughout therapy. In addition, the regular point of contact and refill coordination encourages improved compliance, appropriate medication use, ongoing safety monitoring, and improved communication with the provider for quicker interventions. This fosters increased accessibility, convenience, and patient confidence. Improving patient outcomes--the priority goal of this service model--will be assessed in future planned studies. Through this new practice model, providers are empowered to incorporate specialty medication management into transitions in care, admission and discharge quality indicators, readmissions, and other core measures. An integrated pharmacy practice model that includes an interdisciplinary team of physicians, nurses, and pharmacists improved patient compliance with MS therapies.

  4. Retention among ART patients in the Highlands of Papua New Guinea: evaluating the PAPUA model.

    Science.gov (United States)

    Das, Sarthak; Carmone, Andy; Franke, Molly F; Frank, Dale; Kiromat, Hannelly; Kaima, Petronia; Kiromat, Mobumo

    2014-02-01

    Despite more than 10,000 patients on antiretroviral therapy (ART), there remains a dearth of operational research in Papua New Guinea related to HIV service delivery. This study examined the effectiveness of a locally developed model of HIV service delivery called PAPUA (Patient and Provider Unified Approach) in the Highlands of Papua New Guinea. The model emphasizes coordinated patient and provider support along with decentralized services to rural districts in the Highlands. We conducted a chart review among HIV-infected adults on ART at clinics in Eastern Highlands Province, where the PAPUA model was implemented in addition to the standard of care, and in Western Highlands Province, where the standard of care was implemented. We calculated yearly retention rates and used multivariable Cox proportional hazards regression analyses to compare retention rates across the provinces. Data for 2457 patients from the 2 provinces were analyzed. Among patients receiving ART under the PAPUA model in Eastern Highlands, the 12-, 24-, 36-, and 48-month retention proportions were 0.79, 0.73, 0.68, and 0.63, respectively. When we compared retention probabilities across the 2 provinces, patients receiving care under the PAPUA model had a 15% lower rate of attrition from care during the first 4 years of ART (hazard ratio, 0.85; 95% confidence interval: 0.74 to 0.99; P = 0.03), after adjusting for age, gender, and year of enrollment. The PAPUA model seems to be a promising intervention although it is inextricably linked to the limitations posed by a resource-constrained health system.

  5. Development of a patient-doctor communication skills model for medical students.

    Science.gov (United States)

    Lee, Young Hee; Lee, Young-Mee

    2010-09-01

    Communication is a core clinical skill that can be taught and learned. The authors intended to develop a patient-doctor communication model for teaching and assessing undergraduate medical students in Korea. To develop a model, literature reviews and an iterative process of discussion between faculty members of a communication skills course for second year medical students were conducted. The authors extracted common communication skill competencies by comparing the Kalamazoo Consensus Statement, SEGUE framework communication skills, the Calgary Cambridge Observation Guides, and previous communication skills lists that have been used by the authors. The content validity, with regard to clinical importance and feasibility, was surveyed by both faculty physicians and students. The first version of the model consisted of 36 items under 7 categories: initiating the session (8 items), building a relationship (6), gathering information (8), understanding a patient's perspectives (4), sharing information (4), reaching an agreement (3), and closing the session (3). It was used as a guide for both students and teachers in an actual communication skills course. At the end of the course, student performance was assessed using two 7-minute standardized patient interviews with a 34-item checklist. This assessment tool was modified from the first version of the model to reflect the case specificity of the scenarios. A patient-doctor communication model, which can be taught to those with limited patient care experience, was finally developed. We recommended a patient-doctor communication skills model that can be used for teaching and evaluating preclinical and clinical students. Further studies are needed to verify its validity and reliability.

  6. Clinical impact of (11)C-Pittsburgh compound-B positron emission tomography carried out in addition to magnetic resonance imaging and single-photon emission computed tomography on the diagnosis of Alzheimer's disease in patients with dementia and mild cognitive impairment.

    Science.gov (United States)

    Omachi, Yoshie; Ito, Kimiteru; Arima, Kunimasa; Matsuda, Hiroshi; Nakata, Yasuhiro; Sakata, Masuhiro; Sato, Noriko; Nakagome, Kazuyuki; Motohashi, Nobutaka

