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Sample records for outcome indicators extending

  1. An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys.

    Science.gov (United States)

    Biedron, Caitlin; Pagano, Marcello; Hedt, Bethany L; Kilian, Albert; Ratcliffe, Amy; Mabunda, Samuel; Valadez, Joseph J

    2010-02-01

    Large investments and increased global prioritization of malaria prevention and treatment have resulted in greater emphasis on programme monitoring and evaluation (M&E) in many countries. Many countries currently use large multistage cluster sample surveys to monitor malaria outcome indicators on a regional and national level. However, these surveys often mask local-level variability important to programme management. Lot Quality Assurance Sampling (LQAS) has played a valuable role for local-level programme M&E. If incorporated into these larger surveys, it would provide a comprehensive M&E plan at little, if any, extra cost. The Mozambique Ministry of Health conducted a Malaria Indicator Survey (MIS) in June and July 2007. We applied LQAS classification rules to the 345 sampled enumeration areas to demonstrate identifying high- and low-performing areas with respect to two malaria program indicators-'household possession of any bednet' and 'household possession of any insecticide-treated bednet (ITN)'. As shown by the MIS, no province in Mozambique achieved the 70% coverage target for household possession of bednets or ITNs. By applying LQAS classification rules to the data, we identify 266 of the 345 enumeration areas as having bednet coverage severely below the 70% target. An additional 73 were identified with low ITN coverage. This article demonstrates the feasibility of integrating LQAS into multistage cluster sampling surveys and using these results to support a comprehensive national, regional and local programme M&E system. Furthermore, in the recommendations we outlined how to integrate the Large Country-LQAS design into macro-surveys while still obtaining results available through current sampling practices.

  2. Extended indications for percutaneous tracheostomy.

    Science.gov (United States)

    Ben Nun, Alon; Altman, Eduard; Best, Lael Anson

    2005-10-01

    In recent years, percutaneous tracheostomy has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short, fat neck or obesity as relative contraindications whereas cervical injury, coagulopathy, and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the feasibility of percutaneous tracheostomy in patients with some of these contraindications. The aim of this study is to determine the safety and efficacy of percutaneous tracheostomy in conditions commonly referred to as contraindications. Between June 2000 and July 2001, 157 consecutive percutaneous tracheostomy procedures were performed on 154 critically ill adult patients in the general intensive care unit of a major tertiary care facility. The Griggs technique and Portex set were used at the bedside. All procedures were performed by staff thoracic surgeons and anesthesiologists experienced with the technique. Anatomical conditions, presence of coagulopathy and anti-coagulation therapy, demographics, and complication rates were recorded. Five of 157 procedures (154 patients owing to three repeat tracheostomies) had complications. In patients with normal anatomical conditions and coagulation profiles, there was one case of bleeding (50 cc to 120 cc) and one case of mild cellulitis around the stoma. In patients with adverse conditions, there was one case of bleeding (50 cc to 120 cc) and two cases of minor bleeding (< 50 cc). Patients with adverse conditions had a low complication rate similar to patients with normal conditions. For this reason, we believe that percutaneous tracheostomy is indicated in patients with short, fat neck; inability to perform neck extension; enlarged isthmus of thyroid; previous tracheostomy; or coagulopathy and anti-coagulation therapy.

  3. Allograft Pancreatectomy: Indications and Outcomes.

    Science.gov (United States)

    Nagai, S; Powelson, J A; Taber, T E; Goble, M L; Mangus, R S; Fridell, J A

    2015-09-01

    This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  4. Laparoscopic pancreatectomy: Indications and outcomes

    Science.gov (United States)

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

    The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

  5. Effective Spectral Indices of Core and Extended Emissions for Radio ...

    Indian Academy of Sciences (India)

    Effective Spectral Indices of Core and Extended Emissions for Radio Sources. R. S. Yang1,∗, J. H. Yang1,2 & J. J. Nie1. 1Department of Physics and Electronics Science, Hunan University of Arts and Science,. Changde 415000, China. 2Centre for Astrophysics, Guangzhou University, Guangzhou 510006, China. ∗ e-mail: ...

  6. Indicators of fetal and infant health outcomes

    NARCIS (Netherlands)

    Buitendijk, Simone; Zeitlin, Jennifer; Cuttini, Marina; Langhoff-Roos, Jens; Bottu, Jean

    2003-01-01

    OBJECTIVE: To assess the ability of the member states of the European Union to produce the indicators recommended by the PERISTAT project on perinatal health indicators and to provide an overview of fetal and infant health outcomes for these countries according to the information now available.

  7. Nurses' extended work hours: Patient, nurse and organizational outcomes.

    Science.gov (United States)

    Kunaviktikul, W; Wichaikhum, O; Nantsupawat, A; Nantsupawat, R; Chontawan, R; Klunklin, A; Roongruangsri, S; Nantachaipan, P; Supamanee, T; Chitpakdee, B; Akkadechanunt, T; Sirakamon, S

    2015-09-01

    Nursing shortages have been associated with increased nurse workloads that may result in work errors, thus impacting patient, nurse and organizational outcomes. To examine for the first time in Thailand nurses' extended work hours (working more than 40 h per week) and its relationship to patient, nurse and organizational outcomes. Using multistage sampling, 1524 registered nurses working in 90 hospitals across Thailand completed demographic forms: the Nurses' Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire and the Maslach Burnout Inventory. The data were analysed using descriptive statistics, Spearman's rank correlation and logistic regression. The average extended work hour of respondents was 18.82 h per week. About 80% worked two consecutive shifts. The extended work hours had a positive correlation with patient outcomes, such as patient identification errors, pressure ulcers, communication errors and patient complaints and with nurse outcomes of emotional exhaustion and depersonalization. Furthermore, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay and organizational productivity. Nurses who had extended work hours of >16 h per week were significantly more likely to perceive all four adverse patient outcomes than participants working an extended ≤8 h per week. Patient outcomes were measured by respondents' self-reports. This may not always reflect the real occurrence of adverse events. Associations between extended work hours and outcomes for patients, nurses and the organization were found. The findings demonstrate that working two shifts (16 h) more than the regular work hours lead to negative outcomes for patients, nurses and the organization. Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems

  8. Elbow arthroscopy: indications, techniques, outcomes, and complications.

    Science.gov (United States)

    Adams, Julie E; King, Graham J W; Steinmann, Scott P; Cohen, Mark S

    2015-01-01

    Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. To achieve favorable outcomes after elbow arthroscopy, the surgeon should be aware of contraindications, technical considerations, anatomic principles, and the need for proper patient positioning and portal selection. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

  9. Meniscectomy: indications, procedure, outcomes, and rehabilitation

    Directory of Open Access Journals (Sweden)

    Anetzberger H

    2013-12-01

    Full Text Available Hermann Anetzberger,1 Christof Birkenmaier,2 Stephan Lorenz3 1Orthopädische Gemeinschaftspraxis am OEZ, Munich, Germany; 2Department of Orthopedics, Ludwig-Maximilian-University Munich, Munich, Germany; 3Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany Abstract: Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human knee's menisci in relation to surgical indications, surgical techniques, rehabilitation, and outcomes. In order to identify the relevant literature, we performed a PubMed search for the years ranging from 1980–2013 using the following search terms: meniscus; biomechanical function; meniscectomy; meniscal repair; and clinical outcome. The meniscus helps to distribute the forces between the tibial and femoral articular cartilage layers in a load-sharing capacity. Meniscus damage or meniscectomy intuitively leads to an overloading of the cartilage and, hence, to the development of osteoarthrosis. Precise knowledge of meniscal shape and function, of the type of injury, of surgical techniques, as well as of postsurgical rehabilitative care are of decisive importance for an individually-adjusted treatment strategy. Other underlying coexisting knee pathologies also need to be considered. The diagnosis of a meniscal injury is based upon clinical history, physical examination, and imaging studies. The treatment of a meniscal lesion includes conservative, as well as operative, procedures. The goals of surgery are to reduce pain and disability, as well as to preserve meniscal function without causing additional cartilage damage. The resection of meniscal tissue should be restricted to as much as is necessary, and as little as is reasonably possible. Postoperative rehabilitation serves the purpose of improving functional deficits and pain, as well as of restoring a good range of

  10. Lateral Transpsoas Fusion: Indications and Outcomes

    Directory of Open Access Journals (Sweden)

    Vishal C. Patel

    2012-01-01

    Full Text Available Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

  11. Towards Validating Risk Indicators Based on Measurement Theory (Extended version)

    NARCIS (Netherlands)

    Morali, A.; Wieringa, Roelf J.

    Due to the lack of quantitative information and for cost-efficiency, most risk assessment methods use partially ordered values (e.g. high, medium, low) as risk indicators. In practice it is common to validate risk indicators by asking stakeholders whether they make sense. This way of validation is

  12. Prognostic indicators influencing short term outcomes among ...

    African Journals Online (AJOL)

    Background: Head injury causes significant morbidity and mortalityand accounts for about 10 million cases globally. In Tanzaniait's the most common type of injury contributing about 32% to 50% of all trauma patients. Favorable outcomes for head injury patients depends on initial evaluation and proper timely intervention.

  13. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    Uterine rupture and cesarean hysterectomy were associated with an outcome of neonatal death (p<0.001). Infrastructure and personnel limitations are major barriers to the improvement of quality of cesarean deliveries. Future endeavors towards quality improvement must address these deficiencies. (Afr J Reprod Health ...

  14. Rib Fracture Fixation: Indications and Outcomes.

    Science.gov (United States)

    Senekjian, Lara; Nirula, Raminder

    2017-01-01

    Rib fractures are a frequently identified injury in the trauma population. Not only are multiple rib fractures painful, but they are associated with an increased risk of adverse outcomes. Pneumonia in particular can be devastating, especially to an elderly patient, but other complications such as prolonged ventilation and increased intensive care and hospital durations of stay have a negative impact on the patient. Computed tomography scan is the best modality to diagnosis rib fractures but the treatment of fractures is still evolving. Currently patient care involves a multidisciplinary approach that includes pain control, aggressive pulmonary therapy, and possibly surgical fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis.

    Science.gov (United States)

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-11-01

    This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86 years, and the mean BMI was 30.31 kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, and this decreased as the series progressed. The median length of stay was 5 days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (± standard deviation) preoperative visual analogue scale (VAS) of 8.28 ± 1.39 to 1.50 ± 1.05 at 12 months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82 mm to 2.80 mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    The objective of this research study is to identify quality indicators of cesarean deliveries and determine their relationship to neonatal ..... (N=39). P value. Mean. Age. 24.8 + 5.8. 25.6 + 5.9. 0.74. Duration of labor. (hours) ... chains must be improved on a national and local ... emergency obstetric care: A handbook, Geneva,.

  17. Does the extended Glasgow Outcome Scale add value to the conventional Glasgow Outcome Scale?

    Science.gov (United States)

    Weir, James; Steyerberg, Ewout W; Butcher, Isabella; Lu, Juan; Lingsma, Hester F; McHugh, Gillian S; Roozenbeek, Bob; Maas, Andrew I R; Murray, Gordon D

    2012-01-01

    The Glasgow Outcome Scale (GOS) is firmly established as the primary outcome measure for use in Phase III trials of interventions in traumatic brain injury (TBI). However, the GOS has been criticized for its lack of sensitivity to detect small but clinically relevant changes in outcome. The Glasgow Outcome Scale-Extended (GOSE) potentially addresses this criticism, and in this study we estimate the efficiency gain associated with using the GOSE in place of the GOS in ordinal analysis of 6-month outcome. The study uses both simulation and the reanalysis of existing data from two completed TBI studies, one an observational cohort study and the other a randomized controlled trial. As expected, the results show that using an ordinal technique to analyze the GOS gives a substantial gain in efficiency relative to the conventional analysis, which collapses the GOS onto a binary scale (favorable versus unfavorable outcome). We also found that using the GOSE gave a modest but consistent increase in efficiency relative to the GOS in both studies, corresponding to a reduction in the required sample size of the order of 3-5%. We recommend that the GOSE be used in place of the GOS as the primary outcome measure in trials of TBI, with an appropriate ordinal approach being taken to the statistical analysis.

  18. Investigating Underlying Components of the ICT Indicators Measurement Scale: The Extended Version

    Science.gov (United States)

    Akbulut, Yavuz

    2009-01-01

    This study aimed to investigate the underlying components constituting the extended version of the ICT Indicators Measurement Scale (ICTIMS), which was developed in 2007, and extended in the current study through the addition of 34 items. New items addressing successful ICT integration at education faculties were identified through the examination…

  19. Outcome Indicators on Interprofessional Collaboration Interventions for Elderly

    Directory of Open Access Journals (Sweden)

    Giannoula Tsakitzidis

    2016-05-01

    Full Text Available    Background: Geriatric care increasingly needs more multidisciplinary health care services to deliver the necessary complex and continuous care. The aim of this study is to summarize indicators of effective interprofessional outcomes for this population. Method: A systematic review is performed in the Cochrane Library, Pubmed (Medline, Embase, Cinahl and Psychinfo with a search until June 2014. Results: Overall, 689 references were identified of which 29 studies met the inclusion criteria. All outcome indicators were summarized in three categories: collaboration, patient level outcome and costs. Seventeen out of 24 outcome indicators within the category of ‘collaboration’ reached significant difference in advantage of the intervention group. On ‘patient outcome level’ only 15 out of 32 outcome parameters met statistical significance. In the category of ‘costs’ only one study reached statistical significance. Discussion and conclusion: The overall effects of interprofessional interventions for elderly are positive, but based on heterogeneous outcomes. Outcome indicators of interprofessional collaboration for elderly with a significant effect can be summarized in three main categories: ‘collaboration’, patient level’ and ‘costs’. For ‘collaboration’ the outcome indicators are key elements of collaboration, involved disciplines, professional and patient satisfaction and quality of care. On ‘patient level’ the outcome indicators are pain, fall incidence, quality of life, independence for daily life activities, depression and agitated behaviour, transitions, length of stay in hospital, mortality and period of rehabilitation. ‘Costs’ of interprofessional interventions on short- and long-term for elderly need further investigation. When organizing interprofessional collaboration or interprofessional education these outcome indicators can be considered as important topics to be addressed. Overall more research is

  20. Indications, outcome and complications of ureteroscopy, at Gezira ...

    African Journals Online (AJOL)

    Indications, outcome and complications of ureteroscopy, at Gezira Hospital for renal diseases and surgery, Sudan: a seven years 'experience. Mustafa O. Mansour, Sami M. Taha, Abd Elmahmood Abdallah, Mohammed El Imam ...

  1. How noise and coupling influence leading indicators of population extinction in a spatially extended ecological system.

    Science.gov (United States)

    O'Regan, Suzanne M

    2018-12-01

    Anticipating critical transitions in spatially extended systems is a key topic of interest to ecologists. Gradually declining metapopulations are an important example of a spatially extended biological system that may exhibit a critical transition. Theory for spatially extended systems approaching extinction that accounts for environmental stochasticity and coupling is currently lacking. Here, we develop spatially implicit two-patch models with additive and multiplicative forms of environmental stochasticity that are slowly forced through population collapse, through changing environmental conditions. We derive patch-specific expressions for candidate indicators of extinction and test their performance via a simulation study. Coupling and spatial heterogeneities decrease the magnitude of the proposed indicators in coupled populations relative to isolated populations, and the noise regime and the degree of coupling together determine trends in summary statistics. This theory may be readily applied to other spatially extended ecological systems, such as coupled infectious disease systems on the verge of elimination.

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

    NARCIS (Netherlands)

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

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

  3. Identifying Indicators Related to Constructs for Engineering Design Outcome

    Science.gov (United States)

    Wilhelmsen, Cheryl A.; Dixon, Raymond A.

    2016-01-01

    This study ranked constructs articulated by Childress and Rhodes (2008) and identified the key indicators for each construct as a starting point to explore what should be included on an instrument to measure the engineering design process and outcomes of students in high schools that use the PLTW and EbDTM curricula in Idaho. A case-study design…

  4. Indications and visual outcome of first hundred pars plana ...

    African Journals Online (AJOL)

    Objective: To review the indications and visual outcome of the first one hundred pars plana vitrectomies performed at the newly established surgical retina unit of Makkah Specialist Eye Hospital, Kano, Kano State, Nigeria. Materials and Methods: Aretrospective chart review was performed. Data recorded from the patient ...

  5. Response to capacitating stimuli indicates extender-related differences in boar sperm function.

    Science.gov (United States)

    Schmid, S; Henning, H; Petrunkina, A M; Weitze, K F; Waberski, D

    2013-10-01

    Spermatozoa, especially those of the porcine species, are highly susceptible to in vitro chilling and ageing. Extenders are continuously developed to protect boar spermatozoa from chilling injury. New semen extenders and other modified preservation strategies require sensitive testing for essential sperm functions. The key process on the pathway of fertilization is capacitation. The aim of the present study was to examine whether the specific response to capacitating stimuli is sensitive enough to indicate different preservation capacities of extenders during hypothermic storage of boar spermatozoa. Semen was diluted in Beltsville Thawing Solution (BTS) and Androstar Plus and kept for 3 h at 22°C or stored at 17°C, 10°C, and 5°C. Semen was analyzed at 24 and 96 h of storage. Motility and membrane integrity remained at high levels, except for lower values when stored in BTS at 5°C. Washed subsamples were incubated in capacitating medium (Tyrode) and control medium and were assessed for intracellular calcium concentration and integrity of plasma membranes using a flow cytometer. On the basis of the loss of low-calcium live cells in a kinetic approach, the specific response to capacitation stimuli was determined. There was a higher loss of response in semen stored hypothermically in the standard extender BTS compared to Androstar Plus. Assessment of the extent of phospholipid disorder under capacitating and control conditions by use of merocyanine staining did not reveal any significant extender-related differences. A field insemination trial with 778 sows was performed to relate in vitro results to fertility. Fertility parameters did not differ in semen stored up to 48 h at 10°C in Androstar Plus compared to controls stored at 17°C in BTS. In conclusion, assessment of specific reactivity to capacitating stimuli appears to be a sensitive tool for detection of extender-dependent alterations in functionality of chilled boar spermatozoa.

  6. A Method for Reducing Misclassification in the Extended Glasgow Outcome Score

    OpenAIRE

    Lu, Juan; Marmarou, Anthony; Lapane, Kate; Turf, Elizabeth; Wilson, Lindsay

    2010-01-01

    The eight-point extended Glasgow Outcome Scale (GOSE) is commonly used as the primary outcome measure in traumatic brain injury (TBI) clinical trials. The outcome is conventionally collected through a structured interview with the patient alone or together with a caretaker. Despite the fact that using the structured interview questionnaires helps reach agreement in GOSE assessment between raters, significant variation remains among different raters. We introduce an alternate GOSE rating syste...

  7. Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer.

    Science.gov (United States)

    Hartwig, W; Gluth, A; Hinz, U; Koliogiannis, D; Strobel, O; Hackert, T; Werner, J; Büchler, M W

    2016-11-01

    In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer. A consecutive series of patients with primary pancreatic adenocarcinoma undergoing extended pancreatectomies, as defined by the new ISGPS consensus, were compared with patients who had a standard pancreatectomy. Univariable and multivariable analysis was performed to identify risk factors for perioperative mortality and characteristics associated with survival. Long-term outcome was assessed by means of Kaplan-Meier analysis. The 611 patients who had an extended pancreatectomy had significantly greater surgical morbidity than the 1217 patients who underwent a standard resection (42·7 versus 34·2 per cent respectively), and higher 30-day mortality (4·3 versus 1·8 per cent) and in-hospital mortality (7·5 versus 3·6 per cent) rates. Operating time of 300 min or more, extended total pancreatectomy, and ASA fitness grade of III or IV were associated with increased in-hospital mortality in multivariable analysis, whereas resections involving the colon, portal vein or arteries were not. Median survival and 5-year overall survival rate were reduced in patients having extended pancreatectomy compared with those undergoing a standard resection (16·1 versus 23·6 months, and 11·3 versus 20·6 per cent, respectively). Older age, G3/4 tumours, two or more positive lymph nodes, macroscopic positive resection margins, duration of surgery of 420 min or above, and blood loss of 1000 ml or more were independently associated with decreased overall survival. Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable

  8. The european primary care monitor: structure, process and outcome indicators

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

  9. Revision of reversed total shoulder arthroplasty. Indications and outcome

    Directory of Open Access Journals (Sweden)

    Farshad Mazda

    2012-08-01

    Full Text Available Abstract Background The complications of reversed total shoulder arthroplasty (RTSA requiring an additional intervention, their treatment options and outcome are poorly known. It was therefore the purpose of this retrospective study, to identify the reasons for revision of RTSA and to report outcomes. Methods Four hundred and forty-one performed RTSA implanted between 1999 and 2008 were screened. Sixty-seven of these cases had an additional intervention to treat a complication. Causes were identified in these 67 cases and the outcome of the first 37 patients who could be followed for more than two years after their first additional intervention was analyzed. Results Of 441 RTSA, 67 cases (15% needed at least one additional intervention to treat a complication, 30 of them needed a second, eleven a third and four a fourth additional intervention. The most common complication requiring a first intervention was instability (18% followed by hematoma or superficial wound complications (15% and complications of the glenoid component (12%. Patients benefitted from RTSA despite the need of additional interventions as indicated by a mean increase in total Constant-Murley score from 23 points before RTSA to 46 points at final follow-up (p  Conclusions Instability, hematoma or superficial wound complications and complications of the glenoid component are the most common reasons for an additional intervention after RTSA. Patients undergoing an additional intervention as treatment of these complications profit significantly as long as the prosthesis remains in place.

  10. Renal histology in the elderly: indications and outcomes.

    LENUS (Irish Health Repository)

    Brown, Catherine M

    2011-06-28

    Background: Renal disease is being increasingly diagnosed in the elderly. However, reports on biopsy-confirmed renal disease in this population are limited. The aim of this study was to give an overview of the most important indications, diagnoses and outcomes of renal biopsies in the elderly in our center. Methods: This was a retrospective review of all elderly renal biopsies over 5 years. Patients were eligible for inclusion if they were aged =65 years and had had a native kidney biopsy performed. The data recorded included age, sex, indications for biopsy, histological diagnoses and outcomes. Results: During this time, 1,372 native renal biopsies were performed. Of these, 236 (17%) were in patients aged =65 years; 150 male (64%) and 86 female (36%). The most common indications for biopsy were acute renal failure and nephrotic syndrome. Common diagnoses included pauci-immune crescentic glomerulonephritis, tubulointerstitial nephritis, membranous nephropathy, IgA nephropathy and chronic thrombotic microangiopathy. Long-term follow-up of 3 years was available for 102 patients; median serum creatinine at the time of biopsy was 427 µmol\\/L (interquartile range 204-702) and at 3 years post biopsy had fallen to 192 µmol\\/L (interquartile range 152-408). Conclusions: In our center, 17% of native kidney biopsies are performed in elderly patients aged =65 years. In our experience, this procedure was safe and had a 97% diagnostic rate. The available follow-up data of patients suggest that renal histology is not only of benefit in diagnosis but also of potential value in terms of prognosis and treatment.

  11. Renal histology in the elderly: indications and outcomes.

    LENUS (Irish Health Repository)

    2012-02-01

    Background: Renal disease is being increasingly diagnosed in the elderly. However, reports on biopsy-confirmed renal disease in this population are limited. The aim of this study was to give an overview of the most important indications, diagnoses and outcomes of renal biopsies in the elderly in our center. Methods: This was a retrospective review of all elderly renal biopsies over 5 years. Patients were eligible for inclusion if they were aged =65 years and had had a native kidney biopsy performed. The data recorded included age, sex, indications for biopsy, histological diagnoses and outcomes. Results: During this time, 1,372 native renal biopsies were performed. Of these, 236 (17%) were in patients aged =65 years; 150 male (64%) and 86 female (36%). The most common indications for biopsy were acute renal failure and nephrotic syndrome. Common diagnoses included pauci-immune crescentic glomerulonephritis, tubulointerstitial nephritis, membranous nephropathy, IgA nephropathy and chronic thrombotic microangiopathy. Long-term follow-up of 3 years was available for 102 patients; median serum creatinine at the time of biopsy was 427 micromol\\/L (interquartile range 204-702) and at 3 years post biopsy had fallen to 192 micromol\\/L (interquartile range 152-408). Conclusions: In our center, 17% of native kidney biopsies are performed in elderly patients aged =65 years. In our experience, this procedure was safe and had a 97% diagnostic rate. The available follow-up data of patients suggest that renal histology is not only of benefit in diagnosis but also of potential value in terms of prognosis and treatment.

  12. Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review.

    Science.gov (United States)

    Sardana, Vandit; Philippon, Marc J; de Sa, Darren; Bedi, Asheesh; Ye, Lily; Simunovic, Nicole; Ayeni, Olufemi R

    2015-10-01

    To identify the indications and outcomes in patients undergoing revision hip arthroscopy. The electronic databases Embase, Medline, HealthStar, and PubMed were searched from 1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the data quality of the studies using the Methodological Index for Non-Randomized Studies scale. Data were abstracted in duplicate. Agreement and descriptive statistics are presented. Six studies were included (3 prospective case series and 3 retrospective chart reviews), with a total of 448 hips examined. The most common indications for revision hip arthroscopy included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions. The mean interval between revision arthroscopy and the index procedure was 25.6 months. Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures were required, including re-revision hip arthroscopy (8.0%), total hip replacement (5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision hip arthroscopy (59.7%). The current evidence examined in this review supports revision hip arthroscopy as a successful intervention to improve functional outcomes (modified Harris Hip Score) and relieve pain in patients with residual symptoms after primary FAI surgery, although the outcomes are inferior when compared with a matched cohort of patients undergoing primary hip arthroscopy for FAI. The main indication for revision is a candidate who has symptoms due to residual cam- or pincer-type deformity that was either unaddressed or under-resected during the index operation. However, it is important to consider that the studies included in this review are of low-quality evidence. Surgeons should consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation surgery because revisions tended to occur within this

  13. The floating knee: epidemiology, prognostic indicators & outcome following surgical management.

    Science.gov (United States)

    Rethnam, Ulfin; Yesupalan, Rajam S; Nair, Rajagopalan

    2007-11-26

    Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. We present the outcome of these injuries after surgical management. 29 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. Assessment of the end result was done by the Karlstrom criteria after bony union. The mechanism of injury was road traffic accident in 27/29 patients. There were 38 associated injuries. 20/29 patients had intramedullary nailing for both fractures. The complications were knee stiffness, foot drop, delayed union of tibia and superficial infection. The bony union time ranged from 15 - 22.5 weeks for femur fractures and 17 - 28 weeks for the tibia. According to the Karlstrom criteria the end results were Excellent - 15, Good - 11, Acceptable - 1 and Poor - 3. The associated injuries and the type of fracture (open, intra-articular, comminution) are prognostic indicators in the Floating knee. Appropriate management of the associated injuries, intramedullary nailing of both the fractures and post operative rehabilitation are necessary for good final outcome.

  14. Colostomy in neonates under local anaesthesia: indications, technique and outcome.

    Science.gov (United States)

    Lukong, Christopher Suiye; Jabo, Basheer Abdullahi; Mfuh, Anita Yafeh

    2012-01-01

    Colostomy is a resuscitative procedure in paediatric surgical practice. In critical patients, mortality may be high, if general anaesthesia is used. Local anaesthesia may be an alternative in this group of neonates. The aim of this article was to evaluate the indications, the technique and outcome of colostomy in neonates under local anaesthesia. A prospective analysis of 38 neonates who had colostomy under local anaesthesia, from July 2008 to September 2011, in our centre. There were 34 boys and 4 girls. The median age was 4 days (range 2-11 days),and all presented in a critical state. The indication for colostomy was anorectal malformation 37 (97.4%) and colonic atresia 1 (2.6%). COLOSTOMY: sigmoid 7 (18.4%), descending 29 (76.3%), transverse 2 (5.3%). The median duration of the procedure was 45 minutes (range 30-60 minutes). The hospital stay was 7-15 days (median 7 days) and cost of treatment 7000-7500 Naira (median 7500 Naira = $50). There were 5 (13.2%) early complications, namely, skin excoriation 2, superficial site infection 2, and bowel evisceration 1; mortality was 2 (5.3%). The late complications were stomal stenosis 1 (2.6%), colostomy diarrhoea 2 (5.3%), and parastomal hernia 2 (5.3%). 25 (65.7%) had colostomy takedown and 13 (34%) were yet to have colostomy takedown. Follow-up was for 1-2 years. None of the patients had a permanent colostomy. Colostomy in neonates under local anaesthesia is feasible, safe and cost-effective. The outcome is good and may be used when neonatal anaesthetic expertise and intensive care facilities are lacking.

  15. Evaluating stakeholder participation in water management: intermediary outcomes as potential indicators for future resource management outcomes

    Science.gov (United States)

    Carr, Gemma; Bloeschl, Guenter; Loucks, Daniel Pete

    2013-04-01

    . Furthermore, failure to achieve intermediary outcomes correlates to failure to achieve resource management outcomes. Evaluating intermediary outcomes leads to both a broader assessment of a programme's achievements at the time of evaluation, and can indicate whether a programme will go on to achieve resource management objectives in the future.

  16. Tracheostomy for Severe Pediatric Obstructive Sleep Apnea: Indications and Outcomes.

    Science.gov (United States)

    Rizzi, Christopher J; Amin, Julian D; Isaiah, Amal; Valdez, Tulio A; Jeyakumar, Anita; Smart, Suzanne E; Pereira, Kevin D

    2017-08-01

    Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed. Results Twenty-nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, -2.2 to 6.2). Mean body mass index z score was -1.2 (95% CI, -4.9 to -2.5). Mean preoperative AHI was 60.2 (95% CI, -15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44-45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow-up was 30.6 months (95% CI, -10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9-73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, -9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%-100%). Conclusion OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.

  17. Surgical management of bronchiectasis. The indications and outcomes

    International Nuclear Information System (INIS)

    Gursoy, S.; Ozturk, A.A.; Ucvet, A.; Erbaycu, A.E.

    2010-01-01

    Social limitations in addition to treatment failure, despite preventive precautions and aggressive medical treatment, are the main indications for surgery in patients with bronchiectasis. The aim of this study was to evaluate all aspects of treatment outcomes in surgically treated patients with bronchiectasis. Ninety-two patients with bronchiectasis treated by a surgical resection between January 2002 and June 2007 were included in the study. Age, sex, symptoms, etiologic factors, radiological findings, surgical procedures, postoperative morbidity and mortality, and hospital stay were analyzed. Fifty-four patients were female and 38 were male, with an average age of 38.7 (range, 10-67) years, and 84.8% were symptomatic. The etiologic factors included frequent infections (37%), childhood infections (22%), tuberculosis (12%), foreign bodies (3%), and unknown causes (26%). Ten pneumonectomies, 36 lobectomies, 2 bilobectomies, 32 lobectomies and segmentectomies, and 12 segmentectomies were performed. The morbidity was 16%, the mortality was 1%, and the mean follow-up duration was 15.3 months. Follow-up data were obtained in 75 patients of whom 63 (84%) were asymptomatic, 8 (10.7%) were symptomatic with clinical improvement, and 4 (5.3%) had had no clinical improvement. Despite the advances in preventive precautions, medical treatment, and follow-up, surgery, with its low mortality and morbidity rates, remains a good alternative in selected patients in the treatment of bronchiectasis, and fulfills the clinical and social improvement expectations of patients. (author)

  18. Revisiting the extended spring indices using gridded weather data and machine learning

    Science.gov (United States)

    Mehdipoor, Hamed; Izquierdo-Verdiguier, Emma; Zurita-Milla, Raul

    2016-04-01

    The extended spring indices or SI-x [1] have been successfully used to predict the timing of spring onset at continental scales. The SI-x models were created by combining lilac and honeysuckle volunteered phenological observations, temperature data (from weather stations) and latitudinal information. More precisely, these models use a linear regression to predict the day of year of first leaf and first bloom for these two indicator species. In this contribution we revisit both the data and the method used to calibrate the SI-x models to check whether the addition of new input data or the use of non-linear regression methods could lead to improments in the model outputs. In particular, we use a recently published dataset [2] of volunteered observations on cloned and common lilac over longer period of time (1980-2014) and we replace the weather station data by 54 features derived from Daymet [3], which provides 1 by 1 km gridded estimates of daily weather parameters (maximum and minimum temperatures, precipitation, water vapor pressure, solar radiation, day length, snow water equivalent) for North America. These features consist of both daily weather values and their long- and short-term accumulations and elevation. we also replace the original linear regression by a non-linear method. Specifically, we use random forests to both identify the most important features and to predict the day of year of the first leaf of cloned and common lilacs. Preliminary results confirm the importance of the SI-x features (maximum and minimum temperatures and day length). However, our results show that snow water equivalent and water vapor pressure are also necessary to properly model leaf onset. Regarding the predictions, our results indicate that Random Forests yield comparable results to those produced by the SI-x models (in terms of root mean square error -RMSE). For cloned and common lilac, the models predict the day of year of leafing with 16 and 15 days of accuracy respectively

  19. Validity of a Pediatric Version of the Glasgow Outcome Scale–Extended

    OpenAIRE

    Beers, Sue R.; Wisniewski, Stephen R.; Garcia-Filion, Pamela; Tian, Ye; Hahner, Thomas; Berger, Rachel P.; Bell, Michael J.; Adelson, P. David

    2012-01-01

    The Glasgow Outcome Scale (GOS) and its most recent revision, the GOS–Extended (GOS-E), provide the gold standard for measuring traumatic brain injury (TBI) outcome. The GOS-E exhibits validity when used with adults and some adolescents, but validity with younger children is not established. Because the GOS-E lacks the developmental specificity necessary to evaluate children, toddlers, and infants, we modified the original version to create the GOS-E Pediatric Revision (GOS-E Peds), a develop...

  20. The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax.

    Science.gov (United States)

    Saito, Yoshitaro; Suzuki, Yohei; Demura, Ryo; Kawai, Hideki

    2018-03-01

    Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06). Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.

  1. Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes.

    Science.gov (United States)

    Boas, F Edward; Bodei, Lisa; Sofocleous, Constantinos T

    2017-09-01

    Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using 90 Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types of 90 Y microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of 90 Y microspheres selectively to treat a tumor

  2. Indications and Outcome of Mandibular Condylar and Ramus ...

    African Journals Online (AJOL)

    ... (13.0%) patients and four procedures were done for dislocation in 2 (8.6%) patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

  3. Indications and Visual Outcome of First Hundred Pars Plana ...

    African Journals Online (AJOL)

    tulyasys

    prevention programs because it is assumed that they are not a common cause of blindness and the outcome of treating retinal diseases do not justify the effort and expense involved.[4] The huge cost of equipment and shortage of trained man.

  4. 76 FR 14024 - Guidance for Industry on Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims...

    Science.gov (United States)

    2011-03-15

    ...] Guidance for Industry on Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims... ``Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims.'' This guidance is intended to assist applicants in developing labeling for outcome claims for drugs that are indicated to treat hypertension. With...

  5. Indicators of outcome after internal fixation of complex acetabular ...

    African Journals Online (AJOL)

    T.A. El-khadrawe

    2012-01-23

    Jan 23, 2012 ... Avascular necrosis. 0. 0. Osteoarthritis. 14. 24.45. Early local complication versus outcome. No local complications. 17.00(7.00–18.00) z = А2.564 p = .01. Local complications. 12.00(6.00–15.00). Post-operative displacement versus arthritis. No arthritis. 2.00(00.00–10.00) mm z = А3.36 p = .001. Arthritis.

  6. The floating knee: epidemiology, prognostic indicators & outcome following surgical management

    OpenAIRE

    Yesupalan Rajam S; Rethnam Ulfin; Nair Rajagopalan

    2007-01-01

    Abstract Background Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. We present the outcome of these injuries after surgical management. Methods 29 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. ...

  7. Quality of Life Indicators for Individuals with Intellectual Disabilities: Extending Current Practice

    Science.gov (United States)

    Brown, Ivan; Hatton, Chris; Emerson, Eric

    2013-01-01

    Quality of life is a social construct that is measured by what are considered to be its most appropriate indicators. Quality of life measurement in intellectual disability reflects a variety of indicators, often grouped under life domains. Subjective and objective methods of measuring indicators each have strengths and drawbacks, but it is…

  8. Operative Fixation of Rib Fractures Indications, Techniques, and Outcomes.

    Science.gov (United States)

    Galos, David; Taylor, Benjamin; McLaurin, Toni

    2017-01-01

    Rib fractures are extremely common injuries and vary in there severity from single nondisplaced fractures to multiple segmental fractures resulting in flail chest and respiratory compromise. Historically, rib fractures have been treated conservatively with pain control and respiratory therapy. However this method may not be the best treatment modality in all situations. Operative fixation of select rib fractures has been increasing in popularity especially in patients with flail chest and respiratory compromise. Newer techniques use muscle sparing approaches and precontoured locking plate technology to obtain stable fixation and allow improved respiration. Current reports shows that rib fracture fixation offers the benefits of improved respiratory mechanics and improved pain control in the severe chest wall injury with resultant improvement in patient outcomes by decreasing time on the ventilator, time in the intensive care unit, and overall hospital length of stay.

  9. Outcome of endoscopy-assisted microscopic extended transsphenoidal surgery for suprasellar craniopharyngiomas

    Directory of Open Access Journals (Sweden)

    Hidetoshi eIkeda

    2012-02-01

    Full Text Available Objectives. Craniopharyngiomas are difficult to treat. The extended transsphenoidal approach has recently been described in several small series. We describe the usefulness of microscopy-assisted angled endoscopy for visualizing vital structures such as tumor attachment or tumor invasion to the pituitary stalk to achieve confident radical tumor removal.Design and Participants. Between 2006 and 2010, 15 patients underwent the microscopy-assisted extended transsphenoidal approach for resection of entirely suprasellar craniopharyngiomas. 14 patients had the transinfundibular type, and one had the transinfundibular type with the extension to third ventricle. We observed color change within the pituitary stalk by endoscopy. The pituitary stalk was cut intentionally in ten patients, because of suspected tumor invasion surrounding the stalk. Main Outcome Measures and Results. Total removal was accomplished in nine patients. Pathological specimens from the pituitary stalk showed tumor invasion spreading over the surface of the pituitary stalk, shown by a discolored pituitary stalk, and this was essential for confident radical tumor removal. Even after stalk resection, postoperative DI was minimal when a bright signal on T1 in the posterior lobe was not confirmed on preoperative magnetic resonance imaging. Conclusion. Confident radical tumor removal is possible with the introduction of the endoscopy-assisted microscopic extended transsphenoidal approach.

  10. Management of postintubation tracheal stenosis: appropriate indications make outcome differences.

    Science.gov (United States)

    Melkane, Antoine E; Matar, Nayla E; Haddad, Amine C; Nassar, Michel N; Almoutran, Homère G; Rohayem, Ziad; Daher, Mohammad; Chalouhy, Georges; Dabar, George

    2010-01-01

    Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared. Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups. Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria. Copyright 2010 S. Karger AG, Basel.

  11. Indications and outcome of Open Reduction and Internal Fixation of ...

    African Journals Online (AJOL)

    Background: Open reduction and internal fixation (ORIF) is a well-established surgical treatment of fractures worldwide. However, the indications and modes of stabilization of long bone fractures vary and are evolving .The general trend now is towards fixation with locked intramedullary nail (i.m nail) rather than plate and ...

  12. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

    International Nuclear Information System (INIS)

    Strach, Katharina; Schröck, Andreas; Wilhelm, Kai; Greschus, Susanne; Tschampa, Henriette; Möhlenbruch, Markus; Naehle, Claas P.; Jakob, Mark; Gerstner, Andreas O. H.; Bootz, Friedrich; Schild, Hans H.; Urbach, Horst

    2011-01-01

    Objective: Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis. Methods: All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed. Results: A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization. Conclusions: Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk–benefit profile.

  13. Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes.

    Science.gov (United States)

    Michaels, Joseph; Coon, Devin; Calotta, Nicholas A; Peter Rubin, J

    2018-04-01

    The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  14. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, Anthony James, E-mail: consultant@radiologist.co.uk [The Imaging Clinic (United Kingdom)

    2015-08-15

    Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

  15. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

    International Nuclear Information System (INIS)

    Lopez, Anthony James

    2015-01-01

    Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure

  16. Productivity in Academia: An Assessment of Causal Linkages between Output and Outcome Indicators

    Science.gov (United States)

    Wamala, Robert; Ssembatya, Vincent A.

    2015-01-01

    Purpose: The purpose of this paper is to investigate causal linkages between output and outcome indicators of productivity in academia. Design/methodology/approach: The duration of teaching service and the number of graduate students supervised to completion were adopted as output indicators of productivity. Equivalent outcome indicators were the…

  17. Video-assisted thoracic surgery for left upper lobectomy for complex lesions: how to extend the indication with optimal safety?

    Science.gov (United States)

    Bayard, Nathanaël Frank; Barnett, Stephen Arthur; Rinieri, Philippe; Melki, Jean; Peillon, Christophe; Baste, Jean Marc

    2016-08-01

    The feasibility of extending the VATS approach to locally advanced NSCLC has been described with good clinical outcome. These complex resections are still technically challenging and patient safety must remain the highest priority. In this article, we describe our routine VATS approach for left upper lobectomy in proximal, locally advanced lesions. Both surgical and anaesthesiology teams are trained during simulation sessions to respond rapidly in case of urgent thoracotomy. Encircling arterial and venous vessels allow control of inadvertent bleeding during difficult dissection. Also, whenever needed the double vessel control technique is a time saver waiting for conversion to thoracotomy.

  18. Open Access Citation Advantage in selected Information Science journals: an extended analysis to altmetrics indicators

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Cintra

    2017-04-01

    Full Text Available Introduction: Open access refers to scientific literature available free of charge and free of copyright restrictions and licensing for its reuse. An increase in the total number of citations received by articles available in open access in relation to those of restricted, pay-walled access is expected, according to the Open Access Citation Advantage hypothesis. Objective: Assess the possible citation advantages and mentions on the social web that open access can offer to the Information Science area. Methodology: Bibliometric and altmetric indicators were analyzed in two journals: Journal of the American Society for Information Science and Scientometrics. Data collection was conducted in the Web of Science, Google Scholar, Altmetric.com and Mendeley. Results: The results indicated that for both journals, open access offers an advantage in the number of citations received by articles. It was also demonstrated that the advantage is maintained over time. Conclusions: This research confirmed the hypothesis of an Open Access Citation Advantage for the journals analyzed in the area of Information Science. This pattern was also observed for the altmetric data.

  19. Comparison of visual outcomes after bilateral implantation of extended range of vision and trifocal intraocular lenses.

    Science.gov (United States)

    Ruiz-Mesa, Ramón; Abengózar-Vela, Antonio; Aramburu, Ana; Ruiz-Santos, María

    2017-06-26

    To compare visual outcomes after cataract surgery with bilateral implantation of 2 intraocular lenses (IOLs): extended range of vision and trifocal. Each group of this prospective study comprised 40 eyes (20 patients). Phacoemulsification followed by bilateral implantation of a FineVision IOL (group 1) or a Symfony IOL (group 2) was performed. The following outcomes were assessed up to 1 year postoperatively: binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity (UIVA) at 60 cm, binocular uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, defocus curves, mesopic and photopic contrast sensitivity, halometry, posterior capsule opacification (PCO), and responses to a patient questionnaire. The mean binocular values in group 1 and group 2, respectively, were SE -0.15 ± 0.25 D and -0.19 ± 0.18 D; UDVA 0.01 ± 0.03 logMAR and 0.01 ± 0.02 logMAR; UIVA 0.11 ± 0.08 logMAR and 0.09 ± 0.08 logMAR; UNVA 0.06 ± 0.07 logMAR and 0.17 ± 0.06 logMAR. Difference in UNVA between IOLs (pvisual outcomes. The FineVision IOL showed better near visual acuity. Predictability of the refractive results and optical performance were excellent; all patients achieved spectacle independence. The 2 IOLs gave similar and good contrast sensitivity in photopic and mesopic conditions and low perception of halos by patients.