    2015-12-01

    The purpose of this study was to evaluate the clinical impact of addition of [(11)C]Pittsburgh compound-B positron emission tomography ((11)C-PiB PET) on routine clinical diagnosis of Alzheimer's disease (AD) dementia and mild cognitive impairment (MCI), and to assess diagnostic agreement between clinical criteria and research criteria of the National Institute on Aging-Alzheimer's Association. The diagnosis in 85 patients was made according to clinical criteria. Imaging examinations, including both magnetic resonance imaging and single-photon emission computed tomography/computed tomography to identify neuronal injury (NI), and (11)C-PiB PET to identify amyloid were performed, and all subjects were re-categorized according to the research criteria. Among 40 patients with probable AD dementia (ProAD), 37 were NI-positive, 29 were (11)C-PiB-positive, and 27 who were both NI- and (11C-PiB-positive were categorized as having 'ProAD dementia with a high level of evidence of the AD pathophysiological process'. Among 20 patients with possible AD dementia (PosAD), 17 were NI-positive, and six who were both NI- and (11)C-PiB-positive were categorized as having 'PosAD with evidence of the AD pathophysiological process'. Among 25 patients with MCI, 18 were NI-positive, 13 were (11)C-PiB-positive, and 10 who were both NI- and (11)C-PiB-positive were categorized as having 'MCI due to AD-high likelihood'. Diagnostic concordance between clinical criteria and research criteria may not be high in this study. (11)C-PiB PET may be of value in making the diagnosis of dementia and MCI in cases with high diagnostic uncertainty. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

  7. Population pharmacodynamic modeling and simulation of the respiratory effect of acetazolamide in decompensated COPD patients.

    Directory of Open Access Journals (Sweden)

    Nicholas Heming

    Full Text Available Chronic obstructive pulmonary disease (COPD patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis.619 time-respiratory (minute ventilation, tidal volume and respiratory rate and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug.The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily was required to significantly increase minute ventilation (P0.75 L min(-1 in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day.Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide.

  8. The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow.

    Science.gov (United States)

    Nugus, Peter; Forero, Roberto; McCarthy, Sally; McDonnell, Geoff; Travaglia, Joanne; Hilman, Ken; Braithwaite, Jeffrey

    2014-01-01

    Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. A mathematical model for predicting glucose levels in critically-ill patients: the PIGnOLI model

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    2015-06-01

    Full Text Available Background and Objectives. Glycemic control is of paramount importance in the intensive care unit. Presently, several BG control algorithms have been developed for clinical trials, but they are mostly based on experts’ opinion and consensus. There are no validated models predicting how glucose levels will change after initiating of insulin infusion in critically ill patients. The study aimed to develop an equation for initial insulin dose setting.Methods. A large critical care database was employed for the study. Linear regression model fitting was employed. Retested blood glucose was used as the independent variable. Insulin rate was forced into the model. Multivariable fractional polynomials and interaction terms were used to explore the complex relationships among covariates. The overall fit of the model was examined by using residuals and adjusted R-squared values. Regression diagnostics were used to explore the influence of outliers on the model.Main Results. A total of 6,487 ICU admissions requiring insulin pump therapy were identified. The dataset was randomly split into two subsets at 7 to 3 ratio. The initial model comprised fractional polynomials and interactions terms. However, this model was not stable by excluding several outliers. I fitted a simple linear model without interaction. The selected prediction model (Predicting Glucose Levels in ICU, PIGnOLI included variables of initial blood glucose, insulin rate, PO volume, total parental nutrition, body mass index (BMI, lactate, congestive heart failure, renal failure, liver disease, time interval of BS recheck, dextrose rate. Insulin rate was significantly associated with blood glucose reduction (coefficient: −0.52, 95% CI [−1.03, −0.01]. The parsimonious model was well validated with the validation subset, with an adjusted R-squared value of 0.8259.Conclusion. The study developed the PIGnOLI model for the initial insulin dose setting. Furthermore, experimental study is

  10. Validation of a Cochlear Implant Patient Specific Model of the Voltage Distribution in a Clinical Setting

    Directory of Open Access Journals (Sweden)

    Waldo Nogueira

    2016-11-01

    Full Text Available Cochlear Implants (CIs are medical implantable devices that can restore the sense of hearing in people with profound hearing loss. Clinical trials assessing speech intelligibility in CI users have found large inter-subject variability. One possibility to explain the variability is the individual differences in the interface created between electrodes of the CI and the auditory nerve. In order to understand the variability, models of the voltage distribution of the electrically stimulated cochlea may be useful. With this purpose in mind, we developed a parametric model that can be adapted to each CI user based on landmarks from individual cone beam computed tomography (CBCT scans of the cochlea before and after implantation. The conductivity values of each cochlea compartment as well as the weighting factors of different grounding modes have been also parameterized. Simulations were performed modeling the cochlea and electrode positions of 12 CI users. Three models were compared with different levels of detail: A homogeneous model (HM, a non-patient specific model (NPSM and a patient specific model (PSM. The model simulations were compared with voltage distribution measurements obtained from the backward telemetry of the 12 CI users. Results show that the PSM produces the lowest error when predicting individual voltage distributions. Given a patient specific geometry and electrode positions we show an example on how to optimize the parameters of the model and how to couple it to an auditory nerve model. The model here presented may help to understand speech performance variability and support the development of new sound coding strategies for CIs.