  20. A method for reducing misclassification in the extended Glasgow Outcome Score.

    Science.gov (United States)

    Lu, Juan; Marmarou, Anthony; Lapane, Kate; Turf, Elizabeth; Wilson, Lindsay

    2010-05-01

    The eight-point extended Glasgow Outcome Scale (GOSE) is commonly used as the primary outcome measure in traumatic brain injury (TBI) clinical trials. The outcome is conventionally collected through a structured interview with the patient alone or together with a caretaker. Despite the fact that using the structured interview questionnaires helps reach agreement in GOSE assessment between raters, significant variation remains among different raters. We introduce an alternate GOSE rating system as an aid in determining GOSE scores, with the objective of reducing inter-rater variation in the primary outcome assessment in TBI trials. Forty-five trauma centers were randomly assigned to three groups to assess GOSE scores on sample cases, using the alternative GOSE rating system coupled with central quality control (Group 1), the alternative system alone (Group 2), or conventional structured interviews (Group 3). The inter-rater variation between an expert and untrained raters was assessed for each group and reported through raw agreement and with weighted kappa (kappa) statistics. Groups 2 and 3 without central review yielded inter-rater agreements of 83% (weighted kappa = 0.81; 95% CI 0.69, 0.92) and 83% (weighted kappa = 0.76, 95% CI 0.63, 0.89), respectively, in GOS scores. In GOSE, the groups had an agreement of 76% (weighted kappa = 0.79; 95% CI 0.69, 0.89), and 63% (weighted kappa = 0.70; 95% CI 0.60, 0.81), respectively. The group using the alternative rating system coupled with central monitoring yielded the highest inter-rater agreement among the three groups in rating GOS (97%; weighted kappa = 0.95; 95% CI 0.89, 1.00), and GOSE (97%; weighted kappa = 0.97; 95% CI 0.91, 1.00). The alternate system is an improved GOSE rating method that reduces inter-rater variations and provides for the first time, source documentation and structured narratives that allow a thorough central review of information. The data suggest that a collective effort can be made to

  1. The Social Outcomes of Older Adult Learning in Taiwan: Evaluation Framework and Indicators

    Science.gov (United States)

    Lin, Li-Hui

    2015-01-01

    The purpose of this study is to explore the social outcomes of older adult learning in Taiwan. In light of our society's aging population structure, the task of establishing evaluation framework and indicators for the social outcomes of learning (SOL) as applied to older adults is urgent. In order to construct evaluation indicators for older adult…

  2. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex.

    Science.gov (United States)

    Mathoulin, C L

    2017-07-01

    This review includes updated understanding of the roles of intrinsic and extrinsic carpal ligaments in scapholunate instability and details the author's experience of indications, arthroscopic repair methods, and outcomes of treating the instability. A classification on triangular fibrocartilage complex injuries is reviewed, followed by author's indications, methods, and outcomes of arthroscopic repair of triangular fibrocartilage complex injuries.

  3. Extending a Consensus-based Fuzzy Ordered Weighting Average (FOWA Model in New Water Quality Indices

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Baghapour

    2017-07-01

    Full Text Available In developing a specific WQI (Water Quality Index, many water quality parameters are involved with different levels of importance. The impact of experts’ different opinions and viewpoints, current risks affecting their opinions, and plurality of the involved parameters double the significance of the issue. Hence, the current study tries to apply a consensus-based FOWA (Fuzzy Ordered Weighting Average model as one of the most powerful and well-known Multi Criteria Decision Making (MCDM techniques to determine the importance of the used parameters in the development of such WQIs which is shown with an example. This operator has provided the capability of modeling the risks in decision-making through applying the optimistic degree of stakeholders and their power coupled with the use of fuzzy numbers. Totally, 22 water quality parameters for drinking purposes are considered in this study. To determine the weight of each parameter, the viewpoints of 4 decision-making groups of experts are taken into account. After determining the final weights, to validate the use of each parameter in a potential WQI, consensus degrees of both the decision makers and the parameters are calculated. All calculations are carried out by using the expertise software called Group Fuzzy Decision Making (GFDM. The highest and the lowest weight values, 0.999 and 0.073 respectively, are related to Hg and temperature. Regarding the type of consumption that is drinking, the parameters’ weights and ranks are consistent with their health impacts. Moreover, the decision makers’ highest and lowest consensus degrees were 0.9905 and 0.9669, respectively. Among the water quality parameters, temperature (with consensus degree of 0.9972 and Pb (with consensus degree of 0.9665, received the highest and lowest agreement from the decision making group. This study indicates that the weight of parameters in determining water quality largely depends on the experts’ opinions and

  4. Extending a Consensus-based Fuzzy Ordered Weighting Average (FOWA Model in New Water Quality Indices

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Baghapour

    2017-07-01

    Full Text Available In developing a specific WQI (Water Quality Index, many quality parameters are involved with different levels of importance. The impact of experts’ different opinions and viewpoints, current risks affecting their opinions, and plurality of the involved parameters double the significance of the issue. Hence, the current study tries to apply a consensus-based FOWA (Fuzzy Ordered Weighting Average model as one of the most powerful and well-known Multi-Criteria Decision- Making (MCDM techniques to determine the importance of the used parameters in the development of such WQIs which is shown with an example. This operator has provided the capability of modeling the risks in decision-making through applying the optimistic degree of stakeholders and their power coupled with the use of fuzzy numbers. Totally, 22 water quality parameters for drinking purposes were considered in this study. To determine the weight of each parameter, the viewpoints of 4 decision-making groups of experts were taken into account. After determining the final weights, to validate the use of each parameter in a potential WQI, consensus degrees of both the decision makers and the parameters are calculated. The highest and the lowest weight values, 0.999 and 0.073 respectively, were related to Hg and temperature. Regarding the type of consumption that was drinking, the parameters’ weights and ranks were consistent with their health impacts. Moreover, the decision makers’ highest and lowest consensus degrees were 0.9905 and 0.9669, respectively. Among the water quality parameters, temperature (with consensus degree of 0.9972 and Pb (with consensus degree of 0.9665, received the highest and lowest agreement with the decision-making group. This study indicated that the weight of parameters in determining water quality largely depends on the experts’ opinions and approaches. Moreover, using the FOWA model provides results accurate and closer- to-reality on the significance of

  5. Item-Level Psychometrics of the Glasgow Outcome Scale: Extended Structured Interviews.

    Science.gov (United States)

    Hong, Ickpyo; Li, Chih-Ying; Velozo, Craig A

    2016-04-01

    The Glasgow Outcome Scale-Extended (GOSE) structured interview captures critical components of activities and participation, including home, shopping, work, leisure, and family/friend relationships. Eighty-nine community dwelling adults with mild-moderate traumatic brain injury (TBI) were recruited (average = 2.7 year post injury). Nine items of the 19 items were used for the psychometrics analysis purpose. Factor analysis and item-level psychometrics were investigated using the Rasch partial-credit model. Although the principal components analysis of residuals suggests that a single measurement factor dominates the measure, the instrument did not meet the factor analysis criteria. Five items met the rating scale criteria. Eight items fit the Rasch model. The instrument demonstrated low person reliability (0.63), low person strata (2.07), and a slight ceiling effect. The GOSE demonstrated limitations in precisely measuring activities/participation for individuals after TBI. Future studies should examine the impact of the low precision of the GOSE on effect size. © The Author(s) 2016.

  6. Extended long term functional outcome of inflatable penile prosthesis in a single institution.

    LENUS (Irish Health Repository)

    Thomas, A Z

    2011-02-01

    We sought to evaluate the extended long term functional outcome of the AMS700 three piece inflatable prosthesis in men with erectile dysfunction in a single urological department and assess our revision rates. Patients that underwent first-time insertion or revision of an AMS700 3 piece inflatable penile prosthesis between 1984-2007 were included. Data was obtained from medical records and long term follow up of patients was conducted by telephone interview. The medical records of 38 patients were available for review. Of these 38 men, 56 prostheses were inserted. The mean follow up was 8.4 years (101 months). The revision rate at 50 months postoperatively was 7\\/38 (18%). The overall revision rate was 18\\/38 (47%). The mean time to revision in these 18 patients was 72 months (12-156 months) after initial insertion of AMS700 penile prosthesis. This study highlights that with longer follow u revision rates markedly increase after 72 months.

  7. Six uneventful pregnancy outcomes in an extended vascular Ehlers-Danlos syndrome family.

    Science.gov (United States)

    Baas, Annette F; Spiering, Wilko; Moll, Frans L; Page-Christiaens, Lieve; Beenakkers, Ingrid C M; Dooijes, Dennis; Vonken, Evert-Jan P A; van der Smagt, Jasper J; Knoers, Nine V; Koenen, Steven V; van Herwaarden, Joost A; Sieswerda, Gertjan Tj

    2017-02-01

    Vascular Ehlers-Danlos Syndrome (vEDS) is caused by heterozygous mutations in COL3A1 and is characterized by fragile vasculature and hollow organs, with a high risk of catastrophic events at a young age. During pregnancy and delivery, maternal mortality rates up until 25% have been reported. However, recent pedigree analysis reported a substantial lower pregnancy-related mortality rate of 4.9%. Here, we describe an extended vEDS family with multiple uneventful pregnancy outcomes. In the proband, a 37-year-old woman, DNA-analysis because of an asymptomatic iliac artery dissection revealed a pathogenic mutation in COL3A1 (c.980G>A; p. Gly327Asp). She had had three uneventful vaginal deliveries. At the time of diagnosis, her 33-year-old niece was 25 weeks pregnant. She had had one uneventful vaginal delivery. Targeted DNA-analysis revealed that she was carrier of the COL3A1 mutation. Ultrasound detected an aneurysm in the abdominal aorta with likely a dissection. An uneventful elective cesarean section was performed at a gestational age of 37 weeks. The 40-year-old sister of our proband had had one uneventful vaginal delivery and an active pregnancy wish. Cascade DNA-screening showed her to carry the COL3A1 mutation. Computed Tomography Angiography (CTA) of her aorta revealed a type B dissection with the most proximal entry tear just below the superior mesenteric artery. Pregnancy was therefore discouraged. This familial case illustrates the complexity and challenges of reproductive decision-making in a potentially lethal condition as vEDS, and highlights the importance of a multidisciplinary approach. Moreover, it suggests that previous pregnancy-related risks of vEDS may be overestimated. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework

    Directory of Open Access Journals (Sweden)

    Burke Martyn

    2011-08-01

    Full Text Available Abstract Background Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF. Methods The indicator testing protocol involved a multi-step and methodological process: 1 The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2 data extraction from patients' medical records, to test technical feasibility and reliability, 3 diaries, to test workload, 4 cost-effectiveness modelling, and 5 semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Results Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010 involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. Conclusions This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health

  9. Stereotactic radiotherapy and radiosurgery in pediatric patients: analysis of indications and outcome

    DEFF Research Database (Denmark)

    Mirza, Bilal; Mønsted, Anne; Jensen, Josephine Harding

    2010-01-01

    We describe indications, outcomes, and risk profiles of fractionated stereotactic radiotherapy (SRT) and single fraction "radiosurgery" (SRS) in pediatric patients compared to the adult population and evaluate the causal role of SRS and SRT in inducing new neurological complications....

  10. Lateral epicondylitis in general practice : Course and prognostic indicators of outcome

    NARCIS (Netherlands)

    Smidt, Nynke; Lewis, Martyn; Van Der Windt, Daniëlle A.W.M.; Hay, Elaine M.; Bouter, Lex M.; Croft, Peter

    2006-01-01

    Objective. To investigate the course of lateral epicondylitis and identify prognostic indicators associated with short- and longterm outcome of pain intensity. Methods. We prospectively followed patients (n = 349) from 2 randomized controlled trials investigating conservative interventions for

  11. Extended Renal Outcomes with Use of Iodixanol versus Iohexol after Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Horng-Ruey Chua

    2014-01-01

    Full Text Available The impact of isoosmolar versus low-osmolar contrast media (CM administration on contrast-induced acute kidney injury (CI-AKI and extended renal dysfunction (ERD is unclear. We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar versus iohexol (low-osmolar during angiography for cardiac indications. Of 713 patients, 560 (cohort A, 190 (cohort B, and 172 (cohort C had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively. 18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P=0.006. However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR. On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR<45 mL/min/1.73 m2. 32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively. CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk. Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors. CI-AKI predicts longer-term ERD.

  12. Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes.

    Science.gov (United States)

    Turton, Mervyn; Africa, Charlene W J

    2017-06-01

    Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes. © 2016 FDI World Dental Federation.

  13. Evaluating social outcomes of HIV/AIDS interventions: a critical assessment of contemporary indicator frameworks.

    Science.gov (United States)

    Mannell, Jenevieve; Cornish, Flora; Russell, Jill

    2014-01-01

    Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks. We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity. The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts. Current indicator frameworks cannot adequately assess the social outcomes of HIV interventions. This limits knowledge about

  14. QSTR with extended topochemical atom (ETA) indices. 14. QSAR modeling of toxicity of aromatic aldehydes to Tetrahymena pyriformis

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Kunal, E-mail: kunalroy_in@yahoo.com [Drug Theoretics and Cheminformatics Laboratory, Division of Medicinal and Pharmaceutical Chemistry, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700 032 (India); Das, Rudra Narayan [Drug Theoretics and Cheminformatics Laboratory, Division of Medicinal and Pharmaceutical Chemistry, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700 032 (India)

    2010-11-15

    Aldehydes are a toxic class of chemicals causing severe health hazards. In this background, quantitative structure-toxicity relationship (QSTR) models have been developed in the present study using Extended Topochemical Atom (ETA) indices for a large group of 77 aromatic aldehydes for their acute toxicity against the protozoan ciliate Tetrahymena pyriformis. The ETA models have been compared with those developed using various non-ETA topological indices. Attempt was also made to include the n-octanol/water partition coefficient (log K{sub o/w}) as an additional descriptor considering the importance of hydrophobicity in toxicity prediction. Thirty different models were developed using different chemometric tools. All the models have been validated using internal validation and external validation techniques. The statistical quality of the ETA models was found to be comparable to that of the non-ETA models. The ETA models have shown the important effects of steric bulk, lipophilicity, presence of electronegative atom containing substituents and functionality of the aldehydic oxygen to the toxicity of the aldehydes. The best ETA model (without using log K{sub o/w}) shows encouraging statistical quality (Q{sub int}{sup 2}=0.709,Q{sub ext}{sup 2}=0.744). It is interesting to note that some of the topological models reported here are better in statistical quality than previously reported models using quantum chemical descriptors.

  15. Theoretical Framework to Extend Adverse Outcome Pathways to Include Pharmacokinetic Considerations

    Science.gov (United States)

    Adverse Outcome Pathways (AOPs) have generated intense interest for their utility in linking known population outcomes to a molecular initiating event (MIE) that can be quantified using in vitro methods. While there are tens of thousands of chemicals in commercial use, biology h...

  16. Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention".

    Science.gov (United States)

    Luzia, Melissa de Freitas; Argenta, Carla; Almeida, Miriam de Abreu; Lucena, Amália de Fátima

    2018-01-01

    to construct conceptual definitions for indicators of nursing outcome Knowledge: Fall Prevention, selected for evaluation of hospitalized patients with the nursing diagnosis Risk for falls. integrative literature review performed in the LILACS, MEDLINE and Web of Science databases, comprising articles published in English, Spanish and Portuguese languages from 2005 to 2015. the final sample of the study was composed of 17 articles. The conceptualizations were constructed for 14 indicators of nursing outcome Knowledge: Fall Prevention focused on hospitalized patients. the theoretical support of the Nursing Outcomes Classification (NOC), through the process of constructing the conceptual definitions of the indicators of its results, allows nurses to accurately implement this classification in clinical practice and to evaluate the effectiveness of their interventions through the change of the patients' status over time.

  17. Associations between HIV-RNA-based indicators and virological and clinical outcomes

    DEFF Research Database (Denmark)

    Laut, Kamilla G; Shepherd, Leah C; Pedersen, Court

    2016-01-01

    OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. DESIGN: Multinational cohort study. METHODS: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load measureme......OBJECTIVES: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. DESIGN: Multinational cohort study. METHODS: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load...... measurements after baseline (the latest of 01/01/2001 or entry into EuroSIDA). Using multivariate Poisson regression, we modelled the association between short-term (resistance, triple-class failure) and long-term (all-cause mortality, any AIDS/non-AIDS clinical event) outcomes and the indicators: viraemia...

  18. Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

    OpenAIRE

    Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad,; Rosdara Masayuni bt Mohd Sani,; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

    2007-01-01

    Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were great...

  19. Systematic ultrasound-guided saturation and template biopsy of the prostate: indications and advantages of extended sampling.

    Science.gov (United States)

    Isbarn, Hendrik; Briganti, Alberto; De Visschere, Pieter J L; Fütterer, Jurgen J; Ghadjar, Pirus; Giannarini, Gianluca; Ost, Piet; Ploussard, Guillaume; Sooriakumaran, Prasanna; Surcel, Christian I; van Oort, Inge M; Yossepowitch, Ofer; van den Bergh, Roderick C N

    2015-04-01

    Prostate biopsy (PB) is the gold standard for the diagnosis of prostate cancer (PCa). However, the optimal number of biopsy cores remains debatable. We sought to compare contemporary standard (10-12 cores) vs. saturation (=18 cores) schemes on initial as well as repeat PB. A non-systematic review of the literature was performed from 2000 through 2013. Studies of highest evidence (randomized controlled trials, prospective non-randomized studies, and retrospective reports of high quality) comparing standard vs saturation schemes on initial and repeat PB were evaluated. Outcome measures were overall PCa detection rate, detection rate of insignificant PCa, and procedure-associated morbidity. On initial PB, there is growing evidence that a saturation scheme is associated with a higher PCa detection rate compared to a standard one in men with lower PSA levels (40 cc), or lower PSA density values (sampling is associated with a high rate of acute urinary retention, whereas other severe adverse events, such as sepsis, appear not to occur more frequently with saturation schemes. Current evidence suggests that saturation schemes are associated with a higher PCa detection rate compared to standard ones on initial PB in men with lower PSA levels or larger prostates, and on repeat PB. Since most data are derived from retrospective studies, other endpoints such as detection rate of insignificant disease - especially on repeat PB - show broad variations throughout the literature and must, thus, be interpreted with caution. Future prospective controlled trials should be conducted to compare extended templates with newer techniques, such as image-guided sampling, in order to optimize PCa diagnostic strategy.

  20. Extended cardiac rehabilitation for socially vulnerable patients improves attendance and outcome

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Meillier, Lucette Kirsten; Larsen, Mogens Lytken

    2013-01-01

    Patients living alone or having a low socioeconomic status are likely to quit cardiac rehabilitation. We aimed to compare patients being offered extended rehabilitation (ERP) with those being offered standard rehabilitation (SRP) as concerns 1) attendance rates and 2) achievement of treatment goals...

  1. [Identification of health outcome indicators in Primary Care. A review of systematic reviews].

    Science.gov (United States)

    Olry de Labry Lima, A; García Mochón, L; Bermúdez Tamayo, C

    Outcome measures are being widely used by health services to assess the quality of health care. It is important to have a battery of useful performance indicators with high validity and feasibility. Thus, the objective of this study is to perform a review of reviews in order to identify outcome indicators for use in Primary Care. A review of systematic reviews (umbrella review) was carried out. The following databases were consulted: MedLine, EMBASE, and CINAHL, using descriptors and free terms, limiting searches to documents published in English or Spanish. In addition, a search was made for free terms in different web pages. Those reviews that offered indicators that could be used in the Primary Care environment were included. This review included a total of 5 reviews on performance indicators in Primary Care, which consisted of indicators in the following areas or clinical care processes: in osteoarthritis, chronicity, childhood asthma, clinical effectiveness, and prescription safety indicators. A total of 69 performance indicators were identified, with the percentage of performance indicators ranging from 0% to 92.8%. None of the reviews identified performed an analysis of the measurement control (feasibility or sensitivity to change of indicators). This paper offers a set of 69 performance indicators that have been identified and subsequently validated and prioritised by a panel of experts. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems

    Directory of Open Access Journals (Sweden)

    Alba Luz Rodríguez-Acelas

    Full Text Available Objective.Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Methods. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Results. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. Conclusion. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.

  3. Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators

    Directory of Open Access Journals (Sweden)

    Elma Nelisiwe Maleka

    2017-01-01

    Full Text Available There are number of Non-Governmental Organisations (NGOs in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS, however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA. Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour

  4. Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators.

    Science.gov (United States)

    Maleka, Elma Nelisiwe

    2017-12-01

    There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected

  5. Relationships Between Training Load Indicators and Training Outcomes in Professional Soccer

    NARCIS (Netherlands)

    Jaspers, Arne; Brink, Michel S.; Probst, Steven G M; Frencken, Wouter G. P.; Helsen, Werner F.

    Background In professional senior soccer, training load monitoring is used to ensure an optimal workload to maximize physical fitness and prevent injury or illness. However, to date, different training load indicators are used without a clear link to training outcomes. Objective The aim of this

  6. Treatment outcomes of extended-field radiation therapy for thoracic superficial esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Doo Yeul; Moon, Sung Ho; Cho, Kwan Ho; Kim, Tae Hyun; Kim, Moon Soo; Lee, Jong Yeul; Suh, Yang Gun [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2017-09-15

    To evaluate the efficacy and safety of extended-field radiation therapy for patients with thoracic superficial esophageal cancer (SEC). From May 2007 to October 2016, a total of 24 patients with thoracic SEC (T1a and T1b) who underwent definitive radiotherapy and were analyzed retrospectively. The median total radiotherapy dose was 64 Gy (range, 54 to 66 Gy) in conventional fractionation. All 24 patients received radiotherapy to whole thoracic esophagus and 23 patients received elective nodal irradiation. The supraclavicular lymph nodes, the celiac lymph nodes, and both of those nodal areas were included in 11, 3, and 9 patients, respectively. The median follow-up duration was 28.7 months (range 7.9 to 108.0 months). The 3-year overall survival, local control, and progression-free survival rates were 95.2%, 89.7%, and 78.7%, respectively. There were 5 patients (20.8%) with progression of disease, 2 local failures (8.3%) and 3 (12.5%) regional failures. Three patients also experienced distant metastasis and had died of disease progression. There were no treatment-related toxicities of grade 3 or higher. Definitive extended-field radiotherapy for thoracic SEC showed durable disease control rates in medically inoperable and endoscopically unfit patients. Even extended-field radiotherapy with elective nodal irradiation was safe without grade 3 or 4 toxicities.

  7. Treatment outcomes of extended-field radiation therapy for thoracic superficial esophageal cancer

    International Nuclear Information System (INIS)

    Lee, Doo Yeul; Moon, Sung Ho; Cho, Kwan Ho; Kim, Tae Hyun; Kim, Moon Soo; Lee, Jong Yeul; Suh, Yang Gun

    2017-01-01

    To evaluate the efficacy and safety of extended-field radiation therapy for patients with thoracic superficial esophageal cancer (SEC). From May 2007 to October 2016, a total of 24 patients with thoracic SEC (T1a and T1b) who underwent definitive radiotherapy and were analyzed retrospectively. The median total radiotherapy dose was 64 Gy (range, 54 to 66 Gy) in conventional fractionation. All 24 patients received radiotherapy to whole thoracic esophagus and 23 patients received elective nodal irradiation. The supraclavicular lymph nodes, the celiac lymph nodes, and both of those nodal areas were included in 11, 3, and 9 patients, respectively. The median follow-up duration was 28.7 months (range 7.9 to 108.0 months). The 3-year overall survival, local control, and progression-free survival rates were 95.2%, 89.7%, and 78.7%, respectively. There were 5 patients (20.8%) with progression of disease, 2 local failures (8.3%) and 3 (12.5%) regional failures. Three patients also experienced distant metastasis and had died of disease progression. There were no treatment-related toxicities of grade 3 or higher. Definitive extended-field radiotherapy for thoracic SEC showed durable disease control rates in medically inoperable and endoscopically unfit patients. Even extended-field radiotherapy with elective nodal irradiation was safe without grade 3 or 4 toxicities

  8. Comparison of Functional Outcome after Extended versus Super-Extended Pelvic Lymph Node Dissection during Radical Prostatectomy in High-Risk Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Heikki Seikkula

    2017-11-01

    Full Text Available BackgroundUrinary continence and erectile function (EF are best preserved when meticulous dissection of prostate and nerve sparing technique are used during radical prostatectomy (RP. However, extent of lymph node dissection (LND may also adversely affect functional results.ObjectiveTo determine whether performing a super-extended LND (seLND has a significant effect on recovery of urinary continence and EF after RP.Design, setting, and participantsAll patients who underwent RP from January 2007 until December 2013 were handed questionnaires assessing continence and EF. All patients in whom at least an extended LND (eLND was performed were selected. This search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires and were included in our analysis.Outcome measurements and statistical analysisAll questionnaires were reviewed. We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full recovery of continence (no loss of urine and full recovery of EF (successful intercourse possible. Patients who did not reach the endpoint when the last questionnaire was filled out were censored at that time. Median follow-up was 12.43 months for continence, and 18.97 months for EF.Results and limitationsPatients undergoing seLND have a lower chance of regaining both urinary continence [hazard ratio (HR 0.59, 95% CI 0.39–0.90, p = 0.026] and EF (HR 0.28, 95% CI 0.13–0.57, p = 0.009. Age at surgery had a significant influence on both continence and EF in multivariate analysis. Major limitation of the study was that no formal preoperative assessment of continence and potency was done.ConclusionExtending the LND template beyond the eLND template may cause at least a significant delay in recovery of urinary continence and leads to less recovery of EF.

  9. Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?

    Directory of Open Access Journals (Sweden)

    Grigory Sidorenkov

    Full Text Available BACKGROUND: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes. METHODS: A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure- and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR with 95% confidence intervals. RESULTS: Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94. Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93. Treatment intensification with glucose-lowering but not with lipid-, blood pressure- and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89. CONCLUSION: Treatment quality indicators measuring lipid- and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient

  10. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

    International Nuclear Information System (INIS)

    Jaremko, J.L.; Lambert, R.G.W.; Rowe, B.H.; Johnson, J.A.; Majumdar, S.R.

    2007-01-01

    Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal (∼6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 ± 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary

  11. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Jaremko, J.L. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Rowe, B.H. [Department of Emergency Medicine, University of Alberta, Edmonton, Alberta (Canada); Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Johnson, J.A. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada); Majumdar, S.R. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada) and Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada)]. E-mail: me2.majumdar@ualberta.ca

    2007-01-15

    Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ({approx}6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 {+-} 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.

  12. Outcome indicators for the evaluation of energy policy instruments and technical change

    International Nuclear Information System (INIS)

    Neij, Lena; Astrand, Kerstin

    2006-01-01

    The aim of this paper is to propose a framework for the evaluation of policy instruments designed to affect development and dissemination of new energy technologies. The evaluation approach is based on the analysis of selected outcome indicators describing the process of technical change, i.e. the development and dissemination of new energy technologies, on the basis of a socio-technical systems approach. The outcome indicators are used to analyse the effect, in terms of outcome, and outcome scope of the policy instruments as well as the extent to which the policy instruments support diversity, learning and institutional change. The analysis of two cases of evaluations, of energy efficiency policy and wind energy policy in Sweden, shows that the approach has several advantages, allowing continuous evaluation and providing important information for the redesign of policy instruments. There are also disadvantages associated with the approach, such as complexity, possible high cost and the requirement of qualified evaluators. Nevertheless, it is concluded that the information on the continuous performance of different policy instruments and their effects on the introduction and dissemination of new energy technologies, provided by this evaluation approach, is essential for an improved adaptation and implementation of energy and climate policy

  13. The Fishery Performance Indicators: A Management Tool for Triple Bottom Line Outcomes

    Science.gov (United States)

    Anderson, James L.; Anderson, Christopher M.; Chu, Jingjie; Meredith, Jennifer; Asche, Frank; Sylvia, Gil; Smith, Martin D.; Anggraeni, Dessy; Arthur, Robert; Guttormsen, Atle; McCluney, Jessica K.; Ward, Tim; Akpalu, Wisdom; Eggert, Håkan; Flores, Jimely; Freeman, Matthew A.; Holland, Daniel S.; Knapp, Gunnar; Kobayashi, Mimako; Larkin, Sherry; MacLauchlin, Kari; Schnier, Kurt; Soboil, Mark; Tveteras, Sigbjorn; Uchida, Hirotsugu; Valderrama, Diego

    2015-01-01

    Pursuit of the triple bottom line of economic, community and ecological sustainability has increased the complexity of fishery management; fisheries assessments require new types of data and analysis to guide science-based policy in addition to traditional biological information and modeling. We introduce the Fishery Performance Indicators (FPIs), a broadly applicable and flexible tool for assessing performance in individual fisheries, and for establishing cross-sectional links between enabling conditions, management strategies and triple bottom line outcomes. Conceptually separating measures of performance, the FPIs use 68 individual outcome metrics—coded on a 1 to 5 scale based on expert assessment to facilitate application to data poor fisheries and sectors—that can be partitioned into sector-based or triple-bottom-line sustainability-based interpretative indicators. Variation among outcomes is explained with 54 similarly structured metrics of inputs, management approaches and enabling conditions. Using 61 initial fishery case studies drawn from industrial and developing countries around the world, we demonstrate the inferential importance of tracking economic and community outcomes, in addition to resource status. PMID:25946194

  14. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

    Science.gov (United States)

    Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

    2006-01-01

    Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

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

    OpenAIRE

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

    2011-01-01

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

  16. Extending the theory of realistic conflict to competition in institutional settings: intergroup status and outcome.

    Science.gov (United States)

    Echebarria-Echabe, Agustin; Guede, Emilia Fernández

    2003-12-01

    The authors analyzed the extent to which the Theory of Realistic Conflict can be extended to institutional settings in which groups are not actively involved in decisions but are passive targets of decisions taken by an institutional authority (the rector). A negative interdependence between the in-group (psychology) and a high- or low-status outgroup (engineering versus nursing) was established by an institutional authority (the rector). The competition (induced by the rector) was beneficial (an increase in the budget previously invested in the faculty) or detrimental (a decrease in the budget) for the in-group. The results confirmed that competition affects mutual attitudes, images, and behaviors of groups even if the groups are passive targets of decisions that the institutional authority makes. Moreover, competition--regardless of whether beneficial or detrimental--deteriorated images of and attitudes toward high-status out-groups. In contrast, competition improved images and opinions about low-status out-groups, but only in the loss condition.

  17. Indications and Visual Outcome of Penetrating Keratoplasty in Tertiary Eye Care Institute in Uttarakhand

    Science.gov (United States)

    Gupta, Neeti; Dhasmana, Renu; Nagpal, Ramesh Chander; Bahadur, Harsh; Maitreya, Amit

    2016-01-01

    Introduction Corneal blindness forms significant proportion of visual blindness in developing countries and penetrating keratoplasty (PK) can restore vision for this. The prognosis of PK is dependent on the corneal diseases responsible for corneal blindness. Aim To evaluate the indications and visual outcome of PK in tertiary eye care institute in Uttarakhand. Materials and Methods Data was reviewed from the medical records of 145 PK done in Department of Ophthalmology, Himalayan Institute of Medical Sciences from January 2012 to October 2014. Analysis of data was done for evaluation of the indications and visual outcome by Paired student’s t-test for hypothesis testing of grouped values of preoperative and last follow-up best corrected visual acuity in cases of optical and therapeutic grafts. A p-value < 0.05 was considered statistically significant. Results In this study data of 145 eyes of 138 patients was reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma 48 (33.10%). Therapeutic keratoplasty was done for 33 cases with maximum 30(20.68%) cases of infectious keratitis. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (p=.0001) in best corrected visual acuity improvement from 1.39 logMAR+ 0.022(SD) preoperatively to 0.367 logMAR+0.44(SD) postoperatively and 1.4 logMAR+.000(SD) preoperatively to 0.16 logMAR+0.57(SD) postoperatively for optical and therapeutic grafts respectively. Conclusion Infective keratitis either active or healed was the major indication for keratoplasty. Poor prognosis indications were most common in this part of the country. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty. PMID:27504319

  18. Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication.

    Science.gov (United States)

    Myint, Phyo Kyaw; Kwok, Chun Shing; Roffe, Christine; Kontopantelis, Evangelos; Zaman, Azfar; Berry, Colin; Ludman, Peter F; de Belder, Mark A; Mamas, Mamas A

    2016-06-01

    Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented. The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization). A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively. Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur. © 2016 American Heart Association, Inc.

  19. Key Performance Indicators in Irish Hospital Libraries: Developing Outcome-Based Metrics

    Directory of Open Access Journals (Sweden)

    Michelle Dalton

    2012-12-01

    Full Text Available Objective – To develop a set of generic outcome-based performance measures for Irishhospital libraries.Methods – Various models and frameworks of performance measurement were used as atheoretical paradigm to link the impact of library services directly with measurablehealthcare objectives and outcomes. Strategic objectives were identified, mapped toperformance indicators, and finally translated into response choices to a single-questiononline survey for distribution via email.Results – The set of performance indicators represents an impact assessment tool whichis easy to administer across a variety of healthcare settings. In using a model directlyaligned with the mission and goals of the organization, and linked to core activities andoperations in an accountable way, the indicators can also be used as a channel throughwhich to implement action, change, and improvement.Conclusion – The indicators can be adopted at a local and potentially a national level, asboth a tool for advocacy and to assess and improve service delivery at a macro level. Toovercome the constraints posed by necessary simplifications, substantial further research is needed by hospital libraries to develop more sophisticated and meaningful measures of impact to further aid decision making at a micro level.

  20. Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems.

    Science.gov (United States)

    Rodríguez-Acelas, Alba Luz; Reich, Rejane; de Abreu Almeida, Miriam; Oliveira Crossetti, Maria da Graça; de Fátima Lucena, Amália

    2016-04-01

    Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infec

  1. Prediction of extubation outcome in preterm infants by composite extubation indices.

    Science.gov (United States)

    Dimitriou, Gabriel; Fouzas, Sotirios; Vervenioti, Aggeliki; Tzifas, Sotirios; Mantagos, Stefanos

    2011-11-01

    To determine whether composite extubation indices can predict extubation outcome in preterm infants. Prospective observational study. Level III neonatal intensive care unit. Fifty-six preterm infants cared for in the neonatal intensive care unit of a tertiary teaching hospital during 2007 and 2008. None. The study consisted of two parts. In the first part, different extubation indices were evaluated in a group of 28 neonates (derivation group). These indices included the diaphragmatic pressure-time index, the respiratory muscle pressure-time index, the maximal transdiaphragmatic pressure, the maximal inspiratory pressure, the airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure ratio, the airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure ratio, the tidal volume, and the respiratory rate to tidal volume ratio. After exploratory analysis, the best performing indices and the optimal threshold values to predict extubation outcome were selected. In the second part of the study, these indices were validated at the predetermined threshold values in an additional group of 28 preterm neonates (validation group). Four infants (14.3%) in the derivation group and four in the validation group (14.3%) failed extubation. Receiver operator characteristic curve analysis revealed that a diaphragmatic pressure-time index of ≤0.12, a respiratory muscle pressure-time index ≤0.10, a airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure of ≤0.14, and a airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure of ≤0.09 were the most accurate predictors of extubation outcome in the derivation group. In the validation group, a diaphragmatic pressure-time index of ≤0.12 and a respiratory muscle pressure-time index of ≤0.10 both had zero false-positive results, predicting with accuracy successful extubation. Composite

  2. Indications and Outcome of Tracheostomy in Ilorin, North Central Nigeria: 10 Years Review

    Science.gov (United States)

    Alabi, B. S.; Afolabi, O. A.; Dunmade, A. D.; Omokanye, H. K.; Ajayi, I. O.; Ayodele, S. O.; Busari, N. O.

    2018-01-01

    Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens’. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens’. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy. PMID:29363628

  3. Effects of live weight adjusted feeding strategy on plasma indicators of energy balance in Holstein cows managed for extended lactation

    DEFF Research Database (Denmark)

    Gaillard, Charlotte; Vestergaard, Mogens; Weisbjerg, Martin Riis

    2016-01-01

    In early lactation, most of the dairy cows are in negative energy balance; the extent and duration depend in part on the feeding strategy. Previous studies showed an increased lactation milk yield by use of a live weight (LW) adjusted feeding strategy with a high energy diet before and a reduced......, the HD-LD cows had higher glucose and lower beta-hydroxybutyrate and non-esterified fatty acids (NEFA) concentrations than the LD-LD cows. After the shift until 36 weeks after calving, plasma NEFA was higher in HD-LD than LD-LD cows. Insulin and insulin-like growth factor-1 were not affected...... of the negative energy balance, and that the reduction in diet energy concentration from LW nadir will extend the negative energy balance period further. Sixty-two Holstein cows (30% first parity) were managed for 16 months extended lactation and randomly allocated to one of two feeding strategies at calving. Two...

  4. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

    DEFF Research Database (Denmark)

    Rasmussen, J V; Polk, A; Sorensen, A K

    2014-01-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

  5. Indications and outcomes of pediatric keratoplasty in a tertiary eye care center: A retrospective review.

    Science.gov (United States)

    Gulias-Cañizo, Rosario; Gonzalez-Salinas, Roberto; Hernandez-Zimbron, Luis Fernando; Hernandez-Quintela, Everardo; Sanchez-Huerta, Valeria

    2017-11-01

    To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.

  6. Social media indicators of the food environment and state health outcomes.

    Science.gov (United States)

    Nguyen, Q C; Meng, H; Li, D; Kath, S; McCullough, M; Paul, D; Kanokvimankul, P; Nguyen, T X; Li, F

    2017-07-01

    Contextual factors can influence health through exposures to health-promoting and risk-inducing factors. The aim of this study was to (1) build, from geotagged Twitter and Yelp data, a national food environment database and (2) to test associations between state food environment indicators and health outcomes. This is a cross-sectional study based upon secondary analyses of publicly available data. Using Twitter's Streaming Application Programming Interface (API), we collected and processed 4,041,521 food-related, geotagged tweets between April 2015 and March 2016. Using Yelp's Search API, we collected data on 505,554 unique food-related businesses. In linear regression models, we examined associations between food environment characteristics and state-level health outcomes, controlling for state-level differences in age, percent non-Hispanic white, and median household income. A one standard deviation increase in caloric density of food tweets was related to higher all-cause mortality (+46.50 per 100,000), diabetes (+0.75%), obesity (+1.78%), high cholesterol (+1.40%), and fair/poor self-rated health (2.01%). More burger Yelp listings were related to higher prevalence of diabetes (+0.55%), obesity (1.35%), and fair/poor self-rated health (1.12%). More alcohol tweets and Yelp bars and pub listings were related to higher state-level binge drinking and heavy drinking, but lower mortality and lower percent reporting fair/poor self-rated health. Supplemental analyses with county-level social media indicators and county health outcomes resulted in finding similar but slightly attenuated associations compared to those found at the state level. Social media can be utilized to create indicators of the food environment that are associated with area-level mortality, health behaviors, and chronic conditions. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  7. Predictors and outcomes of cardiac resynchronization therapy extended to the second generator.

    Science.gov (United States)

    Li, Xuping; Yang, Dachun; Kusumoto, Fred; Shen, Win-Kuang; Mulpuru, Siva; Zhou, Shenghua; Liang, Jinjun; Wu, Gang; Yang, Mei; Liu, Jin-Qu; Friedman, Paul A; Cha, Yong-Mei

    2017-12-01

    A proportion of patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) live to receive a second generator. Controversy exists on whether an implantable cardioverter-defibrillator (ICD) should be offered to patients who have normalized or near-normalized left ventricular ejection fraction (LVEF) at the time of generator replacement (GR). The purpose of this study was to evaluate incidence of appropriate ICD therapy after CRT-D GR. This series involved 1026 consecutive patients who underwent CRT-D implant between January 1, 2002 and December 31, 2012. Echocardiography was assessed before the initial device implant and before GR. ICDs were monitored at our device clinic in person or remotely, or both. Of the cohort, 227 patients (22.1%) underwent CRT-D GR at our institution. Approximately 48% of the patients who received new CRT-D generators were no longer meeting the guidelines indication for ICD use at the time of GR. These patients received subsequent appropriate ICD therapies at a significantly lower rate than those with LVEF generator after GR. Improvement in LVEF after CRT-D GR is associated with significantly reduced incidence of appropriate ICD therapy. Ventricular arrhythmia is less likely to develop with normalized LVEF in nonischemic cardiomyopathy. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Team Performance Indicators Explain Outcome during Women’s Basketball Matches at the Olympic Games

    Directory of Open Access Journals (Sweden)

    Anthony S. Leicht

    2017-12-01

    Full Text Available The Olympic Games is the pinnacle international sporting competition with team sport coaches interested in key performance indicators to assist the development of match strategies for success. This study examined the relationship between team performance indicators and match outcome during the women’s basketball tournament at the Olympic Games. Team performance indicators were collated from all women’s basketball matches during the 2004–2016 Olympic Games (n = 156 and analyzed via linear (binary logistic regression and non-linear (conditional interference (CI classification tree statistical techniques. The most parsimonious linear model retained “defensive rebounds”, “field-goal percentage”, “offensive rebounds”, “fouls”, “steals”, and “turnovers” with a classification accuracy of 85.6%. The CI classification tree retained four performance indicators with a classification accuracy of 86.2%. The combination of “field-goal percentage”, “defensive rebounds”, “steals”, and “turnovers” provided the greatest probability of winning (91.1%, while a combination of “field-goal percentage”, “steals”, and “turnovers” provided the greatest probability of losing (96.7%. Shooting proficiency and defensive actions were identified as key team performance indicators for Olympic female basketball success. The development of key defensive strategies and/or the selection of athletes highly proficient in defensive actions may strengthen Olympic match success. Incorporation of non-linear analyses may provide teams with superior/practical approaches for elite sporting success.

  9. Indicators of a poor outcome after temporary pacing in patients with complete atrioventricular block

    International Nuclear Information System (INIS)

    Kazmi, U.; Hyder, S.N.; Sheikh, A.M.

    2013-01-01

    Background: Temporary pace maker (tpm) implantation is an emergency procedure, performed in symptomatic patients with AV block We report our experience of temporary pacing at a tertiary care center. It is the first study of its type from a local center. Objectives: To study the clinical course of patients after tpm implantation and to determine indicators of a poor outcome after tpm implantation. Methods: This was descriptive retrospective study. Data of all tpm procedures performed at Children Hospital from 2006 to 2012 was retrieved. We excluded patients with surgically placed tpm leads. All patients receiving transvenous tpm were included in our study. Results: Total of 12 patients received tpm, 8 were male (66.6%) and 4 were female (33.3%). Median age was 6 years ( range 1.4 -13 year ). Mean weight was 30kg, (range 8.7 - 50kg). All of them presented with complete heart block.One patient each had post diphtheria cardiomyopathy, unknown poisoning. The rest had congenital heart block. The mean period between tpm to ppm implantation was 5 days, (range 1 - 30 days). One patient spontaneously reverted to sinus rhythm(8.3%), 6 had ppm implantation (58.3%), 5 patients expired (33.3%). A low Ejection Fraction was found to be associated with a poor outcome (p<0.01). Variables that were associated with a poor outcome(mortality), were SOB (p<0.015), weak pulses (p<0.015), and hepatomegaly (p<0.01). Conclusion: Low Ejection Fraction and Heart failure is associated with a poor outcome and increased mortality in patients with complete AV block. We suggest that pacing should be considered in patients earlier, before they develop signs or symptoms of cardiac dysfunction. (author)

  10. CBCT in orthodontics: assessment of treatment outcomes and indications for its use

    Science.gov (United States)

    Nervina, J M

    2015-01-01

    Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics. PMID:25358833

  11. Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

    Science.gov (United States)

    Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad; Rosdara Masayuni bt Mohd Sani; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

    2007-01-01

    Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in ‘ESBL’ than in ‘non-ESBL’ group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72–7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians. PMID:22993489

  12. Types and Indications of Colostomy and Determinants of Outcomes of Patients After Surgery.

    Science.gov (United States)

    Engida, Abebe; Ayelign, Tsehay; Mahteme, Bekele; Aida, Tilahun; Abreham, Berhane

    2016-03-01

    Colostomy is one of the commonest life saving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool. Indications may vary from region to region. Attending morbidity and mortality is significant. the objective of this study was to Determine the common indications and types of colostomy, and outcomes of patients operated at SPHMMC. A retrospective medical records of patients, operation log book and nursing records review was done in a two-year period between January 2011 and December 2013 at the College Teaching Hospital, St Paul's Hospital Millennium Medical, Addis Ababa. During the two years, 253 colostomies were done and 219(86.6%) cases used for analysis. Of these, 151(68.9%) were males. Age ranged from 15 to 85 years with a mean of 50.8. Most of the surgeries, 196(89.5%), were done for emergency conditions. The three most common indications were gangrenous sigmoid volvulus, 102(46.6%), colorectal cancers, 46(21.0%, and abdominal injuries, 28(12.8%). The commonest type of colostomy done was Hartman's colostomy, 179(81.7.1%), gangrenous sigmoid volvulus being the predominant indication, 102(57%). Loop colostomy constituted 35(16%) of all the colostomies. Penetrating abdominal injuries was the main indication 15(42.9%). Overall, 157 complications were seen on 106(48.4%) patients. The most common complications were surgical site infection, 51(23.3%), hospital acquired pneumonia, (10.5%), and wound dehiscence, 17(7.8%). The mortality rate was 9.6% (21). Gangrenous sigmoid volvulus is the leading indication for colostomy. Mortality and morbidity rates are high. Aggressive resuscitation, early prompt operation and post op close follow-up should be emphasized.

  13. PCI in Patients Supported With CF-LVADs: Indications, Safety, and Outcomes.

    Science.gov (United States)

    Anyanwu, Emeka C; Ota, Takeyoshi; Sayer, Gabriel; Nathan, Sandeep; Jeevanandam, Valluvan; Shah, Atman; Uriel, Nir

    2016-06-01

    Patients with heart failure supported with left ventricular assist devices (LVADs) may require coronary intervention during their support. This case series seeks to explore the indications, safety, and outcomes of percutaneous coronary intervention (PCI) in this population. Electronic medical records of patients with LVADs undergoing PCI at a large academic medical center were reviewed. Demographics, reason for PCI, procedural success, complications, and outcomes were collected. From 2010-2014, a total of 6 patients underwent PCI post LVAD implantation. Three patients had PCI in the early postimplantation period (1-3 days post LVAD implantation) while the other three received it later in the LVAD support period. Three indications for PCI were found in the reviewed cases: right ventricular failure (right coronary artery stenting), bridge to left ventricular recovery, and ventricular tachycardia (VT) storm. All patients were maintained on triple blood thinning therapy (aspirin, clopidogrel, and warfarin). There were no acute complications during the interventions; however, 2 patients died in the early intervention period and 2 died much later. The 2 deaths in the early intervention period were related to fatal gastrointestinal bleeding while on dual-antiplatelet therapy and warfarin, and intractable VT that PCI did not correct. The 2 deaths in the late postintervention period occurred due to unknown causes nearly 1 and 2 years post intervention, respectively. PCI was performed in patients with continuous-flow LVAD with several possible indications and without acute complications. The utility of PCI in this patient population, however, is likely limited by the risk of bleeding related to combined antiplatelet and anticoagulation therapies as well as lack of immediate apparent benefit. Further studies are necessary to better characterize this risk as well as quantify any potential long-term benefits.

  14. Physical examination-indicated cerclage in singleton and twin pregnancies: maternal-fetal outcomes.

    Science.gov (United States)

    Bernabeu, Andrea; Goya, Maria; Martra, Miquel; Suy, Anna; Pratcorona, Laia; Merced, Carme; Llurba, Elisa; Casellas, Manel; Carreras, Elena; Cabero, Luis

    2016-01-01

    To study maternal and perinatal outcomes after physical examination-indicated cerclage in both singleton and twin pregnancies and evaluate the possible risk factors associated. Retrospective review of all women undergoing physical examination-indicated cerclage at the Hospital Vall d'Hebro, Barcelona from January 2009 to December 2012 after being diagnosed with cervical incompetence and risk of premature birth. During the study period, 60 cases of women diagnosed with cervical incompetence who were carrying live and morphologically-normal fetuses (53 singleton and 7 twin pregnancies), and who had an imminent risk of premature birth were evaluated. Mean gestational age until birth was 35 weeks in singleton and 32 weeks in twin pregnancies. Four cases (7.5%) of immature births and one case (2.0%) of neonatal death were recorded in singleton pregnancies. No cases of immature births or neonatal deaths were recorded in twin pregnancies. Diagnostic amniocentesis was performed IN all cases to rule out possible chorioamnionitis. Physical examination-indicated cerclage for cervical incompetence in women at risk for immature or preterm birth demonstrates good perinatal prognosis without increasing maternal morbidity in either singleton or twin pregnancies. The increase in gestation time in our study may also have been due to the fact that patients with subclinical chorioamnionitis were excluded by diagnostic amniocentesis.

  15. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

    Science.gov (United States)

    Pozzoli, Alberto; Lapenna, Elisabetta; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

    2016-09-01

    The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

  16. Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation.

    Science.gov (United States)

    Williams, Amy E; Arzola, Gladys Marina; Strutt, Adriana M; Simpson, Richard; Jankovic, Joseph; York, Michele K

    2011-06-01

    Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson's disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25-30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. A comparison of published multidimensional indices to predict outcome in idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Charles Sharp

    2017-03-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF has an unpredictable course and prognostic factors are incompletely understood. We aimed to identify prognostic factors, including multidimensional indices from a significant IPF cohort at the Bristol Interstitial Lung Disease Centre in the UK. Patients diagnosed with IPF between 2007 and 2014 were identified. Longitudinal pulmonary physiology and exercise testing results were collated, with all-cause mortality used as the primary outcome. Factors influencing overall, 12- and 24-month survival were identified using Cox proportional hazards modelling and receiver operating characteristic curve analysis. We found in this real-world cohort of 167 patients, diffusing capacity for carbon monoxide (DLCO and initiation of long-term oxygen were independent markers of poor prognosis. Exercise testing results predicted 12-month mortality as well as DLCO, but did not perform as well for overall survival. The Composite Physiological Index was the best performing multidimensional index, but did not outperform DLCO. Our data confirmed that patients who experienced a fall in forced vital capacity (FVC >10% had significantly worse survival after that point (p=0.024. Our data from longitudinal follow-up in IPF show that DLCO is the best individual prognostic marker, outperforming FVC. Exercise testing is important in predicting early poor outcome. Regular and complete review should be conducted to ensure appropriate care is delivered in a timely fashion.

  18. Technical and tactical performance indicators based on the outcome of the set in the school volleyball

    Directory of Open Access Journals (Sweden)

    Yago Pessoa da Costa

    2017-09-01

    Full Text Available The aim of the study was to identify and compare the technical and tactical performance indicators based on the outcome of the set in the school female volleyball. The study included 110 athletes, aged between 12 and 14 years, belonging to 11 teams. Fifty-eight sets of 28 games were filmed and 7194 actions, 2830 serves, 2157 serve reception, 1358 passes and 1299 attacks were analyzed. Afterwards, the game sets were divided into winners and losers sets. Teams that won the sets had advantage at the serve reception, set and attack on error and excellence/point criteria (p< 0.05 and of serve, set and attack (p< 0.001. In conclusion, the winner’s sets were those with a better technical-tactical performance quantitatively and qualitatively.

  19. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes.

    Science.gov (United States)

    Loffroy, R; Favelier, S; Pottecher, P; Estivalet, L; Genson, P Y; Gehin, S; Cercueil, J P; Krausé, D

    2015-01-01

    Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Transcatheter arterial embolization is a fast, safe, and effective minimally invasive alternative to surgery, when endoscopic treatment fails to control acute bleeding from the upper gastrointestinal tract. This article describes the role of arterial embolization in the management of acute nonvariceal upper gastrointestinal bleeding and summarizes the literature evidence on the outcomes of endovascular therapy in such a setting. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  20. [Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

    Science.gov (United States)

    Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

    2017-02-01

    To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

  1. A new PCR-based approach indicates the range of Clonorchis sinensis now extends to Central Thailand.

    Directory of Open Access Journals (Sweden)

    Rebecca J Traub

    Full Text Available Differentiation of the fish-borne trematodes belonging to the Opisthorchiidae, Heterophyidae and Lecithodendriidae is important from a clinical and epidemiological perspective, yet it is impossible to do using conventional coprological techniques, as the eggs are morphologically similar. Epidemiological investigation therefore currently relies on morphological examination of adult worms following expulsion chemotherapy. A PCR test capable of amplifying a segment of the internal transcribed spacer region of ribosomal DNA for the opisthorchiid and heterophyid flukes eggs taken directly from faeces was developed and evaluated in a rural community in central Thailand. The lowest quantity of DNA that could be amplified from individual adults of Opisthorchis viverrini, Clonorchis sinensis and Haplorchis taichui was estimated at 0.6 pg, 0.8 pg and 3 pg, respectively. The PCR was capable of detecting mixed infection with the aforementioned species of flukes under experimental conditions. A total of 11.6% of individuals in rural communities in Sanamchaikaet district, central Thailand, were positive for 'Opisthorchis-like' eggs in their faeces using conventional parasitological detection techniques. In comparison to microscopy, the PCR yielded a sensitivity and specificity of 71.0% and 76.7%, respectively. Analysis of the microscopy-positive PCR products revealed 64% and 23% of individuals to be infected with O. viverrini and C. sinensis, respectively. The remaining 13% (three individuals were identified as eggs of Didymozoidae, presumably being passed mechanically in the faeces following the ingestion of infected fishes. An immediate finding of this study is the identification and first report of a C. sinensis-endemic community in central Thailand. This extends the known range of this liver fluke in Southeast Asia. The PCR developed herein provides an important tool for the specific identification of liver and intestinal fluke species for future

  2. Frequencies of circulating B- and T-lymphocytes as indicators for stroke outcomes

    Directory of Open Access Journals (Sweden)

    Wang Y

    2017-10-01

    with the percentage of B-lymphocytes at stroke onset.Conclusion: The proportions of B- and T-lymphocytes are associated with neurological outcomes of stroke patients and might be used as an indicator for severity and prognosis of ischemic stroke. Keywords: lymphocytes, stroke, neurological deficits, infarct

  3. The social functional outcome of being naturalistically treated with paliperidone extended-release in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Nakagawa R

    2015-06-01

    Full Text Available Ryoko Nakagawa,1 Takashi Ohnishi,1 Hisanori Kobayashi,1 Akihide Wakamatsu,2 Ai Tanimura,3 Kazuo Morita,3 Toshio Yamaoka,3 Hideo Usui,3 Yoshimasa Ogawa,3 Akiko Fujino,3 Kazutake Yoshizawa11Evidence Generation Department, Medical Affairs Division, 2Medical Affairs Strategy Department, Medical Affairs Division, 3Drug Safety Surveillance Department, Japan Safety and Surveillance Division, Janssen Pharmaceutical K.K., Tokyo, JapanBackground: Social functioning is an important outcome for patients with schizophrenia. To evaluate the effects of paliperidone extended-release (PAL-ER on social function, symptomatology, and safety in the routine clinical practice, we conducted a 1-year post-marketing surveillance study of PAL-ER. We also explored relationships between symptomatic improvement and socially functional outcome in patients with schizophrenia.Patients and methods: Patients with an established diagnosis of schizophrenia were allowed flexible 3–12 mg/day dosing during the surveillance. Patients were assessed on social functioning using the Social and Occupational Functioning Assessment Scale (SOFAS and on symptomatology using the Clinical Global Impression–Schizophrenia scale. All adverse events (AEs were also collected.Results: A total of 1,429 patients were enrolled in the surveillance study, of whom 1,405 were evaluable for safety and 1,142 were evaluable for efficacy. The treatment discontinuation rate for any reason during the observation period was 34.66%. Significant improvements were observed on both Social and Occupational Functioning Assessment Scale and Clinical Global Impression–Schizophrenia scale during the observation period. The percentage of patients with socially functional remission (SOFAS ≥61 also increased significantly. A significant association between early improvements in positive symptoms, sex, severity of negative symptoms at baseline, and socially functional remission was observed. A total of 33.52% of patients

  4. Cerebrospinal Fluid Indices in Acute Drug Intoxication; Do They Predict the Patients’ Outcome?

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    Mohammadreza Farsinejad

    2012-08-01

    Full Text Available Introduction: In some intoxicated patients, cerebrospinal fluid (CSF is examined due to the prolonged loss of consciousness, focal neurologic findings, and fever of unknown origin. We aimed to evaluate the probable relationship between the different toxicity causes and the CSF indices in poisoned patients and determine if they could predict the patients’ outcome. Methods: All patients who had been admitted to the toxicology intensive care unit of Loghman-Hakim hospital between March 2006 and March 2011 and had undergone lumbar puncture (LP were included into this retrospective study. The patients’ demographic data and results of CSF evaluation (level of glucose, lactate dehydrogenase, protein, and white blood cells in CSF fluid were evaluated. The data was analyzed using SPSS software version 17. Results: A total of 111 patients were evaluated. Mean age of the patients was 37±15 years. Thirteen (11.7% had deceased. No relation was found between the cause of poisoning (medication involved and the changes in CSF indices. A statistically significant difference was found between the survivors and non-survivors in terms of CSF protein, LDH, and WBC. However, such a difference was not detected between these two groups regarding CSF glucose. Conclusion: In intoxicated patients with prolonged decreased level of consciousness or prolonged fever, early evaluation of CSF can help early diagnosis of complications such as meningitis and prompt treatment. Also, high level of protein, LDH, and WBC in the CSF can predict higher mortality rates in these patients.

  5. Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes.

    Science.gov (United States)

    Drazin, Doniel; Shirzadi, Ali; Jeswani, Sunil; Ching, Harry; Rosner, Jack; Rasouli, Alexandre; Kim, Terrence; Pashman, Robert; Johnson, J Patrick

    2011-11-01

    Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes. A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: "spondylolysis," "pars fracture," "repair," "athlete," and/or "sport." Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up. Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months. For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and

  6. Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Davide Lazzeri

    2013-01-01

    Full Text Available BackgroundThe aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects.MethodsA comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller flaps used for lower extremity reconstruction were excluded from meta-analysis.ResultsFrom the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3% comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed.ConclusionsPedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.

  7. Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Davide Lazzeri

    2013-01-01

    Full Text Available Background The aim of this investigation was to systematically review the current literatureto provide the best data for indications, outcomes, survival, and complication rates ofpedicled propeller perforator flaps for upper body defects.Methods A comprehensive literature review for articles published from January 1991 toDecember 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articleswithout available full-text, single case reports or papers with excessive missing data wereexcluded. Papers reporting pedicle-perforator (propeller flaps used for lower extremityreconstruction were excluded from meta-analysis.Results From the initial 1,736 studies our search yielded, 343 studies qualified for the secondstage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusionand exclusion criteria. Of the selected 41 articles, 26 were case series, original papers orretrospective reviews and were included, whereas 15 were case report papers and thereforewere excluded. Two hundred ninety-five propeller flaps were reported to have been used ina total of 283 patients. Indications include repair of trauma-induced injuries, post-traumarevision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with amajor complication rate (3.3% comparable to that of free flaps. No specific exclusion criteriafor the procedure were presented in the studies reviewed.Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that areeasy and quick to raise and that provide unlimited clinical solutions because of the theoreticalpossibility of harvesting them based on any perforator chosen among those classified in the body.

  8. Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R Bryan; Thygesen, Torben

    2017-09-01

    This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed. A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests. The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

  9. Myoglobin as a prognostic indicator for outcome in dogs with gastric dilatation-volvulus.

    Science.gov (United States)

    Adamik, Katja N; Burgener, Iwan A; Kovacevic, Alan; Schulze, Sebastian P; Kohn, Barbara

    2009-06-01

    To determine whether myoglobin (Mb) is a useful prognostic indicator for outcome and to investigate any relationship between Mb and mortality in dogs with gastric dilatation-volvulus (GDV). Prospective study. Veterinary teaching hospital. Seventy-two dogs with GDV. Blood sampling. Mb levels were measured at the time of diagnosis (Mbt0), 24 hours (Mbt1), and 48 hours (Mbt2) after signs of GDV were recognized. Fifty-seven dogs survived (group I) and 15 dogs did not survive (group II). Mbt0 differed significantly between groups (P=0.04). Mbt0 in group I ranged from 700 ng/mL (n=57, median 74 ng/mL), and in group II from 34 to >700 ng/mL (n=15, median 238 ng/mL). Analysis of a receiver operating characteristic curve of Mbt0 suggested that the best single cutpoint would be 168 ng/mL (sensitivity 60.0%, specificity 84.2%). Fifty percent of dogs with Mbt0>168 ng/mL were euthanized, while 88.9% with Mbt0700 ng/mL (n=55, median 123 ng/mL), and Mbt1 in group II ranged from 131 to 643 ng/mL (n=7, median 343 ng/mL) (P=0.006). Mbt2 in group I ranged from 30 to 597 ng/mL (n=54, median 101 ng/mL), and in group II from 141 to >700 ng/mL (n=8, median 203 ng/mL) (P=0.02). In this study, Mbt0 is a moderately sensitive and specific prognostic indicator. Almost 90% of the dogs below the cutpoint survived to discharge, whereas 50% with Mbt0 above the cutpoint did not survive.

  10. Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes

    Directory of Open Access Journals (Sweden)

    Saraf Rashmi

    2010-01-01

    Full Text Available Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%. Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.

  11. Colorectal stenting for colonic obstruction: The indications, complications, effectiveness and outcome-5-Year review

    International Nuclear Information System (INIS)

    Athreya, S.; Moss, J.; Urquhart, G.; Edwards, R.; Downie, A.; Poon, F.W.

    2006-01-01

    Introduction: Currently self-expanding metallic stents are being used for palliation and acute decompression of colonic obstruction. The aim of this study is to review our experience of using these metallic stents over a 5-year period. Materials and methods: Case records of 102 patients who had colorectal stenting between 1998 and 2004 were reviewed retrospectively. The indications for colorectal stenting, efficacy of the procedure in relieving the obstruction, complications and clinical outcome were analysed. Results: Ninety-nine patients had malignant disease and in three patients a benign cause of obstruction was demonstrated. All procedures were performed during normal working hours. Stenting was technically successful in 87 patients (85%). A single stent was placed in 80 patients. Seven patients required two stents. Of the successful cases, 67 had stents placed by fluoroscopy alone and 20 by a combined fluoroscopy/endoscopy procedure. Four percent had early complications (within 30 days) which included four perforations. There were late complications (over 30 days) in 9% which included five stent migrations, two blocked stents and one colovesical fistula. Ninety percent (n = 76) of the successful patients needed no further radiological or surgical intervention later. Survival ranged from 14 days to 2 years. Conclusion: Colorectal stenting when technically successful is an effective procedure for both preoperative and palliative decompression of colonic obstruction

  12. Extended criteria donor kidney transplantation: comparative outcome analysis between single versus double kidney transplantation at 5 years.

    Science.gov (United States)

    Lucarelli, G; Bettocchi, C; Battaglia, M; Impedovo, S V; Vavallo, A; Grandaliano, G; Castellano, G; Schena, F P; Selvaggi, F P; Ditonno, P

    2010-05-01

    Dual kidney transplantation (DKT), using extended criteria donor (ECD) grafts not suitable for single kidney transplantation (SKT), has been suggested to expand the kidney donor pool. Herein, we reviewed the long-term outcomes of DKT to assess its results versus a control group of 179 ECD SKTs. The allocation policy was based on a Remuzzi score obtained from a pretransplant biopsy. We analyzed SKT in 179 (31.8%) and DKT in 41 (7.3%) of 563 cadaveric transplants from 2000 to 2008. Patients with DKT versus SKT showed mean recipient ages of 54 versus 51 years. We performed 17 ipsilateral and 24 bilateral DKT. The mean score was 2.78 for SKT and 4.3/4.6 for DKT. Delayed graft function requiring dialysis occurred in 23 (56.1%) DKT and 70 (39.1%) SKT recipients. Primary nonfunction was observed in 1 (2.4%) DKT and 7 (3.9%) SKT recipients respectively. One DKT patient underwent monolateral transplantectomy. In the DKT versus SKT group, patient survivals were 92% versus 95%, 89% versus 93%, and 89 versus 91% at 12, 36, and 60 months, respectively (P = .3). Graft survivals were 100% versus 94%, 95% versus 90%, and 89% versus 78% at 12, 36, and 60 months, respectively (P DKT. ECD graft survival using DKT provided better results compared with SKT, despite the use of organs from higher-risk donors. At 5 years follow-up, DKT was a safe strategy to face the organ shortage. To optimize the use of available kidneys, the criteria for DKT require further refinement and standardization. Preimplantation evaluation must maximize transplant success and protect recipients from receiving organs at increased risk of premature failure. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  13. [Kirschner wire transfixation of unstable ankle fractures: indication, surgical technique and outcomes].

    Science.gov (United States)

    Marvan, J; Džupa, V; Bartoška, R; Kachlík, D; Krbec, M; Báča, V

    2015-01-01

    transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.

  14. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.

    Science.gov (United States)

    Failla, Mathew J; Logerstedt, David S; Grindem, Hege; Axe, Michael J; Risberg, May Arna; Engebretsen, Lars; Huston, Laura J; Spindler, Kurt P; Snyder-Mackler, Lynn

    2016-10-01

    Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). The cohort treated with additional preoperative

  15. High MRPS23 expression contributes to hepatocellular carcinoma proliferation and indicates poor survival outcomes.

    Science.gov (United States)

    Pu, Meng; Wang, Jianlin; Huang, Qike; Zhao, Ge; Xia, Congcong; Shang, Runze; Zhang, Zhuochao; Bian, Zhenyuan; Yang, Xishegn; Tao, Kaishan

    2017-07-01

    Hepatocellular carcinoma is one of the most prevalent neoplasms and the leading cause of cancer-related mortality worldwide. Mitochondrial ribosomal protein S23 is encoded by a nuclear gene and participates in mitochondrial protein translation. Mitochondrial ribosomal protein S23 overexpression has been found in many types of cancer. In this study, we explored mitochondrial ribosomal protein S23 expression in primary hepatocellular carcinoma tissues compared with matched adjacent non-tumoral liver tissues using mitochondrial ribosomal protein S23 messenger RNA and protein levels collected from public databases and clinical samples. Immunohistochemistry was performed to analyze the relationship between mitochondrial ribosomal protein S23 and various clinicopathological features. The results indicated that mitochondrial ribosomal protein S23 was significantly overexpressed in hepatocellular carcinoma. High mitochondrial ribosomal protein S23 expression was correlated with the tumor size and tumor-metastasis-node stage. Moreover, patients with high mitochondrial ribosomal protein S23 expression levels presented poorer survival rates. Mitochondrial ribosomal protein S23 was an independent prognostic factor for survival, especially at the early stage of hepatocellular carcinoma. In addition, the downregulation of mitochondrial ribosomal protein S23 decreased the proliferation of hepatocellular carcinoma in vitro and in vivo. In conclusion, we verified for the first time that mitochondrial ribosomal protein S23 expression was upregulated in hepatocellular carcinoma. High mitochondrial ribosomal protein S23 levels can predict poor clinical outcomes in hepatocellular carcinoma, and this protein plays a key role in tumor proliferation. Therefore, mitochondrial ribosomal protein S23 may be a potential therapeutic target for hepatocellular carcinoma.

  16. A Systematic Review on Prognostic Indicators of Acute Liver Failure and Their Predictive Value for Poor Outcome

    NARCIS (Netherlands)

    Wlodzimirow, Kama A.; Eslami, Saeid; Abu-Hanna, Ameen; Nieuwoudt, Martin; Chamuleau, Robert A. F. M.

    2014-01-01

    This review provides a large amount of information, including the extensive list of worldwide used indicators to predict outcome in patients with acute liver failure. There is large heterogeneity in prognostic indicators of acute liver failure, methods of measurement, complexity of calculation and

  17. Immediate outcome indicators in perioperative care: a controlled intervention study on quality improvement in hospitals in Tanzania.

    Science.gov (United States)

    Bosse, Goetz; Mtatifikolo, Ferdinand; Abels, Wiltrud; Strosing, Christian; Breuer, Jan-Philipp; Spies, Claudia

    2013-01-01

    Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators. Surgical care quality in six hospitals in Tanzania was assessed from 2006-2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates. In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n = 12,530) in 2006, 3.5% (n = 21,114) in 2009 and 4.6% (n = 18,840) in 2011. In the control group it was 3.1% (n = 17,827) in 2006, 4.2% (n = 13,632) in 2009 and 3.8% (n = 17,059) in 2011. Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care. Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome

  18. National socioeconomic indicators are associated with outcomes after aneurysmal subarachnoid hemorrhage: a hierarchical mixed-effects analysis.

    Science.gov (United States)

    Guha, Daipayan; Ibrahim, George M; Kertzer, Joshua D; Macdonald, R Loch

    2014-11-01

    Although heterogeneity exists in patient outcomes following subarachnoid hemorrhage (SAH) across different centers and countries, it is unclear which factors contribute to such disparities. In this study, the authors performed a post hoc analysis of a large international database to evaluate the association between a country's socioeconomic indicators and patient outcome following aneurysmal SAH. An analysis was performed on a database of 3552 patients enrolled in studies of tirilazad mesylate for aneurysmal SAH from 1991 to 1997, which included 162 neurosurgical centers in North and Central America, Australia, Europe, and Africa. Two primary outcomes were assessed at 3 months after SAH: mortality and Glasgow Outcome Scale (GOS) score. The association between these outcomes, nation-level socioeconomic indicators (percapita gross domestic product [GDP], population-to-neurosurgeon ratio, and health care funding model), and patientlevel covariates were assessed using a hierarchical mixed-effects logistic regression analysis. Multiple previously identified patient-level covariates were significantly associated with increased mortality and worse neurological outcome, including age, intraventricular hemorrhage, and initial neurological grade. Among national-level covariates, higher per-capita GDP (p funding model was not a significant predictor of either primary outcome. Higher per-capita gross GDP and population-to-neurosurgeon ratio were associated with improved outcome after aneurysmal SAH. The former result may speak to the availability of resources, while the latter may be a reflection of better outcomes with centralized care. Although patient clinical and radiographic phenotypes remain the primary predictors of outcome, this study shows that national socioeconomic disparities also explain heterogeneity in outcomes following SAH.

  19. Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization

    Directory of Open Access Journals (Sweden)

    Emre Gazyakan, MD, MSc

    2015-04-01

    Conclusions: The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.

  20. The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting.

    Science.gov (United States)

    Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F; Buxton, Orfeu M

    2016-12-01

    To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Cluster randomized trial. Extended-care (nursing) facilities. US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

  1. Predictors of Course Outcomes: Early Indicators of Delay in Online Classrooms

    Science.gov (United States)

    McElroy, Barbara Woods; Lubich, Bruce H.

    2013-01-01

    Studies have long shown that students who begin or submit their work later tend to have negative academic outcomes. The measures of procrastination used in those studies may not have provided information timely enough for instructor intervention. This article focuses on delay in the online environment among graduate students. We propose two new…

  2. Balloon Dilation of Sinus Ostia in the Department of Defense: Diagnoses, Actual Indications, and Outcomes

    Science.gov (United States)

    2016-05-18

    NECESSARY CHANGES· JZNO 0 YES If ye~ . 91vc U~lc G NIA ·- 27. COW.~E1𔃻 S ~ flf’PROVED 0 OISAPflROVEO -n~ ~o.- .... ~~~+ ea ctfF~. - 2h PRl1’ TEO t/Af.IF...Aug;28(4):323-9. 4. Chandra RK, Kem RC, Cutler JL, Welch KC , Russell PT. REMODEL larger cohort with long-tenn outcomes and meta-analysis of

  3. How to define successful transition? An exploration of consensus indicators and outcomes in young adults with chronic conditions.

    NARCIS (Netherlands)

    Sattoe, J.N.T.; Hilberink, S.R.; Staa, A. van

    2017-01-01

    Background: In this short report, we use data from a previous cohort study to explore the relationship between five out of eight consensus indicators for successful transition and patient-reported outcomes in young adulthood. Methods: Data came from a 6-year cohort study that consisted of a survey

  4. Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Wen Shi

    2004-11-01

    Full Text Available Abstract Background One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. Methods We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995–1997, which was a matched multiple birth file (only twins were included in the current analysis. We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. Results There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score Conclusions Mothers whose partner's information was partly and (especially totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.

  5. Factors influencing oral hygiene behaviour and gingival outcomes 3 and 12 months after initial periodontal treatment: an exploratory test of an extended Theory of Reasoned Action.

    Science.gov (United States)

    Jönsson, Birgitta; Baker, Sarah R; Lindberg, Per; Oscarson, Nils; Ohrn, Kerstin

    2012-02-01

    The aim was to empirically test the extended Theory of Reasoned Action (TRA) and the prospective direct and indirect role of attitudes, beliefs, subjective norms, self-efficacy, and a cognitive behavioural intervention in adult's oral hygiene behaviour and gingival outcomes at 3- and 12-month follow-up. Data were derived from an RCT evaluating the effectiveness of oral hygiene educational programs integrated in non-surgical periodontal treatment (n = 113). Before baseline examination, participants completed a self-report questionnaire. Structural equation modelling using maximum likelihood estimation with bootstrapping was used to test the direct and indirect (mediated) pathways within the extended TRA model. The extended TRA model explained a large amount of variance in gingival outcome scores at 12 months (56%). A higher level of self-efficacy at baseline was associated with higher frequencies of oral hygiene behaviour at 3 months. Being female was linked to more normative beliefs that, in turn, related to greater behavioural beliefs and self-efficacy. Gender was also related to behavioural beliefs, attitudes and subjective norms. Both frequency of oral hygiene behaviour at 3 months and the cognitive behavioural intervention predicted gingival outcome at 12 months. The model demonstrated that self-efficacy, gender and a cognitive behavioural intervention were important predictors of oral hygiene behavioural change. © 2011 John Wiley & Sons A/S.

  6. Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'

    DEFF Research Database (Denmark)

    Cryer, Colin; Davie, Gabrielle S; Gulliver, Pauline J

    2018-01-01

    Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious...... injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for 'all...

  7. Surgical decompression of thoracic spinal stenosis in achondroplasia: indication and outcome.

    Science.gov (United States)

    Vleggeert-Lankamp, Carmen; Peul, Wilco

    2012-08-01

    The achondroplastic spinal canal is narrow due to short pedicles and a small interpedicular distance. Compression of neural structures passing through this canal is therefore regularly encountered but rarely described. Symptomatology, radiological evaluation, and treatment of 20 patients with achondroplasia who underwent decompression of the thoracic spinal cord are described and outcome is correlated with the size of the spinal canal and the thoracolumbar kyphotic angle. Scores from the modified Japanese Orthopaedic Association scale, Nurick scale, European Myelopathy scale, Cooper myelopathy scale for lower extremities, and Odom criteria before and after surgery were compared. Magnetic resonance imaging was evaluated to determine the size of the spinal canal, spinal cord compression, and presence of myelomalacia. The thoracolumbar kyphotic angle was measured using fluoroscopy. Patient symptomatology included deterioration of walking pattern, pain, cramps, spasms, and incontinence. Magnetic resonance images of all patients demonstrated spinal cord compression due to degenerative changes. Surgery resulted in a slight improvement on all the ranking scales. Surgery at the wrong level occurred in 15% of cases, but no serious complications occurred. The mean thoracolumbar kyphotic angle was 20°, and no correlation was established between this angle and outcome after surgery. No postoperative increase in this angle was reported. There was also no correlation between size of the spinal canal and outcome. Decompressive surgery of the thoracic spinal cord in patients with achondroplasia can be performed safely if anatomical details are taken into consideration. Spondylodesis did not appear essential. Special attention should be given to the method of surgery, identification of the level of interest, and follow-up of the thoracolumbar kyphotic angle.

  8. Initial validation of a proxy indicator of functioning as a potential tool for establishing a clinically meaningful cocaine use outcome.

    Science.gov (United States)

    Kiluk, Brian D; Babuscio, Theresa A; Nich, Charla; Carroll, Kathleen M

    2017-10-01

    Establishing a non-abstinence cocaine use outcome as clinically meaningful has been elusive, in part due to the lack of association between cocaine use outcomes and meaningful indicators of long-term functioning. Using data pooled across 7 clinical trials evaluating treatments for cocaine (N=718), a dichotomous indicator of functioning was created to represent a meaningful outcome ('problem-free functioning' - PFF), defined as the absence of problems across non-substance-related domains on the Addiction Severity Index. Its validity was evaluated at multiple time points (baseline, end-of-treatment, terminal follow-up) and used to explore associations with cocaine use. The percentage of participants meeting PFF criteria increased over time (baseline=18%; end-of-treatment=32%; terminal follow-up=37%). At each time point, ANOVAs indicated those who met PFF criteria reported significantly less distress on the Brief Symptom Inventory and less perceived stress on the Perceived Stress Scale. Generalized linear models indicated categorical indices of self-reported cocaine use at the end of treatment were predictive of the probability of meeting PFF criteria during follow-up (β=-0.01, pcocaine use in the final month of treatment was associated with PFF during follow-up, with strongest associations between PFF and abstinence or 'occasional' use. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Predicting the outcomes of performance error indicators on accreditation status in the nuclear power industry

    International Nuclear Information System (INIS)

    Wilson, P.A.

    1986-01-01

    The null hypothesis for this study suggested that there was no significant difference in the types of performance error indicators between accredited and non-accredited programs on the following types of indicators: (1) number of significant event reports per unit, (2) number of forced outages per unit, (3) number of unplanned automatic scrams per unit, and (4) amount of equivalent availability per unit. A sample of 90 nuclear power plants was selected for this study. Data were summarized from two data bases maintained by the Institute of Nuclear Power Operations. Results of this study did not support the research hypothesis. There was no significant difference between the accredited and non-accredited programs on any of the four performance error indicators. The primary conclusions of this include the following: (1) The four selected performance error indicators cannot be used individually or collectively to predict accreditation status in the nuclear power industry. (2) Annual performance error indicator ratings cannot be used to determine the effects of performance-based training on plant performance. (3) The four selected performance error indicators cannot be used to measure the effect of operator job performance on plant effectiveness

  10. Pancreatectomy and autologous islet transplantation for painful chronic pancreatitis: indications and outcomes.

    Science.gov (United States)

    Bellin, Melena D; Sutherland, David E R; Robertson, R Paul

    2012-08-01

    Total pancreatectomy with intrahepatic autoislet transplantation (TP/IAT) is a definitive treatment for relentlessly painful chronic pancreatitis. Pain relief is reported to be achieved in approximately 80% of patients. Overall, 30% to 40% achieve insulin independence, and 70% of recipients remain insulin independent for > 2 years, sometimes longer if > 300 000 islets are successfully transplanted. Yet, this approach to chronic pancreatitis is underemphasized in the general medical and surgical literature and vastly underused in the United States. This review emphasizes the history and metabolic outcomes of TP/IAT and considers its usefulness in the context of other, more frequently used approaches, such as operative intervention with partial pancreatectomy and/or lateral pancreaticojejunostomy (Puestow procedure), as well as endoscopic retrograde cholangiopancreatography with pancreatic duct modification and stent placement. Distal pancreatectomy and Puestow procedures compromise isolation of islet mass, and adversely affect islet autotransplant outcomes. Therefore, when endoscopic measures fail to relieve pain in severe chronic pancreatitis, we recommend early intervention with TP/IAT.

  11. The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: Indications, Complications, and Outcomes in 11885 Patients

    DEFF Research Database (Denmark)

    De La Rosette, Jean; Denstedt, John D; Geavlete, Petrisor A

    2013-01-01

    Purpose: To assess the current indications for ureteroscopy (URS) treatment, outcome in terms of stone-free rate, and intra- and postoperative complications using the modified Clavien grading system. Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) collected...... prospective data as part of the URS Global Study for consecutive patients treated with URS at centers around the world for 1 year. URS was performed according to study protocol and local clinical practice guidelines. Stone size and location were recorded and postoperative outcome and complications, graded...

  12. Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

    NARCIS (Netherlands)

    Houwert, R. Marijn; Roovers, Jan Paul W. R.; Venema, Pieter L.; Bruinse, Hein W.; Dijkgraaf, Marcel G. W.; Vervest, Harry A. M.

    2010-01-01

    OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a

  13. Linking Governance to Sustainable Management Outcomes: Applying Dynamic Indicator Profiles to River Basin Organization Case Studies around the World.

    Science.gov (United States)

    Wei, Y.; Bouckaert, F. W.

    2017-12-01

    Institutional best practice for integrated river basin management advocates the river basin organisation (RBO) model as pivotal to achieve sustainable management outcomes and stakeholder engagement. The model has been widely practiced in transboundary settings and is increasingly adopted at national scales, though its effectiveness remains poorly studied. A meta-analysis of four river basins has been conducted to assess governance models and linking it to evaluation of biophysical management outcomes. The analysis is based on a Theory of Change framework, and includes functional dynamic governance indicator profiles, coupled to sustainable ecosystem management outcome profiles. The governance and outcome profiles, informed by context specific indicators, demand that targets for setting objectives are required in multiple dimensions, and trajectory outlines are a useful tool to track progress along the journey mapped out by the Theory of Change framework. Priorities, trade-offs and objectives vary in each basin, but the diagnostics tool allows comparison between basins in their capacity to reach targets through successive evaluations. The distance between capacity and target scores determines how program planning should be prioritized and resources allocated for implementation; this is a dynamic process requiring regular evaluations and adaptive management. The findings of this study provide a conceptual framework for combining dimensions of integrated water management principles that bridge tensions between (i) stakeholder engagement and participatory management (bottom-up approach) using localized knowledge and (ii) decision-making, control-and-command, system-scale, accountable and equitable management (top-down approach).The notion of adaptive management is broadened to include whole-of-program learnings, rather than single hypothesis based learning adjustments. This triple loop learning combines exploitative methods refinement with explorative evaluation of

  14. Education, outreach, and inclusive engagement: Towards integrated indicators of successful program outcomes in participatory science.

    Science.gov (United States)

    Haywood, Benjamin K; Besley, John C

    2014-01-01

    The use and utility of science in society is often influenced by the structure, legitimacy, and efficacy of the scientific research process. Public participation in scientific research (PPSR) is a growing field of practice aimed at enhancing both public knowledge and understanding of science (education outreach) and the efficacy and responsiveness of scientific research, practice, and policy (participatory engagement). However, PPSR objectives focused on "education outreach" and "participatory engagement" have each emerged from diverse theoretical traditions that maintain distinct indicators of success used for program development and evaluation. Although areas of intersection and overlap among these two traditions exist in theory and practice, a set of comprehensive standards has yet to coalesce that supports the key principles of both traditions in an assimilated fashion. To fill this void, a comprehensive indicators framework is proposed with the goal of promoting a more integrative and synergistic PPSR program development and assessment process.

  15. Indications and outcome of childhood preventable bowel resections in a developing country

    Directory of Open Access Journals (Sweden)

    Uchechukwu Obiora Ezomike

    2014-01-01

    Full Text Available Background: While many bowel resections in developed countries are due to congenital anomalies, indications for bowel resections in developing countries are mainly from preventable causes. The aim of the following study was to assess the indications for, morbidity and mortality following preventable bowel resection in our centre. Patients and Methods: Retrospective analysis of all cases of bowel resection deemed preventable in children from birth to 18 years from June 2005 to June 2012. Results: There were 22 preventable bowel resections with an age range of 7 days to 17 years (median 6 months and male:female ratio of 2.1:1. There were 2 neonates, 13 infants and 7 older children. The indications were irreducible/gangrenous intussusceptions (13, abdominal gunshot injury (2, gangrenous umbilical hernia (2, blunt abdominal trauma (1, midgut volvulus (1, necrotizing enterocolitis (1, strangulated inguinal hernia (1, post-operative band intestinal obstructions (1. There were 16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of symptoms before presentation was 3.9 days (range: 3 h-14 days. Average time to surgical intervention was 42 h for survivors and 53 h for non-survivors. Only 19% presented within 24 h of onset of symptoms and all survived. For those presenting after 24 h, the cause of delay was a visit to primary or secondary level hospitals (75% and ignorance (25%. Average duration of post-operative hospital stay is 14 days and 9 patients (41% developed 18 complications. Seven patients died (31.8% mortality which diagnoses were irreducible/gangrenous intussusceptions (5, necrotising enterocolitis (1, midgut volvulus (1. One patient died on the operating table while others had overwhelming sepsis. Conclusion: There is a high rate of morbidity and mortality in these cases of preventable bowel resection. Typhoid intestinal perforation did not feature as an indication for bowel resection in this

  16. Plasma exchange for paediatric kidney disease-indications and outcomes: a single-centre experience.

    Science.gov (United States)

    Reddy, Sudheer Kumar; Jahan, Afsana; Chaturvedi, Swasti; Agarwal, Indira

    2015-12-01

    Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. A retrospective chart review of children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchange was undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis. Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5-15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody-associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96-7.85] mg/dL with a mean eGFR of 43 (IQR 27.54-56.7) mL/min/1.73 m(2). Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5-26), dialysis and immunosuppressive therapy. The mean duration of follow-up was 4 months (range 2-24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and another was lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73 m(2), while eGFR was 15-60 mL/min/1.73 m(2) in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.

  17. A comparison of the extended-release and standard-release formulations of tacrolimus in de novo kidney transplant recipients: a 12-month outcome study.

    Science.gov (United States)

    Fanous, Helen; Zheng, Rebecca; Campbell, Carolyn; Huang, Michael; Nash, Michelle M; Rapi, Lindita; Zaltzman, Jeffrey S; Prasad, G V Ramesh

    2013-02-01

    BACKGROUND: Limited comparative data are available on the outcomes between extended-release and standard-release tacrolimus when used de novo in kidney transplant recipients (KTRs). METHODS: We identified KTRs transplanted at our institution during 2009-10 routinely prescribed extended-release tacrolimus and compared them with those transplanted during 2008-09 prescribed standard-release tacrolimus. Graft function (eGFR by MDRD-7 equation) at 12 months post-transplant (primary outcome); new-onset diabetes and other cardiovascular risk factors, BK viremia incidence, acute rejection, and graft survival to 12 months (secondary outcomes) were compared by intent-to-treat analysis. Time-to-steady-state concentration and number of dose adjustments required to attain steady state were recorded. RESULTS: There were no important demographic differences between the extended-release (N = 106) and standard-release (N = 95) cohorts. The estimated glomerular filtration rate (eGFR) at 12 months was similar (58.8 ± 17 versus 59.2 ± 18 mL/min/1.73 m(2), P = 0.307). There was no difference in new-onset diabetes (17 versus 20%, P = 0.581), BK viremia (10 versus 7%, P = 0.450), acute rejection (7 versus 16%, P = 0.067) or graft survival (97 versus 95%, P = 0.301). Time-to-steady state was similar (9.2 ± 1.1 versus 8.1 ± 4.7 days, P = 0.490) although extended-release patients required fewer adjustments to attain steady state (1.2 ± 1.7 [0-8] versus 1.7 ± 1.5 [0-7], P = 0.030) but a similar dose (7.2 ± 2.4 [2-17] versus 7 ± 2.7 [2-16] mg/day, P = 0.697). CONCLUSION: De novo KTRs prescribed extended-release or standard-release tacrolimus demonstrate similar 12-month outcomes.

  18. Surgical management of peptic ulcer disease today--indication, technique and outcome.

    Science.gov (United States)

    Zittel, T T; Jehle, E C; Becker, H D

    2000-03-01

    The current surgical management of peptic ulcer disease and its outcome have been reviewed. Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1-2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery.

  19. Trends in Biometric Health Indices Within an Employer-Sponsored Wellness Program With Outcome-Based Incentives.

    Science.gov (United States)

    Fu, Patricia Lin; Bradley, Kent L; Viswanathan, Sheila; Chan, June M; Stampfer, Meir

    2016-07-01

    To evaluate changes in employees' biometrics over time relative to outcome-based incentive thresholds. Retrospective cohort analysis of biometric screening participants (n = 26 388). Large employer primarily in Western United States. Office, retail, and distribution workforce. A voluntary outcome-based biometric screening program, incentivized with health insurance premium discounts. Body mass index (BMI), cholesterol, blood glucose, blood pressure, and nicotine. Followed were participants from their first year of participation, evaluating changes in measures. On average, participants who did not meet the incentive threshold at baseline decreased their BMI (1%), glucose (8%), blood pressure (systolic 9%, diastolic 8%), and total cholesterol (8%) by year 2 with improvements generally sustained or continued during each additional year of participation. On average, individuals at high health risk who participated in a financially incentivized biometric assessment program improved their health indices over time. Further research is needed to understand key determinants that drive health improvement indicated here. © The Author(s) 2016.