  11. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome.

    Science.gov (United States)

    Street, Richard L

    2013-09-01

    Although researchers have long investigated relationships between clinician-patient communication and health outcomes, much of the research has produced null, inconsistent, or contradictory findings. This essay examines challenges in the study of how clinician-patient communication contributes to a patient's health and offers recommendations for future research. Communication may directly impact outcomes, but more often it will have an indirect effect through its influence on intervening variables (e.g., patient understanding, clinician-patient agreement on treatment, adherence to treatment). For example, a patient communication skills intervention may not directly improve pain control for cancer patients. However, it may do so indirectly by activating patients to talk about cancer pain, which prompts the physician to change pain medication, which leads to better pain control. Additionally, communication measurement is complicated because relationships among communication behavior, meaning, and evaluation are complex. Researchers must do more to model pathways linking clinician-patient communication to the outcomes of interest, particularly pathways in which the communication effects are indirect or mediated through other variables. To better explicate how communication contributes to health outcomes, researchers must critically reflect on the assumptions they are making about communication process and choose measures consistent with those assumptions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Supernatural beliefs, aetiological models and help seeking behaviour in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Natasha Kate

    2012-01-01

    Full Text Available Background: Few studies have evaluated the supernatural beliefs of patients with schizophrenia. This study aimed to study the personal beliefs, aetiological models and help seeking behaviour of patients with schizophrenia using a self-rated questionnaire. Materials and Methods: Seventy three patients returned the completed supernatural Attitude questionnaire. Results: 62% of patients admitted that people in their community believed in sorcery and other magico-religious phenomena. One fourth to half of patients believed in ghosts/evil spirit (26%, spirit intrusion (28.8% and sorcery (46.6%. Two-third patients believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, divine wrath, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. 40% of the subjects attributed mental disorders to more than one of these beliefs. About half of the patients (46.6% believed that only performance of prayers was sufficient to improve their mental status. Few patients (9.6% believed that magico-religious rituals were sufficient to improve their mental illness but about one-fourth (24.7% admitted that during recent episode either they or their caregivers performed magico-religious rituals. Conclusion: Supernatural beliefs are common in patients with schizophrenia and many of them attribute the symptoms of mental disorders to these beliefs.

  13. Supernatural beliefs, aetiological models and help seeking behaviour in patients with schizophrenia.

    Science.gov (United States)

    Kate, Natasha; Grover, Sandeep; Kulhara, Parmanand; Nehra, Ritu

    2012-01-01

    Few studies have evaluated the supernatural beliefs of patients with schizophrenia. This study aimed to study the personal beliefs, aetiological models and help seeking behaviour of patients with schizophrenia using a self-rated questionnaire. Seventy three patients returned the completed supernatural Attitude questionnaire. 62% of patients admitted that people in their community believed in sorcery and other magico-religious phenomena. One fourth to half of patients believed in ghosts/evil spirit (26%), spirit intrusion (28.8%) and sorcery (46.6%). Two-third patients believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, divine wrath, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. 40% of the subjects attributed mental disorders to more than one of these beliefs. About half of the patients (46.6%) believed that only performance of prayers was sufficient to improve their mental status. Few patients (9.6%) believed that magico-religious rituals were sufficient to improve their mental illness but about one-fourth (24.7%) admitted that during recent episode either they or their caregivers performed magico-religious rituals. Supernatural beliefs are common in patients with schizophrenia and many of them attribute the symptoms of mental disorders to these beliefs.

  14. Violence and weapon carrying in music videos. A content analysis.

    Science.gov (United States)