  20. Long-term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study.

    Science.gov (United States)

    Jang, Jin-Young; Kang, Jae Seung; Han, Youngmin; Heo, Jin Seok; Choi, Seong Ho; Choi, Dong Wook; Park, Sang Jae; Han, Sung-Sik; Yoon, Dong Sup; Park, Joon Seong; Yu, Hee Chul; Kang, Koo Jeong; Kim, Sang Geol; Lee, Hongeun; Kwon, Wooil; Yoon, Yoo-Seok; Han, Ho-Seong; Kim, Sun-Whe

    2017-07-01

    Our previous randomized controlled trial revealed no difference in 2-year overall survival (OS) between extended and standard resection for pancreatic adenocarcinoma. The present study evaluated the 5-year OS and recurrence patterns according to the extent of pancreatectomy. Between 2006 and 2009, 169 consecutive patients were prospectively enrolled and randomized to standard (n = 83) or extended resection (n = 86) groups to compare 5-year OS rate, long-term recurrence patterns and factors associated with long-term survival. The surgical R0 rate was similar between the standard and extended groups (85.5 vs. 90.7%, P = 0.300). Five-year OS (18.4 vs. 14.4%, P = 0.388), 5-year disease-free survival (14.8 vs. 14.0%, P = 0.531), and overall recurrence rates (74.7 vs. 69.9%, P = 0.497) were not significantly different between the two groups, although the incidence of peritoneal seeding was higher in the extended group (25 vs. 8.1%, P = 0.014). Extended pancreatectomy does not have better short-term and long-term survival outcomes, and shows similar R0 rates and overall recurrence rates compared with standard pancreatectomy. Extended pancreatectomy does not have to be performed routinely for all cases of resectable pancreatic adenocarcinoma, especially considering its associated increased morbidity shown in our previous study. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  1. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

    Directory of Open Access Journals (Sweden)

    Muhly WT

    2015-11-01

    Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

  2. Impact of Liver Indicators on Clinical Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Wendt, Daniel; Kahlert, Philipp; Canbay, Ali; Knipp, Stephan; Thoenes, Martin; Cremer, Gordina; Al-Rashid, Fadi; Jánosi, Rolf-Alexander; El-Chilali, Karim; Kamler, Markus; El Gabry, Mohamed; Marx, Philipp; Dohle, Daniel Sebastian; Tsagakis, Konstantinos; Benedik, Jaroslav; Gerken, Guido; Rassaf, Tienush; Jakob, Heinz; Thielmann, Matthias

    2017-10-01

    Liver dysfunction increases death and morbidity after cardiac operations. There are currently no data evaluating liver function in patients undergoing transcatheter aortic valve replacement (TAVR). We aimed therefore to evaluate our TAVR results in regard to liver function. A total of 640 consecutive TAVR patients were evaluated. Of those, 11 patients presented with chronic liver disease before TAVR. The Model for End-Stage Liver Disease score was used to measure liver function in these patients. The primary study end point was 30-day mortality in patients presenting with liver dysfunction. Secondary study end point was liver enzymes after TAVR. The mean Model for End-Stage Liver Disease score in patients with chronic liver disease was 16.8 ± 6.2 (median, 18; range, 7 to 26). The 30-day mortality was 9.1% (57 of 629) in patients presenting without liver disease and 9.1% (1 of 11) in patients with liver disease (p = 1.00). Patients with chronic liver disease showed significantly higher preoperative levels of γ-glutamyl transpeptidase (p < 0.001). After TAVR, we observed a significant increase in alanine aminotransferase on postoperative day 3 compared with preoperative values (p < 0.001), accompanied by a decrease in albumin (p < 0.001). Liver cirrhosis per se is not considered as a contraindication for cardiac operations. In the present study, we did not observe a higher 30-day mortality rate in liver cirrhotic patients undergoing TAVR, suggesting TAVR as a feasible alternative with acceptable outcomes in patients with chronic liver disease. Moreover, the present study is the first to evaluate liver variables in patients undergoing TAVR. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Performance indicators analysis at Brazilian and Italian women's volleyball leagues according to game location, game outcome, and set number.

    Science.gov (United States)

    Campos, Fabio A D; Stanganélli, Luiz C R; Campos, Leandra C B; Pasquarelli, Bruno N; Gómez, Miguel-Angel

    2014-04-01

    This study was done to investigate the advantage of playing at home in elite women's volleyball leagues and the influence of performance indicators in the game score according to set number. The sample consisted of 240 games of the Brazilian Volleyball League (n = 132 games) and the Italian Volleyball League (n = 108 games) from the 2011-2012 season. The relationship of performance indicators (including serve, attack, block, and opponents' errors) with the game outcome (win or lose) was assessed. The results showed that there was a home advantage effect in women's volleyball leagues, with a higher prevalence of victory for the home teams in Brazilian and Italian leagues (58 and 56%, respectively). When related to the performance indicators and among the aspects that were most highly correlated with victory, the attack was the technical indicator that explained most of the results of volleyball games.

  4. QSTR with extended topochemical atom (ETA) indices. 16. Development of predictive classification and regression models for toxicity of ionic liquids towards Daphnia magna

    International Nuclear Information System (INIS)

    Roy, Kunal; Das, Rudra Narayan

    2013-01-01

    Highlights: • Ionic liquids are not intrinsically ‘green chemicals’ and require toxicological assessment. • Predictive QSTR models have been developed for toxicity of ILs to Daphnia magna. • Simple two dimensional descriptors were used to reduce the computational burden. • Discriminant and regression based models showed appreciable predictivity and reproducibility. • The extracted features can be explored in designing novel environmentally-friendly agents. -- Abstract: Ionic liquids have been judged much with respect to their wide applicability than their considerable harmful effects towards the living ecosystem which has been observed in many instances. Hence, toxicological introspection of these chemicals by the development of predictive mathematical models can be of good help. This study presents an attempt to develop predictive classification and regression models correlating the structurally derived chemical information of a group of 62 diverse ionic liquids with their toxicity towards Daphnia magna and their interpretation. We have principally used the extended topochemical atom (ETA) indices along with various topological non-ETA and thermodynamic parameters as independent variables. The developed quantitative models have been subjected to extensive statistical tests employing multiple validation strategies from which acceptable results have been reported. The best models obtained from classification and regression studies captured necessary structural information on lipophilicity, branching pattern, electronegativity and chain length of the cationic substituents for explaining ecotoxicity of ionic liquids towards D. magna. The derived information can be successfully used to design better ionic liquid analogues acquiring the qualities of a true eco-friendly green chemical

  5. The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure

    DEFF Research Database (Denmark)

    Sever, Peter S; Poulter, Neil R; Dahlof, Bjorn

    2008-01-01

    Aims To determine the cardiovascular benefits in those originally assigned atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-2.2 years after closure of the lipid-lowering arm of the trial (ASCOT-LLA). Methods and results The Blood Pressure Lowering Arm of the ASCOT trial (ASCOT......-BPLA) compared two different antihypertensive treatment strategies on cardiovascular outcomes. ASCOT-LLA was a double-blind placebo-controlled trial of atorvastatin in those enrolled into ASCOT-BPLA with total cholesterol concentrations at baseline of ... enrolled in ASCOT-BPLA and 10 305 were further assigned either atorvastatin, 10 mg, or placebo. ASCOT-LLA was stopped prematurely after a median 3.3 years follow-up because of substantial cardiovascular benefits in those assigned atorvastatin. Trial physicians were invited to offer atorvastatin to all...

  6. Extending the scope of interprofessional education: Integrating insights from policy, management and economics for improved health outcomes

    OpenAIRE

    Shafqat Shehzad, PhD Health Economics

    2016-01-01

    This study explores the potential of bringing innovations in public health education by drawing insights from the specialised disciplines of Economics, Policy and Management for their applications in the health sector. Working with subject experts from these disciplines can enhance the understanding of a working health care system and the necessary improvements for better health outcomes. Sole reliance on one field or skewed allocation of resources in certain areas may not result in achieving...

  7. Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation.

    Science.gov (United States)

    Sancho-Muriel, Jorge; Frasson, Matteo; Hervás, David; Flor-Lorente, Blas; Ramos Rodriguez, José Luis; Romero Simó, Manuel; Escoll Rufino, Jordi; Santamaría Olabarrieta, Marta; Viñas Martinez, José; López Bañeres, Manolo; García-Granero, Eduardo

    2017-01-01

    Lately there has been an increasing interest in identifying quality standards in different pathologies, among them colon cancer due to its great prevalence. The main goal of this study is to define the quality standards of colon cancer surgery based on a large prospective national study dataset. Data from the prospective national study ANACO were used. This study included a consecutive series of patients operated on for colon cancer in 52 Spanish hospitals (2011-2012). Centers with less than 30 patients were excluded. The present analysis finally included 42 centers (2975 patients). Based on the results obtained in 4main indicators from each hospital (anastomotic leak, lymph-nodes found in the specimen, mortality and length of stay), a nomogram that allows the evaluation of the performance of each center was designed. Standard results for further 5 intraoperative and 5 postoperative quality indicators were also reported. Median of anastomotic leak and mortality rate was 8.5% (25 th -75 th percentiles 6.1%-12.4%) and 2.5% (25 th -75 th percentiles 0.6%-4.7%), respectively. Median number of nodes found in the surgical specimen was 15,1 (25 th -75 th percentiles 18-14 nodes). Median length of postoperative stay was 7.7 days (25 th -75 th percentiles 6.9-9.2 days). Based on these data, a nomogram for hospital audit was created. Standard surgical results after colon cancer surgery were defined, creating a tool for auto-evaluation and allowing each center to identify areas for improvement in the surgical treatment of colon cancer. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators.

    Science.gov (United States)

    D'Amico, Gennaro; De Franchis, Roberto

    2003-09-01

    Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis. The aim of this multicenter, prospective, cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis. A training set of 291 and a test set of 174 bleeding cirrhotic patients were included. Treatment was according to the preferences of each center and the follow-up period was 6 weeks. Predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality were developed by the logistic model in the training set and validated in the test set. Initial treatment controlled bleeding in 90% of patients, including vasoactive drugs in 27%, endoscopic therapy in 10%, combined (endoscopic and vasoactive) in 45%, balloon tamponade alone in 1%, and none in 17%. The 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%. Corresponding findings for variceal versus nonvariceal bleeding were 15% versus 7% (P =.034), 19% versus 10% (P =.019), and 20% versus 15% (P =.22). Active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure; alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality. Prognostic reassessment including blood transfusions improved the predictive accuracy. All the developed prognostic models were superior to the Child-Pugh score. In conclusion, prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades. Initial treatment stops bleeding in 90% of patients. Accurate predictive rules are provided for early recognition of high-risk patients.

  9. Indications, complications and outcomes of elderly patients undergoing retrievable inferior vena cava filter placement.

    Science.gov (United States)

    Rottenstreich, Amihai; Kleinstern, Geffen; Bloom, Allan I; Klimov, Alexander; Kalish, Yosef

    2017-10-01

    The utilization of inferior vena cava filter placement for pulmonary embolism prevention in elderly patients has not been well characterized. The present study aimed to review indications, complications and follow-up data of elderly patients undergoing inferior vena cava filter placement. A retrospective review was carried out of consecutive admitted patients who underwent inferior vena cava filter insertion at a large university hospital with a level I trauma center. Overall, 455 retrievable filters were inserted between 2009 and 2014. A total of 133 patients (29.2%) were aged ≥70 years. Elderly patients were less likely to have their filter retrieved compared with non-elderly patients (5.3% vs 21.4%, P Filter-related complications occurred in 13% of non-elderly patients and 14.3% of elderly patients (P = 0.72), most of them occurring in the first 3 months after filter placement. Survival among elderly patients with no evidence of active malignancy was similar to the non-elderly patients with a 1-year survival rate of 76.3% versus 82% in non-elderly patients (P = 0.22), and a 2-year survival rate of 73.1% versus 78.6% in non-elderly patients (P = 0.27). Although decreased, survival rates among elderly patients with active cancer were still substantial, with a 1-year survival rate of 45% and 2-year survival rate of 40%. Elderly patients had significantly lower rates of filter retrieval with similar complication rate. Survival rates among elderly patients were substantial, and in elderly patients with no active cancer were even comparable with non-elderly patients. When feasible, filter retrieval should be attempted in all elderly patients in order to prevent filter-related complications. Geriatr Gerontol Int 2017; 17: 1508-1514. © 2016 Japan Geriatrics Society.

  10. Ileal-conduit following cystectomy, single-institution revision of indications and outcome

    International Nuclear Information System (INIS)

    Abol-Enein, Hassan A.; Abdul-Muhsin, Ausama S.; Alhallaq, Yousuf M.

    2008-01-01

    Objective was to revise indications, case fatality ratio, and postoperative early and late complications of ileal conduit as a method of urinary diversion. This is a retrospective study in which 200 patients underwent an ileal conduit from August 1994 to December 2000 in Mansoura Urology and Nephrology Center, Mansoura, Egypt. Preoperative criteria of patient selection, preoperative findings and postoperative follow-up data were reviewed. In 200 patients aged 29-75 years, with a mean age of 55.84-/+ 8.91 years, the ileal conduit was chosen as a method of urinary diversion, due to one of the following patient or surgical factors; 50 (25%) cardiopulmonary co-morbidities, 27(13.5%) liver cirrhosis, 20 (10%) impaired renal function, 18 (9%) poorly controlled diabetes mellitus and 3 (1.5%) morbid obesity. Frozen section pathological examination showed carcinoma invasion of the urethra in 26 (13%) and prostate stroma in 16 (8%) male patients. Severe adhesions and difficulty cystectomy were encountered in 25 (12.5%) patients. Tumor was found at or close to the bladder neck in 13 (6.5%) female patients and 2 (1%) patients were found to have short mesentery. The mean follow up period was 90.02 -/+ 22.63 months. Fatality rate was 2%. Twenty-three (11.5%) patients had early complications, while 36 (23.7%) patients had late complications. Ileal conduit is still the best urinary diversion method in many patients who have bladder cancer with associated chronic medical disease or certain surgical factors that render other urinary diversion methods more difficult carry more postoperative morbidity and mortality or both. (author)

  11. Indices of language outcome 11 years after intrathecal chemotherapy for acute lymphoblastic leukemia: a sibling case-control study.

    Science.gov (United States)

    Lewis, Fiona M; Su, I-Fan; Murdoch, Bruce E

    2012-03-01

    Studies are emerging that suggest that major language indices do not differentiate children treated for acute lymphoblastic leukemia (ALL) with risk-adapted intrathecal chemotherapy (ITC) from control children matched on age, gender, and educational level. No study to date has controlled for cognitive environment, an important variable influencing language achievement and outcome. This case-control study applies the deconfounding principle by using a sibling as a control to investigate language outcomes in a male child 11 years after administration of ITC for ALL at the age of 2 years 3 months. A comprehensive behavioral language test battery failed to differentiate the siblings on current language performance when descriptively compared, but neurophysiological assessment revealed that the ITC-treated child required more time and elicited a smaller N400 component compared to his sibling during picture-word matching. The findings suggest that in the absence of pretreatment performance indices, comparison with sibling achievement may supplement what is known on posttreatment language skill development drawn from comparative studies using children matched on age, sex, and educational level drawn from the community. The study's findings offer pilot data of language outcomes following ITC beyond the early stage of survivorship. The benefits and limitations of using siblings in research where the cognitive environment is known to make an important contribution to skill development are discussed.

  12. The Role of Physiotherapy Extended Scope Practitioners in Musculoskeletal care with Focus on Decision Making and Clinical Outcomes: A Systematic Review of Quantitative and Qualitative Research.

    Science.gov (United States)

    Thompson, Jonathan; Yoward, Samantha; Dawson, Pamela

    2017-06-01

    Physiotherapy extended scope practitioner (ESP) roles are widely utilized in the management of musculoskeletal conditions. The present article reviews the current literature, with particular emphasis on the decision-making process, patient/clinician interaction and clinical outcomes. A systematic review of musculoskeletal extended scope practice was carried out. The review focused on the outcome of interventions, and the interactions and decision-making processes between ESPs and their patients. A wide search strategy was employed, through multiple databases, grey literature and experts in the field. Qualitative and quantitative studies alike were included and a mixed-methods synthesis approach was undertaken in analysing the findings of included studies. A total of 476 articles were identified for inclusion, 25 of which (22 quantitative and three qualitative) meeting the criteria for full quality appraisal and synthesis. It was not possible to conduct a meta-analysis owing to data heterogeneity. The results showed high patient satisfaction with the ESP role, support for ESP staff listing patients for orthopaedic surgery, a high positive correlation of decision making between ESPs and orthopaedic surgeons and evidence of a positive impact on patient outcomes. Qualitative themes reflected the importance of ESP clinical decision making and interpersonal skills and their role in patient education. There is broad support for the physiotherapy ESP role and evidence of favourable outcomes from ESP intervention. Clinical decisions made by ESPs correlate well with those of medical colleagues, although there is a lack of detail explaining the ESP decision-making process itself and the influences and mechanisms by which this occurs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  13. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data.

    Directory of Open Access Journals (Sweden)

    Manisha Nair

    Full Text Available As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1 the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI by reproducing an Australian indicator using routinely available hospital data, 2 the impact of modifications to the indicator to address potential data quality issues, 3 the reliability of the indicator.We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES database of the Health and Social care Information centre (HSCIC. A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.EMMOI included 26 morbid events (17 diagnosis and 9 procedures. Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

  14. Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.

    Science.gov (United States)

    Mesterton, Johan; Lindgren, Peter; Ekenberg Abreu, Anna; Ladfors, Lars; Lilja, Monica; Saltvedt, Sissel; Amer-Wåhlin, Isis

    2016-05-31

    Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for

  15. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer.

    Science.gov (United States)

    Ouyang, Yi; Wang, Yanhong; Chen, Kai; Cao, Xinping; Zeng, Yiming

    2017-12-01

    The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (Pirradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

  16. Evaluating the impact of healthcare provider training to improve tuberculosis management: a systematic review of methods and outcome indicators used.

    Science.gov (United States)

    Wu, Shishi; Roychowdhury, Imara; Khan, Mishal

    2017-03-01

    Developing human resources capacity is vital for tuberculosis (TB) control in low- and middle-income countries. Although investments in TB healthcare provider (HCP) training programmes have increased, it is unclear whether these are robustly evaluated. The objective of this systematic review was to synthesize the methods and outcome indicators used to assess TB HCP training programmes. A systematic scoping review of publications reporting on evaluations of training programmes for TB HCPs - including doctors, nurses, paramedics, and lay health workers - was conducted through a search in three electronic databases, Google Scholar, and five websites of non-profit organizations. Data on the study location, population trained, outcomes assessed, and evaluation approach were extracted. After screening 499 unique publications, 21 were eligible for inclusion in the analysis. The majority of evaluations were conducted in Africa. The most common evaluation methods were a review of patient records (n=8, 38%) and post-training interview with trainees (n=7, 33%). In terms of outcomes, more than half of the studies (n=12, 57%) evaluated knowledge acquisition of trainees, with only six (29%) assessing on-the-job behaviour change. Even though more funds have been invested in TB HCP training, publications from robust evaluations assessing the impact on quality of care and behaviour change are limited. Copyright © 2016. Published by Elsevier Ltd.

  17. Functional Connectivity in Frontoparietal Network: Indicator of Preoperative Cognitive Function and Cognitive Outcome Following Surgery in Patients with Glioma.

    Science.gov (United States)

    Lang, Stefan; Gaxiola-Valdez, Ismael; Opoku-Darko, Michael; Partlo, Lisa A; Goodyear, Bradley G; Kelly, John J P; Federico, Paolo

    2017-09-01

    Patients with diffuse glioma are known to have impaired cognitive functions preoperatively. However, the mechanism of these cognitive deficits remains unclear. Resting-state functional connectivity in the frontoparietal network (FPN) is associated with cognitive performance in healthy subjects. For this reason, it was hypothesized that functional connectivity of the FPN would be related to cognitive functioning in patients with glioma. To assess this relationship, preoperative cognitive status was correlated to patient-specific connectivity within the FPN. Further, we assessed whether connectivity could predict neuropsychologic outcome following surgery. Sixteen patients with diffuse glioma underwent neuropsychologic assessment and preoperative functional magnetic resonance imaging using task (n-back) and resting-state scans. Thirteen patients had postoperative cognitive assessment. An index of patient-specific functional connectivity in the FPN was derived by averaging connectivity values between 2 prefrontal and 2 parietal cortex regions defined by activation during the n-back task. The relationship of these indices with cognitive performance was assessed. Higher average connectivity within the FPN is associated with lower composite cognitive scores. Higher connectivity of the parietal region of the tumor-affected hemisphere is associated specifically with lower fluid cognition. Lower connectivity of the parietal region of the nontumor hemisphere is associated with worse neuropsychologic outcome 1 month after surgery. Resting-state functional connectivity between key regions of the FPN is associated with cognitive performance in patients with glioma and is related to cognitive outcome following surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle: 95 cases (1999-2011).

    Science.gov (United States)

    Hartnack, Amanda K; Niehaus, Andrew J; Rousseau, Marjolaine; Pentecost, Rebecca L; Miesner, Matt D; Anderson, David E

    2015-09-15

    To evaluate indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle. Retrospective case series. 95 cattle that underwent rumenotomy or rumenostomy. Medical records for 95 cattle that underwent either rumenostomy or rumenotomy at 2 veterinary teaching hospitals in 1999 through 2011 were analyzed. Reasons for the procedures were noted. Long-term outcome was determined during telephone interviews with owners. 42 (44%) bovids underwent rumenostomy and 53 (56%) bovids underwent rumenotomy. Among the 42 animals undergoing rumenostomy, 18 (43%) had rumen cannulas placed during elective procedures. Other indications for rumenostomy included ruminal tympany (bloat [n = 20]), esophageal obstruction (choke [1]), grain overload (1), and provision of access for administration of enteral nutrition (2). Indications for rumenotomy included traumatic reticuloperitonitis (n = 31), bloat (9), foreign body (6), choke (5), and other (2). Long-term follow-up data were available for 31 of 42 (74%) bovids that underwent rumenostomy. Of those 31 animals, 17 (55%) were still in the herd, 4 (13%) had been culled, and 10 (32%) had died or were euthanized. Long-term follow-up data were available for 38 of 53 (72%) bovids that underwent rumenotomy. Of those 38 animals, 13 (34%) were still in the herd, 14 (37%) had been culled, and 11 (29%) had died or been euthanized. Results indicated that rumenotomy and rumenostomy can be effective in treating or relieving complications secondary to forestomach disorders in cattle. Bovids undergoing rumen surgery had a favorable prognosis for survival and a fair prognosis for potential return to production.

  19. The radio-X-ray relation as a star formation indicator: results from the Very Large Array-Extended Chandra Deep Field-South

    Science.gov (United States)

    Vattakunnel, S.; Tozzi, P.; Matteucci, F.; Padovani, P.; Miller, N.; Bonzini, M.; Mainieri, V.; Paolillo, M.; Vincoletto, L.; Brandt, W. N.; Luo, B.; Kellermann, K. I.; Xue, Y. Q.

    2012-03-01

    In order to trace the instantaneous star formation rate (SFR) at high redshift, and thus help in understanding the relation between the different emission mechanisms related to star formation, we combine the recent 4-Ms Chandra X-ray data and the deep Very Large Array radio data in the Extended Chandra Deep Field-South region. We find 268 sources detected both in the X-ray and radio bands. The availability of redshifts for ˜95 per cent of the sources in our sample allows us to derive reliable luminosity estimates and the intrinsic properties from X-ray analysis for the majority of the objects. With the aim of selecting sources powered by star formation in both bands, we adopt classification criteria based on X-ray and radio data, exploiting the X-ray spectral features and time variability, taking advantage of observations scattered across more than 10 years. We identify 43 objects consistent with being powered by star formation. We also add another 111 and 70 star-forming candidates detected only in the radio and X-ray bands, respectively. We find a clear linear correlation between radio and X-ray luminosity in star-forming galaxies over three orders of magnitude and up to z˜ 1.5. We also measure a significant scatter of the order of 0.4 dex, higher than that observed at low redshift, implying an intrinsic scatter component. The correlation is consistent with that measured locally, and no evolution with redshift is observed. Using a locally calibrated relation between the SFR and the radio luminosity, we investigate the LX(2-10 keV)-SFR relation at high redshift. The comparison of the SFR measured in our sample with some theoretical models for the Milky Way and M31, two typical spiral galaxies, indicates that, with current data, we can trace typical spirals only at z≤ 0.2, and strong starburst galaxies with SFRs as high as ˜100 M⊙ yr-1, up to z˜ 1.5.

  20. Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

    Science.gov (United States)

    Hecking, Erwin; Bragg-Gresham, Jennifer L; Rayner, Hugh C; Pisoni, Ronald L; Andreucci, Vittorio E; Combe, Christian; Greenwood, Roger; McCullough, Keith; Feldman, Harold I; Young, Eric W; Held, Philip J; Port, Friedrich K

    2004-01-01

    The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study designed to evaluate practice patterns in random samples of haemodialysis facilities and patients across three continents. Participating countries include France, Germany, Italy, Spain and the UK (Euro-DOPPS), Japan and the USA. DOPPS data collection has used the same questionnaires and protocols across all participating countries to assess components of dialysis therapy and outcomes. This study focuses on dialysis prescription, adherence and nutrition among the Euro-DOPPS countries. In each Euro-DOPPS country, patients were selected randomly from 20-21 representative facilities. Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients. Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses. Among the five countries, mean delivered dose as measured by normalized urea clearance (Kt/V) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components, including blood flow rates, treatment times, and dialyser membrane and flux characteristics. By country, a nearly 2-fold difference was observed in indicators of patient adherence and management (skipping and shortening dialysis, hyperkalaemia, hyperphosphataemia and high interdialytic weight gain). Indicators of malnutrition varied substantially. This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose, adherence and nutrition. Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy.

  1. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration

    Directory of Open Access Journals (Sweden)

    Sarah Mrejen

    2015-07-01

    Full Text Available With the advent of anti-vascular endothelial growth factor (VEGF therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD, a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naïve NVAMD initially classified based on fluorescein angiography (FA alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes were followed over an average of 3.5 years (range 1–6.6 with a retention rate of 62.9%, and visual acuity significantly improved with a TER that required a mean number of 8.3 (±1.6 (± standard deviation intravitreal anti-VEGF injections/year (range 4–13. The number of injections and the anatomic classification were independent predictors of visual acuity at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events. A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than those with other neovascular subtypes.

  2. Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index.

    Science.gov (United States)

    Ondeck, Nathaniel T; Bohl, Daniel D; Bovonratwet, Patawut; McLynn, Ryan P; Cui, Jonathan J; Shultz, Blake N; Lukasiewicz, Adam M; Grauer, Jonathan N

    2018-01-01

    As research tools, the American Society of Anesthesiologists (ASA) physical status classification system, the modified Charlson Comorbidity Index (mCCI), and the modified Frailty Index (mFI) have been associated with complications following spine procedures. However, with respect to clinical use for various adverse outcomes, no known study has compared the predictive performance of these indices specifically following posterior lumbar fusion (PLF). This study aimed to compare the discriminative ability of ASA, mCCI, and mFI, as well as demographic factors including age, body mass index, and gender for perioperative adverse outcomes following PLF. A retrospective review of prospectively collected data was performed. Patients undergoing elective PLF with or without interbody fusion were extracted from the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Perioperative adverse outcome variables assessed included the occurrence of minor adverse events, severe adverse events, infectious adverse events, any adverse event, extended length of hospital stay, and discharge to higher-level care. Patient comorbidity indices and characteristics were delineated and assessed for discriminative ability in predicting perioperative adverse outcomes using an area under the curve analysis from the receiver operating characteristics curves. In total, 16,495 patients were identified who met the inclusion criteria. The most predictive comorbidity index was ASA and demographic factor was age. Of these two factors, age had the larger discriminative ability for three out of the six adverse outcomes and ASA was the most predictive for one out of six adverse outcomes. A combination of the most predictive demographic factor and comorbidity index resulted in improvements in discriminative ability over the individual components for five of the six outcome variables. For PLF, easily obtained patient ASA and age have overall similar or better

  3. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  4. Life Outcomes and Higher Education: The Need for Longitudinal Research Using a Broad Range of Quality of Life Indicators.

    Science.gov (United States)

    Sheppard-Jones, Kathleen; Kleinert, Harold; Butler, Laura; Whaley, Barry

    2018-02-01

    Higher education is increasingly becoming an option for young adults with intellectual disability (ID). Although initial evaluations of postsecondary education for this population have been promising, a broader "quality of life" framework needs to be adopted in order to truly understand the impact of these programs. Moreover, researchers and program evaluators must collect longitudinal data that follows former students for multiple years and uses multiple measures. We conducted a pilot evaluation of the life outcomes of students who had attended at least two semesters in Kentucky's supported higher education program for students with ID, collecting data on life status and experiences using measures from the National Core Indicators-Adult Consumer Survey. The findings from this pilot study show better outcomes for young adults who participated in a postsecondary education program compared to young adults who did not, but these findings need to be considered in light of several limitations. In many respects, our data provided more new questions than answers. Recommendations for collecting and evaluating broad-based, longitudinal data to gain insight into the potential benefits of postsecondary education for people with intellectual disability are discussed.

  5. Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India.

    Directory of Open Access Journals (Sweden)

    Gayatri Desai

    Full Text Available Even though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India.The aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India.Prospectively collected data of deliveries (N = 19923 from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women.The caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01 respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01 of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%, previous caesarean section (23.9%, breech (16% and prolonged labour (11.2%. There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90 and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26 comparing the tribal and non-tribal women.Similar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries.

  6. Risk factors and treatment outcomes of bloodstream infection caused by extended-spectrum cephalosporin-resistant Enterobacter species in adults with cancer.

    Science.gov (United States)

    Huh, Kyungmin; Kang, Cheol-In; Kim, Jungok; Cho, Sun Young; Ha, Young Eun; Joo, Eun-Jeong; Chung, Doo Ryeon; Lee, Nam Yong; Peck, Kyong Ran; Song, Jae-Hoon

    2014-02-01

    Treatment of Enterobacter infection is complicated due to its intrinsic resistance to cephalosporins. Medical records of 192 adults with cancer who had Enterobacter bacteremia were analyzed retrospectively to evaluate the risk factors for and the treatment outcomes in extended-spectrum cephalosporin (ESC)-resistant Enterobacter bacteremia in adults with cancer. The main outcome measure was 30-day mortality. Of the 192 patients, 53 (27.6%) had bloodstream infections caused by ESC-resistant Enterobacter species. Recent use of a third-generation cephalosporin, older age, tumor progression at last evaluation, recent surgery, and nosocomial acquisition were associated with ESC-resistant Enterobacter bacteremia. The 30-day mortality rate was significantly higher in the resistant group. Multivariate analysis showed that respiratory tract infection, tumor progression, septic shock at presentation, Enterobacter aerogenes as the culprit pathogen, and diabetes mellitus were independent risk factors for mortality. ESC resistance was significantly associated with mortality in patients with E. aerogenes bacteremia, although not in the overall patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Prevalence and impact of extended-spectrum β-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia.

    Science.gov (United States)

    Kim, Sun Jong; Park, Ki-Ho; Chung, Jin-Won; Sung, Heungsup; Choi, Seong-Ho; Choi, Sang-Ho

    2014-09-01

    We examined the prevalence of extended-spectrum β-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.

  8. [Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction].

    Science.gov (United States)

    Molnár, András; Surányi, Andrea; Jakó, Mária; Nyári, Tibor; Németh, Gábor

    2017-07-01

    Development of intrauterine growth restriction (IUGR) can be traced back to maternal or fetal factors, but in many cases we find placental factors (reduced placental circulation) in the background. Our aim was to examine whether the reduced placental bloodperfusion and vascularity show any correlation with cesarean section frequency and the clinical outcome in IUGR pregnancies. The aim of the present study was also to use a properly calibrated and reproducible method for evaluating placental blood flow, that can later be incorporated into the routine examination. 254 women were recruited in our prospective case-control study. The 3 dimensional power Doppler (3DPD) ultrasound indices; vascularisation index (VI), flow index (FI) and vascularization flow index (VFI) were measured on each participant. Median VI was 3.7% (interquartile range [IQR] 3.2%-4.2%) in the IUGR group and 10.1% (IQR 8.6%-10.9%) in the control group (p = 0.001). Median FI value was 40.0 (IQR 39.7-42.5) in the IUGR group and 45.1 (IQR 44.1-53.1) in the control group (p = 0.012). Median VFI was 2.2 (IQR 2.1-2.4) in the IUGR group and 4.8 (IQR 4.4-5.3) in the control. The 3DPD indices may be useful for examining changes in circulation in IUGR pregnancies to characterize the underlying pathology. Orv Hetil. 2017; 158(26): 1008-1013.

  9. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: A comparison of indications, complications and outcomes in 370 patients

    International Nuclear Information System (INIS)

    Silas, Anne M.; Pearce, Lindsay F.; Lestina, Lisa S.; Grove, Margaret R.; Tosteson, Anna; Manganiello, Wendy D.; Bettmann, Michael A.; Gordon, Stuart R.

    2005-01-01

    Objective: Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques. Methods: Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed. Results: 177 gastrostomies were placed endoscopically and 193 fluoroscopically. Nutrition was the most common indication in each group (94 and 92%), but the most common underlying diagnosis was neurologic impairment in the endoscopic group (n = 89, 50%) and malignancy in the fluoroscopic group (n = 134, 69%) (p < 0.001). Complications in the first 30 days were more common with fluoroscopic placement (23% versus 11%, p = 0.002), with infection most frequent. Correlates of late complications were inpatient status (OR 0.26, 95%CI: 0.13-0.51) and a diagnosis of malignancy (OR 2.2, 95%CI: 1.03-4.84). Average follow-up time was 108 days in the fluoroscopic group and 174 days in the endoscopic group. Conclusions: Both endoscopic and fluoroscopic gastrostomy tube placement are safe and effective. Outpatient status was associated with greater early and late complication rates; minor complications such as infection were greater in the fluoroscopic group, while malignancy was associated with late complications

  10. CD117 expression in fibroblasts-like stromal cells indicates unfavorable clinical outcomes in ovarian carcinoma patients.

    Directory of Open Access Journals (Sweden)

    Ruixia Huang

    Full Text Available The stem cell factor (SCF receptor CD117 (c-kit, is widely used for identification of hematopoietic stem cells and cancer stem cells. Moreover, CD117 expression in carcinoma cells indicates a poor prognosis in a variety of cancers. However the potential expression in tumor microenvironment and the biological and clinical impact are currently not reported. The expression of CD117 was immunohistochemically evaluated in a serial of 242 epithelial ovarian cancer (EOC cases. Thirty-eight out of 242 cases were CD117 positive in fibroblast-like stromal cells and 22 cases were positive in EOC cells. Four cases were both positive in fibroblast-like stromal cells and EOC cells for CD117. CD117 expression in fibroblast-like stromal cells in ovarian carcinoma was closely linked to advanced FIGO stage, poor differentiation grade and histological subtype (p<0.05, and it was significantly associated with poor overall survival (OS and progression free survival (PFS (Kaplan-Meier analysis; p<0.05, log-rank test. CD117 expression in ovarian carcinoma cells was not associated with these clinicopathological variables. The CD117 positive fibroblast-like stromal cells were all positive for mesenchymal stem/stromal cell (MSC marker CD73 but negative for fibroblast markers fibroblast activation protein (FAP and α smooth muscle actin (α-SMA, indicating that the CD117+/CD73+ fibroblast-like stromal cells are a subtype of mesenchymal stem cells in tumor stroma, although further characterization of these cells are needed. It is concluded herewith that the presence of CD117+/CD73+ fibroblast-like stromal cells in ovarian carcinoma is an unfavorable clinical outcome indication.

  11. Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons.

    Science.gov (United States)

    Matloob, Samir A; Nasir, Haleema A; Choi, David

    2016-08-01

    Chordomas are rare tumours affecting the skull base. There is currently no clear consensus on the post-surgical radiation treatments that should be used after maximal tumour resection. However, high-dose proton beam therapy is an accepted option for post-operative radiotherapy to maximise local control, and in the UK, National Health Service approval for funding abroad is granted for specific patient criteria. To review the indications and efficacy of proton beam therapy in the management of skull base chordomas. The primary outcome measure for review was the efficacy of proton beam therapy in the prevention of local occurrence. A systematic review of English and non-English articles using MEDLINE (1946-present) and EMBASE (1974-present) databases was performed. Additional studies were reviewed when referenced in other studies and not available on these databases. Search terms included chordoma or chordomas. The PRISMA guidelines were followed for reporting our findings as a systematic review. A total of 76 articles met the inclusion and exclusion criteria for this review. Limitations included the lack of documentation of the extent of primary surgery, tumour size, and lack of standardised outcome measures. Level IIb/III evidence suggests proton beam therapy given post operatively for skull base chordomas results in better survival with less damage to surrounding tissue. Proton beam therapy is a grade B/C recommended treatment modality for post-operative radiation therapy to skull base chordomas. In comparison to other treatment modalities long-term local control and survival is probably improved with proton beam therapy. Further, studies are required to directly compare proton beam therapy to other treatment modalities in selected patients.

  12. LSD treatment in Scandinavia: emphasizing indications and short-term treatment outcomes of 151 patients in Denmark.

    Science.gov (United States)

    Larsen, Jens Knud

    2017-10-01

    New research has suggested the clinical use of lysergic acid diethylamide (LSD) and psilocybin in selected patient populations. However, concerns about the clinical use of LSD were advanced in a large Danish follow-up study that assessed 151 LSD-treated psychiatric patients approximately 25 years after their treatment in the 1960s. The purpose of the present study was to give a retrospective account of the short-term outcome of LSD treatment in these 151 Danish psychiatric patients. The LSD case material in the Danish State Archives consists of medical case records of 151 LSD-treated patients, who complained and received economic compensation with the LSD Damages Law. The author carefully read and reviewed the LSD case material. LSD was used to treat a wide spectrum of mental disorders. Independent of diagnoses, 52 patients improved, and 48 patients worsened acutely with the LSD treatment. In a subgroup of 82 neurotic patients, the LSD dose-index (number of treatments multiplied by the maximal LSD dose) indicated the risk of acute worsening. In another subgroup of 19 patients with obsessive-compulsive neurosis, five patients later underwent psychosurgery. A small subgroup of 12 patients was treated with psilocybin. The long-term outcome was poor in most of the patients. Despite the significant limitations to a retrospective design, this database warrants caution in mental health patients. The use of LSD and psilocybin in mental health patients may be associated with serious short- and long-term side effects. Until further trials with rigorous designs have cleared these drugs of their potential harms, their clinical utility in these groups of patients has not been fully clarified.

  13. Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding.

    Science.gov (United States)

    Bender, Miriam; Smith, Tyler C

    2016-01-01

    Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative International Classification of Disease (ICD-9) coding for, and "gold standard" clinician documentation of, mental health issues (MHIs) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. A 13% random sample (n = 504) was selected from all unique patients (n = 3,769) hospitalized with a primary HF diagnosis at 4 San Diego County community hospitals during 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding 290-319. Records were audited for clinician documentation of MHI. A total of 43% (n = 216) had mental health clinician documentation; 33% (n = 164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and kappa 0.69 (95% confidence interval 0.61-0.79). More specific ICD-9 MHI code bundles had kappas ranging from 0.44 to 0.82 and sensitivities ranging from 42% to 82%. Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly "rule in" MHI for hospitalized patients with heart failure. More specific MHI code bundles had fair to almost perfect agreement, with a wide range of sensitivities for identifying patients with an MHI. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    LENUS (Irish Health Repository)

    Elliott, Naomi

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

  15. Physical health indicators in major mental illness: data from the Quality and Outcome Framework in the UK.

    Science.gov (United States)

    Martin, Julie Langan; Lowrie, Richard; McConnachie, Alex; McLean, Gary; Mair, Frances; Mercer, Stewart; Smith, Daniel

    2015-02-26

    In the UK, the Quality and Outcome Framework (QOF) has specific targets for general practictioners to record body-mass index (BMI) and blood pressure (BP) in major mental illness, diabetes, and chronic kidney disease. Although incentives are given for aspects of major mental illness (schizophrenia, bipolar disorder, and related psychoses), barriers to care can occur. Our aim was to compare recording of specific targets for BP and BMI in individuals with major mental illness relative to diabetes and chronic kidney disease across the UK. Using 2012 and 2013 QOF data from 9731 general practices across all four countries in the UK, we calculated median payment, population achievement, and exception rates for BP indicators in major mental illness and chronic kidney disease and BMI indicators in major mental illness and diabetes. Differences in unweighted rates between practices in the same UK country were tested with a sign test. Differences in population achievement rate between practices in different countries were compared with those in England by use of a quantile regression analysis. UK payment and population achievement rates for BMI recording in major mental illness were significantly lower than were those in diabetes (payment 92·7% vs 95·5% and population achievement 84·0% vs 92·5%, pmental illness than for chronic kidney disease (94·1% vs 97·8% and 87·0% vs 97·1%, pmental illness were significantly lower in Scotland than in England (for BMI -1·5%, 99% CI -2·7 to -0·3, and for BP -1·8%, -2·7 to -0·9; pmental illness than in diabetes and chronic kidney disease throughout the UK. We also found variation in these rates between countries. This finding is probably multifactorial, reflecting a combination of patient, clinician, and wider organisational factors; however, it might also suggest inequality in access to certain aspects of health care for people with major mental illness. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Clinical and economic outcomes associated with community-acquired intra-abdominal infections caused by extended spectrum beta-lactamase (ESBL) producing bacteria in China.

    Science.gov (United States)

    Hu, Bijie; Ye, Huifeng; Xu, Yingchun; Ni, Yuxing; Hu, Yunjian; Yu, Yunsong; Huang, Zhenfei; Ma, Larry

    2010-06-01

    To compare clinical and economic outcomes in patients with community-acquired intra-abdominal infection (IAI) due to extended spectrum beta-lactamase (ESBL) producing (ESBL-positive) bacteria versus non-ESBL-producing (ESBL-negative) bacteria in China. This was a retrospective chart review study of patients hospitalized with community-acquired IAI due to ESBL-positive or ESBL-negative infections caused by Escherichia coli or Klebsiella spp. Data were collected from six hospitals in China that participated in the Study for Monitoring Antibiotic Resistance Trends (SMART) during 2006-2007. Outcomes included clinical response at discharge and following first-line antibiotic, number of antibiotic agents and classes, duration of hospitalization, and overall hospitalization and intravenous antibiotic costs. Of the 85 patients included in the study, 32 (37.6%) had ESBL-positive and 53 (62.4%) had ESBL-negative infections; E. coli was responsible for 77.6% of infections. Infection resolved at discharge in 30 (93.8%) ESBL-positive and 48 (90.6%) ESBL-negative patients (P = NS). Fewer ESBL-positive patients achieved complete response following first-line antibiotics (56.3% versus 83.0%; P = 0.01). ESBL-positive patients required longer antibiotic treatment, more antibiotics, longer hospitalization (24.3 versus 14.6 days; 1.67-fold ratio; P = 0.001), and incurred higher hospitalization costs ( yen24,604 vs. yen13,788; $3604 vs. $2020; 1.78-fold ratio; P < 0.001). Patients with ESBL-positive infection had similar resolution rates at discharge compared to those with ESBL-negative infection, despite poorer first-line antibiotic response. However, ESBL-positive infection led to significantly greater hospitalization cost and intravenous antibiotic cost, and longer hospital stay.

  17. Extended objects

    International Nuclear Information System (INIS)

    Creutz, M.

    1976-01-01

    After some disconnected comments on the MIT bag and string models for extended hadrons, I review current understanding of extended objects in classical conventional relativistic field theories and their quantum mechanical interpretation

  18. Sequence diversity of hepatitis C virus 6a within the extended interferon sensitivity-determining region correlates with interferon-alpha/ribavirin treatment outcomes.

    Science.gov (United States)

    Zhou, Daniel X M; Chan, Paul K S; Zhang, Tiejun; Tully, Damien C; Tam, John S

    2010-10-01

    Studies on the association between sequence variability of the interferon sensitivity-determining region (ISDR) of hepatitis C virus and the outcome of treatment have reached conflicting results. In this study, 25 patients infected with HCV 6a who had received interferon-alpha/ribavirin combination treatment were analyzed for the sequence variations. 14 of them had the full genome sequences obtained from a previous study, whereas the other 11 samples were sequenced for the extended ISDR (eISDR). This eISDR fragment covers 192 bp (64 amino acids) upstream and 201 bp (67 amino acids) downstream from the ISDR previously defined for HCV 1b. The comparison between interferon-alpha resistance and response groups for the amino acid mutations located in the full genome (6 and 8 patients respectively) as well as the mutations located in the eISDR (10 and 15 patients respectively) showed that the mutations I2160V, I2256V, V2292I (Pc) 2010 Elsevier B.V. All rights reserved.

  19. Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: Extending the indication for ablation?

    International Nuclear Information System (INIS)

    Zheng, J.-S.; Long, J.; Sun, B.; Lu, N.-N.; Fang, D.; Zhao, L.-Y.; Du, N.

    2014-01-01

    Aim: To retrospectively assess long-term survival benefit and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombosis (PVTT), and to evaluate factors that significantly affect outcomes of these patients. Materials and methods: One hundred and thirty-four HCC patients (118 men and 16 women; mean age 54.8 years, range 26–79 years) with PVTT were retrospectively assessed. Patients were treated with TACE combined with RFA. Data analysed included patient demographics, liver volume, Child–Pugh score, and Cancer of the Liver Italian Programme (CLIP) score and imaging findings. Survival time (from occurrence of PVTT to last follow-up) was calculated using the Kaplan–Meier method, predictive factors and its correlation with survival was assessed using the multivariate Cox proportional hazards regression method. Results: The median overall survival (OS) time was 29.5 months (range 16.6–42.4 months), the 1, 3, and 5 year OS were 63%, 40%, and 23%. Cox hazards regression analysis revealed that functional remnant liver volume (FRLV), remnant liver volume (RLV)/total liver volume (TLV), radiation, tumour number, vascular endothelial growth factor (VEGF) distribution, and gross type were the only independent predictive factors of outcome (p = 0.039, 0.010, 0.009, 0.034, 0.031, and 0.000, respectively). Conclusion: TACE combined with RFA was found to be an effective therapy, FRLV and RLV/TLV have close correlation with survival for HCC patients with PVTT type I, II, or partial III and Child–Pugh A or B

  20. 2008 Key Student Outcomes Indicators for BC Diploma, Associate Degree, and Certificate Programs: Survey Results by Institution

    Science.gov (United States)

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…

  1. Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST-Elevation Acute Coronary Syndrome Undergoing Deferred Angiography.

    Science.gov (United States)

    Fefer, Paul; Beigel, Roy; Atar, Shaul; Aronson, Doron; Pollak, Arthur; Zahger, Doron; Asher, Elad; Iakobishvili, Zaza; Shlomo, Nir; Alcalai, Ronny; Einhorn-Cohen, Michal; Segev, Amit; Goldenberg, Ilan; Matetzky, Shlomi

    2017-07-25

    Few data are available regarding the optimal management of ST-elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess whether immediate reperfusion can be deferred. Data were drawn from a prospective nationwide survey, ACSIS (Acute Coronary Syndrome Israeli Survey). Definition of SR was predefined as both (1) ≥70% reduction in ST-segment elevation on consecutive ECGs and (2) ≥70% resolution of pain. Of 2361 consecutive ST-elevation-acute coronary syndrome patients in Killip class 1, 405 (17%) were not treated with primary reperfusion therapy because of SR. Intervention in SR patients was performed a median of 26 hours after admission. These patients were compared with the 1956 ST-elevation myocardial infarction patients who underwent primary reperfusion with a median door-to-balloon of 66 minutes (interquartile range 38-106). Baseline characteristics were similar except for slightly higher incidence of renal dysfunction and prior angina pectoris in SR patients. Time from symptom onset to medical contact was significantly greater in SR patients. Patients with SR had significantly less in-hospital heart failure (4% versus 11%) and cardiogenic shock (0% versus 2%) ( P <0.01 for all). No significant differences were found in in-hospital mortality (1% versus 2%), 30-day major cardiac events (4% versus 4%), and mortality at 30 days (1% versus 2%) and 1 year (4% versus 4%). Patients with clinically defined SR have a favorable prognosis. Deferring immediate intervention seems to be safe in patients with clinical indices of spontaneous reperfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  2. Survey indicated that core outcome set development is increasingly including patients, being conducted internationally and using Delphi surveys.

    Science.gov (United States)

    Biggane, Alice M; Brading, Lucy; Ravaud, Philippe; Young, Bridget; Williamson, Paula R

    2018-02-17

    There are numerous challenges in including patients in a core outcome set (COS) study, these can vary depending on the patient group. This study describes current efforts to include patients in the development of COS, with the aim of identifying areas for further improvement and study. Using the COMET database, corresponding authors of COS projects registered or published from 1 January 2013 to 2 February 2017 were invited via a personalised email to participate in a short online survey. The survey and emails were constructed to maximise the response rate by following the academic literature on enhancing survey responses. Personalised reminder emails were sent to non-responders. This survey explored the frequency of patient input in COS studies, who was involved, what methods were used and whether or not the COS development was international. One hundred and ninety-two COS developers were sent the survey. Responses were collected from 21 February 2017 until 7 May 2017. One hundred and forty-six unique developers responded, yielding a 76% response rate and data in relation to 195 unique COSs (as some developers had worked on multiple COSs). Of focus here are their responses regarding 162 COSs at the published, completed or ongoing stages of development. Inclusion of patient participants was indicated in 87% (141/162) of COSs in the published completed or ongoing stages and over 94% (65/69) of ongoing COS projects. Nearly half (65/135) of COSs included patient participants from two or more countries and 22% (30/135) included patient participants from five or more countries. The Delphi survey was reported as being used singularly or in combination with other methods in 85% (119/140) of projects. Almost a quarter (16/65) of ongoing studies reported using a combination of qualitative interviews, Delphi survey and consensus meeting. These findings indicated that the Delphi survey is the most popular method of facilitating patient participation, while the combination of

  3. Mismatch negativity is a stronger indicator of functional outcomes than neurocognition or theory of mind in patients with schizophrenia.

    Science.gov (United States)

    Lee, Seung-Hwan; Sung, Kyongae; Lee, Kyong-Sang; Moon, Eunok; Kim, Chang-Gyu

    2014-01-03

    Mismatch negativity (MMN) is known to be associated with neurocognition, social cognition, and functional outcomes. The present study explored the relationships of MMN with neurocognition, theory of mind, and functional outcomes in patients with schizophrenia, first-degree relatives of patients with schizophrenia, and healthy controls. Twenty-five patients with schizophrenia, 21 first-degree relatives of patients with schizophrenia, and 29 healthy controls were recruited. We examined symptom severity, neurocognition, theory of mind, functional outcomes, and MMN. MMN amplitudes decreased in order of patients with schizophrenia, then first-degree relatives, then healthy controls. MMN amplitude was significantly correlated with measures of neurocognition, theory of mind, and functional outcome measurements in patients with schizophrenia. However, the most powerful correlations were those between MMN in the frontal region and measures of functional outcomes. The power and frequency of the correlations were weaker in first-degree relatives and healthy controls than in patients with schizophrenia. Hierarchical regression analysis revealed that functional outcomes (relative to measures of neurocognition and theory of mind) constituted the most powerful predictor of MMN. Our results suggest that MMN reflects functional outcomes more efficiently than do measures of neurocognition and theory of mind in patients with schizophrenia. © 2013.

  4. Casemix and process indicators of outcome in stroke. The Royal College of Physicians minimum data set for stroke.

    Science.gov (United States)

    Irwin, P; Rudd, A

    1998-01-01

    The emphasis on outcomes measurement requires that casemix is considered in any comparative studies. In 1996 the Intercollegiate Working Party for Stroke agreed a minimum data set to measure the severity of casemix in stroke. The reasons for its development, the evidence base supporting the items included and the possible uses of the data set are described. It is currently being evaluated in national outcome and process audits to be reported at a later date.

  5. Development and validation of stability indicating method for the quantitative determination of venlafaxine hydrochloride in extended release formulation using high performance liquid chromatography

    Directory of Open Access Journals (Sweden)

    Jaspreet Kaur

    2010-01-01

    Full Text Available Objective : Venlafaxine,hydrochloride is a structurally novel phenethyl bicyclic antidepressant, and is usually categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI but it has been referred to as a serotonin-norepinephrine-dopamine reuptake inhibitor. It inhibits the reuptake of dopamine. Venlafaxine HCL is widely prescribed in the form of sustained release formulations. In the current article we are reporting the development and validation of a fast and simple stability indicating, isocratic high performance liquid chromatographic (HPLC method for the determination of venlafaxine hydrochloride in sustained release formulations. Materials and Methods : The quantitative determination of venlafaxine hydrochloride was performed on a Kromasil C18 analytical column (250 x 4.6 mm i.d., 5 μm particle size with 0.01 M phosphate buffer (pH 4.5: methanol (40: 60 as a mobile phase, at a flow rate of 1.0 ml/min. For HPLC methods, UV detection was made at 225 nm. Results : During method validation, parameters such as precision, linearity, accuracy, stability, limit of quantification and detection and specificity were evaluated, which remained within acceptable limits. Conclusions : The method has been successfully applied for the quantification and dissolution profiling of Venlafaxine HCL in sustained release formulation. The method presents a simple and reliable solution for the routine quantitative analysis of Venlafaxine HCL.

  6. Stress degradation studies of Telmisartan and Metoprolol extended release tablets by a validated stability indicating reverse phase-high performance liquid chromatography method

    Directory of Open Access Journals (Sweden)

    Kabeer Ahmed Shaikh

    2014-01-01

    Full Text Available Background and Aim: A sensitive reverse phase high-performance liquid chromatographic method has been developed for the simultaneous determination of Telimisartan and Metoprolol in tablet dosage form. Materials and Method: The chromatographic separation was achieved on Inertsil ODS 3V, 150 x 4.6 mm, 5μ analytical column. Mobile phase consisting of mobile phase A- 0.05M sodium dihydrogen phosphate buffer pH 3.0 and mobile phase B-Acetonitrile, with gradient program time in min /Mobile phase B% 0/22, 4/45, 6/45,18/22, 20/22. Detector was set at 222nm. Results and Conclusion: The described method shows excellent linearity over a range of 80-2 μg mL−1 for Telmisartan and 100-4 μg mL−1 for Metoprolol. The correlation coefficient for Telmisartan is 0.9998 and Metoprolol is 0.9999. The proposed method was found to be suitable for determination of Telmisartan and Metoprolol in tablet dosage form. Forced degradation of the drug product was conducted in accordance with the ICH guideline. Acidic, basic, hydrolytic, oxidative, thermal and photolytic degradation was used to assess the stability indicating power of the method. The drug product was found to be stable in acid, oxidation, thermal and photolytic stress condition and found degradation in base hydrolysis stress condition.

  7. Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety.

    Science.gov (United States)

    Davies, Carolyn D; Niles, Andrea N; Pittig, Andre; Arch, Joanna J; Craske, Michelle G

    2015-03-01

    Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Deriving common comorbidity indices from the MedDRA classification and exploring their performance on key outcomes in patients with rheumatoid arthritis.

    Science.gov (United States)

    Putrik, Polina; Ramiro, Sofia; Lie, Elisabeth; Michaud, Kaleb; Kvamme, Maria K; Keszei, Andras P; Kvien, Tore K; Uhlig, Till; Boonen, Annelies

    2018-03-01

    To develop algorithms for calculating the Rheumatic Diseases Comorbidity Index (RDCI), Charlson-Deyo Index (CDI) and Functional Comorbidity Index (FCI) from the Medical Dictionary for Regulatory Activities (MedDRA), and to assess how these MedDRA-derived indices predict clinical outcomes, utility and health resource utilization (HRU). Two independent researchers linked the preferred terms of the MedDRA classification into the conditions included in the RDCI, the CDI and the FCI. Next, using data from the Norwegian Register-DMARD study (a register of patients with inflammatory joint diseases treated with DMARDs), the explanatory value of these indices was studied in models adjusted for age, gender and DAS28. Model fit statistics were compared in generalized estimating equation (prediction of outcome over time) models using as outcomes: modified HAQ, HAQ, physical and mental component summary of SF-36, SF6D and non-RA related HRU. Among 4126 patients with RA [72% female, mean (s.d.) age 56 (14) years], median (interquartile range) of RDCI at baseline was 0.0 (1.0) [range 0-6], CDI 0.0 (0.0) [0-7] and FCI 0.0 (1.0) [0-6]. All the comorbidity indices were associated with each outcome, and differences in their performance were moderate. The RDCI and FCI performed better on clinical outcomes: modified HAQ and HAQ, hospitalization, physical and mental component summary, and SF6D. Any non-RA related HRU was best predicted by RDCI followed by CDI. An algorithm is now available to compute three commonly used comorbidity indices from MedDRA classification. Indices performed comparably well in predicting a variety of outcomes, with the CDI performing slightly worse when predicting outcomes reflecting functioning and health. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  9. Extended Emotions

    DEFF Research Database (Denmark)

    Krueger, Joel; Szanto, Thomas

    2016-01-01

    beyond the neurophysiological confines of organisms; some even argue that emotions can be socially extended and shared by multiple agents. Call this the extended emotions thesis (ExE). In this article, we consider different ways of understanding ExE in philosophy, psychology, and the cognitive sciences...

  10. High-Dose and Extended-Field Intensity Modulated Radiation Therapy for Early-Stage NK/T-Cell Lymphoma of Waldeyer's Ring: Dosimetric Analysis and Clinical Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Bi, Xi-Wen; Li, Ye-Xiong, E-mail: yexiong@yahoo.com; Fang, Hui; Jin, Jing; Wang, Wei-Hu; Wang, Shu-Lian; Liu, Yue-Ping; Song, Yong-Wen; Ren, Hua; Dai, Jian-Rong

    2013-12-01

    Purpose: To assess the dosimetric benefit, treatment outcome, and toxicity of high-dose and extended-field intensity modulated radiation therapy (IMRT) in patients with early-stage NK/T-cell lymphoma of Waldeyer's ring (WR-NKTCL). Methods and Materials: Thirty patients with early-stage WR-NKTCL who received extended-field IMRT were retrospectively reviewed. The prescribed dose was 50 Gy to the primary involved regions and positive cervical lymph nodes (planning target volume requiring radical irradiation [PTV{sub 50}]) and 40 Gy to the negative cervical nodes (PTV{sub 40}). Dosimetric parameters for the target volume and critical normal structures were evaluated. Locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Results: The median mean doses to the PTV{sub 50} and PTV{sub 40} were 53.2 Gy and 43.0 Gy, respectively. Only 1.4% of the PTV{sub 50} and 0.9% of the PTV{sub 40} received less than 95% of the prescribed dose, indicating excellent target coverage. The average mean doses to the left and right parotid glands were 27.7 and 28.4 Gy, respectively. The 2-year OS, PFS, and LRC rates were 71.2%, 57.4%, and 87.8%. Most acute toxicities were grade 1 to 2, except for grade ≥3 dysphagia and mucositis. The most common late toxicity was grade 1-2 xerostomia, and no patient developed any ≥grade 3 late toxicities. A correlation between the mean dose to the parotid glands and the degree of late xerostomia was observed. Conclusions: IMRT achieves excellent target coverage and dose conformity, as well as favorable survival and locoregional control rates with acceptable toxicities in patients with WR-NKTCL.

  11. Bath Breakfast Project (BBP - Examining the role of extended daily fasting in human energy balance and associated health outcomes: Study protocol for a randomised controlled trial [ISRCTN31521726

    Directory of Open Access Journals (Sweden)

    Jeans Matthew

    2011-07-01

    Full Text Available Abstract Background Current guidance regarding the role of daily breakfast in human health is largely grounded in cross-sectional observations. However, the causal nature of these relationships has not been fully explored and what limited information is emerging from controlled laboratory-based experiments appears inconsistent with much existing data. Further progress in our understanding therefore requires a direct examination of how daily breakfast impacts human health under free-living conditions. Methods/Design The Bath Breakfast Project (BBP is a randomised controlled trial comparing the effects of daily breakfast consumption relative to extended fasting on energy balance and human health. Approximately 70 men and women will undergo extensive laboratory-based assessments of their acute metabolic responses under fasted and post-prandial conditions, to include: resting metabolic rate, substrate oxidation, dietary-induced thermogenesis and systemic concentrations of key metabolites/hormones. Physiological and psychological indices of appetite will also be monitored both over the first few hours of the day (i.e. whether fed or fasted and also following a standardised test lunch used to assess voluntary energy intake under controlled conditions. Baseline measurements of participants' anthropometric characteristics (e.g. DEXA will be recorded prior to intervention, along with an oral glucose tolerance test and acquisition of adipose tissue samples to determine expression of key genes and estimates of tissue-specific insulin action. Participants will then be randomly assigned either to a group prescribed an energy intake of ≥3000 kJ before 1100 each day or a group to extend their overnight fast by abstaining from ingestion of energy-providing nutrients until 1200 each day, with all laboratory-based measurements followed-up 6 weeks later. Free-living assessments of energy intake (via direct weighed food diaries and energy expenditure (via

  12. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    Science.gov (United States)

    Elliott, Naomi; Begley, Cecily; Kleinpell, Ruth; Higgins, Agnes

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners. In many countries, advanced practitioners in nursing and midwifery have responsibility as leaders for health care development, but without having leadership outcome measures available they are unable to demonstrate the results of their activities. In Ireland, a sequential mixed method research study was used to develop a validated tool for the evaluation of clinical specialists and advanced practitioners. Despite strong evidence of leadership activities, few leadership-specific outcomes were generated from the primary analysis. Secondary analysis of a multiple case study data set. Data set comprised 23 case studies of advanced practitioner/clinical specialists from 13 sites across each region in Ireland from all divisions of the Nursing Board Register. Data were collected 2008-2010. Data sources included non-participant observation (n = 92 hours) of advanced practitioners in practice, interviews with clinicians (n = 21), patients (n = 20) and directors of nursing/midwifery (n = 13) and documents. Analysis focused on leadership outcome-indicator development in line with the National Health Service's Good Indicators Guide. The four categories of leadership outcomes for advanced practitioner developed were as follows: (i) capacity and capability building of multidisciplinary team; (ii) measure of esteem; (iii) new initiatives for clinical practice and healthcare delivery; and (iv) clinical practice based on evidence. The proposed set of leadership outcome-indicators derived from a secondary analysis captures the complexity of leadership in practice. They add to existing clinical outcomes measuring advanced practice. © 2013 John Wiley & Sons Ltd.

  13. Parents Suggest Which Indicators of Progress and Outcomes Should Be Measured in Young Children with Autism Spectrum Disorder

    Science.gov (United States)

    McConachie, Helen; Livingstone, Nuala; Morris, Christopher; Beresford, Bryony; Le Couteur, Ann; Gringras, Paul; Garland, Deborah; Jones, Glenys; Macdonald, Geraldine; Williams, Katrina; Parr, Jeremy R.

    2018-01-01

    Evaluation of interventions for children with autism spectrum disorder (ASD) is hampered by the multitude of outcomes measured and tools used. Measurement in research with young children tends to focus on core impairments in ASD. We conducted a systematic review of qualitative studies of what matters to parents. Parent advisory groups completed…

  14. CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.

    Science.gov (United States)

    Pallesen, Lars P; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik Jrj; Algra, Ale; Kapelle, L Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M; Schonewille, Wouter; Puetz, Volker

    2017-02-01

    Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

  15. Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

    International Nuclear Information System (INIS)

    Guckenberger, Matthias; Alexandrow, Nikolaus; Flentje, Michael

    2012-01-01

    To analyze long-term results of radiotherapy alone for stage I-III low grade follicular lymphoma and to compare outcome after extended field irradiation (EFI) and total nodal irradiation (TNI). Between 1982 and 2007, 107 patients were treated with radiotherapy alone for low grade follicular lymphoma at Ann Arbor stage I (n = 50), II (n = 36) and III (n = 21); 48 and 59 patients were treated with EFI and TNI, respectively. The median total dose in the first treatment series of the diaphragmatic side with larger lymphoma burden was 38 Gy (25 Gy – 50 Gy) and after an interval of median 30 days, a total dose of 28 Gy (12.6 Gy – 45 Gy) was given in the second treatment series completing TNI. After a median follow-up of 14 years for living patients, 10-years and 15-years overall survival (OS) were 64% and 50%, respectively. Survival was not significantly different between stages I, II and III. TNI and EFI resulted in 15-years OS of 65% and 34% but patients treated with TNI were younger, had better performance status and higher stage of disease compared to patients treated with EFI. In multivariate analysis, only age at diagnosis (p < 0.001, relative risk [RR] 1.06) and Karnofsky performance status (p = 0.04, RR = 0.96) were significantly correlated with OS. Freedom from progression (FFP) was 58% and 56% after 10-years and 15-years, respectively. Recurrences outside the irradiated volume were significantly reduced after TNI compared to EFI; however, increased rates of in-field recurrences and extra-nodal out-of-field recurrence counterbalanced this effect resulting in no significant difference in FFP between TNI and EFI. In univariate analysis, FFP was significantly improved in stage I compared to stage II but no differences were observed between stages I/II and stage III. In multivariate analysis no patient or treatment parameter was correlated with FFP. Acute toxicity was significantly increased after TNI compared to EFI with a trend to increased late toxicity as

  16. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals

    Science.gov (United States)

    Mumford, Virginia; Greenfield, David; Hogden, Anne; Debono, Deborah; Gospodarevskaya, Elena; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-01-01

    Objectives The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. Design A retrospective, longitudinal, multisite comparative survey. Setting Acute public hospitals in New South Wales, Australia. Participants 96 acute hospitals with accreditation survey results from two surveys during 2009–2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Outcomes Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010–2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Results Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010–2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (phand hygiene rates, accreditation outcomes and infection control scores is less clear. Conclusions Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection

  17. If patient-reported outcome measures are considered key health-care quality indicators, who is excluded from participation?

    Science.gov (United States)

    Kroll, Thilo; Wyke, Sally; Jahagirdar, Deepa; Ritchie, Karen

    2014-10-01

    Patient-reported outcome measures have received increasing attention with regard to ensuring quality improvement across the health service. However, there is a risk that people with disabilities and low literacy are systematically excluded from the development of these measures as well as their application in clinical practice. This editorial highlights some of these risks and the potential consequences of exclusion for these groups. © 2012 John Wiley & Sons Ltd.

  18. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study

    NARCIS (Netherlands)

    Visser, G.H.A.; Bilardo, Caterina M.; Derks, J. B.; Ferrazzi, E.; Fratelli, Nicola; Frusca, T.; Ganzevoort, W.; Lees, Christoph C.; Napolitano, Raffaele; Todros, T.; Wolf, H.; Hecher, K.; Marlow, N.; Arabin, B.; Brezinka, C.; Diemert, A.; Duvekot, Johannes J.; Martinelli, P.; Ostermayer, E.; Papageorghiou, Aris T.; Schlembach, D.; Schneider, K. T M; Thilaganathan, B.; Valcamonico, A.; Aktas, Ayse; Borgione, Silvia; Chaoui, Rabih; Cornette, Jerome M J; Diehl, Thilo; van Eyck, J.; van Haastert, I. C.; Kingdom, J.C.; Lobmaier, Silvia; Lopriore, E.; Missfelder-Lobos, Hannah; Mansi, Giuseppina; Martelli, Paola; Maso, Gianpaolo; Marsal, K.; Maurer-Fellbaum, Ute; Mensing van Charante, N.; Mulder-De Tollenaer, Susanne; Oberto, Manuela; Oepkes, D.; Ogge, Giovanna; van der Post, Joris A. M.; Prefumo, Federico; Preston, Lucy; Raimondi, Francesco; Rattue, H.; Reiss, Irwin K M; Scheepers, L. S.; Skabar, Aldo; Spaanderman, M.; Thornton, J.G.; Valensise, H.; Weisglas-Kuperus, N.; Zimmermann, Andrea

    2017-01-01

    Objective: In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR)

  19. Indications and Outcomes for Microfracture as an Adjunct to Hip Arthroscopy for Treatment of Chondral Defects in Patients With Femoroacetabular Impingement: A Systematic Review.

    Science.gov (United States)

    MacDonald, Austin E; Bedi, Asheesh; Horner, Nolan S; de Sa, Darren; Simunovic, Nicole; Philippon, Marc J; Ayeni, Olufemi R

    2016-01-01

    To evaluate the indications, preoperative workup outcomes, and postoperative rehabilitation of patients with femoroacetabular impingement (FAI) receiving microfracture as an adjunct to hip arthroscopy for chondral defects. The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving patients with FAI treated arthroscopically with microfracture of the hip for chondral defects either solely or as an adjunct to hip arthroscopy. Data regarding indications, investigations, outcomes, and postoperative rehabilitation were abstracted from eligible studies. The references of included studies were additionally searched, and descriptive statistics are provided. There were 12 studies included in this review, involving 267 patients. With the exception of a single, one-patient case report, 11 of the 12 studies reported positive outcomes after hip arthroscopy with microfracture. Only 0.7% of the total patients experienced a complication, and 1.1% required further surgery on the basis of outcomes evaluated at a mean follow-up of 29.5 (range, 4 to 60) months across the studies. Eight of 12 studies discussed the preoperative workup of these patients, with X-rays and magnetic resonance imaging being the most common preoperative imaging used. There was little reported on weight-bearing status during postoperative rehabilitation. The outcomes reported in the literature after hip arthroscopy with microfracture for chondral defects are, in general, positive, with a very low percentage of patients requiring further surgery or experiencing complications. The most common indication used in the literature for microfracture is a full-thickness, focal chondral defect (Outerbridge grade IV). The vast majority of literature recommends limited weight bearing after microfracture; however, there was significant variation among the specific rehabilitation protocols used. More research is needed to explore what indications and postoperative

  20. Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery: A single center pilot study.

    Science.gov (United States)

    Jenks, Christopher L; Hernandez, Ana; Stavinoha, Peter L; Morris, Michael C; Tian, Fenghua; Liu, Hanli; Garg, Parvesh; Forbess, Joseph M; Koch, Joshua

    To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Outcomes and indications for intervention in non-operative management of paediatric liver trauma: A 5 year retrospective study

    International Nuclear Information System (INIS)

    Inchingolo, R.; Ljutikov, A.; Deganello, A.; Kane, P.; Karani, J.

    2014-01-01

    Aim: To determine the applicability of accurate computed tomography (CT) evaluation and embolization as non-operative management for liver trauma in a paediatric population. Material and methods: A retrospective observational study of 37 children (mean age 10.5 years) with hepatic trauma (28 blunt, 9 penetrating) admitted to a trauma referral centre over a 5 year period. All patients were evaluated with CT and scored with an Association for the Surgery of Trauma score. Inpatient information was reviewed for demographics, associated injuries, modes of management, efficacy and complications of management, and outcome. Statistical analysis was performed. Results: There were seven contusions, two grade I, two grade II, nine grade III, and 17 grade IV liver lacerations. Only two patients (grade IV, penetrating) underwent surgery for the management of bowel perforation. All children had non-surgical treatment of their liver trauma: three cases (grade IV) had primary angiography due to CT evidence of active bleeding and embolization was performed in two of these. Seven patients (two grade III, five grade IV) had angiography during the follow-up for evidence of a complicating pseudoaneurysm and embolization was performed in six of them. Embolization was successful in all the children; one minor complication occurred (cholecystitis). Endoscopic retrograde cholangiopancreatography (ERCP) plus stenting was performed in two cases for a bile leak. All 37 children had a positive outcome. Conclusion: The present study demonstrates that non-operative management of hepatic trauma is applicable to children and may have a higher success rate than in adults

  2. Use of the Satinsky clamp for hilar clamping during robotic partial nephrectomy: indications, technique, and multi-center outcomes.

    Science.gov (United States)

    Abdullah, Newaj; Rahbar, Haider; Barod, Ravi; Dalela, Deepansh; Larson, Jeff; Johnson, Michael; Mass, Alon; Zargar, Homayoun; Kaouk, Jihad; Allaf, Mohamad; Bhayani, Sam; Stifelman, Michael; Rogers, Craig

    2017-03-01

    A Satinsky clamp may be a backup option for hilar clamping during robotic partial nephrectomy (RPN) if there are challenges with application of bulldog clamps, but there are potential safety concerns. We evaluate outcomes of RPN using Satinsky vs. bulldog clamps, and provide tips for safe use of the Satinsky as a backup option. Using a multi-center database, we identified 1073 patients who underwent RPN between 2006 and 2013, and had information available about method of hilar clamping (bulldog clamp vs. Satinsky clamp). Patient baseline characteristics, tumor features, and perioperative outcomes were compared between the Satinsky and bulldog clamp groups. A Satinsky clamp was used for hilar clamping in 94 (8.8 %) RPN cases, and bulldog clamps were used in 979 (91.2 %) cases. The use of a Satinsky clamp was associated with greater operative time (198 vs. 175 min, p hilar clamping during challenging RPN cases, but requires careful technique, and was rarely necessary.

  3. Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long-term follow-up.

    Science.gov (United States)

    Sohn, Seo Young; Kim, Hye In; Kim, Young Nam; Kim, Tae Hyuk; Kim, Sun Wook; Chung, Jae Hoon

    2018-02-01

    Distant metastases, although uncommon, represent maximum disease-related mortality in differentiated thyroid carcinoma (DTC). Lungs are the most frequent sites of metastases. We aimed to evaluate long-term outcomes and identify prognostic factors in metastatic DTC limited to the lungs. This retrospective study included 89 patients with DTC and metastases limited to the lungs, who were treated between 1996 and 2012 at Samsung Medical Center. Progression-free survival (PFS) and cancer-specific survival (CSS) rates were evaluated according to clinicopathologic factors. Cox regression analysis was used to identify independent factors associated with structural progressive disease (PD) and cancer-specific death. With a median follow-up of 84 months, the 5- and 10-year CSS rates were 78% and 73%, respectively. Older age at diagnosis (≥55 years), radioactive iodine (RAI) nonavidity, preoperative or late diagnosis of metastasis and macro-nodular metastasis (≥1 cm) were predictive of decreased PFS and CSS. Multivariate analysis identified older age (P = .002), RAI nonavidity (P = .045) and preoperative (P = .030) or late diagnosis (P = .026) as independent predictors of structural PD. RAI avidity was also independent predictor of cancer-specific death (P = .025). Patients with DTC and metastatic disease limited to the lungs had favourable long-term outcomes. Age, RAI avidity and timing of metastasis were found to be major factors for predicting prognosis. © 2017 John Wiley & Sons Ltd.

  4. Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity.

    Directory of Open Access Journals (Sweden)

    Maria Hoeltzenbein

    Full Text Available Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7% and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3-40 were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.

  5. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    LENUS (Irish Health Repository)

    Owens, C

    2012-02-01

    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  6. Extended thermodynamics

    CERN Document Server

    Müller, Ingo

    1993-01-01

    Physicists firmly believe that the differential equations of nature should be hyperbolic so as to exclude action at a distance; yet the equations of irreversible thermodynamics - those of Navier-Stokes and Fourier - are parabolic. This incompatibility between the expectation of physicists and the classical laws of thermodynamics has prompted the formulation of extended thermodynamics. After describing the motifs and early evolution of this new branch of irreversible thermodynamics, the authors apply the theory to mon-atomic gases, mixtures of gases, relativistic gases, and "gases" of phonons and photons. The discussion brings into perspective the various phenomena called second sound, such as heat propagation, propagation of shear stress and concentration, and the second sound in liquid helium. The formal mathematical structure of extended thermodynamics is exposed and the theory is shown to be fully compatible with the kinetic theory of gases. The study closes with the testing of extended thermodynamics thro...

  7. Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women.

    Science.gov (United States)

    Chambers, Brittany D; Erausquin, Jennifer Toller; Tanner, Amanda E; Nichols, Tracy R; Brown-Jeffy, Shelly

    2017-12-07

    Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009-2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.

  8. Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): nutrition guidelines, indicators, and practices.

    Science.gov (United States)

    Combe, Christian; McCullough, Keith P; Asano, Yasushi; Ginsberg, Nancy; Maroni, Bradley J; Pifer, Trinh B

    2004-11-01

    Nutritional markers are important predictors of morbidity and mortality in dialysis patients. The Clinical Practice Guidelines for Nutrition in Chronic Renal Failure provides guidelines for assessing nutritional status that were evaluated using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS). The level of various nutritional markers (serum albumin, modified subjective global assessment, serum creatinine, normalized protein catabolic rate [nPCR], and body mass index) were described for representative samples of patients and facilities from 7 countries (France, Germany, Italy, Spain, Japan, United Kingdom, and United States) participating in the DOPPS. A strong inverse association was observed between mortality and serum albumin, with a mortality risk 1.38 times higher for patients with serum albumin concentration less than 3.5 g/dL (35 g/L). There were significant differences by country in the proportion of moderately and severely malnourished patients as determined by the modified subjective global assessment score. In the US sample, severely and moderately malnourished patients had a higher mortality risk compared with those not malnourished, 33% and 5% higher, respectively. An inverse relationship exists between serum creatinine concentration and mortality, with a mortality risk 60% to 70% higher in the lowest quartile group compared with the highest quartile group in Europe and the United States. Levels of nPCR varied significantly between European countries, and there was no association between mortality and nPCR in US data. After adjustment for demographic and comorbidity factors, the mortality risk decreased as body mass index increased in both US and European samples. DOPPS data highlight the importance of routine assessment of nutritional status, using multiple parameters, in clinical practice to improve patient care.

  9. The marketing plan and outcome indicators for recruiting and retaining parents in the HomeStyles randomized controlled trial.

    Science.gov (United States)

    Byrd-Bredbenner, Carol; Delaney, Colleen; Martin-Biggers, Jennifer; Koenings, Mallory; Quick, Virginia

    2017-11-15

    Despite the critical importance of successful recruitment and retention to study integrity, reporting of recruitment and retention strategies along with factors associated with successful recruitment and retention of participants in health-related interventions remain rare, especially for health and obesity prevention programs. Thus, the purpose of this article is to retrospectively examine the recruitment and retention marketing plan used in the online HomeStyles randomized controlled trial (RCT) and discuss outcomes associated with completion of the intervention. The HomeStyles RCT is an online intervention developed to motivate parents of young children to gain the skills and self-confidence needed to shape home environments and lifestyles to be protective against childhood obesity. Using the seven Ps of services marketing (i.e., people, place, product, physical evidence, price, promotion, and process), a comprehensive and systematic plan for recruitment and retention was implemented and outcomes assessed. A total of 489 parents with a young child aged 2 to attractiveness, interestingness, and usefulness. Despite all the retention efforts, the average monthly recruitment accrual rate of ~ 33 eligible enrolled participants at baseline (i.e., 489 participants/15-month recruitment period), declined to ~ 18, 11, 9, and 8 remaining recruited participants/month at midpoint, post, follow-up, and long-term follow-up surveys, respectively. In general, survey completers were significantly more likely to be female and perceived their child's health status to be better, and they were significantly less likely to be restrictive of their child's food intake. The findings of the present study highlight the need for far-reaching, concentrated, and varied recruitment strategies; sufficient time in the research plan for recruitment and retention activities; and creative, tireless, flexible, persistent project staff for health-related interventions.

  10. Extended family medicine training

    Science.gov (United States)

    Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.

    2016-01-01

    Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of

  11. Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial.

    Science.gov (United States)

    Tita, Alan T; Doherty, Lindsay; Roberts, Jim M; Myatt, Leslie; Leveno, Kenneth J; Varner, Michael W; Wapner, Ronald J; Thorp, John M; Mercer, Brian M; Peaceman, Alan; Ramin, Susan M; Carpenter, Marshall W; Iams, Jay; Sciscione, Anthony; Harper, Margaret; Tolosa, Jorge E; Saade, George R; Sorokin, Yoram

    2018-06-01

     To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).  A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.  Of 9,867 women, 10.4% ( N  = 1,038) were PTBs; 32.7% ( n  = 340) IPTBs and 67.3% ( n  = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB-4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4-11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1-3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times).  Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Indications for and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury.

    Science.gov (United States)

    Fouda, E; Emile, S; Elfeki, H; Youssef, M; Ghanem, A; Fikry, A A; Elshobaky, A; Omar, W; Khafagy, W; Morshed, M

    2016-08-01

    Injuries of the colon are a serious sequel of abdominal trauma owing to the associated morbidity and mortality. This study aims to assess postoperative outcome and complications of faecal diversion and primary repair of colon injuries when applied according to established guidelines for the management of colon injuries. This retrospective study was conducted on 110 patients with colon injuries. Guided by estimation of risk factors, patients were managed either by primary repair alone, repair with proximal diversion or diversion alone. There were 102 (92.7%) male patients and 8 (7.3%) female patients of median age 38 years. Thirty-seven were managed by primary repair and 73 by faecal diversion. Colon injuries were caused by penetrating abdominal trauma in 65 and blunt trauma in 45 patients. Forty-three patients were in shock on admission, and were all managed by faecal diversion. Forty patients developed 84 complications after surgery. Primary repair had a significantly lower complication rate than faecal diversion (P = 0.037). Wound infection was the commonest complication. The overall mortality rate was 3.6%. Primary repair, when employed properly, resulted in a significantly lower complication rate than faecal diversion. Significant predictive factors associated with a higher complication rate were faecal diversion, severe faecal contamination, multiple colon injuries, an interval of more than 12 h after colon injury and shock. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

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

    Science.gov (United States)

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

    2017-10-01

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

  14. Comparative Study of Pregnancy Outcome in Premature Rupture of Membranes With Amniotic Fluid Indices of less and more than 5

    Directory of Open Access Journals (Sweden)

    F Tavassoli

    2010-03-01

    Full Text Available Introduction: Preterm premature rupture of the membranes (PPROM is one of the most important causes of perinatal morbidity and mortality. The aim of this study was to evaluate pregnancy outcome in preterm premature rupture of the membranes with amniotic fluid index less than 5 and more than 5. Methods: This prospective study was performed on 137 pregnant women with gestational age of 28-34 weeks with PPROM from Oct 2006 to Oct 2008. The patients were divided in two groups according to amniotic fluid index: AFI<5 (77 cases, AFI≥5 (60 cases. Chi-square test was used for qualitative variables, while T-student test was used for quantitative test. Results: Both groups were similar with respect to number of pregnancies, gestational age at rupture of the membranes and birth weight. In the group with AFI<5, applied latency was significantly shorter (PV=0.049, rate of cesarean section was higher due to fetal distress (PV=0.008, neonatal Apgar score in first minute was lower during the first week (PV=0.0127 and the rate of neonatal death was higher (PV=0.045 during the first week. Conclusion: An AFI<5 cm after PPROM is associated with earlier delivery, higher rate of cesarean due to fetal distress, higher rate of neonatal death, and lower neonatal Apgar score in first minute during the first week

  15. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D; Schwarzenberg, Sarah J; Radosevich, David M; Cook, Marie; Dunn, Ty B; Beilman, Gregory J; Freeman, Martin L; Balamurugan, A N; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J; Vickers, Selwyn M; Pruett, Timothy L; Sutherland, David E R

    2014-07-01

    Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients. Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes. Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001). Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.

  16. Extending Puppet

    CERN Document Server

    Franceschi, Alessandro

    2014-01-01

    This book is a clear, detailed and practical guide to learn about designing and deploying you puppet architecture, with informative examples to highlight and explain concepts in a focused manner. This book is designed for users who already have good experience with Puppet, and will surprise experienced users with innovative topics that explore how to design, implement, adapt, and deploy a Puppet architecture. The key to extending Puppet is the development of types and providers, for which you must be familiar with Ruby.

  17. The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden

    Directory of Open Access Journals (Sweden)

    Anders Lars Anell

    2014-12-01

    Full Text Available Background: A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P schemes by both national and local governments to support developments.Objective: To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.Method: Data were collected from the Region Skåne county council. Eight primary care providers and associated community services were compared in a ranking exercise based on information from interviews and registered data. Registered data from 150 primary care providers were analysed in regression models.Results and conclusion: Both the ranking exercise and regression models revealed important problems related to risk-adjustment, attribution, randomness and measurement fixation when using indicators in P4P schemes and for external accountability purposes. Instead of using indicators in incentive schemes targeting individual providers, indicators may be used for diagnostic purposes and to support development of new knowledge, targeting local systems that move beyond organizational boundaries.

  18. A 12-year-experience with tracheostomy for neonates and infants in northern Taiwan: Indications, hospital courses, and long-term outcomes

    Directory of Open Access Journals (Sweden)

    Chia-Huei Chen

    2018-04-01

    Full Text Available Background: Tracheostomy is a valuable procedure in infants and neonates with chronic respiratory failure or severe airway obstruction. The aim of this study is to identify the indication, hospital course, and long-term outcome in a cohort of infants who required tracheostomy in a neonatal and pediatric tertiary care center in northern Taiwan. Methods: Medical records of infants, who underwent tracheostomy between January 2002 and December 2013, were retrospectively reviewed. Demographics, indication for tracheostomy, hospital course, discharge disposition, further hospitalization and surgery, and long-term outcome data were collected. Results: Fifty-six patients were enrolled. The median gestational age was 38.0 weeks, and median birth weight was 2770 g. he median age at tracheostomy was 104.5 days. The primary indications for tracheostomy were airway obstruction in 35 patients (62.5%, craniofacial anomalies in 7 (12.5%, neuromuscular disorder in 7 (12.5%, cardiopulmonary disorder in 5 (8.9%, and brain injury-related problem in 2 (3.6%. Twenty-two patients (39.3% were decannulated successfully, and the median time from tracheostomy to decannulation was 2.1 years. Overall mortality rate was 3.6%, but no death was related to tracheostomy. Forty-nine patients underwent regular follow-up at our hospital, and 46 patients (93.9% required further hospitalization, and 30 (61.2% underwent further surgery related to a respiratory problem or tracheostomy. Ratio of delayed growth at the time of tracheostomy (28.6% did not have significant difference at 1 year of age (21.4% and 2 years of age (25.0%. Conclusion: In this study, the most common indication for tracheostomy in neonates and infants was airway obstruction. Excluding patients with neuromuscular diseases, a successful decannulation rate of >50% can be achieved. Key Words: decannulation, indication, infant, outcome, tracheostomy

  19. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping of talar osteochondral lesions: Indicators of clinical outcomes.

    Science.gov (United States)

    Rehnitz, Christoph; Kuni, Benita; Wuennemann, Felix; Chloridis, Dimitrios; Kirwadi, Anand; Burkholder, Iris; Kauczor, Hans-Ulrich; Weber, Marc-André

    2017-12-01

    To evaluate the utility of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T 2 mapping in evaluation of type II osteochondral lesions (OCLs) of the talus and define cutoff values for identifying patients with good/poor clinical outcomes. 28 patients (mean age, 42.3 years) underwent T 2 mapping and dGEMRIC at least 1.5 years (mean duration, 3.5 years) after microfracture (n = 12) or conservative (n = 16) treatment for type II OCL. Clinical outcomes were considered good with an American Orthopedic Foot and Ankle Society score ≥80. The T 1 /T 2 -values and indices of repair tissue (RT; cartilage above the OCL) were compared to those of the adjacent normal cartilage (NC) by region-of-interest analysis. The ability of the two methods to discriminate RT from NC was determined by area under the receiver operating characteristics curve (AUC) analysis. The Youden index was maximized for T 1 /T 2 measures for identifying cutoff values indicative of good/poor clinical outcomes. Repair tissue exhibited lower dGEMRIC values (629.83 vs. 738.51 msec) and higher T 2 values (62.07 vs. 40.69 msec) than NC (P < 0.001). T 2 mapping exhibited greater AUC than dGEMRIC (0.88 vs. 0.69; P = 0.0398). All T 1 measures exhibited higher maximized Youden indices than the corresponding T 2 measures. The highest maximized Youden index for T 1difference was observed at a cutoff value of 84 msec (sensitivity, 78%; specificity, 83%). While T 2 mapping is superior to dGEMRIC in discriminating RT, the latter better identifies good/poor clinical outcomes in patients with type II talar OCL. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1601-1610. © 2017 International Society for Magnetic Resonance in Medicine.

  20. Arginase II expressed in cancer-associated fibroblasts indicates tissue hypoxia and predicts poor outcome in patients with pancreatic cancer.

    Directory of Open Access Journals (Sweden)

    Yoshinori Ino

    Full Text Available An adequate level of arginine in the tissue microenvironment is essential for T cell activity and survival. Arginine levels are regulated by the arginine-catabolizing enzyme, arginase (ARG. It has been reported that arginase II (ARG2, one of two ARGs, is aberrantly expressed in prostate cancer cells, which convert arginine into ornithine, resulting in a lack of arginine that weakens tumor-infiltrating lymphocytes and renders them dysfunctional. However, immune suppression mediated by ARG2-expressing cancer cells in lung cancer has not been observed. Here we studied the expression of ARG2 in pancreatic ductal carcinoma (PDC tissue clinicopathologically by examining over 200 cases of PDC. In contrast to prostate cancer, ARG2 expression was rarely demonstrated in PDC cells by immunohistochemistry, and instead ARG2 was characteristically expressed in α-smooth muscle actin-positive cancer-associated fibroblasts (CAFs, especially those located within and around necrotic areas in PDC. The presence of ARG2-expressing CAFs was closely correlated with shorter overall survival (OS; P  = 0.003 and disease-free survival (DFS; P  = 0.0006. Multivariate Cox regression analysis showed that the presence of ARG2-expressing CAFs in PDC tissue was an independent predictor of poorer OS (hazard ratio [HR]  = 1.582, P  = 0.007 and DFS (HR  = 1.715, P  = 0.001 in PDC patients. In addition to the characteristic distribution of ARG2-expressing CAFs, such CAFs co-expressed carbonic anhydrase IX, SLC2A1, or HIF-1α, markers of hypoxia, in PDC tissue. Furthermore, in vitro experiments revealed that cultured fibroblasts extracted from PDC tissue expressed the ARG2 transcript after exposure to hypoxia, which had arginase activity. These results indicate that cancer cell-mediated immune suppression through ARG2 expression is not a general event and that the presence of ARG2-expressing CAFs is an indicator of poor prognosis, as well as hypoxia, in PDC

  1. [Quality of care in nursing homes: a review of literature regarding structure, process and outcome indicators related to the risk of malnutrition].