    DuRant, R H; Rich, M; Emans, S J; Rome, E S; Allred, E; Woods, E R

    1997-05-01

    The positive portrayal of violence and weapon carrying in televised music videos is thought to have a considerable influence on the normative expectations of adolescents about these behaviors. To perform a content analysis of the depictions of violence and weapon carrying in music videos, including 5 genres of music (rock, rap, adult contemporary, rhythm and blues, and country), from 4 television networks and to analyze the degree of sexuality or eroticism portrayed in each video and its association with violence and weapon carrying, as an indicator of the desirability of violent behaviors. Five hundred eighteen videos were recorded during randomly selected days and times of the day from the Music Television, Video Hits One, Black Entertainment Television, and Country Music Television networks. Four female and 4 male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. Interobserver reliability testing resulted in a mean (+/- SD) percentage agreement of 89.25% +/- 7.10% and a mean (+/- SD) kappa of 0.73 +/- 0.20. All videos were observed by rotating 2-person, male-female teams that were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi 2 tests. A higher percentage (22.4%) of Music Television videos portrayed overt violence than Video Hits One (11.8%), Country Music Television (11.8%), and Black Entertainment Television (11.5%) videos (P = .02). Rap (20.4%) had the highest portrayal of violence, followed by rock (19.8%), country (10.8%), adult contemporary (9.7%), and rhythm and blues (5.9%) (P = .006). Weapon carrying was higher on Music Television (25.0%) than on Black Entertainment Television (11.5%), Video Hits One (8.4%), and Country Music Television (6.9%) (P music videos are between 3 and 4 minutes long, these data indicate that even modest levels of viewing may result in substantial exposure to violence and weapon carrying, which is

  15. Knowledge-based immunosuppressive therapy for kidney transplant patients--from theoretical model to clinical integration.

    Science.gov (United States)

    Seeling, Walter; Plischke, Max; de Bruin, Jeroen S; Schuh, Christian

    2015-01-01

    Immunosuppressive therapy is a risky necessity after a patient received a kidney transplant. To reduce risks, a knowledge-based system was developed that determines the right dosage of the immunosuppresive agent Tacrolimus. A theoretical model, to classify medication blood levels as well as medication adaptions, was created using data from almost 500 patients, and over 13.000 examinations. This model was then translated into an Arden Syntax knowledge base, and integrated directly into the hospital information system of the Vienna General Hospital. In this paper we give an overview of the construction and integration of such a system.

  16. Predictive models for lymph node metastases in patients with testicular germ cell tumors.

    Science.gov (United States)

    Mao, Yun; Hedgire, Sandeep; Prapruttam, Duangkamon; Harisinghani, Mukesh

    2015-10-01

    To develop predictive models for lymph node (LN) metastasis in testicular germ cell tumors. 291 patients with testicular germ cell tumors were included, which were divided into seminomatous and nonseminomatous groups. For screening the risk factors for LN metastasis, the tumor-related characteristics (including histopathological information and tumor markers) alpha fetoprotein and the lymph node-related features on CT were compared between metastatic cases and nonmetastatic cases. Two logistic regression models were built for each histological group, one depending on all tumor- and lymph node-related risk factors (Model 1) and another only on tumor-related factors (Model 2). Receivers operating characteristic curves were used to evaluate the predictive abilities of these models. 117 positive nodes/regions were identified in 68 patients, including 51 metastases and 17 occult metastases. Based on the selected independent risk factors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Models 1 and 2 in seminomatous and nonseminomatous groups were (95.5%, 95.3%, 95.3%, 77.8%, and 99.2%), (63.6%, 83.6%, 80.7%, 40.0%, and 93.0%), (93.5%, 94.7%, 94.3%, 89.6%, and 96.8%), and (89.1%, 44.2%, 58.9%, 43.6%, and 89.4%), respectively. Two predictive models for each seminomatous and nonseminomatous testicular tumor were established based on lymph node- and tumor-related risk factors. In patients with tumor and lymph node-related risk factors, regular CT surveillance is likely sufficient for predicting LN status, while in the patients without any tumor and lymph node-related risk factors a long interval-time CT follow-up should be considered. Additionally, right side tumors tend to involve contralateral LNs compared to left side ones. Positive inguinal LNs more frequently occur in patients with a history of groin surgery.

  17. Population pharmacokinetic modelling of the changes in atazanavir plasma clearance caused by ritonavir plasma concentrations in HIV‐1 infected patients

    Science.gov (United States)

    Moltó, José; Estévez, Javier A.; Miranda, Cristina; Cedeño, Samandhy; Clotet, Bonaventura