    Science.gov (United States)

    Lorini, C; Mencacci, M; Bonaccorsi, G

    2012-01-01

    The admissions and the demands for entering nursing homes (NHs) are gradually increasing. Focusing on the quality of care in NHs, the risk of protein- calorie malnutrition has a key role. The purpose of this paper is to select and describe structure, process of care and outcome indicators, as well as individual risk factors (confounders), related to malnutrition in NHs. We have analyzed scientific articles found in MEDLINE, published from 2000 to 2011, identified through four different string selections. 505 articles have been collected, 17 of whom were chosen because they included specific malnutrition indicators in the framework of quality of care indicators. Three papers specifically deal with malnutrition as one of the elements of the quality of care in NHs linked to structure, processes and outcome. From this review, it clearly emerges that scientific articles addressing malnutrition as one of the requirements of healthcare quality in NHs are scarce, compared with a rather large number of publications concerning the prevalence and/or the description of interventions related to--and made to solve or reduce--malnutrition already in place. It is therefore necessary to spread the culture and the approach of nutritional risk analysis within the systems aimed at evaluating the quality of care in NHs, by selecting and monitoring appropriate malnutrition indicators.

  2. A multicenter prospective study of neonatal outcomes at less than 32 weeks associated with indications for maternal admission and delivery.

    Science.gov (United States)

    Garite, Thomas J; Combs, C Andrew; Maurel, Kimberly; Das, Anita; Huls, Kevin; Porreco, Richard; Reisner, Dale; Lu, George; Bush, Melissa; Morris, Bruce; Bleich, April

    2017-07-01

    Counseling for patients with impending premature delivery traditionally has been based primarily on the projected gestational age at delivery. There are limited data regarding how the indications for the preterm birth affect the neonatal outcome and whether this issue should be taken into account in decisions regarding management and patient counseling. We performed a prospective study of pregnancies resulting in premature delivery at less than 32 weeks to determine the influence of both the indications for admission and their associated indications for delivery on neonatal mortality and complications of prematurity. This is a multicenter, prospective study in 10 hospitals where all data from the neonatal intensive care unit routinely was imported to a deidentified data warehouse. Maternal data were collected prospectively at or near the time of delivery. Eligible subjects included singleton deliveries in these hospitals between 23 0/7 and 31 6/7 weeks. The primary hypothesis of the study was to determine whether there was a difference in the primary outcome, which was defined as neonatal composite morbidity, between those neonates delivered after admission for premature labor vs premature rupture of membranes, because these were expected to be the 2 most frequent diagnoses leading to premature birth. The sample size was calculated based on a 10% difference in outcomes for these 2 entities. We based this hypothesis on the knowledge that premature rupture of membranes has a greater incidence of intra-amniotic infection and inflammation than premature labor and that outcomes for premature neonates are worse when delivery is associated with intra-amniotic infection. Additional outcomes were analyzed for all other indications for admission and delivery. Composite morbidity was defined as ≥1 of the following: respiratory distress syndrome (oxygen requirement, clinical diagnosis, and consistent chest radiograph), bronchopulmonary dysplasia (requirement for oxygen

  3. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes.

    Science.gov (United States)

    Brauchli, Rebecca; Jenny, Gregor J; Füllemann, Désirée; Bauer, Georg F

    2015-01-01

    Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate-selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

  4. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes

    Directory of Open Access Journals (Sweden)

    Rebecca Brauchli

    2015-01-01

    Full Text Available Studies using the Job Demands-Resources (JD-R model commonly have a heterogeneous focus concerning the variables they investigate—selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

  5. Gene Expression Profiling to Predict Clinical Outcome of Breast Cancer: reproducing, analyzing and extending the Nature publication by vhVeer et al

    NARCIS (Netherlands)

    Li R.; Visser, H.M.

    2010-01-01

    Chemotherapy and hormonal therapy as adjuvant systemic therapies to inhibit breast cancer recurrence are not necessary for each patient. In Veer's paper "Gene expression profiling predicts clinical outcome of breast cancer" (Nature 2002, PMID: 11823860), they introduced a method based on DNA

  6. A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Wang BZ

    2013-03-01

    Full Text Available Bob Z Wang, Elsie Chan, Rasik B Vajpayee The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia Background: The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR insertion during cataract surgery. Methods: A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient's demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained. Results: Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0% did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%. An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%. Postoperatively, the most common complications were a decentered intraocular lens (8.3% and persistent corneal edema (6.0%. Overall, 61 eyes (72.6% had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8% achieving vision of 20/40 or better. Conclusion: For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability. Keywords: capsular tension ring, cataract extraction, indications, outcomes

  7. Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends

    Directory of Open Access Journals (Sweden)

    Streppel Marjolijn

    2010-02-01

    Full Text Available Abstract Background In our region (Eastern South Limburg, The Netherlands an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1 to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP; (2 to analyse changes in indications and outcomes over the years. Methods (1 Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management (response rate 83% of 625 consecutive patients (Dec. 2002 - March 2007 were analysed cross-sectionally. (2 For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 (n = 1001 were compared. Results The echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea (32%, cardiac murmur (59%, and peripheral oedema (17%. Of the other indications (22%, one-third was for evaluation of suspected left ventricular hypertrophy (LVH. Expected outcomes were left ventricular dysfunction (LVD (43%, predominantly diastolic and valve disease (25%. We also found a high proportion of LVH (50%. Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist's advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for 'cardiac murmur' and 'other' indications, but less for 'dyspnoea'. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased. Conclusion Overall, GPs used the open access echocardiography service efficiently (i.e. with a high chance of finding relevant pathology

  8. Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends.

    Science.gov (United States)

    van Heur, Leanne M S G; Baur, Leo H B; Tent, Marleen; Lodewijks-van der Bolt, Cara L B; Streppel, Marjolijn; Winkens, Ron A G; Stoffers, Henri E J H

    2010-02-10

    In our region (Eastern South Limburg, The Netherlands) an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1) to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP); (2) to analyse changes in indications and outcomes over the years. (1) Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management (response rate 83%) of 625 consecutive patients (Dec. 2002-March 2007) were analysed cross-sectionally. (2) For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 (n = 1001) were compared. The echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea (32%), cardiac murmur (59%), and peripheral oedema (17%). Of the other indications (22%), one-third was for evaluation of suspected left ventricular hypertrophy (LVH). Expected outcomes were left ventricular dysfunction (LVD) (43%, predominantly diastolic) and valve disease (25%). We also found a high proportion of LVH (50%). Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist's advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for 'cardiac murmur' and 'other' indications, but less for 'dyspnoea'. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased. Overall, GPs used the open access echocardiography service efficiently (i.e. with a high chance of finding relevant pathology), but efficiency decreased slightly over the years

  9. Consciousness extended

    DEFF Research Database (Denmark)

    Carrara-Augustenborg, Claudia

    2012-01-01

    There is no consensus yet regarding a conceptualization of consciousness able to accommodate all the features of such complex phenomenon. Different theoretical and empirical models lend strength to both the occurrence of a non-accessible informational broadcast, and to the mobilization of specific...... brain areas responsible for the emergence of the individual´s explicit and variable access to given segments of such broadcast. Rather than advocating one model over others, this chapter proposes to broaden the conceptualization of consciousness by letting it embrace both mechanisms. Within...... such extended framework, I propose conceptual and functional distinctions between consciousness (global broadcast of information), awareness (individual´s ability to access the content of such broadcast) and unconsciousness (focally isolated neural activations). My hypothesis is that a demarcation in terms...

  10. What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges.

    Science.gov (United States)

    Meier, Frederick A; Badrick, Tony C; Sikaris, Kenneth A

    2018-02-17

    For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal

  11. The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

    Science.gov (United States)

    Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

    2014-12-01

    In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.

  12. Older Adults With a Combination of Vision and Hearing Impairment Experience Higher Rates of Cognitive Impairment, Functional Dependence, and Worse Outcomes Across a Set of Quality Indicators.

    Science.gov (United States)

    Davidson, Jacob G S; Guthrie, Dawn M

    2017-08-01

    Hearing and vision impairment were examined across several health-related outcomes and across a set of quality indicators (QIs) in home care clients with both vision and hearing loss (or dual sensory impairment [DSI]). Data collected using the Resident Assessment Instrument for Home Care (RAI-HC) were analyzed in a sample of older home care clients. The QIs represent the proportion of clients experiencing negative outcomes (e.g., falls, social isolation). The average age of clients was 82.8 years ( SD = 7.9), 20.5% had DSI and 8.5% had a diagnosis of Alzheimer's disease (AD). Clients with DSI were more likely to have a diagnosis of dementia (not AD), have functional impairments, report loneliness, and have higher rates across 20 of the 22 QIs, including communication difficulty and cognitive decline. Clients with highly impaired hearing, and any visual impairment, had the highest QI rates. Individuals with DSI experience higher rates of adverse events across many health-related outcomes and QIs. Understanding the unique contribution of hearing and vision in this group can promote optimal quality of care.

  13. A systematic review of the psychosocial outcomes associated with erectile dysfunction: does the impact of erectile dysfunction extend beyond a man's inability to have sex?

    Science.gov (United States)

    McCabe, Marita P; Althof, Stanley E

    2014-02-01

    The aim of this study was to report and analyze the published data from randomized controlled trials (RCTs) for (i) the psychosocial outcomes associated with erectile dysfunction (ED) before treatment with a phosphodiesterase type 5 (PDE5) inhibitor; and (ii) the change in psychosocial outcomes after the use of a PDE5 inhibitor in men with ED. The method used was a prospectively designed systematic literature review of publications reported in MEDLINE via PubMed, EMBASE, the Cochrane Library, Science Citation Index Expanded, and PsychINFO from January 1, 1995 to May 14, 2012. The main outcome measures were scores on psychosocial measures in men who were treated for ED with a PDE5 inhibitor before and after treatment. A total of 1,714 publications were retrieved; 1,674 publications were excluded because they did not meet the design requirements of the review, and 40 publications (32 RCTs) were retained. Before treatment, men who participated in clinical trials reported relatively good quality of life and overall relationships, but poor sexual relationships and sexual satisfaction, diminished confidence, low self-esteem, and symptoms of depression. After treatment, there were significant improvements from baseline in most of these measures, except for overall life satisfaction and overall relationship satisfaction. ED and the treatment of ED are associated with substantially broader aspects of a man's life than just erectile functioning. This review demonstrates the importance of evaluating the psychosocial factors associated with ED and its treatment, and the importance of using standardized scales to conduct this evaluation. Further research is needed to better understand the mechanisms underlying the reciprocal relationships among physical and psychological functioning in men with ED. © 2013 International Society for Sexual Medicine.

  14. Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study.

    Science.gov (United States)

    Michalsen, Andreas; Riegert, Markus; Lüdtke, Rainer; Bäcker, Marcus; Langhorst, Jost; Schwickert, Myriam; Dobos, Gustav J

    2005-12-22

    Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA) or fibromyalgia (FM) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16) or FM (n = 35) were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y) or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y). Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA) were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09). Clinical outcome was not related to alterations in the intestinal flora. Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal

  15. Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study

    Directory of Open Access Journals (Sweden)

    Schwickert Myriam

    2005-12-01

    Full Text Available Abstract Background Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA or fibromyalgia (FM a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. Methods During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16 or FM (n = 35 were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y. Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. Results We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09. Clinical outcome was not related to alterations in the intestinal flora. Conclusion Neither Mediterranean diet nor fasting

  16. Perfusion MRI derived indices of microvascular shunting and flow control correlate with tumor grade and outcome in patients with cerebral glioma

    DEFF Research Database (Denmark)

    Tietze, Anna; Mouridsen, Kim; Lassen-Ramshad, Yasmin

    2015-01-01

    Objectives: Deficient microvascular blood flow control is thought to cause tumor hypoxia and increase resistance to therapy. In glioma patients, we tested whether perfusion-weighted MRI (PWI) based indices of microvascular flow control provide more information on tumor grade and patient outcome...... than does the established PWI angiogenesis marker, cerebral blood volume (CBV). Material and Methods: Seventy-two glioma patients (sixty high-grade, twelve low-grade gliomas) were included. Capillary transit time heterogeneity (CTH) and COV, its ratio to blood mean transit time, provide indices...... of microvascular flow control and the extent to which oxygen can be extracted by tumor tissue. The ability of these parameters and CBV to differentiate tumor grade were assessed by receiver operating characteristic curves and logistic regression. Their ability to predict time to progression and overall survival...

  17. Volatile organic compounds and good laboratory practices in the in vitro fertilization laboratory: the important parameters for successful outcome in extended culture.

    Science.gov (United States)

    Agarwal, Nupur; Chattopadhyay, Ratna; Ghosh, Sanghamitra; Bhoumik, Arpita; Goswami, S K; Chakravarty, Baidyanath

    2017-08-01

    This study aims to describe the role of implementing good laboratory practices to improve in vitro fertilization (IVF) outcomes which are of great interest for practitioners dealing with infertility. Certain modifications were introduced in May 2015 in our IVF laboratory like high-efficiency particulate air CODA system, steel furniture instead of wooden, use of new disinfectants like oosafe, and restriction of personnel entry along with avoidance of cosmetics like perfume to improve pregnancy rates. Volatile organic compound (VOC) meter reading was monitored at two time points and five different places in the laboratory to compare the embryonic development parameters before (group A: July 2014-April 2015) and after (group B: July 2015-April 2016) remodeling. The IVF outcomes from 1036 cycles were associated in this study. Reduction in VOC meter readings, enhanced air quality, improvement in blastocyst formation rate, implantation, and clinical pregnancy rate were observed in the laboratory after implementation of new facilities. Results illustrated that the attention must be focused on potential hazards which expose laboratories to elevated VOC levels. Blastocyst formation rate increased around 18%. Implantation rate, clinical pregnancy rate, and live birth rate increased by around 11, 10, and 8%, respectively. In conclusion, with proper engineering and material selection, we have been able to reduce chemical contamination and adverse effects on culture with optimized IVF results. None.

  18. Impact of Pretransplantation Indices in Hematopoietic Stem Cell Transplantation: Knowledge of Center-Specific Outcome Data Is Pivotal before Making Index-Based Decisions.

    Science.gov (United States)

    Törlén, Johan; Remberger, Mats; Le Blanc, Katarina; Ljungman, Per; Mattsson, Jonas

    2017-04-01

    Outcome after allogeneic hematopoietic stem cell transplantation is influenced by patient comorbidity, disease type, and status before treatment. We performed a retrospective study involving 521 consecutive adult hematopoietic stem cell transplantation patients who underwent transplantation for hematological malignancy at our center from 2000 to 2012 to compare the predictive value of the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) and the disease risk index (DRI) for overall survival and transplantation-related mortality. Patients in the highest HCT-CI risk group (HCT-CI score ≥3) had a lower 5-year overall survival rate (50%) than the low-risk group (63%; P 6 [n = 9]). Five-year overall survival in the highest DRI risk group was significantly poorer (44%) than in the low-risk group (63%; P indices failed to predict differences in transplantation-related mortality (HCT-CI, P = .54; DRI, P = .17). We conclude that HCT-CI and DRI were predictive of overall survival in our patient population. Even so, our data show that different patient groups may have different outcomes despite sharing the same index risk group and that indices should, therefore, be evaluated according to local data before clinical implementation at the single-center level. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  19. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes.

    Science.gov (United States)

    Helminen, Heli; Luukkaala, Tiina; Saarnio, Juha; Nuotio, Maria

    2017-04-01

    Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture. Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type. All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility. All measures were strong indicators of short- and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Two-Year Outcomes of a Treat-and-Extend Regimen Using Intravitreal Aflibercept Injections for Typical Age-Related Macular Degeneration.

    Science.gov (United States)

    Ito, Arisa; Matsumoto, Hidetaka; Morimoto, Masahiro; Mimura, Kensuke; Akiyama, Hideo

    2017-01-01

    The aim of this study was to evaluate the efficacy of a treat-and-extend (TAE) regimen using intravitreal injection of aflibercept (IVA) for typical age-related macular degeneration (tAMD). We retrospectively studied 61 treatment-naïve eyes with tAMD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), number of injections, and complications during 2 years were evaluated. BCVA significantly improved by on average 0.13 logMAR units, and CMT and CCT significantly decreased after 2 years. The number of injections was on average 13.6. In the second year, eyes with classic choroidal neovascularization (CNV) needed significantly fewer treatments than eyes with occult CNV. Fourteen eyes, which developed subfoveal fibrosis, showed significantly poorer BCVA after 2 years. Subfoveal fibrosis was significantly common in classic CNV. A TAE regimen using IVA for tAMD might be effective for improving BCVA and exudative changes. The exudation may be suppressed with fewer treatments in classic CNV compared to occult CNV. © 2017 S. Karger AG, Basel.

  1. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity

    International Nuclear Information System (INIS)

    Vargo, John A.; Verma, Vivek; Kim, Hayeon; Kalash, Ronny; Heron, Dwight E.; Johnson, Ronald; Beriwal, Sushil

    2014-01-01

    Purpose: Accelerated partial breast irradiation (APBI) with balloon and catheter-based brachytherapy has gained increasing popularity in recent years and is the subject of ongoing phase III trials. Initial data suggest promising local control and cosmetic results in appropriately selected patients. Long-term data continue to evolve but are limited outside of the context of the American Society of Breast Surgeons Registry Trial. Methods and Materials: A retrospective review of 157 patients completing APBI after breast-conserving surgery and axillary staging via high-dose-rate 192 Ir brachytherapy from June 2002 to December 2007 was made. APBI was delivered with a single-lumen MammoSite balloon-based applicator to a median dose of 34 Gy in 10 fractions over a 5-day period. Tumor coverage and critical organ dosimetry were retrospectively collected on the basis of computed tomography completed for conformance and symmetry. Results: At a median follow-up time of 5.5 years (range, 0-10.0 years), the 5-year and 7-year actuarial incidences of ipsilateral breast control were 98%/98%, of nodal control 99%/98%, and of distant control 99%/99%, respectively. The crude rate of ipsilateral breast recurrence was 2.5% (n=4); of nodal failure, 1.9% (n=3); and of distant failure, 0.6% (n=1). The 5-year and 7-year actuarial overall survival rates were 89%/86%, with breast cancer–specific survival of 100%/99%, respectively. Good to excellent cosmetic outcomes were achieved in 93.4% of patients. Telangiectasia developed in 27% of patients, with 1-year, 3-year, and 5-year actuarial incidence of 7%/24%/33%; skin dose >100% significantly predicted for the development of telangiectasia (50% vs 14%, P<.0001). Conclusions: Long-term single-institution outcomes suggest excellent tumor control, breast cosmesis, and minimal late toxicity. Skin toxicity is a function of skin dose, which may be ameliorated with dosimetric optimization afforded by newer multicatheter brachytherapy applicators and

  2. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Vargo, John A.; Verma, Vivek; Kim, Hayeon; Kalash, Ronny; Heron, Dwight E.; Johnson, Ronald; Beriwal, Sushil, E-mail: beriwals@upmc.edu

    2014-02-01

    Purpose: Accelerated partial breast irradiation (APBI) with balloon and catheter-based brachytherapy has gained increasing popularity in recent years and is the subject of ongoing phase III trials. Initial data suggest promising local control and cosmetic results in appropriately selected patients. Long-term data continue to evolve but are limited outside of the context of the American Society of Breast Surgeons Registry Trial. Methods and Materials: A retrospective review of 157 patients completing APBI after breast-conserving surgery and axillary staging via high-dose-rate {sup 192}Ir brachytherapy from June 2002 to December 2007 was made. APBI was delivered with a single-lumen MammoSite balloon-based applicator to a median dose of 34 Gy in 10 fractions over a 5-day period. Tumor coverage and critical organ dosimetry were retrospectively collected on the basis of computed tomography completed for conformance and symmetry. Results: At a median follow-up time of 5.5 years (range, 0-10.0 years), the 5-year and 7-year actuarial incidences of ipsilateral breast control were 98%/98%, of nodal control 99%/98%, and of distant control 99%/99%, respectively. The crude rate of ipsilateral breast recurrence was 2.5% (n=4); of nodal failure, 1.9% (n=3); and of distant failure, 0.6% (n=1). The 5-year and 7-year actuarial overall survival rates were 89%/86%, with breast cancer–specific survival of 100%/99%, respectively. Good to excellent cosmetic outcomes were achieved in 93.4% of patients. Telangiectasia developed in 27% of patients, with 1-year, 3-year, and 5-year actuarial incidence of 7%/24%/33%; skin dose >100% significantly predicted for the development of telangiectasia (50% vs 14%, P<.0001). Conclusions: Long-term single-institution outcomes suggest excellent tumor control, breast cosmesis, and minimal late toxicity. Skin toxicity is a function of skin dose, which may be ameliorated with dosimetric optimization afforded by newer multicatheter brachytherapy

  3. Outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma: 54 cases (1988-2002).

    Science.gov (United States)

    Smelstoys, Jennifer A; Davis, Garrett J; Learn, Amy E; Shofer, Frances E; Brown, Dorothy Cimino

    2004-07-15

    To determine the outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma. Retrospective study. 43 dogs and 11 cats. Medical records of dogs and cats with radiographic evidence of pneumoperitoneum and no history of penetrating trauma were reviewed. Information collected included signalment, previous medical problems, initial complaint, duration of illness, physical examination findings, radiographic findings, laboratory abnormalities, abdominocentesis results, bacterial culture results, concurrent diseases, hospitalization time, and outcome. Abdominal radiographs were reviewed, and radiographic severity of pneumoperitoneum was classified. For those animals that underwent exploratory laparotomy, time from admission to surgery and results of histologic examination of biopsy specimens were recorded. 24 (44%) animals survived and were discharged from the hospital, but none of the variables examined was associated with whether animals survived. Rupture of the gastrointestinal tract was the cause of pneumoperitoneum in 40 animals. However, cause and location of gastrointestinal tract rupture was not associated with whether animals survived. Twenty-three of 40 (58%) animals that underwent exploratory laparotomy survived, compared with only 1 of 14 animals that did not undergo surgery. Results suggest that pneumoperitoneum in dogs and cats without any history of penetrating trauma is most commonly associated with rupture of the gastrointestinal tract and requires immediate surgical intervention. Even when appropriate treatment is instituted, the shortterm prognosis is only fair.

  4. Cardiac Myosin Binding Protein-C Autoantibodies are Potential Early Indicators of Cardiac Dysfunction and Patient Outcome in Acute Coronary Syndrome.

    Science.gov (United States)

    Lynch, Thomas L; Kuster, Diederik W D; Gonzalez, Beverly; Balasubramanian, Neelam; Nair, Nandini; Day, Sharlene; Calvino, Jenna E; Tan, Yanli; Liebetrau, Christoph; Troidl, Christian; Hamm, Christian W; Güçlü, Ahmet; McDonough, Barbara; Marian, Ali J; van der Velden, Jolanda; Seidman, Christine E; Huggins, Gordon S; Sadayappan, Sakthivel

    2017-04-01

    The degradation and release of cardiac myosin binding protein-C (cMyBP-C) upon cardiac damage may stimulate an inflammatory response and autoantibody (AAb) production. We determined whether the presence of cMyBP-C-AAbs associated with adverse cardiac function in CVD patients. Importantly, cMyBP-C-AAbs were significantly detected in ACS patient sera upon arrival to the emergency department, particularly in STEMI patients. Patients positive for cMyBP-C-AAbs had a reduced LVEF and elevated levels of clinical biomarkers of MI. We conclude that cMyBP-C-AAbs may serve as early predictive indicators of deteriorating cardiac function and patient outcome in ACS patients prior to the infarction.

  5. Cardiac Myosin Binding Protein-C Autoantibodies Are Potential Early Indicators of Cardiac Dysfunction and Patient Outcome in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Thomas L. Lynch, IVPhD

    2017-04-01

    Full Text Available Summary: The degradation and release of cardiac myosin binding protein-C (cMyBP-C upon cardiac damage may stimulate an inflammatory response and autoantibody (AAb production. We determined whether the presence of cMyBP-C-AAbs associated with adverse cardiac function in cardiovascular disease patients. Importantly, cMyBP-C-AAbs were significantly detected in acute coronary syndrome patient sera upon arrival to the emergency department, particularly in ST-segment elevation myocardial infarction patients. Patients positive for cMyBP-C-AAbs had reduced left ventricular ejection fraction and elevated levels of clinical biomarkers of myocardial infarction. We conclude that cMyBP-C-AAbs may serve as early predictive indicators of deteriorating cardiac function and patient outcome in acute coronary syndrome patients prior to the infarction. Key Words: acute myocardial infarction, autoantibodies, cardiac myosin binding protein-c, cardiomyopathy

  6. Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation.

    Science.gov (United States)

    Fu, H-C; Huang, K-H; Tseng, C-W; Liang, H-M; Lin, H; Chou, Y-J; Kung, F-T

    2006-11-01

    To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined. Copyright (c) 2006 ISUOG.

  7. RASSF1A hypermethylation is associated with ASXL1 mutation and indicates an adverse outcome in non-M3 acute myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Liu F

    2017-08-01

    Full Text Available Fang Liu,1,* Ming Gong,2,* Li Gao,2,* Xiaoping Cai,3 Hui Zhang,2 Yigai Ma2 1Department of Oncology, Chinese PLA General Hospital, 2Department of Hematology, China-Japan Friendship Hospital, 3Department of Geriatric Medicine, Army General Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Objective: The purpose of this study was to evaluate the frequency of RASSF1A hypermethylation in patients with acute myeloid leukemia (AML, in an attempt to modify the current molecular model for disease prognosis.Materials and methods: Aberrant RASSF1A promoter methylation levels were assessed in 226 newly diagnosed non-M3 AML patients and 30 apparently healthy controls, by quantitative methylation-specific polymerase chain reaction. Meanwhile, RASSF1A mRNA levels were detected by real-time quantitative polymerase chain reaction. Furthermore, hematological characteristics, cytogenetic abnormalities, and genetic aberrations were assessed. Finally, associations of RASSF1A hypermethylation with clinical outcomes were evaluated.Results: RASSF1A hypermethylation was observed in 23.0% of patients with non-M3 AML (52/226, but not in controls. Meanwhile, hypermethylation of the RASSF1A promoter was significantly associated with ASXL1 mutation. Furthermore, the log-rank test revealed that RASSF1A hypermethylation indicated decreased relapse-free survival (RFS and overall survival (OS in patients with non-M3 AML (P=0.012 and P=0.014, respectively. In multivariate analysis, RASSF1A hypermethylation was an independent prognostic factor for RFS (P=0.040, but not for OS (P=0.060.Conclusion: Hypermethylation of the RASSF1A promoter is associated with ASXL1 mutation in non-M3 AML patients, likely indicating poor outcome. These findings provide a molecular basis for stratified diagnosis and prognostic evaluation. Keywords: RASSF1A, hypermethylation, acute myeloid leukemia, clinical outcome, survival

  8. Does an Immigrant Background Affect the Indication, Incidence or Outcome of Emergency Cesarean Section? Results of the Prospective Data Collection of 111 Births.

    Science.gov (United States)

    David, Matthias; Scherer, Katrin Alexandra; Henrich, Wolfgang; Breckenkamp, Jürgen

    2018-02-01

    Does the incidence and/or indication(s) for emergency cesarean section differ if the pregnant woman has an immigrant background (IB)? Does a lack of language proficiency (communication problems) and a low acculturation level result in a longer decision-to-delivery interval (D-D interval)? Are neonates born to women with IB by emergency cesarean section in a poorer condition post delivery? Standardized interviews were carried out before or immediately after delivery in three Berlin obstetric hospitals. Questions were asked about the sociodemographic background and care aspects as well as about immigration and level of acculturation. Collected data were linked to information obtained from the expectant mother's antenatal records and to care data and perinatal data routinely recorded by the hospitals. Data was analyzed using regression models which adjusted for age, parity, and socio-economic status. The total patient population consisted of 7100 women (rate of response: 89.6%); of these women, 111 required emergency cesarean section (50 women without IB, 61 immigrant women). Risk factors such as late first antenatal check-up, gestational diabetes, pregnancy-induced hypertension, fetal macrosomia, smoking, and weight gain were similar in both patient cohorts. The incidence of and indications for emergency cesarean section and the D-D interval were similar for both groups. Limited German language proficiency and low levels of acculturation among immigrant women did not prolong the D-D interval. There were no statistically relevant differences between immigrant and non-immigrant cohorts with regard to adverse neonatal conditions (5-minute Apgar score ≤ 7, umbilical cord arterial pH cesarean section. The factor "immigrant background" did not affect the indication or obstetric outcome following emergency cesarean section.

  9. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

    Directory of Open Access Journals (Sweden)

    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  10. Comparison between publicly accessible publications, registries, and protocols of phase III trials indicated persistence of selective outcome reporting.

    Science.gov (United States)

    Zhang, Sheng; Liang, Fei; Li, Wenfeng

    2017-11-01

    The decision to make protocols of phase III randomized controlled trials (RCTs) publicly accessible by leading journals was a landmark event in clinical trial reporting. Here, we compared primary outcomes defined in protocols with those in publications describing the trials and in trial registration. We identified phase III RCTs published between January 1, 2012, and June 30, 2015, in The New England Journal of Medicine, The Lancet, The Journal of the American Medical Association, and The BMJ with available protocols. Consistency in primary outcomes between protocols and registries (articles) was evaluated. We identified 299 phase III RCTs with available protocols in this analysis. Out of them, 25 trials (8.4%) had some discrepancy for primary outcomes between publications and protocols. Types of discrepancies included protocol-defined primary outcome reported as nonprimary outcome in publication (11 trials, 3.7%), protocol-defined primary outcome omitted in publication (10 trials, 3.3%), new primary outcome introduced in publication (8 trials, 2.7%), protocol-defined nonprimary outcome reported as primary outcome in publication (4 trials, 1.3%), and different timing of assessment of primary outcome (4 trials, 1.3%). Out of trials with discrepancies in primary outcome, 15 trials (60.0%) had discrepancies that favored statistically significant results. Registration could be seen as a valid surrogate of protocol in 237 of 299 trials (79.3%) with regard to primary outcome. Despite unrestricted public access to protocols, selective outcome reporting persists in a small fraction of phase III RCTs. Only studies from four leading journals were included, which may cause selection bias and limit the generalizability of this finding. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Prognostic value of FDG-PET indices for the assessment of histological response to neoadjuvant chemotherapy and outcome in pediatric patients with Ewing sarcoma and osteosarcoma.

    Directory of Open Access Journals (Sweden)

    Clement Bailly

    Full Text Available The objective of this retrospective work was to evaluate the prognostic value on histological response and survival of quantitative indices derived from FDG-PET performed before and after chemotherapy (CHT, in a homogeneous pediatric Ewing sarcoma (EWS and Osteosarcoma (OST population.Thirty-one patients with EWS and 31 with OST were included. All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had FDG-PET at diagnosis and after CHT, prior to surgery. Several parameters were evaluated: SUVmax, SUVpeak, SUVmean, metabolic tumor volume, total lesion glycolysis, 7 textural features and 3 shape features (SF. The segmentation was performed using an adaptive approach. Results were compared to histopathological regression of the resected tumor and to clinical follow-up for survival evaluation.For EWS, univariate analysis did not highlight any prognostic value on histological response, or survival regardless of all the considered metrics. For OST, only one of the SF, namely elongation, was significantly associated with PFS and OS on both univariate and multivariate analysis (PFS: p = 0.019, HR = 5.583; OS: p = 0.0062, HR = 7.113.Only elongation determined on initial FDG-PET has a potential interest as a prognostic factor of PFS and OS in pediatric OST patients. Unlike recent studies of the literature realized in adult population, all the metrics reveal limited additional prognostic value in pediatric EWS patients. This seems to reinforce the question of whether children experience different subtypes of the same pathologies than older patients, with different outcomes.

  12. [Distance covered in walking test after heart surgery in patients over 70 years of age: outcome indicator for the assessment of quality of care in intensive rehabilitation].

    Science.gov (United States)

    De Feo, Stefania; Mazza, Antonio; Camera, Federica; Maestri, Antonella; Opasich, Cristina; Tramarin, Roberto

    2003-06-01

    For quality-of-care assessment of rehabilitation programs after cardiac surgery, measures of functional recovery have been proposed as outcome indicators. Aim of this study was to evaluate the feasibility, the safety and the informative content of the 6-min walking test (6 WT) performed in elderly patients soon after admission in an intensive rehabilitation program after cardiac surgery. Population consists of 115 consecutive over-70 patients admitted to an in-hospital rehabilitation program after cardiac surgery. Within 7 days of admission, in 107 patients (93%) clinical conditions allowed the execution of a 6 WT, on ECG telemetry monitoring. Resting and exertional heart rate, score of fatigue (Borg Scale 1 divided by 20), symptoms, ECG alterations and arrhythmias were recorded. Other considered variables were: comorbidity (Charlson index), length of stay and complications occurring during the whole surgical and rehabilitation in-hospitalisation stay, disability (nursing needs: Maslow and nursing chart), functional status at discharge, left ventricular ejection fraction, number of exercise treatment sessions, self-perceived health-status at admission and at discharge (EuroQoL questionnaire). The mean walked distance was 194 +/- 93 m. No complication neither ECG alteration occurred during the 6 WT; only isolated premature ventricular beats were recorded in 26 pts. Heart rate increased from 86 +/- 13 at rest to 95 +/- 17 bpm at the end of the 6 WT (p needs, self-perceived health-status and functional capacity at discharge differed between patients who performed the 6 WT within 4 days compared with those who did it later, and between patients who walked < or = 120 m (lower quartile) compared with those who walked more. In elderly patients after cardiac surgery the 6 WT performed within the first week of admission in rehabilitation unit is feasible and safe. Simple cut-offs like timing of the 6 WT and walking performance identify more severe patients with lower

  13. Building a University-Community Partnership to Explore Health Challenges among Residents at Extended-Stay Hotels

    Science.gov (United States)

    Lewinson, Terri

    2014-01-01

    Extended-stay hotels are housing solutions for some older adults on the fringe of street homelessness. Research indicates that these environments can produce negative health outcomes for older adults. Strategies for managing negative environmental conditions must be identified to help older adults manage health outcomes. This paper describes a…

  14. A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics.

    Science.gov (United States)

    Turton, Mervyn Sydney; Henkel, Ralf Reinhold; Africa, Charlene Wilma Joyce

    2017-12-01

    Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics. At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki. Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

  15. Extended fuel cycle length

    International Nuclear Information System (INIS)

    Bruyere, M.; Vallee, A.; Collette, C.

    1986-09-01

    Extended fuel cycle length and burnup are currently offered by Framatome and Fragema in order to satisfy the needs of the utilities in terms of fuel cycle cost and of overall systems cost optimization. We intend to point out the consequences of an increased fuel cycle length and burnup on reactor safety, in order to determine whether the bounding safety analyses presented in the Safety Analysis Report are applicable and to evaluate the effect on plant licensing. This paper presents the results of this examination. The first part indicates the consequences of increased fuel cycle length and burnup on the nuclear data used in the bounding accident analyses. In the second part of this paper, the required safety reanalyses are presented and the impact on the safety margins of different fuel management strategies is examined. In addition, systems modifications which can be required are indicated

  16. High plasma cyst(e)ine level may indicate poor clinical outcome in patients with acute stroke: possible involvement of hydrogen sulfide.

    Science.gov (United States)

    Wong, Peter T H; Qu, Kun; Chimon, Ghislain N; Seah, Alvin B H; Chang, Hui Meng; Wong, Meng Cheong; Ng, Yee Kong; Rumpel, Helmut; Halliwell, Barry; Chen, Christopher P L H

    2006-02-01

    Cysteine is known to cause neuronal cell death and has been reported to be elevated in brain ischemia, but it has not been studied in clinical stroke. In this study, we correlated plasma levels of cyst(e)ine with long-term clinical outcome at 3 months in acute stroke. Patients were classified into 3 groups at 3 months as follows: good outcome (Rankin 0-1, n = 11), poor outcome (Rankin 2-5, n = 20), and dead (n = 5). Their plasma cyst(e)ine levels within 24 hours of stroke onset were 61 +/- 12, 67 +/- 9, and 82 +/- 14 micromol/L (standard deviation), respectively. The correlation between early plasma cyst(e)ine levels and long-term clinical outcome assessed at 3 months is significant with p ine was also significantly elevated in patients who had early stroke deterioration (p ine in patients with stroke may reflect increased production of H2S in the brain and thus predispose to poor outcome in clinical stroke. Inhibition of H2S formation may therefore be a novel approach in acute stroke therapy.

  17. How Far Can Extended Knowledge Be Extended?

    DEFF Research Database (Denmark)

    Wray, K. Brad

    2018-01-01

    by an artifact, like a notebook or telescope. The chapter illustrates this by applying Pritchard’s account of extended knowledge to collaborating scientists. The beliefs acquired through collaborative research cannot satisfy both of Pritchard’s conditions of creditability. Further, there is evidence......Duncan Pritchard (2010) has developed a theory of extended knowledge based on the notion of extended cognition initially developed by Clark and Chalmers (1998). Pritchard’s account gives a central role to the notion of creditability, which requires the following two conditions to be met: (i...... that scientists are not prepared to take responsibility for the actions of the scientists with whom they collaborate....

  18. The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers - Are there indications not to perform thrombectomy based on CT angiography?

    Science.gov (United States)

    Nordmeyer, Hannes; Webering, Nadine; Chapot, Rene; Hadisurya, Jeffrie; Heddier, Markus; Stracke, Paul; Berger, Klaus; Isenmann, Stefan; Weber, Ralph

    2017-06-01

    To investigate the association between baseline pial collateral status on computed tomography angiography (CTA) with recanalization and functional outcome in patients with acute anterior circulation stroke treated with stent retriever thrombectomy. Retrospective analysis of 87 patients from a prospective thrombectomy registry. Collateral status on CTA source images was categorized into good, moderate, and poor with the Tan and Miteff scores by two-blinded readers. Association between CTA collateral status and successful recanalization was investigated with univariate regression analysis. Multivariate logistic regression was used to analyse the association between collateral score and favourable clinical outcome (mRS 0-2) and death at follow-up. Mean age was 72.5 years and baseline median NIHSS score was 15. Patients with poor collaterals on Tan score had a significant higher mortality compared with moderate or good collaterals during a mean follow-up period of 5.2 months (85.7% vs. 30.6% vs. 25.7%, Pcollateral score could be assessed only in 65 of the 87 patients and the Tan collateral score had a higher interrater reliability. Poor collaterals on CTA were associated with a very high rate of fatal outcome in anterior circulation stroke patients despite a high rate of successful recanalization with stent retrievers. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of hematomas.

    Science.gov (United States)

    Yilmaz, Adem; Musluman, Ahmet Murat; Kanat, Ayhan; Cavusoglu, Halit; Terzi, Yuksel; Aydin, Yunus

    2011-01-01

    The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated. Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery. Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG. Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.

  20. Consensus building on the development of a stress-based indicator for LCA-based impact assessment of water consumption: outcome of the expert workshops

    Science.gov (United States)

    The WULCA group, active since 2007 on Water Use in LCA, commenced the development of consensus-based indicators in January 2014. This activity is planned to last 2 years and covers human health, ecosystem quality, and a stress-based indicator. This latter encompasses potential de...

  1. Extended Enterprise performance Management

    NARCIS (Netherlands)

    Bobbink, Maria Lammerdina; Hartmann, Andreas

    2014-01-01

    The allegiance of partnering organisations and their employees to an Extended Enterprise performance is its proverbial sword of Damocles. Literature on Extended Enterprises focuses on collaboration, inter-organizational integration and learning to avoid diminishing or missing allegiance becoming an

  2. Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes

    OpenAIRE

    Brauchli, Rebecca; Jenny, Gregor J.; Füllemann, Désirée; Bauer, Georg F.

    2015-01-01

    Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate?selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model ...

  3. Perspectives on extended Deterrence

    International Nuclear Information System (INIS)

    Tertrais, Bruno; Yost, David S.; Bunn, Elaine; Lee, Seok-soo; Levite, Ariel e.; Russell, James A.; Hokayem, Emile; Kibaroglu, Mustafa; Schulte, Paul; Thraenert, Oliver; Kulesa, Lukasz

    2010-05-01

    In November 2009, the Foundation for Strategic Research (Fondation pour la recherche strategique, FRS) convened a workshop on 'The Future of extended Deterrence', which included the participation of some of the best experts of this topic, from the United States, Europe, the Middle East and East Asia, as well as French and NATO officials. This document brings together the papers prepared for this seminar. Several of them were updated after the publication in April 2010 of the US Nuclear Posture Review. The seminar was organized with the support of the French Atomic energy Commission (Commissariat a l'energie atomique - CEA). Content: 1 - The future of extended deterrence: a brainstorming paper (Bruno Tertrais); 2 - US extended deterrence in NATO and North-East Asia (David S. Yost); 3 - The future of US extended deterrence (Elaine Bunn); 4 - The future of extended deterrence: a South Korean perspective (Seok-soo Lee); 5 - Reflections on extended deterrence in the Middle East (Ariel e. Levite); 6 - extended deterrence, security guarantees and nuclear weapons: US strategic and policy conundrums in the Gulf (James A. Russell); 7 - extended deterrence in the Gulf: a bridge too far? (Emile Hokayem); 8 - The future of extended deterrence: the case of Turkey (Mustafa Kibaroglu); 9 - The future of extended deterrence: a UK view (Paul Schulte); 10 - NATO and extended deterrence (Oliver Thraenert); 11 - extended deterrence and assurance in Central Europe (Lukasz Kulesa)

  4. Sex Effect on Obesity Indices and Metabolic Outcomes in Patients with Obese Obstructive Sleep Apnea and Type 2 Diabetes After Laparoscopic Roux-en-Y Gastric Bypass Surgery: a Preliminary Study.

    Science.gov (United States)

    Xu, Huajun; Zhang, Pin; Han, Xiaodong; Yu, Haoyong; Di, Jianzhong; Zou, Jianyin; Wang, Yuyu; Qian, Yingjun; Tu, Yinfang; Bao, Yuqian; Yi, Hongliang; Guan, Jian; Yin, Shankai; Jia, Weiping

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) surgery is an effective therapy for obstructive sleep apnea (OSA). However, little attention has been paid to the treatment goals systematically stratified by sex. The objective of this study was to assess how sex differences affect obesity indices and metabolic outcomes after RYGB surgery. A sleep questionnaire was conducted and medical histories were taken. Full-night polysomnography (PSG), anthropometric variables, and blood samples were collected. Thirty-five consecutive patients with OSA who underwent laparoscopic RYGB surgery were prospectively examined for at least 6 months were included in the study. Significant improvements (p obesity indices, and metabolic outcomes [except low-density lipoprotein in men and high-density lipoprotein (HDL) in women] were obtained in men and women with OSA. Men had higher baseline triglyceride (TG) (p women. However, only TG in men improved more than in women (p = 0.02). Sleep parameters, obesity indices, and metabolic outcomes after RYGB surgery were of similar magnitude in women and men with OSA. Alleviating sleep and obesity problems was correlated with metabolic outcomes in men and women.

  5. Obstetric care quality indicators and outcomes based on the degree of acculturation of immigrants-results from a cross-sectional study in Berlin.

    Science.gov (United States)

    David, Matthias; Borde, Theda; Brenne, Silke; Ramsauer, Babett; Hinkson, Larry; Henrich, Wolfgang; Razum, Oliver; Breckenkamp, Jürgen

    2018-02-01

    Acculturation is a complex, multidimensional process involving the integration of the traditional norms, values, and lifestyles of a new cultural environment. It is, however, unclear what impact the degree of acculturation has on obstetric outcomes. Data collection was performed in 2011 and 2012 at three obstetric tertiary centers in Berlin, Germany. Standardized interviews (20-30 min.) were performed with support of evaluated questionnaires. The primary collected data were then linked to the perinatal data recorded at the individual clinics provided from the obstetric centers which correspond with the routinely centralized data collected for quality assurance throughout Germany. The questionnaire included questions on sociodemographic, health care, and migrant-related aspects. Migrant women and women with a migration background were assessed using the Frankfurt Acculturation Scale, a one-dimensional measurement tool to assess the degree of acculturation (15 items on language and media usage as well as integration into social networks). In summary, 7100 women were available for the survey (response rate of 89.6%) of which 3765 (53%) had a migration background. The probability of low acculturation is significantly (p relationships between the degree of acculturation and obstetric parameters show no significant differences for prematurity, 5 min.-Apgar values > 7, arterial umbilical cord pH values > 7.00 and admissions to the neonatal unit. In Berlin, among migrant women a low degree of acculturation may have an unfavorable effect on the utilization of pregnancy care provision. However, there were no relevant differences in obstetric outcome parameters in relation to the degree of acculturation within the migrant population of Berlin.

  6. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.

    Science.gov (United States)

    Chu, Vivian H; Park, Lawrence P; Athan, Eugene; Delahaye, Francois; Freiberger, Tomas; Lamas, Cristiane; Miro, Jose M; Mudrick, Daniel W; Strahilevitz, Jacob; Tribouilloy, Christophe; Durante-Mangoni, Emanuele; Pericas, Juan M; Fernández-Hidalgo, Nuria; Nacinovich, Francisco; Rizk, Hussien; Krajinovic, Vladimir; Giannitsioti, Efthymia; Hurley, John P; Hannan, Margaret M; Wang, Andrew

    2015-01-13

    Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management. © 2014 American Heart Association, Inc.

  7. Evaluation of human sperm chromatin status after selection using a modified Diff-Quik stain indicates embryo quality and pregnancy outcomes following in vitro fertilization.

    Science.gov (United States)

    Tavares, R S; Silva, A F; Lourenço, B; Almeida-Santos, T; Sousa, A P; Ramalho-Santos, J

    2013-11-01

    Sperm chromatin/DNA damage can be measured by a variety of assays. However, it has been reported that these tests may lose prognostic value in Assisted Reproductive Technology (ART) cycles when assessed in post-prepared samples, possibly due to the normalizing effect promoted by sperm preparation procedures. We have recently implemented a modified version of the Diff-Quik staining assay that allows for the evaluation of human sperm chromatin status in native samples, together with standard sperm morphology assessment. However, the value of this parameter in terms of predicting in vitro fertilization (IVF) and Intracytoplasmic sperm injection (ICSI) outcomes after sperm selection is unknown. In this study, data from 138 couples undergoing in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI) treatments showed that sperm chromatin integrity was significantly improved after density gradient centrifugation and swim up (p embryo development rates (p > 0.05). However, sperm samples presenting lower percentages of damaged chromatin were associated with better quality (Grade I) embryos in both ART procedures (p selection may occur; but not in ICSI, where sperm selection is operator dependent. This quick and low-cost assay is suggested as an alternative method to detect sperm chromatin status in minimal clinical settings, when no other well-established and robust assays (e.g. Sperm chromatin structure assay, terminal deoxynucleotidyl transferase-mediated dUDP nick-end labelling) are available. © 2013 American Society of Andrology and European Academy of Andrology.

  8. Elevated second-trimester maternal serum β-human chorionic gonadotropin and amniotic fluid alpha-fetoprotein as indicators of adverse obstetric outcomes in fetal Turner syndrome.

    Science.gov (United States)

    Alvarez-Nava, Francisco; Soto, Marisol; Lanes, Roberto; Pons, Hector; Morales-Machin, Alisandra; Bracho, Ana

    2015-12-01

    The objective of this study was to determine the ability of biochemical analytes to identify adverse outcomes in pregnancies with Turner syndrome. Maternal serum and amniotic fluid (AF) marker concentrations were measured in 73 singleton pregnancies with Turner syndrome (10-22 weeks of gestation). Fetal Turner syndrome was definitively established by cytogenetic analysis. Two subgroups, fetuses with hydrops fetalis versus fetuses with cystic hygroma, were compared. Receiver operating characteristic curves and relative risk were established for a cut-off multiples of the median ≥3.5 for β-subunit of human chorionic gonadotropin (hCG) or AF alpha-fetoprotein (AFP). Forty-nine (67%) of 73 pregnant women had an abnormal maternal serum. While levels of pregnancy-associated plasma protein-A and free β-subunit (fβ)-hCG were not different to those of the control group, AFP, unconjugated estriol and β-hCG concentrations were significantly different in the study group (P Turner syndrome pregnancies with the highest risk of fetal death. © 2015 Japan Society of Obstetrics and Gynecology.

  9. Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study.

    Science.gov (United States)

    Aktas, I; Yalcin, S; Sencer, S

    2010-11-01

    This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) fulfilled the criteria for success. Duration of locking and present preoperative degenerative changes were the most significant factors for treatment outcome. The results suggest it is sufficient to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing the authors from comparing them statistically, they cannot come to that conclusion. To clarify the use of SH in such cases, standardized study groups are necessary for future studies. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

  10. Extended icosahedral structures

    CERN Document Server

    Jaric, Marko V

    1989-01-01

    Extended Icosahedral Structures discusses the concepts about crystal structures with extended icosahedral symmetry. This book is organized into six chapters that focus on actual modeling of extended icosahedral crystal structures. This text first presents a tiling approach to the modeling of icosahedral quasiperiodic crystals. It then describes the models for icosahedral alloys based on random connections between icosahedral units, with particular emphasis on diffraction properties. Other chapters examine the glassy structures with only icosahedral orientational order and the extent of tra

  11. Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indication, Surgical Techniques, Post Operative Management and Long-Term Outcomes

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D.; Schwarzenberg, Sarah J.; Radosevich, David M.; Cook, Marie; Dunn, Ty B.; Beilman, Gregory J.; Freeman, Martin L.; Balamurugan, A.N.; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J.; Vickers, Selwyn M.; Pruett, Timothy L.; Sutherland, David E.R.

    2014-01-01

    Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management PMID:24509206

  12. Extending Database Integration Technology

    National Research Council Canada - National Science Library

    Buneman, Peter

    1999-01-01

    Formal approaches to the semantics of databases and database languages can have immediate and practical consequences in extending database integration technologies to include a vastly greater range...

  13. Critérios e indicadores de resultados para a farmácia hospitalar brasileira utilizando o método Delfos Establishment of criteria and outcome indicators for hospital pharmacies in Brazil using Delphos

    Directory of Open Access Journals (Sweden)

    Rachel Magarinos-Torres

    2007-08-01

    Full Text Available A farmácia hospitalar é responsável por diversas atividades com influência no cuidado à saúde de pacientes hospitalizados. Este artigo descreve a construção de critérios e indicadores de resultado para a farmácia hospitalar brasileira utilizando Delfos, um método de consenso que dispensa contato presencial. Participaram do estudo 22 especialistas de quatro regiões brasileiras. Todo processo ancorou-se no modelo lógico da farmácia hospitalar brasileira, previamente construído. Foram enviados por correio eletrônico quatro documentos de trabalho. A primeira rodada identificou 103 possíveis resultados. O julgamento quanto à adequação, relevância e possibilidade de mensuração permitiu selecionar 22 critérios que originaram 20 indicadores, agrupados em 7 aspectos da qualidade do serviço. As contribuições iniciais permitiram explicitar melhor o objetivo de quatro componentes do modelo lógico. Observa-se que todos os itens considerados como resultado pelos especialistas neste estudo encontram-se descritos na literatura, seja como indicadores de estrutura ou processo da farmácia hospitalar. Estima-se que a construção de indicadores compostos para a farmácia hospitalar, com base nos aspectos de qualidade observados, permitiria traduzir melhor sua contribuição na avaliação do cuidado a pacientes hospitalizados.The hospital pharmacy is responsible for several services which influence inpatient outcomes. This paper describes the construction of criteria and outcome indicators for Brazilian hospital pharmacies using Delphos, a consensus technique in which physical presence of specialists is not necessary. 22 specialists from 4 Brazilian regions participated. The entire process was anchored on the logical model previously constructed for the Brazilian hospital pharmacy. The four phases were conducted through e-mail contact. The first round of contributions identified 103 possible outcomes. These were screened and classified

  14. Indications for diagnostic open biopsy of mammographic screen-detected lesions preoperatively diagnosed as fibroadenomas by needle biopsy and their outcomes

    International Nuclear Information System (INIS)

    Sala, M.A.; Dhillon, R.; Brookes, D.; Lagrange, C.; Metcalf, C.; Wylie, E.

    2015-01-01

    Aim: To identify the clinical, radiological, and histopathological factors that resulted in a diagnostic open biopsy of mammographic screen-detected lesions diagnosed preoperatively as fibroadenomas by needle biopsy. Materials and methods: BreastScreen WA data over 10 year period from 1 January 1999 to 31 December 2008 was reviewed. Results: Among the 760,027 women screened in Western Australia between 1999 and 2008, 31 had a fine-needle aspiration (FNA) or a core biopsy (CB) diagnosing a fibroadenoma and subsequently underwent a diagnostic open biopsy (DOB). Three were preoperatively diagnosed as fibroadenoma by initial FNA but subsequent CB showed that these were not fibroadenomas and, therefore, were excluded from the present series. Of the 28 cases, DOB identified 21 fibroadenomas, two cellular fibroadenomas, two benign phyllodes tumours, one malignant phyllodes tumour, one fibroadenoma containing ductal carcinoma in situ (DCIS), and one case of a 40 mm adenosis tumour with a small 5 mm fibroadenoma. The lesions ranged from 5–100 mm in size with an average size of 28 mm. DOB and CB results were concordant in 25 (89%) of the cases. The primary clinical indications for undergoing DOB included indeterminate histopathological findings of cellular fibroadenomas versus phyllodes tumour (n = 10), enlarging size (n = 4), large size (n = 5), fibroadenomas with atypia (n = 1), discordant radiological and pathological findings (n = 3), patient preference (n = 1), association with a second screen-detected lesion requiring excision (n = 2), and an unknown indication (n = 1). Conclusion: CB diagnosis of fibroadenomas is a safe diagnosis unless it has atypical clinical, radiological, or pathological features. - Highlights: • The aim was to identify factors that lead to excision of benign fibroadenomas. • Screen detected fibroadenomas must be adequately sampled to exclude malignancy. • Large, enlarging, cellular or atypical lesions should undergo

  15. Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry.

    Science.gov (United States)

    Baumann, Stefan; Werner, Nikos; Ibrahim, Karim; Westenfeld, Ralf; Al-Rashid, Fadi; Sinning, Jan-Malte; Westermann, Dirk; Schäfer, Andreas; Karatolios, Konstantinos; Bauer, Timm; Becher, Tobias; Akin, Ibrahim

    2018-03-08

    Percutaneous coronary intervention (PCI) is an alternative strategy to coronary artery bypass grafting (CABG) in patients with high perioperative risk. The microaxial Impella ® pump (Abiomed, Danvers, MA, USA), used as prophylactic and temporary support, is currently the most common device for "protected high-risk PCI" to ensure hemodynamic stability during complex coronary intervention. The study is an observational, retrospective multi-center registry. Patients from nine tertiary hospitals in Germany, who have undergone protected high-risk PCI, are included in the present study. A total of 154 patients (mean age 72.6-10.8 years, 75.3% male) were enrolled. The majority were at a high operative risk illustrated by a logistic EuroSCORE of 14.7-17.4. The initial SYNTAX score was 32.0-13.3, indicating very complex CAD and could be reduced to 14.1-14.3 (p study show that protected PCI is a safe and effective approach to revascularize high-risk patients with complex coronary anatomy and comorbidities.

  16. Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators.

    Science.gov (United States)

    Lunn, Mitchell R; Cui, Wanjun; Zack, Matthew M; Thompson, William W; Blank, Michael B; Yehia, Baligh R

    2017-08-01

    This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs). Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate. In 2013-2015, sexual minority adults represented 2.4% of the U.S. Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion. Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public

  17. A novel method for reproducibly measuring the effects of interventions to improve emotional climate, indices of team skills and communication, and threat to patient outcome in a high-volume thoracic surgery center.

    Science.gov (United States)

    Nurok, Michael; Lipsitz, Stuart; Satwicz, Paul; Kelly, Andrea; Frankel, Allan

    2010-05-01

    To create and test a reproducible method for measuring emotional climate, surgical team skills, and threats to patient outcome by conducting an observational study to assess the impact of a surgical team skills and communication improvement intervention on these measurements. Observational study. Operating rooms in a high-volume thoracic surgery center from September 5, 2007, through June 30, 2008. Thoracic surgery operating room teams. Two 90-minute team skills training sessions focused on findings from a standardized safety culture survey administered to all participants and highlighting positive and problematic aspects of team skills, communication, and leadership. The sessions created an interactive forum to educate team members on the importance of communication and to role-play optimal interactive and communication strategies. Calculated indices of emotional climate, team skills, and threat to patient outcome. The calculated communication and team skills score improved from the preintervention to postintervention periods, but the improvement extinguished during the 3 months after the intervention (P skills and communication and decrease a calculated score of threats to patient outcome. However, the effect is only durable for threats to patient outcome.

  18. Hospital Outcome and Risk Indices of Mortality after redo-mitral valve surgery in Potential Candidates for Transcatheter Procedures: Results From a European Registry.

    Science.gov (United States)

    Onorati, Francesco; Mariscalco, Giovanni; Reichart, Daniel; Perrotti, Andrea; Gatti, Giuseppe; De Feo, Marisa; Rubino, Antonio; Santarpino, Giuseppe; Biancari, Fausto; Detter, Christian; Santini, Francesco; Faggian, Giuseppe

    2018-04-01

    Transcatheter mitral valve-in-valve/valve-in-ring procedures (TM-VIVoR) are increasing. The authors aimed to identify independent predictors for hospital mortality in redo mitral valve surgery as possible future selection criteria for TM-VIVoR. Retrospective multicenter registry. Tertiary university and community hospitals. Two-hundred and sixty patients (out of 920 enrolled) who are potentially candidates for TM-VIVoR undergoing redo-surgery. Redo mitral surgery. Regression analyzes and receiver operating characteristic (ROC) curves identified independent predictors of death. Patients potentially candidates for TM-VIVoR reported significant hospital mortality (9.2%; EuroSCORE II: 13.2 ± 13.1, Society of Thoracic Surgeons [STS] score: 6.2 ± 3.1) and major morbidity (3.8% acute myocardial infarction, 5% stroke, 16.9% perioperative respiratory failure, 16.5% acute renal insufficiency, 25% massive transfusions). EuroSCORE II (odds ration [OR] 1.06; confidence interval [CI] 1.01-1.10; p = 0.005), STS score (OR 1.58; CI 1.27-1.97; p = 0.001), age at surgery (OR 1.05; CI 1.00-1.15; p = 0.05), preoperative dialysis (OR 2.5; CI 1.8-12.6; p = 0.042), left ventricular ejection fraction (LVEF) 13.1; 70.8% sensitivity and 68.2% specificity) and better prediction for STS score (AUC: 0.81; cut-off value: 7.4; 75.0% sensitivity and 66.2% specificity). Quintiles stratification identified EuroSCORE II ≥18.7 (5th quintile, observed mortality: 19.3%) and STS score >9.1 as strong predictors of death within each risk-categorization (OR 5.9 and 12.1, respectively). High EuroSCORE II and STS scores, advanced age at surgery, LVEF indications for TM-VIVoR in the redo-mitral surgery scenario. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Performance Indicators in Spine Surgery.

    Science.gov (United States)

    St-Pierre, Godefroy Hardy; Yang, Michael H; Bourget-Murray, Jonathan; Thomas, Ken C; Hurlbert, Robin John; Matthes, Nikolas

    2018-02-15

    Systematic review. To elucidate how performance indicators are currently used in spine surgery. The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. 1.

  20. Big Gods: Extended prosociality or group binding?

    Science.gov (United States)

    Galen, Luke W

    2016-01-01

    Big Gods are described as having a "prosocial" effect. However, this conflates parochialism (group cohesion) with cooperation extended to strangers or out-group members. An examination of the cited experimental studies indicates that religion is actually associated with increased within-group parochialism, rather than extended or universal prosociality, and that the same general mechanisms underlie both religious and secular effects.

  1. The Extended Enterprise concept

    DEFF Research Database (Denmark)

    Larsen, Lars Bjørn; Vesterager, Johan; Gobbi, Chiara

    1999-01-01

    This paper provides an overview of the work that has been done regarding the Extended Enterprise concept in the Common Concept team of Globeman 21 including references to results deliverables concerning the development of the Extended Enterprise concept. The first section presents the basic concept...... picture from Globeman21, which illustrates the Globeman21 way of realising the Extended Enterprise concept. The second section presents the Globeman21 EE concept in a life cycle perspective, which to a large extent is based on the thoughts and ideas behind GERAM (ISO/DIS 15704)....

  2. Empirical Productivity Indices and Indicators

    NARCIS (Netherlands)

    B.M. Balk (Bert)

    2016-01-01

    textabstractThe empirical measurement of productivity change (or difference) by means of indices and indicators starts with the ex post profit/loss accounts of a production unit. Key concepts are profit, leading to indicators, and profitability, leading to indices. The main task for the productivity

  3. An extended technicolor model

    International Nuclear Information System (INIS)

    Appelquist, T.; Terning, J.

    1994-01-01

    An extended technicolor model is constructed. Quark and lepton masses, spontaneous CP violation, and precision electroweak measurements are discussed. Dynamical symmetry breaking is analyzed using the concept of the big MAC (most attractive channel)

  4. Extending mine life

    International Nuclear Information System (INIS)

    Anon.

    1984-01-01

    Mine layouts, new machines and techniques, research into problem areas of ground control and so on, are highlighted in this report on extending mine life. The main resources taken into account are coal mining, uranium mining, molybdenum and gold mining

  5. Rational extended thermodynamics

    CERN Document Server

    Müller, Ingo

    1998-01-01

    Ordinary thermodynamics provides reliable results when the thermodynamic fields are smooth, in the sense that there are no steep gradients and no rapid changes. In fluids and gases this is the domain of the equations of Navier-Stokes and Fourier. Extended thermodynamics becomes relevant for rapidly varying and strongly inhomogeneous processes. Thus the propagation of high­ frequency waves, and the shape of shock waves, and the regression of small-scale fluctuation are governed by extended thermodynamics. The field equations of ordinary thermodynamics are parabolic while extended thermodynamics is governed by hyperbolic systems. The main ingredients of extended thermodynamics are • field equations of balance type, • constitutive quantities depending on the present local state and • entropy as a concave function of the state variables. This set of assumptions leads to first order quasi-linear symmetric hyperbolic systems of field equations; it guarantees the well-posedness of initial value problems and f...

  6. The dialogically extended mind

    DEFF Research Database (Denmark)

    Fusaroli, Riccardo; Gangopadhyay, Nivedita; Tylén, Kristian

    2014-01-01

    A growing conceptual and empirical literature is advancing the idea that language extends our cognitive skills. One of the most influential positions holds that language – qua material symbols – facilitates individual thought processes by virtue of its material properties. Extending upon this model...... relate our approach to other ideas about collective minds and review a number of empirical studies to identify the mechanisms enabling the constitution of interpersonal cognitive systems....

  7. Extending Mondrian Memory Protection

    Science.gov (United States)

    2010-11-01

    a kernel semaphore is locked or unlocked. In addition, we extended the system call interface to receive notifications about user-land locking...operations (such as calls to the mutex and semaphore code provided by the C library). By patching the dynamically loadable GLibC5, we are able to test... semaphores , and spinlocks. RTO-MP-IST-091 10- 9 Extending Mondrian Memory Protection to loading extension plugins. This prevents any untrusted code

  8. Extended Life Coolant Testing

    Science.gov (United States)

    2016-06-06

    number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 06-06-2016 2. REPORT TYPE Interim Report 3. DATES COVERED ... Corrosion Testing of Traditional and Extended Life Coolants 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Hansen, Gregory A. T...providing vehicle specific coolants. Several laboratory corrosion tests were performed according to ASTM D1384 and D2570, but with a 2.5x extended time

  9. Extended trochanteric osteotomy: current concepts review.

    Science.gov (United States)

    Sambandam, Senthil Nathan; Duraisamy, Gopinath; Chandrasekharan, Jayadev; Mounasamy, Varatharaj

    2016-04-01

    Revision total hip arthroplasty is a technically demanding procedure which has gained importance for more than two decades. It was a nightmare for revision surgeons during its initial years of inception before the advent of extended trochanteric osteotomy (ETO). This technique gains access to the femoral medullary canal without compromising the bone stock and aids removal of primary implant and cement mantle without further damaging the parent bone. Like any other surgery, ETO does have certain limitations and complications as reported by various authors. Though it has been routinely used by revision surgeons, thorough knowledge of technical details of ETO is still lacking. So this review article is aimed at addressing the indications, surgical procedure, fixation technique, implant selection and complication of ETO which has been presented over a period of years by various authors. We searched in the most commonly used portals like MEDLINE (PubMed) and Google scholar using appropriate terminologies for the literature regarding the various preoperative, intraoperative and postoperative clinical scenarios in which revision surgeons utilized ETO. ETO is an important tool in the revision surgeon's armamentarium and can be used in variety of clinical scenarios and for various intraoperative needs and goals. Awareness about biomechanics of ETO, indications, implants selection, fixation techniques and complications is paramount for good intraoperative and postoperative outcome. ETO by posterior approach continues to be a work horse approach for most revision surgeons all over the world.

  10. Quality Indicators and Outcomes of Emergency Caesarean ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    personnel limitations are major barriers to the improvement of quality of cesarean deliveries. Future endeavors towards ..... order to address this problem, medication supply chains must be improved on a national and local level and improved ...

  11. Indications and Treatment Outcomes of Intravitreal Bevacizumab ...

    African Journals Online (AJOL)

    Bevacizumab and Ranibizumab for Retinal Diseases in Benin. City, Nigeria. Odarosa M. .... travel costs and risk of complications such as endophthalmitis and retinal detachment ... antiVEGF to be utilised considering reports of increased risk of.

  12. Waste indicators

    Energy Technology Data Exchange (ETDEWEB)

    Dall, O.; Lassen, C.; Hansen, E. [Cowi A/S, Lyngby (Denmark)

    2003-07-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  13. Waste indicators

    International Nuclear Information System (INIS)

    Dall, O.; Lassen, C.; Hansen, E.

    2003-01-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  14. Extended spider cognition.

    Science.gov (United States)

    Japyassú, Hilton F; Laland, Kevin N

    2017-05-01

    There is a tension between the conception of cognition as a central nervous system (CNS) process and a view of cognition as extending towards the body or the contiguous environment. The centralised conception requires large or complex nervous systems to cope with complex environments. Conversely, the extended conception involves the outsourcing of information processing to the body or environment, thus making fewer demands on the processing power of the CNS. The evolution of extended cognition should be particularly favoured among small, generalist predators such as spiders, and here, we review the literature to evaluate the fit of empirical data with these contrasting models of cognition. Spiders do not seem to be cognitively limited, displaying a large diversity of learning processes, from habituation to contextual learning, including a sense of numerosity. To tease apart the central from the extended cognition, we apply the mutual manipulability criterion, testing the existence of reciprocal causal links between the putative elements of the system. We conclude that the web threads and configurations are integral parts of the cognitive systems. The extension of cognition to the web helps to explain some puzzling features of spider behaviour and seems to promote evolvability within the group, enhancing innovation through cognitive connectivity to variable habitat features. Graded changes in relative brain size could also be explained by outsourcing information processing to environmental features. More generally, niche-constructed structures emerge as prime candidates for extending animal cognition, generating the selective pressures that help to shape the evolving cognitive system.

  15. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also...

  16. Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India

    Science.gov (United States)

    Jain, Rajesh; Davey, Sanjeev; Davey, Anuradha; Raghav, Santosh K.; Singh, Jai V.

    2016-01-01

    Background: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014) after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P 1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study. PMID:27186155

  17. Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India

    Directory of Open Access Journals (Sweden)

    Rajesh Jain

    2016-01-01

    Full Text Available Background: Gestational diabetes mellitus (GDM is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014 after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P 1 in every case. Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001. Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study.

  18. Extending quantum mechanics entails extending special relativity

    International Nuclear Information System (INIS)

    Aravinda, S; Srikanth, R

    2016-01-01

    The complementarity between signaling and randomness in any communicated resource that can simulate singlet statistics is generalized by relaxing the assumption of free will in the choice of measurement settings. We show how to construct an ontological extension for quantum mechanics (QMs) through the oblivious embedding of a sound simulation protocol in a Newtonian spacetime. Minkowski or other intermediate spacetimes are ruled out as the locus of the embedding by virtue of hidden influence inequalities. The complementarity transferred from a simulation to the extension unifies a number of results about quantum non-locality, and implies that special relativity has a different significance for the ontological model and for the operational theory it reproduces. Only the latter, being experimentally accessible, is required to be Lorentz covariant. There may be certain Lorentz non-covariant elements at the ontological level, but they will be inaccessible at the operational level in a valid extension. Certain arguments against the extendability of QM, due to Conway and Kochen (2009) and Colbeck and Renner (2012), are attributed to their assumption that the spacetime at the ontological level has Minkowski causal structure. (paper)

  19. General indicators

    International Nuclear Information System (INIS)

    2003-01-01

    This document summarizes the main 2002 energy indicators for France. A first table lists the evolution of general indicators between 1973 and 2002: energy bill, price of imported crude oil, energy independence, primary and final energy consumption. The main 2002 results are detailed separately for natural gas, petroleum and coal (consumption, imports, exports, production, stocks, prices). (J.S.)

  20. Extended recency effect extended: blocking, presentation mode, and retention interval.

    Science.gov (United States)

    Glidden, L M; Pawelski, C; Mar, H; Zigman, W

    1979-07-01

    The effect of blocking of stimulus items on the free recall of EMR adolescents was examined. In Experiment 1 a multitrial free-recall list of 15 pictures was presented either simultaneously in groups of 3, or sequentially, one at a time. Consistent ordering was used in both conditions, so that on each trial, each item in each set of 3 pictures was presented contiguously with the other 2 items from that set. In addition, recall came immediately or after a filled or unfilled delay of 24.5 seconds. Results showed that simultaneous presentation led to higher recall, subjective organization, and clustering than did sequential presentation, but analysis of serial-position curves showed a much reduced extended recency effect in comparison with previous studies. Experiment 2 was designed to determine whether the cause of the reduced extended recency was the use of pictures rather than words as stimuli. Stimuli were presented either as pictures, as pictures with auditory labels, or as words with auditory labels, with both simultaneous and consistent ordering for all conditions. Results indicated a strong extended recency effect for all groups, eliminating presentation mode as a causal factor in the data of Experiment 1. We concluded that blocking leads to increased organization and recall over a variety of presentation modes, rates, and block sizes.

  1. An Extended Duopoly Game.

    Science.gov (United States)

    Eckalbar, John C.

    2002-01-01

    Illustrates how principles and intermediate microeconomic students can gain an understanding for strategic price setting by playing a relatively large oligopoly game. Explains that the game extends to a continuous price space and outlines appropriate applications. Offers the Mathematica code to instructors so that the assumptions of the game can…

  2. Transversally extended string

    International Nuclear Information System (INIS)

    Akama, Keiichi

    1988-01-01

    Starting with the space-time action of the transversally extended string, we derive its world-sheet action, which is that of a gravitational and gauge theory with matter fields on the world-sheet, with additional effects of the second fundamental quantity. (author)

  3. Extended artistic appreciation.

    Science.gov (United States)

    Wilson, Robert A

    2013-04-01

    I propose that in at least some cases, objects of artistic appreciation are best thought of not simply as causes of artistic appreciation, but as parts of the cognitive machinery that drives aesthetic appreciation. In effect, this is to say that aesthetic appreciation operates via extended cognitive systems.

  4. Towards Extended Vantage Theory

    Science.gov (United States)

    Glaz, Adam

    2010-01-01

    The applicability of Vantage Theory (VT), a model of (colour) categorization, to linguistic data largely depends on the modifications and adaptations of the model for the purpose. An attempt to do so proposed here, called Extended Vantage Theory (EVT), slightly reformulates the VT conception of vantage by capitalizing on some of the entailments of…

  5. Solar Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  6. Trochleoplasty: Indications and Technique.

    Science.gov (United States)

    Nolan, John E; Schottel, Patrick C; Endres, Nathan K

    2018-05-09

    Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

  7. Extended Irreversible Thermodynamics

    CERN Document Server

    Jou, David

    2010-01-01

    This is the 4th edition of the highly acclaimed monograph on Extended Irreversible Thermodynamics, a theory that goes beyond the classical theory of irreversible processes. In contrast to the classical approach, the basic variables describing the system are complemented by non-equilibrium quantities. The claims made for extended thermodynamics are confirmed by the kinetic theory of gases and statistical mechanics. The book covers a wide spectrum of applications, and also contains a thorough discussion of the foundations and the scope of the current theories on non-equilibrium thermodynamics. For this new edition, the authors critically revised existing material while taking into account the most recent developments in fast moving fields such as heat transport in micro- and nanosystems or fast solidification fronts in materials sciences. Several fundamental chapters have been revisited emphasizing physics and applications over mathematical derivations. Also, fundamental questions on the definition of non-equil...

  8. Operational indicators

    International Nuclear Information System (INIS)

    2010-01-01

    The chapter presents the operational indicators related to budget, travel costs and tickets, the evolution of the annual program for regulatory inspection, the scientific production, requested patents and the numbers related to the production of the services offered by the Institution

  9. Extended quantum mechanics

    International Nuclear Information System (INIS)

    Pavel Bona

    2000-01-01

    The work can be considered as an essay on mathematical and conceptual structure of nonrelativistic quantum mechanics which is related here to some other (more general, but also to more special and 'approximative') theories. Quantum mechanics is here primarily reformulated in an equivalent form of a Poisson system on the phase space consisting of density matrices, where the 'observables', as well as 'symmetry generators' are represented by a specific type of real valued (densely defined) functions, namely the usual quantum expectations of corresponding selfjoint operators. It is shown in this paper that inclusion of additional ('nonlinear') symmetry generators (i. e. 'Hamiltonians') into this reformulation of (linear) quantum mechanics leads to a considerable extension of the theory: two kinds of quantum 'mixed states' should be distinguished, and operator - valued functions of density matrices should be used in the role of 'nonlinear observables'. A general framework for physical theories is obtained in this way: By different choices of the sets of 'nonlinear observables' we obtain, as special cases, e.g. classical mechanics on homogeneous spaces of kinematical symmetry groups, standard (linear) quantum mechanics, or nonlinear extensions of quantum mechanics; also various 'quasiclassical approximations' to quantum mechanics are all sub theories of the presented extension of quantum mechanics - a version of the extended quantum mechanics. A general interpretation scheme of extended quantum mechanics extending the usual statistical interpretation of quantum mechanics is also proposed. Eventually, extended quantum mechanics is shown to be (included into) a C * -algebraic (hence linear) quantum theory. Mathematical formulation of these theories is presented. The presentation includes an analysis of problems connected with differentiation on infinite-dimensional manifolds, as well as a solution of some problems connected with the work with only densely defined unbounded

  10. Propelling Extended Objects

    Science.gov (United States)

    Humbert, Richard

    2010-01-01

    A force acting on just part of an extended object (either a solid or a volume of a liquid) can cause all of it to move. That motion is due to the transmission of the force through the object by its material. This paper discusses how the force is distributed to all of the object by a gradient of stress or pressure in it, which creates the local…

  11. Extending Critical Performativity

    DEFF Research Database (Denmark)

    Spicer, André; Alvesson, Mats; Kärreman, Dan

    2016-01-01

    In this article we extend the debate about critical performativity. We begin by outlining the basic tenets of critical performativity and how this has been applied in the study of management and organization. We then address recent critiques of critical performance. We note these arguments suffer...... of public importance; engaging with non-academic groups using dialectical reasoning; scaling up insights through movement building; and propagating deliberation...

  12. Extended Theories of Gravity

    International Nuclear Information System (INIS)

    Capozziello, Salvatore; De Laurentis, Mariafelicia

    2011-01-01

    Extended Theories of Gravity can be considered as a new paradigm to cure shortcomings of General Relativity at infrared and ultraviolet scales. They are an approach that, by preserving the undoubtedly positive results of Einstein’s theory, is aimed to address conceptual and experimental problems recently emerged in astrophysics, cosmology and High Energy Physics. In particular, the goal is to encompass, in a self-consistent scheme, problems like inflation, dark energy, dark matter, large scale structure and, first of all, to give at least an effective description of Quantum Gravity. We review the basic principles that any gravitational theory has to follow. The geometrical interpretation is discussed in a broad perspective in order to highlight the basic assumptions of General Relativity and its possible extensions in the general framework of gauge theories. Principles of such modifications are presented, focusing on specific classes of theories like f(R)-gravity and scalar–tensor gravity in the metric and Palatini approaches. The special role of torsion is also discussed. The conceptual features of these theories are fully explored and attention is paid to the issues of dynamical and conformal equivalence between them considering also the initial value problem. A number of viability criteria are presented considering the post-Newtonian and the post-Minkowskian limits. In particular, we discuss the problems of neutrino oscillations and gravitational waves in extended gravity. Finally, future perspectives of extended gravity are considered with possibility to go beyond a trial and error approach.

  13. [Utility and validity of indicators from the Nursing Outcomes Classification as a support tool for diagnosing Ineffective Self Health Management in patients with chronic conditions in primary health care].

    Science.gov (United States)

    Morilla-Herrera, J C; Morales-Asencio, J M; Fernández-Gallego, M C; Cobos, E Berrobianco; Romero, A Delgado

    2011-01-01

    Self-care and management of therapeutic regime (drugs adherence, preventive behaviours and development of healthy life-styles) are key components for managing chronic diseases. Nursing has standardized languages which describe many of these situations, such as the diagnosis "Ineffective Self Health Management" (ISHM) or many of the Nursing Outcomes Classification (NOC) indicators. The aims of this study were to determine the interobserver reliability of a NOC-based instrument for assessment and aid in diagnosis of the ISHM in patients with chronic conditions in Primary Health Care, to determine its diagnostic validity and to describe the prevalence of patients with this problem. Cross-sectional validation study developed in the provinces of Málaga, Cádiz and Almería from 2006 to 2009. Each patient was assessed by 3 independent observers: the first two observers evaluated scoring of the NOC indicators and the third one acted as the "gold-standard". Two hundred and twenty-eight patients were included, 37.7% of them with more than one chronic condition. NOC indicators showed a high interobserver reliability (ICC>0,70) and a consistency (Cronbach's alpha: 0.81). With a cut-point of 10.5, sensitivity was 61% and specificity 85%, and the area under the curve was 0.81 (CI95%: 0.77 to 0.85). The prevalence of patients with ISHM was 36% (CI 95%: 34 to 40). The use of NOC indicators allows evaluation of management of the therapeutic regime in people with chronic conditions with a satisfactory validity and it provides new approaches for dealing with this problem.

  14. Musical Manipulations and the Emotionally Extended Mind

    Directory of Open Access Journals (Sweden)

    Joel Krueger

    2015-05-01

    Full Text Available I respond to Kersten's criticism in his article "Music and Cognitive Extension" of my approach to the musically extended emotional mind in Krueger (2014. I specify how we manipulate—and in so doing, integrate with—music when, as active listeners, we become part of a musically extended cognitive system. I also indicate how Kersten's account might be enriched by paying closer attention to the way that music functions as an environmental artifact for emotion regulation.

  15. SU-F-T-107: Correlations Between Dosimetric Indices of Pharyngeal Constrictors and Proximal Esophagus with Associated Patient-Reported Outcomes Six Months After Radiation Therapy for Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chera, B; Price, A; Kostich, M; Green, R; Das, S; Mavroidis, P [University of North Carolina, Chapel Hill, North Carolina (United States); Amdur, R; Mendenhall, W [University of Florida, Gainesville, FL (United States); Sheets, N [University of North Carolina, Raleigh, North Carolina (United States); Marks, L [UNC School of Medicine, Chapel Hill, NC (United States)

    2016-06-15

    Purpose: To compare the correlations between different dosimetric indices derived from the pharyngeal constrictor muscles and proximal esophagus with patient-reported difficulty in swallowing 6 months post radiotherapy using a novel patient reported outcome version of CTCAE (PRO-CTCAE). Methods: Forty-three patients with oropharyngeal squamous cell carcinoma were treated on a prospective multi-institutional study. All patients received de-intensified 60 Gy intensity modulated radiotherapy. We investigated correlations of individual patient dosimetric data of the superior (SPC), middle (MPC), inferior (IPC) pharyngeal constrictor muscles, the superior esophagus (SES), and the inferior esophagus (IES) to their self-reported 6 month post-treatment swallowing difficulty responses. Mild (≥ Grade 1) swallowing difficulty responses were used as the clinical endpoint indicating response. The predictive efficacy of Dmean and dose-volume (VD) points were assessed through the area under the Receiver Operating Characteristic curve (ROC) and Odds Ratio (OR). Results: The SES and SPC had more favorable area under the curves (AUC) for the Dmean (0.62 and 0.70) while the Dmean to the IPC, MPC, and IES produced suboptimal AUCs (0.42, 0.48, and 0.52). Additionally, over the range of VD, the V54 and V55 for the SES and SPC demonstrated the highest AUCs: AUC(SES) = 0.76–0.73 and AUC(SPC) = 0.72–0.69, respectively. The IES, IPC, and MPC had worse AUC results over the range of VD. An optimal OR can be found when V54 = 96% for the SPC, where OR = 3.96 (1.07–14.62). Conclusion: The V45 and V55 of the SES and SPC had the highest correlation to the clinical endpoint compared to the commonly used dosimetric index, Dmean for both the esophagus and constrictor muscles. The reported dosimetric data demonstrates that new dosimetric indices may need to be considered in the setting of dose de-escalation and self-reported outcomes.

  16. Extended Testability Analysis Tool

    Science.gov (United States)

    Melcher, Kevin; Maul, William A.; Fulton, Christopher

    2012-01-01

    The Extended Testability Analysis (ETA) Tool is a software application that supports fault management (FM) by performing testability analyses on the fault propagation model of a given system. Fault management includes the prevention of faults through robust design margins and quality assurance methods, or the mitigation of system failures. Fault management requires an understanding of the system design and operation, potential failure mechanisms within the system, and the propagation of those potential failures through the system. The purpose of the ETA Tool software is to process the testability analysis results from a commercial software program called TEAMS Designer in order to provide a detailed set of diagnostic assessment reports. The ETA Tool is a command-line process with several user-selectable report output options. The ETA Tool also extends the COTS testability analysis and enables variation studies with sensor sensitivity impacts on system diagnostics and component isolation using a single testability output. The ETA Tool can also provide extended analyses from a single set of testability output files. The following analysis reports are available to the user: (1) the Detectability Report provides a breakdown of how each tested failure mode was detected, (2) the Test Utilization Report identifies all the failure modes that each test detects, (3) the Failure Mode Isolation Report demonstrates the system s ability to discriminate between failure modes, (4) the Component Isolation Report demonstrates the system s ability to discriminate between failure modes relative to the components containing the failure modes, (5) the Sensor Sensor Sensitivity Analysis Report shows the diagnostic impact due to loss of sensor information, and (6) the Effect Mapping Report identifies failure modes that result in specified system-level effects.

  17. Extended Wordsearches in Chemistry

    Science.gov (United States)

    Cotton, Simon

    1998-04-01

    Students can be encouraged to develop their factual knowledge by use of puzzles. One strategy described here is the extended wordsearch, where the wordsearch element generates a number of words or phrases from which the answers to a series of questions are selected. The wordsearch can be generated with the aid of computer programs, though in order to make them suitable for students with dyslexia or other learning difficulties, a simpler form is more appropriate. These problems can be employed in a variety of contexts, for example, as topic tests and classroom end-of-lesson fillers. An example is provided in the area of calcium chemistry. Sources of suitable software are listed.

  18. Classical extended superconformal symmetries

    International Nuclear Information System (INIS)

    Viswanathan, R.R.

    1990-10-01

    Super-covariant differential operators are defined in two dimensions which map supersymmetry doublets to other doublets. The possibility of constructing a closed algebra among the fields appearing in such operators is explored. Such an algebra exists for Grassmann-odd differential operators. A representation for these operators in terms of free-field doublets is constructed. An explicit closed algebra involving fields of spin 2 and 5/2, in addition to the stress tensor and the supersymmetry generator, is constructed from such a free-field representation as an example of a non-linear extended superconformal algebra. (author). 9 refs

  19. Bayesian Sampling using Condition Indicators

    DEFF Research Database (Denmark)

    Faber, Michael H.; Sørensen, John Dalsgaard

    2002-01-01

    of condition indicators introduced by Benjamin and Cornell (1970) a Bayesian approach to quality control is formulated. The formulation is then extended to the case where the quality control is based on sampling of indirect information about the condition of the components, i.e. condition indicators...

  20. Extending juvenility in grasses

    Energy Technology Data Exchange (ETDEWEB)

    Kaeppler, Shawn; de Leon Gatti, Natalia; Foerster, Jillian

    2017-04-11

    The present invention relates to compositions and methods for modulating the juvenile to adult developmental growth transition in plants, such as grasses (e.g. maize). In particular, the invention provides methods for enhancing agronomic properties in plants by modulating expression of GRMZM2G362718, GRMZM2G096016, or homologs thereof. Modulation of expression of one or more additional genes which affect juvenile to adult developmental growth transition such as Glossy15 or Cg1, in conjunction with such modulation of expression is also contemplated. Nucleic acid constructs for down-regulation of GRMZM2G362718 and/or GRMZM2G096016 are also contemplated, as are transgenic plants and products produced there from, that demonstrate altered, such as extended juvenile growth, and display associated phenotypes such as enhanced yield, improved digestibility, and increased disease resistance. Plants described herein may be used, for example, as improved forage or feed crops or in biofuel production.

  1. Extended biorthogonal matrix polynomials

    Directory of Open Access Journals (Sweden)

    Ayman Shehata

    2017-01-01

    Full Text Available The pair of biorthogonal matrix polynomials for commutative matrices were first introduced by Varma and Tasdelen in [22]. The main aim of this paper is to extend the properties of the pair of biorthogonal matrix polynomials of Varma and Tasdelen and certain generating matrix functions, finite series, some matrix recurrence relations, several important properties of matrix differential recurrence relations, biorthogonality relations and matrix differential equation for the pair of biorthogonal matrix polynomials J(A,B n (x, k and K(A,B n (x, k are discussed. For the matrix polynomials J(A,B n (x, k, various families of bilinear and bilateral generating matrix functions are constructed in the sequel.

  2. Extended conformal algebras

    International Nuclear Information System (INIS)

    Goddard, Peter

    1990-01-01

    The algebra of the group of conformal transformations in two dimensions consists of two commuting copies of the Virasoro algebra. In many mathematical and physical contexts, the representations of ν which are relevant satisfy two conditions: they are unitary and they have the ''positive energy'' property that L o is bounded below. In an irreducible unitary representation the central element c takes a fixed real value. In physical contexts, the value of c is a characteristic of a theory. If c < 1, it turns out that the conformal algebra is sufficient to ''solve'' the theory, in the sense of relating the calculation of the infinite set of physically interesting quantities to a finite subset which can be handled in principle. For c ≥ 1, this is no longer the case for the algebra alone and one needs some sort of extended conformal algebra, such as the superconformal algebra. It is these algebras that this paper aims at addressing. (author)

  3. Extended Poisson Exponential Distribution

    Directory of Open Access Journals (Sweden)

    Anum Fatima

    2015-09-01

    Full Text Available A new mixture of Modified Exponential (ME and Poisson distribution has been introduced in this paper. Taking the Maximum of Modified Exponential random variable when the sample size follows a zero truncated Poisson distribution we have derived the new distribution, named as Extended Poisson Exponential distribution. This distribution possesses increasing and decreasing failure rates. The Poisson-Exponential, Modified Exponential and Exponential distributions are special cases of this distribution. We have also investigated some mathematical properties of the distribution along with Information entropies and Order statistics of the distribution. The estimation of parameters has been obtained using the Maximum Likelihood Estimation procedure. Finally we have illustrated a real data application of our distribution.

  4. Digital Immigrant Teacher Perceptions of an Extended Cyberhunt Strategy

    Science.gov (United States)

    du Plessis, Andre; Webb, Paul

    2012-01-01

    This quantitative and qualitative interpretive exploratory case study investigates whether exposure to an Internet based "Extended Cyberhunt" strategy enables teachers to attain a set of outcomes similar to Prensky's "Essential 21st Century Skills" and the "Critical Outcomes of the South African National Curriculum…

  5. Extended attention span training system

    Science.gov (United States)

    Pope, Alan T.; Bogart, Edward H.