    2016-01-01

    Aims The aim of the present study was to develop a simultaneous population pharmacokinetic model for atazanavir (ATV) incorporating the effect of ritonavir (RTV) on clearance to predict ATV concentrations under different dosing regimens in HIV‐1‐infected patients. Methods A Cross‐sectional study was carried out in 83 HIV‐1‐infected adults taking ATV 400 mg or ATV 300 mg/RTV 100 mg once daily. Demographic and clinical characteristics were registered and blood samples collected to measure drug concentrations. A population pharmacokinetic model was constructed using nonlinear mixed‐effects modelling and used to simulate six dosing scenarios. Results The selected one‐compartmental model described the pharmacokinetics of RTV and ATV simultaneously, showing exponential, direct inhibition of ATV clearance according to the RTV plasma concentration, which explained 17.5% of the variability. A mean RTV plasma concentration of 0.63 mg l–1 predicted an 18% decrease in ATV clearance. The percentages of patients with an end‐of‐dose‐interval concentration of ATV below or above the minimum and maximum target concentrations of 0.15 mg l–1 and 0.85 mg l–1 favoured the selection of the simulated ATV/RTV once‐daily regimens (ATV 400 mg, ATV 300 mg/RTV 100 mg, ATV 300 mg/RTV 50 mg, ATV 200/RTV 100 mg) over the unboosted twice‐daily regimens (ATV 300 mg, ATV 200 mg). Conclusions A one‐compartment simultaneous model can describe the pharmacokinetics of RTV and ATV, including the effect of RTV plasma concentrations on ATV clearance. This model is promising for predicting individuals' ATV concentrations in clinical scenarios, and supports further clinical trials of once‐daily doses of ATV 300 mg/RTV 50 mg or ATV 200 mg/RTV 100 mg to confirm efficacy and safety. PMID:27447851

  18. Surface mesh to voxel data registration for patient-specific anatomical modeling

    Science.gov (United States)

    de Oliveira, Júlia E. E.; Giessler, Paul; Keszei, András.; Herrler, Andreas; Deserno, Thomas M.

    2016-03-01

    Virtual Physiological Human (VPH) models are frequently used for training, planning, and performing medical procedures. The Regional Anaesthesia Simulator and Assistant (RASimAs) project has the goal of increasing the application and effectiveness of regional anesthesia (RA) by combining a simulator of ultrasound-guided and electrical nerve-stimulated RA procedures and a subject-specific assistance system through an integration of image processing, physiological models, subject-specific data, and virtual reality. Individualized models enrich the virtual training tools for learning and improving regional anaesthesia (RA) skills. Therefore, we suggest patient-specific VPH models that are composed by registering the general mesh-based models with patient voxel data-based recordings. Specifically, the pelvis region has been focused for the support of the femoral nerve block. The processing pipeline is composed of different freely available toolboxes such as MatLab, the open Simulation framework (SOFA), and MeshLab. The approach of Gilles is applied for mesh-to-voxel registration. Personalized VPH models include anatomical as well as mechanical properties of the tissues. Two commercial VPH models (Zygote and Anatomium) were used together with 34 MRI data sets. Results are presented for the skin surface and pelvic bones. Future work will extend the registration procedure to cope with all model tissue (i.e., skin, muscle, bone, vessel, nerve, fascia) in a one-step procedure and extrapolating the personalized models to body regions actually being out of the captured field of view.

  19. The evolution of carrying capacity in constrained and expanding tumour cell populations.

    Science.gov (United States)

    Gerlee, Philip; Anderson, Alexander R A

    2015-08-12

    Cancer cells are known to modify their micro-environment such that it can sustain a larger population, or, in ecological terms, they construct a niche which increases the carrying capacity of the population. It has however been argued that niche construction, which benefits all cells in the tumour, would be selected against since cheaters could reap the benefits without paying the cost. We have investigated the impact of niche specificity on tumour evolution using an individual based model of breast tumour growth, in which the carrying capacity of each cell consists of two components: an intrinsic, subclone-specific part and a contribution from all neighbouring cells. Analysis of the model shows that the ability of a mutant to invade a resident population depends strongly on the specificity. When specificity is low selection is mostly on growth rate, while high specificity shifts selection towards increased carrying capacity. Further, we show that the long-term evolution of the system can be predicted using adaptive dynamics. By comparing the results from a spatially structured versus well-mixed population we show that spatial structure restores selection for carrying capacity even at zero specificity, which poses a solution to the niche construction dilemma. Lastly, we show that an expanding population exhibits spatially variable selection pressure, where cells at the leading edge exhibit higher growth rate and lower carrying capacity than those at the centre of the tumour.

  20. Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

    Science.gov (United States)

    Page, Timothy F; Amofah, St Anthony; McCann, Shelia; Rivo, Julie; Varghese, Asha; James, Terisa; Rivo, Marc; Williams, Mark L

    2015-07-01

    This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved. © 2015 Society for Public Health Education.

  1. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

    Science.gov (United States)

    Herschtal, A.; te Marvelde, L.; Mengersen, K.; Hosseinifard, Z.; Foroudi, F.; Devereux, T.; Pham, D.; Ball, D.; Greer, P. B.; Pichler, P.; Eade, T.; Kneebone, A.; Bell, L.; Caine, H.; Hindson, B.; Kron, T.

    2015-02-01

    Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement (‘random error’) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margi