    1991-01-01

    Attention Deficit Disorder (ADD) is a behavioral disorder characterized by the inability to sustain attention long enough to perform activities such as schoolwork or organized play. Treatments for this disorder include medication and brainwave biofeedback training. Brainwave biofeedback training systems feed back information to the trainee showing him how well he is producing the brainwave pattern that indicates attention. The Extended Attention Span Training (EAST) system takes the concept a step further by making a video game more difficult as the player's brainwaves indicate that attention is waning. The trainee can succeed at the game only by maintaining an adequate level of attention. The EAST system is a modification of a biocybernetic system that is currently being used to assess the extent to which automated flight management systems maintain pilot engagement. This biocybernetic system is a product of a program aimed at developing methods to evaluate automated flight deck designs for compatibility with human capabilities. The EAST technology can make a contribution in the fields of medical neuropsychology and neurology, where the emphasis is on cautious, conservative treatment of youngsters with attention disorders.

  6. Interactions of miR-323/miR-326/miR-329 and miR-130a/miR-155/miR-210 as prognostic indicators for clinical outcome of glioblastoma patients

    Directory of Open Access Journals (Sweden)

    Qiu Shuwei

    2013-01-01

    Full Text Available Abstract Background Glioblastoma multiforme (GBM is the most common and aggressive brain tumor with poor clinical outcome. Identification and development of new markers could be beneficial for the diagnosis and prognosis of GBM patients. Deregulation of microRNAs (miRNAs or miRs is involved in GBM. Therefore, we attempted to identify and develop specific miRNAs as prognostic and predictive markers for GBM patient survival. Methods Expression profiles of miRNAs and genes and the corresponding clinical information of 480 GBM samples from The Cancer Genome Atlas (TCGA dataset were downloaded and interested miRNAs were identified. Patients’ overall survival (OS and progression-free survival (PFS associated with interested miRNAs and miRNA-interactions were performed by Kaplan-Meier survival analysis. The impacts of miRNA expressions and miRNA-interactions on survival were evaluated by Cox proportional hazard regression model. Biological processes and network of putative and validated targets of miRNAs were analyzed by bioinformatics. Results In this study, 6 interested miRNAs were identified. Survival analysis showed that high levels of miR-326/miR-130a and low levels of miR-323/miR-329/miR-155/miR-210 were significantly associated with long OS of GBM patients, and also showed that high miR-326/miR-130a and low miR-155/miR-210 were related with extended PFS. Moreover, miRNA-323 and miRNA-329 were found to be increased in patients with no-recurrence or long time to progression (TTP. More notably, our analysis revealed miRNA-interactions were more specific and accurate to discriminate and predict OS and PFS. This interaction stratified OS and PFS related with different miRNA levels more detailed, and could obtain longer span of mean survival in comparison to that of one single miRNA. Moreover, miR-326, miR-130a, miR-155, miR-210 and 4 miRNA-interactions were confirmed for the first time as independent predictors for survival by Cox regression model

  7. A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Zhijun Xin

    2017-01-01

    Full Text Available Objective is to describe a safe and effective percutaneous endoscopic approach for removal of highly migrated and sequestrated disc herniations of the upper lumbar spine and to report the results, surgical indications, and technical considerations of the new technique. Eleven patients who had highly migrated and sequestrated disc herniations in the upper lumbar were included in this study. A retrospective study was performed for all patients after translaminar osseous channel-assisted PELD was performed. Radiologic findings were investigated, and pre-and postoperative visual analog scale (VAS assessments for back and leg pain and Oswestry disability index (ODI evaluations were performed. Surgical outcomes were evaluated under modified MacNab criteria. All of the patients were followed for more than 1 year. The preoperative and postoperative radiologic findings revealed that the decompression of the herniated nucleus pulposus (HNP was complete. After surgery, the mean VAS scores for back and leg pain immediately improved from 8.64 (range, 7–10 and 8.00 (range, 6–10 to 2.91 (range, 2–4 and 2.27 (range, 1–3, respectively. The mean preoperative ODI was 65.58 (range, 52.2–86, which decreased to 7.51 (range, 1.8–18 at the 12-month postoperative follow-up. The MacNab scores at the final follow-up included nine excellent, one good, and one fair. The modified translaminar osseous channel-assisted PELD could be a safe and effective option for the treatment of highly migrated and sequestrated disc herniations of the upper lumbar.

  8. Measuring educational quality by means of indicators

    NARCIS (Netherlands)

    Scheerens, Jaap; Scheerens, J; Luyten, H.; van Ravens, J.

    2011-01-01

    In this chapter the input-process-outcomes-context framework, introduced in Chapter 1 is used for categorising and describing input indicators, process indicators, outcome indicators and context indicators. The chapter starts out with a review and further illustration of this framework and follows

  9. Extended Interneuronal Network of the Dentate Gyrus

    Directory of Open Access Journals (Sweden)

    Gergely G. Szabo

    2017-08-01

    Full Text Available Local interneurons control principal cells within individual brain areas, but anecdotal observations indicate that interneuronal axons sometimes extend beyond strict anatomical boundaries. Here, we use the case of the dentate gyrus (DG to show that boundary-crossing interneurons with cell bodies in CA3 and CA1 constitute a numerically significant and diverse population that relays patterns of activity generated within the CA regions back to granule cells. These results reveal the existence of a sophisticated retrograde GABAergic circuit that fundamentally extends the canonical interneuronal network.

  10. Changes in the influence of alcohol-paired stimuli on alcohol seeking across extended training.

    Directory of Open Access Journals (Sweden)

    Laura H. Corbit

    2016-10-01

    Full Text Available Previous work has demonstrated that goal-directed control of alcohol seeking and other drug-related behaviors is reduced following extended self-administration and drug exposure. Here we examined how the magnitude of stimulus influences on responding changes across similar training and drug exposure. Rats self-administered alcohol or sucrose for two or eight weeks. Previous work has shown that eight, but not two weeks of self-administration produces habitual alcohol seeking. Next, all animals received equivalent Pavlovian conditioning sessions where a discrete stimulus predicted the delivery of alcohol or sucrose. Finally, the impact of the stimuli on ongoing instrumental responding was examined in a Pavlovian-instrumental transfer (PIT test. While a significant PIT effect was observed following two weeks of either alcohol or sucrose self-administration, the magnitude of this effect was greater following eight weeks of training. The specificity of the PIT effect appeared unchanged by extended training. While it is well established that evaluation of the outcome of responding contributes less to behavioral control following extended training and/or drug exposure, our data indicate that reward-predictive stimuli have a stronger contribution to responding after extended training. Together, these findings provide insight into the factors that control behavior after extended drug use which will be important for developing effective methods for controlling and ideally reducing these behaviors.

  11. Changes in the Influence of Alcohol-Paired Stimuli on Alcohol Seeking across Extended Training

    Science.gov (United States)

    Corbit, Laura H.; Janak, Patricia H.

    2016-01-01

    Previous work has demonstrated that goal-directed control of alcohol-seeking and other drug-related behaviors is reduced following extended self-administration and drug exposure. Here, we examined how the magnitude of stimulus influences on responding changes across similar training and drug exposure. Rats self-administered alcohol or sucrose for 2 or 8 weeks. Previous work has shown that 8 weeks, but not 2 weeks of self-administration produces habitual alcohol seeking. Next, all animals received equivalent Pavlovian conditioning sessions where a discrete stimulus predicted the delivery of alcohol or sucrose. Finally, the impact of the stimuli on ongoing instrumental responding was examined in a Pavlovian–instrumental transfer (PIT) test. While a significant PIT effect was observed following 2 weeks of either alcohol or sucrose self-administration, the magnitude of this effect was greater following 8 weeks of training. The specificity of the PIT effect appeared unchanged by extended training. While it is well established that evaluation of the outcome of responding contributes less to behavioral control following extended training and/or drug exposure, our data indicate that reward–predictive stimuli have a stronger contribution to responding after extended training. Together, these findings provide insight into the factors that control behavior after extended drug use, which will be important for developing effective methods for controlling and ideally reducing these behaviors. PMID:27777560

  12. The validity of the extended energy principle

    International Nuclear Information System (INIS)

    Chance, M.S.; Johnson, J.L.; Kulsrud, R.M.

    1994-04-01

    A recent analysis of plasma stability based on modifications of the extended energy principle for magnetohydrodynamic stability led to conclusions that are too optimistic. The original interpretation of this principle is indeed applicable. The present analysis demonstrates explicitly the fallacy of using the wrong functional for δW in the extended energy principle. It then shows that the original energy principle functional δW B is also obtained for a model in which a surface mass is incorporated to provide pressure balance. This work therefore indicates, but does not prove, that the eigenfunctions that are obtained from a minimization of the extended energy principle with the proper kinetic energy norm provide a good representation of what would be achieved with an exact treatment

  13. Describing the characteristics, treatment pathways, outcomes, and costs of people with persistent noncancer pain managed by community pain clinics and generating an indicative estimate of cost-effectiveness: feasibility study protocol

    Directory of Open Access Journals (Sweden)

    AlAujan S

    2016-05-01

    Full Text Available Shiekha AlAujan,1 Saja AlMazrou,1 Roger D Knaggs,1,2 Rachel A Elliott11Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK; 2Pharmacy Department and Pain Management Service, Nottingham University Hospitals NHS Trust, Nottingham, UKBackground: Low back pain (LBP and fibromyalgia (FM, also known as chronic widespread pain (CWP, are highly prevalent chronic painful conditions that have substantial impact on patients, health care systems, and society. Diagnosis is complex and management strategies are associated with various levels of evidence for effectiveness and cost-effectiveness. Multidisciplinary pain services have been shown to be effective in some settings and therefore are recommended by clinical practice guidelines as a rational treatment option to manage these patients. Knowing that these services are resource intensive, evidence is needed to demonstrate their cost-effectiveness. This study aims to describe the management of patients with LBP and FM in two community pain clinics to derive an indicative estimate of cost-effectiveness compared with standard practice.Methods: This is a prospective observational multicenter study, using patient-level data. The data from this study will be combined with modelling of the long-term economic impact of community pain clinics in treating people with LBP and FM. Newly referred patients with LBP and FM who provide written consent will be included. We will collect data on functional disability, pain intensity, quality of life, and health resource utilization. Follow-up data at the 3- and 6-month points will be collected by patient-completed questionnaires and health care contact diaries. Health care resource use from diaries will be compared with patient electronic records to assess the agreement between these recording methods. Patient cohort characteristics, treatment pathways, resource use, and outcomes derived from this study will

  14. Irreducibility conditions for extended superfields

    International Nuclear Information System (INIS)

    Sokatchev, E.

    1981-05-01

    The irreducible supermultiplets contained in an extended superfield are presented as sets of covariant derivatives of the superfield. Differential irreducibility constraints are easily obtained from this decomposition. (author)

  15. N=2 extended supersymmetric GUTs

    International Nuclear Information System (INIS)

    Fayet, P.

    1984-01-01

    We construct N = 2 extended SUSY GUTs which provide a general association between massive spin-1 gauge bosons, spin-1/2 inos and spin-0 Higgs bosons. The corresponding gauge hypermultiplets are of four different types, while leptons and quarks are associated with mirror and spin-0 partners. The anticommutators of the two supersymmetry generators provide two spin-0 symmetry generators Zsub(s) and Zsub(p), which do not commute. Their field-independent parts and do commute, however, and appear as central charges in the symmetry algebra of the spontaneously broken gauge theory. These central charges and are linear combinations of global symmetry generators with grand unification generators such as the weak hypercharge (but not the electrical charge). They survive the electroweak symmetry breaking. They do not vanish for massive gauge hypermultiplets of types II and III, which verify M 2 = 2 + 2 > 0 and M 2 > 2 + 2 > 0, respectively. The formula M 2 approx.= 2 + 2 determines the mass spectrum on the grand unification scale, up to electroweak corrections. Finally, we indicate how our mass relations can be interpreted in a 5- or 6-dimensional formalism, the central charges appearing as the extra components of the covariant momentum along the compact fifth or sixth dimensions; and how to evaluate the grand unification mass msub(x) in terms of the lengths of the latter (msub(x)approx.=(h/2π)/Lsub(5(6))c). (orig./HSI)

  16. Early Adolescent Affect Predicts Later Life Outcomes.

    Science.gov (United States)

    Kansky, Jessica; Allen, Joseph P; Diener, Ed

    2016-07-01

    Subjective well-being as a predictor for later behavior and health has highlighted its relationship to health, work performance, and social relationships. However, the majority of such studies neglect the developmental nature of well-being in contributing to important changes across the transition to adulthood. To examine the potential role of subjective well-being as a long-term predictor of critical life outcomes, we examined indicators of positive and negative affect at age 14 as predictors of relationship, adjustment, self-worth, and career outcomes a decade later at ages 23 to 25, controlling for family income and gender. We utilised multi-informant methods including reports from the target participant, close friends, and romantic partners in a demographically diverse community sample of 184 participants. Early adolescent positive affect predicted fewer relationship problems (less self-reported and partner-reported conflict, and greater friendship attachment as rated by close peers) and healthy adjustment to adulthood (lower levels of depression, anxiety, and loneliness). It also predicted positive work functioning (higher levels of career satisfaction and job competence) and increased self-worth. Negative affect did not significantly predict any of these important life outcomes. In addition to predicting desirable mean levels of later outcomes, early positive affect predicted beneficial changes across time in many outcomes. The findings extend early research on the beneficial outcomes of subjective well-being by having an earlier assessment of well-being, including informant reports in measuring a large variety of outcome variables, and by extending the findings to a lower socioeconomic group of a diverse and younger sample. The results highlight the importance of considering positive affect as an important component of subjective well-being distinct from negative affect. © 2016 The International Association of Applied Psychology.

  17. Enhanced tamper indicator

    Science.gov (United States)

    Garcia, Anthony R.; Johnston, Roger G.

    2003-07-08

    The present invention provides an apparatus and method whereby the reliability and tamper-resistance of tamper indicators can be improved. A flexible connector may be routed through a latch for an enclosure such as a door or container, and the free ends of the flexible connector may be passed through a first locking member and firmly attached to an insert through the use of one or more attachment members such as set screws. A second locking member may then be assembled in interlocking relation with the first locking member to form an interlocked assembly around the insert. The insert may have one or more sharp projections extending toward the first or second locking member so that any compressive force applied in an attempt to disassemble the interlocked assembly results in permanent, visible damage to the first or second locking member.

  18. Extending cosmology: the metric approach

    OpenAIRE

    Mendoza, S.

    2012-01-01

    Comment: 2012, Extending Cosmology: The Metric Approach, Open Questions in Cosmology; Review article for an Intech "Open questions in cosmology" book chapter (19 pages, 3 figures). Available from: http://www.intechopen.com/books/open-questions-in-cosmology/extending-cosmology-the-metric-approach

  19. Extended cognition and epistemic luck

    NARCIS (Netherlands)

    Carter, J.A.

    2013-01-01

    When extended cognition is extended into mainstream epistemology, an awkward tension arises when considering cases of environmental epistemic luck. Surprisingly, it is not at all clear how the mainstream verdict that agents lack knowledge in cases of environmental luck can be reconciled with

  20. From lagging indicators to leading indicators : design of a leading indicator dashboard for Philips Lighting

    NARCIS (Netherlands)

    Cai, Yongjian

    2011-01-01

    KPI (Key Performance Indicators) such as customer service level and stock level are commonly used in industry to measure the supply chain performance. Supply chain managers have a decided preference for these "lagging" indicators since they only measure the final outcomes that result from their

  1. Scale-invariant extended inflation

    International Nuclear Information System (INIS)

    Holman, R.; Kolb, E.W.; Vadas, S.L.; Wang, Y.

    1991-01-01

    We propose a model of extended inflation which makes use of the nonlinear realization of scale invariance involving the dilaton coupled to an inflaton field whose potential admits a metastable ground state. The resulting theory resembles the Jordan-Brans-Dicke version of extended inflation. However, quantum effects, in the form of the conformal anomaly, generate a mass for the dilaton, thus allowing our model to evade the problems of the original version of extended inflation. We show that extended inflation can occur for a wide range of inflaton potentials with no fine-tuning of dimensionless parameters required. Furthermore, we also find that it is quite natural for the extended-inflation period to be followed by an epoch of slow-rollover inflation as the dilaton settles down to the minimum of its induced potential

  2. Social inequalities in pregnancy outcomes and early childhood behaviour: the Generation R study

    NARCIS (Netherlands)

    P.W. Jansen (Pauline)

    2009-01-01

    textabstractaim of this thesis was to extend the existing knowledge on the relation of social disadvantage with pregnancy outcomes and early childhood behaviour. More specifically, we aimed to identify the mechanisms underlying this association. In this thesis, several indicators of social

  3. Viability of bull semen extended with commercial semen extender ...

    African Journals Online (AJOL)

    Andrea Raseona

    stored at 24 °C. Sperm motility parameters, morphology, and viability were analysed ... body size, slow average daily weight gain, decreased fertility, extended .... were determined by counting a total of 200 spermatozoa per each stained slide.

  4. Cosmological dynamics of extended chameleons

    International Nuclear Information System (INIS)

    Tamanini, Nicola; Wright, Matthew

    2016-01-01

    We investigate the cosmological dynamics of the recently proposed extended chameleon models at both background and linear perturbation levels. Dynamical systems techniques are employed to fully characterize the evolution of the universe at the largest distances, while structure formation is analysed at sub-horizon scales within the quasi-static approximation. The late time dynamical transition from dark matter to dark energy domination can be well described by almost all extended chameleon models considered, with no deviations from ΛCDM results at both background and perturbation levels. The results obtained in this work confirm the cosmological viability of extended chameleons as alternative dark energy models.

  5. Extended asymptotic functions - some examples

    International Nuclear Information System (INIS)

    Todorov, T.D.

    1981-01-01

    Several examples of extended asymptotic functions of two variables are given. This type of asymptotic functions has been introduced as an extension of continuous ordinary functions. The presented examples are realizations of some Schwartz distributions delta(x), THETA(x), P(1/xsup(n)) and can be multiplied in the class of the asymptotic functions as opposed to the theory of Schwartz distributions. The examples illustrate the method of construction of extended asymptotic functions similar to the distributions. The set formed by the extended asymptotic functions is also considered. It is shown, that this set is not closed with respect to addition and multiplication

  6. Cosmological dynamics of extended chameleons

    Energy Technology Data Exchange (ETDEWEB)

    Tamanini, Nicola [Institut de Physique Théorique, CEA-Saclay, CNRS UMR 3681, Université Paris-Saclay, F-91191 Gif-sur-Yvette (France); Wright, Matthew, E-mail: nicola.tamanini@cea.fr, E-mail: matthew.wright.13@ucl.ac.uk [Department of Mathematics, University College London, Gower Street, London, WC1E 6BT (United Kingdom)

    2016-04-01

    We investigate the cosmological dynamics of the recently proposed extended chameleon models at both background and linear perturbation levels. Dynamical systems techniques are employed to fully characterize the evolution of the universe at the largest distances, while structure formation is analysed at sub-horizon scales within the quasi-static approximation. The late time dynamical transition from dark matter to dark energy domination can be well described by almost all extended chameleon models considered, with no deviations from ΛCDM results at both background and perturbation levels. The results obtained in this work confirm the cosmological viability of extended chameleons as alternative dark energy models.

  7. Development of an efficient and compact range extender engine; Entwicklung eines effizienten und kompakten Range-Extender-Motors

    Energy Technology Data Exchange (ETDEWEB)

    Mahr, Bernd; Bassett, Mike; Hall, Jonathan; Warth, Marco [Mahle Powertrain Ltd., Northampton (United Kingdom)

    2011-10-15

    Mahle Powertrain has developed a compact, two-cylinder, spark-ignition engine that is specifically designed to be used as a range extender. Drive-cycle simulations and engine tests indicate that a range-extended vehicle using this engine would achieve a significant reduction in fuel consumption and tail-pipe CO{sub 2} levels. (orig.)

  8. Impact of a social-emotional and character development program on school-level indicators of academic achievement, absenteeism, and disciplinary outcomes: A matched-pair, cluster randomized, controlled trial.

    Science.gov (United States)

    Snyder, Frank; Flay, Brian; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac; Beets, Michael; Li, Kin-Kit

    2010-01-01

    This paper reports the effects of a comprehensive elementary school-based social-emotional and character education program on school-level achievement, absenteeism, and disciplinary outcomes utilizing a matched-pair, cluster randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools (mean enrollment = 544) and was conducted from the 2002-03 through the 2005-06 academic years. Using school-level archival data, analyses comparing change from baseline (2002) to one-year post trial (2007) revealed that intervention schools scored 9.8% better on the TerraNova (2 nd ed.) test for reading and 8.8% on math; 20.7% better in Hawai'i Content and Performance Standards scores for reading and 51.4% better in math; and that intervention schools reported 15.2% lower absenteeism and fewer suspensions (72.6%) and retentions (72.7%). Overall, effect sizes were moderate to large (range 0.5-1.1) for all of the examined outcomes. Sensitivity analyses using permutation models and random-intercept growth curve models substantiated results. The results provide evidence that a comprehensive school-based program, specifically developed to target student behavior and character, can positively influence school-level achievement, attendance, and disciplinary outcomes concurrently.

  9. Symmetric extendibility of quantum states

    OpenAIRE

    Nowakowski, Marcin L.

    2015-01-01

    Studies on symmetric extendibility of quantum states become especially important in a context of analysis of one-way quantum measures of entanglement, distilabillity and security of quantum protocols. In this paper we analyse composite systems containing a symmetric extendible part with a particular attention devoted to one-way security of such systems. Further, we introduce a new one-way monotone based on the best symmetric approximation of quantum state. We underpin those results with geome...

  10. Topological defects in extended inflation

    International Nuclear Information System (INIS)

    Copeland, E.J.; Kolb, E.W.; Chicago Univ., IL; Liddle, A.R.

    1990-04-01

    We consider the production of topological defects, especially cosmic strings, in extended inflation models. In extended inflation, the Universe passes through a first-order phase transition via bubble percolation, which naturally allows defects to form at the end of inflation. The correlation length, which determines the number density of the defects, is related to the mean size of bubbles when they collide. This mechanism allows a natural combination of inflation and large-scale structure via cosmic strings. 18 refs

  11. Quasi-extended asymptotic functions

    International Nuclear Information System (INIS)

    Todorov, T.D.

    1979-01-01

    The class F of ''quasi-extended asymptotic functions'' is introduced. It contains all extended asymptotic functions as well as some new asymptotic functions very similar to the Schwartz distributions. On the other hand, every two quasiextended asymptotic functions can be multiplied as opposed to the Schwartz distributions; in particular, the square delta 2 of an asymptotic function delta similar to Dirac's delta-function, is constructed as an example

  12. Some problems with extended inflation

    International Nuclear Information System (INIS)

    Weinberg, E.J.

    1989-01-01

    The recently proposed extended inflation scenario is examined. Upper bounds on the Brans-Dicke parameter ω are obtained by requiring that the recovery from the supercooled regime be such that the presently observed Universe could have emerged. These bounds are well below the present-day experimental limits, implying that one must use models which have a potential to fix the present value of the Brans-Dicke-like scalar field. The implications for extended inflation in such models are discussed

  13. Topological defects in extended inflation

    International Nuclear Information System (INIS)

    Copeland, E.J.; Kolb, E.W.; Liddle, A.R.

    1990-01-01

    We consider the production of topological defects, especially cosmic strings, in extended-inflation models. In extended inflation, the Universe passes through a first-order phase transition via bubble percolation, which naturally allows defects to form at the end of inflation. The correlation length, which determines the number density of the defects, is related to the mean size of the bubbles when they collide. This mechanism allows a natural combination of inflation and large-scale structure via cosmic strings

  14. Comparative Study of foF2 Measurements with IRI-2007 Model Predictions During Extended Solar Minimum

    Science.gov (United States)

    Zakharenkova, I. E.; Krankowski, A.; Bilitza, D.; Cherniak, Iu.V.; Shagimuratov, I.I.; Sieradzki, R.

    2013-01-01

    The unusually deep and extended solar minimum of cycle 2324 made it very difficult to predict the solar indices 1 or 2 years into the future. Most of the predictions were proven wrong by the actual observed indices. IRI gets its solar, magnetic, and ionospheric indices from an indices file that is updated twice a year. In recent years, due to the unusual solar minimum, predictions had to be corrected downward with every new indices update. In this paper we analyse how much the uncertainties in the predictability of solar activity indices affect the IRI outcome and how the IRI values calculated with predicted and observed indices compared to the actual measurements.Monthly median values of F2 layer critical frequency (foF2) derived from the ionosonde measurements at the mid-latitude ionospheric station Juliusruh were compared with the International Reference Ionosphere (IRI-2007) model predictions. The analysis found that IRIprovides reliable results that compare well with actual measurements, when the definite (observed and adjusted) indices of solar activityare used, while IRI values based on earlier predictions of these indices noticeably overestimated the measurements during the solar minimum.One of the principal objectives of this paper is to direct attention of IRI users to update their solar activity indices files regularly.Use of an older index file can lead to serious IRI overestimations of F-region electron density during the recent extended solar minimum.

  15. Extended likelihood inference in reliability

    International Nuclear Information System (INIS)

    Martz, H.F. Jr.; Beckman, R.J.; Waller, R.A.

    1978-10-01

    Extended likelihood methods of inference are developed in which subjective information in the form of a prior distribution is combined with sampling results by means of an extended likelihood function. The extended likelihood function is standardized for use in obtaining extended likelihood intervals. Extended likelihood intervals are derived for the mean of a normal distribution with known variance, the failure-rate of an exponential distribution, and the parameter of a binomial distribution. Extended second-order likelihood methods are developed and used to solve several prediction problems associated with the exponential and binomial distributions. In particular, such quantities as the next failure-time, the number of failures in a given time period, and the time required to observe a given number of failures are predicted for the exponential model with a gamma prior distribution on the failure-rate. In addition, six types of life testing experiments are considered. For the binomial model with a beta prior distribution on the probability of nonsurvival, methods are obtained for predicting the number of nonsurvivors in a given sample size and for predicting the required sample size for observing a specified number of nonsurvivors. Examples illustrate each of the methods developed. Finally, comparisons are made with Bayesian intervals in those cases where these are known to exist

  16. an extended octagonal ring dynamometer for measurement of forces

    African Journals Online (AJOL)

    NIJOTECH

    The analysis, design, construction, evaluation and use of an extended octagonal ring dynamometer for ... For tillage applications, it has been used ..... confirmed that the dynamometer and the measurement system were capable of indicating.

  17. Review of extended producer responsibility: A case study approach.

    Science.gov (United States)

    Gupt, Yamini; Sahay, Samraj

    2015-07-01

    Principles of extended producer responsibility have been the core of most of the recent policies and legislation dealing with the end-of-life management of recyclable goods. This article makes an exploratory review of 27 cases of extended producer responsibility from developed and developing economies with and without informal recycling, to ascertain the most important aspect of extended producer responsibility. A comparative analysis of the cases with respect to role of stakeholders in the upstream and downstream stages of the extended producer responsibility has been carried out. Further, the study uses exploratory factor analysis to determine the important aspects of the extended producer responsibility in practice using 13 variables identified from the review. Findings of the comparative analysis reveal that financial responsibility of the producers and separate collecting and recycling agencies contributed significantly to the success of the extended producer responsibility-based environmental policies. Regulatory provisions, take-back responsibility and financial flow come out to be the three most important aspects of the extended producer responsibility. Presence of informal sector had a negative impact on the regulatory provisions. The outcomes of this study could serve as a guideline for designing of effective extended producer responsibility-based policies. © The Author(s) 2015.

  18. Bacteriospermia in extended porcine semen.

    Science.gov (United States)

    Althouse, Gary C; Lu, Kristina G

    2005-01-15

    Bacteriospermia is a frequent finding in freshly extended porcine semen and can result in detrimental effects on semen quality and longevity if left uncontrolled. The primary source of bacterial contamination is the boar. Other sources that have been identified include environment, personnel, and the water used for extender preparation. A 1-year retrospective study was performed on submissions of extended porcine semen for routine quality control bacteriological screening at the University of Pennsylvania. Out of 250 sample submissions, 78 (31.2%) tested positive for bacterial contamination. The most popular contaminants included Enterococcus spp. (20.5%), Stenotrophomonas maltophilia (15.4%), Alcaligenes xylosoxidans (10.3%), Serratia marcescens (10.3%), Acinetobacter lwoffi (7.7%), Escherichia coli (6.4%), Pseudomonas spp. (6.4%), and others (23.0%). Prudent individual hygiene, good overall sanitation, and regular monitoring can contribute greatly in controlling bacterial load. Strategies that incorporate temperature-dependent bacterial growth and hyperthermic augmentation of antimicrobial activity are valuable for effective control of susceptible bacterial loads. Aminoglycosides remain the most popular antimicrobial class used in porcine semen extenders, with beta-lactam and lincosamide use increasing. With the advent of more novel antimicrobial selection and semen extender compositions in swine, prudent application and understanding of in vitro pharmacodynamics are becoming paramount to industry success in the use of this breeding modality.

  19. Extended Year, Extended Contracts: Increasing Teacher Salary Options.

    Science.gov (United States)

    Gandara, Patricia

    1992-01-01

    Reports on an attempt to raise teacher salaries through an extended contract made possible through year-round school schedules. Teacher satisfaction with the 1987 experiment in three California schools (the Orchard Plan) has been high. Elements that have contributed to job satisfaction are discussed. (SLD)

  20. Extended cognition in science communication.

    Science.gov (United States)

    Ludwig, David

    2014-11-01

    The aim of this article is to propose a methodological externalism that takes knowledge about science to be partly constituted by the environment. My starting point is the debate about extended cognition in contemporary philosophy and cognitive science. Externalists claim that human cognition extends beyond the brain and can be partly constituted by external devices. First, I show that most studies of public knowledge about science are based on an internalist framework that excludes the environment we usually utilize to make sense of science and does not allow the possibility of extended knowledge. In a second step, I argue that science communication studies should adopt a methodological externalism and accept that knowledge about science can be partly realized by external information resources such as Wikipedia. © The Author(s) 2013.

  1. Exclusion Bounds for Extended Anyons

    Science.gov (United States)

    Larson, Simon; Lundholm, Douglas

    2018-01-01

    We introduce a rigorous approach to the many-body spectral theory of extended anyons, that is quantum particles confined to two dimensions that interact via attached magnetic fluxes of finite extent. Our main results are many-body magnetic Hardy inequalities and local exclusion principles for these particles, leading to estimates for the ground-state energy of the anyon gas over the full range of the parameters. This brings out further non-trivial aspects in the dependence on the anyonic statistics parameter, and also gives improvements in the ideal (non-extended) case.

  2. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  3. Exploring extended scope of practice in dietetics: A systems approach.

    Science.gov (United States)

    Ryan, Dominique; Pelly, Fiona; Purcell, Elizabeth

    2017-09-01

    The aim of this study was to explore health professionals' perceptions of an extended scope of a practice clinic, and develop a framework using a systems approach to facilitate extended scope models across various health settings. A qualitative investigation using semi-structured interviews with four health professionals involved in an extended scope dietitian-led gastroenterology clinic in a hospital in regional Queensland was conducted. A case study design was utilised to investigate interviewees' perceptions of the clinic. Participants were conveniently, purposively sampled. Transcript analysis involved a descriptive analytical approach. Interviewee responses were coded and categorised into themes, and investigator triangulation was used to ensure consistency between individual analyses. A secondary interpretative analysis was conducted where relationships between key themes were mapped to the Systems Engineering Initiative for Patient Safety work system model. Interviewees identified various factors as vital inputs to the work system. These were categorised into the four key elements: stakeholder support, resources, planning and the dietitian. Clinic outcomes were categorised into the impact on four key groups: patients, the dietitian, the multidisciplinary team and the health system. Mapping of the relationships between inputs and outcomes resulted in an implementation framework for extended scope of practice. Extended scope of practice in dietetics may provide positive outcomes for various stakeholders. However, further development of extended scope roles for dietitians requires increased advocacy and support from governments, professional bodies, training institutions and dietitians. We have developed an implementation framework which can be utilised by health professionals interested in embracing an extended scope model of care. © 2016 Dietitians Association of Australia.

  4. Extended parental care in communal social groups

    Directory of Open Access Journals (Sweden)

    Stephen H. Forbes

    2002-11-01

    Full Text Available Recent developments in social insect research have challenged the need for close kinship as a prerequisite for the evolution of stable group living. In a model communal bee species, Lasioglossum (Chilalictus hemichalceum, previous allozyme work indicated that groups of cooperating adult females are not relatives. Yet at any given time, not all group members perform the risky task of foraging. We previously hypothesized that tolerance for non-foragers was a component of extended parental care, previously known only for kin based social systems. DNA microsatellites were used to study colony genetic structure in order to test this hypothesis. Microsatellite polymorphism was substantial (He = 0.775. Overall intracolony relatedness, mainly of immatures, was low but significant in nine, late season nests (r = 0.136 plus or minus0.023, indicating that broods contain five to six unrelated sib ships. Detailed analyses of kinship between pairs of individuals revealed that most pairs were unrelated and most related pairs were siblings. Mothers are absent for 89-91% of the developing immature females, and 97% of developing males. Alternatively, 46% of adult females had neither sibs nor offspring in their nests. These findings indicate that the extended parental care model applies broadly to both kin based and nonkin based social systems in the Hymenoptera.

  5. Extended memory management under RTOS

    Science.gov (United States)

    Plummer, M.

    1981-01-01

    A technique for extended memory management in ROLM 1666 computers using FORTRAN is presented. A general software system is described for which the technique can be ideally applied. The memory manager interface with the system is described. The protocols by which the manager is invoked are presented, as well as the methods used by the manager.

  6. Geometrical interpretation of extended supergravity

    International Nuclear Information System (INIS)

    Townsend, P.K.; Nieuwenhuizen, P.van

    1977-01-01

    SO 2 extended supergravity is shown to be a geometrical theory, whose underlying gauge group is OSp(4,2). The couplings which gauge the SO 2 symmetry as well as the accompanying cosmological and masslike terms are directly obtained, and the usual SO 2 model is obtained after a Wigner-Inoenue group contraction. (Auth.)

  7. Spin-4 extended conformal algebras

    International Nuclear Information System (INIS)

    Kakas, A.C.

    1988-01-01

    We construct spin-4 extended conformal algebras using the second hamiltonian structure of the KdV hierarchy. In the presence of a U(1) current a family of spin-4 algebras exists but the additional requirement that the spin-1 and spin-4 currents commute fixes the algebra uniquely. (orig.)

  8. Departies: conceptualizing extended youth parties

    DEFF Research Database (Denmark)

    Fjær, Eivind Grip; Tutenges, Sébastien

    2017-01-01

    Every year, millions of young people travel away from home to party for days or weeks on end in permissive environments, such as music festivals, dance parties, and nightlife resorts. The studies that have been conducted on these extended youth parties have focused primarily on specific risk...

  9. Applying and extending Oracle Spatial

    CERN Document Server

    Simon Gerard Greener, Siva Ravada

    2013-01-01

    This book is an advanced practical guide to applying and extending Oracle Spatial.This book is for existing users of Oracle and Oracle Spatial who have, at a minimum, basic operational experience of using Oracle or an equivalent database. Advanced skills are not required.

  10. Extended unemployment and UI benefits

    OpenAIRE

    Robert G. Valletta; Katherine Kuang

    2010-01-01

    During the current labor market downturn, unemployment duration has reached levels well above its previous highs. Analysis of unemployment data suggests that extended unemployment insurance benefits have not been important factors in the increase in the duration of unemployment or in the elevated unemployment rate.

  11. Engage, Enhance, and Extend Learning!

    Science.gov (United States)

    Keren-Kolb, Liz

    2013-01-01

    Educators often say that technology is more than a gimmick or add-on, and that it should engage, enhance, or extend learning in ways that traditional tools do not. Yet they seldom stop to define these terms, and they can be confusing, especially for teachers and preservice teachers. Recently, while collaborating on an English language arts and…

  12. An Organization's Extended (Soft) Competencies Model

    Science.gov (United States)

    Rosas, João; Macedo, Patrícia; Camarinha-Matos, Luis M.

    One of the steps usually undertaken in partnerships formation is the assessment of organizations’ competencies. Typically considered competencies of a functional or technical nature, which provide specific outcomes can be considered as hard competencies. Yet, the very act of collaboration has its specific requirements, for which the involved organizations must be apt to exercise other type of competencies that affect their own performance and the partnership success. These competencies are more of a behavioral nature, and can be named as soft-competencies. This research aims at addressing the effects of the soft competencies on the performance of the hard ones. An extended competencies model is thus proposed, allowing the construction of adjusted competencies profiles, in which the competency levels are adjusted dynamically according to the requirements of collaboration opportunities.

  13. Relic gravitational waves and extended inflation

    International Nuclear Information System (INIS)

    Turner, M.S.; Wilczek, F.

    1990-08-01

    In extended inflation, a new version of inflation where the transition from the false-vacuum phase to a radiation-dominated Universe is accomplished by bubble nucleation and percolation, bubble collisions supply a potent-and potentially detectable-source of gravitational waves. The present energy density in relic gravity waves from bubble collisions is expected to be about 10(exp -5) of closure density-many orders of magnitude greater than that of the gravity waves produced by quantum fluctuations. Their characteristic wavelength depends upon the reheating temperature T(sub RH): lambda is approximately 10(exp 4) cm (10(exp 14) GeV/T(sub RH)). If large numbers of black holes are produced, a not implausible outcome, they will evaporate producing comparable amounts of shorter wavelength waves, lambda is approximately 10(exp -6) cm (T(sub RH)/10(exp 14) GeV)

  14. The deep space 1 extended mission

    Science.gov (United States)

    Rayman, Marc D.; Varghese, Philip

    2001-03-01

    The primary mission of Deep Space 1 (DS1), the first flight of the New Millennium program, completed successfully in September 1999, having exceeded its objectives of testing new, high-risk technologies important for future space and Earth science missions. DS1 is now in its extended mission, with plans to take advantage of the advanced technologies, including solar electric propulsion, to conduct an encounter with comet 19P/Borrelly in September 2001. During the extended mission, the spacecraft's commercial star tracker failed; this critical loss prevented the spacecraft from achieving three-axis attitude control or knowledge. A two-phase approach to recovering the mission was undertaken. The first involved devising a new method of pointing the high-gain antenna to Earth using the radio signal received at the Deep Space Network as an indicator of spacecraft attitude. The second was the development of new flight software that allowed the spacecraft to return to three-axis operation without substantial ground assistance. The principal new feature of this software is the use of the science camera as an attitude sensor. The differences between the science camera and the star tracker have important implications not only for the design of the new software but also for the methods of operating the spacecraft and conducting the mission. The ambitious rescue was fully successful, and the extended mission is back on track.

  15. Number of evaluated lymph nodes and positive lymph nodes, lymph node ratio, and log odds evaluation in early-stage pancreatic ductal adenocarcinoma: numerology or valid indicators of patient outcome?

    Science.gov (United States)

    Lahat, G; Lubezky, N; Gerstenhaber, F; Nizri, E; Gysi, M; Rozenek, M; Goichman, Y; Nachmany, I; Nakache, R; Wolf, I; Klausner, J M

    2016-09-29

    We evaluated the prognostic significance and universal validity of the total number of evaluated lymph nodes (ELN), number of positive lymph nodes (PLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in a relatively large and homogenous cohort of surgically treated pancreatic ductal adenocarcinoma (PDAC) patients. Prospectively accrued data were retrospectively analyzed for 282 PDAC patients who had pancreaticoduodenectomy (PD) at our institution. Long-term survival was analyzed according to the ELN, PLN, LNR, and LODDS. Of these patients, 168 patients (59.5 %) had LN metastasis (N1). Mean ELN and PLN were 13.5 and 1.6, respectively. LN positivity correlated with a greater number of evaluated lymph nodes; positive lymph nodes were identified in 61.4 % of the patients with ELN ≥ 13 compared with 44.9 % of the patients with ELN < 13 (p = 0.014). Median overall survival (OS) and 5-year OS rate were higher in N0 than in N1 patients, 22.4 vs. 18.7 months and 35 vs. 11 %, respectively (p = 0.008). Mean LNR was 0.12; 91 patients (54.1 %) had LNR < 0.3. Among the N1 patients, median OS was comparable in those with LNR ≥ 0.3 vs. LNR < 0.3 (16.7 vs. 14.1 months, p = 0.950). Neither LODDS nor various ELN and PLN cutoff values provided more discriminative information within the group of N1 patients. Our data confirms that lymph node positivity strongly reflects PDAC biology and thus patient outcome. While a higher number of evaluated lymph nodes may provide a more accurate nodal staging, it does not have any prognostic value among N1 patients. Similarly, PLN, LNR, and LODDS had limited prognostic relevance.

  16. The extended bigraded Toda hierarchy

    International Nuclear Information System (INIS)

    Carlet, Guido

    2006-01-01

    We generalize the Toda lattice hierarchy by considering N + M dependent variables. We construct roots and logarithms of the Lax operator which are uniquely defined operators with coefficients that are ε-series of differential polynomials in the dependent variables, and we use them to provide a Lax pair definition of the extended bigraded Toda hierarchy, generalizing [4]. Using R-matrix theory we give the bi-Hamiltonian formulation of this hierarchy and we prove the existence of a tau function for its solutions. Finally we study the dispersionless limit and its connection with a class of Frobenius manifolds on the orbit space of the extended affine Weyl groups W-tilde (N) (A N+M-1 ) of the A series, defined by Dubrovin and Zhang (1998 Compos. Math. 111 167)

  17. An extended Harry Dym hierarchy

    International Nuclear Information System (INIS)

    Ma Wenxiu

    2010-01-01

    An extended Harry Dym hierarchy is constructed by using eigenfunctions and adjoint eigenfunctions of the spectral problems of the Harry Dym hierarchy associated with the pseudo-differential operator L = u∂ + u 0 + u 1 ∂ -1 + .... The corresponding Lax presentation possesses a self-consistent source involving squared eigenfunctions. The resulting extended Harry Dym hierarchy is reduced to the Harry Dym hierarchy with self-consistent sources under the n-reduction, L n = (L n ) ≥2 , and the k-constrained Harry Dym hierarchy under the k-constraint, L k = (L k ) ≥2 + Σ N i=1 q i ∂ -1 r i ∂ 2 . A few particular examples are computed, together with their Lax pairs.

  18. Black holes from extended inflation

    International Nuclear Information System (INIS)

    Hsu, S.D.H.; Lawrence Berkeley Lab., CA

    1990-01-01

    It is argued that models of extended inflation, in which modified Einstein gravity allows a graceful exit from the false vacuum, lead to copious production of black holes. The critical temperature of the inflationary phase transition must be >10 8 GeV in order to avoid severe cosmological problems in a universe dominated by black holes. We speculate on the possibility that the interiors of false vacuum regions evolve into baby universes. (orig.)

  19. Locating and extending livelihoods research

    DEFF Research Database (Denmark)

    Prowse, Martin

    2008-01-01

    Much poverty and development research is not explicit about its methodology or philosophical foundations. Based on the extended case method of Burawoy and the epistemological standpoint of critical realism, this paper discusses a methodological approach for reflexive inductive livelihoods researc...... that overcomes the unproductive social science dualism of positivism and social constructivism. The approach is linked to a conceptual framework and a menu of research methods that can be sequenced and iterated in light of research questions....

  20. Extended producer responsibility in oligopoly

    OpenAIRE

    Hiroaki Ino

    2007-01-01

    I investigate the optimal environmental tax under a policy based on extended producer responsibility (EPR) in oligopoly markets. I introduce the recycling market and explicitly consider how these policies affect the incentive for recycling. I derive the optimal tax rule, which depends on the weighted sum of the markup in the product market and the markdown in the recycling market. In contrast to the existing works that emphasize that the optimal tax rate is lower than the marginal external da...

  1. Extended radio sources in the cluster environment

    International Nuclear Information System (INIS)

    Burns, J.O. Jr.

    1979-01-01

    Extended radio galaxies that lie in rich and poor clusters were studied. A sample of 3CR and 4C radio sources that spatially coincide with poor Zwicky clusters of galaxies was observed to obtain accurate positions and flux densities. Then interferometer observations at a resolution of approx. = 10 arcsec were performed on the sample. The resulting maps were used to determine the nature of the extended source structure, to make secure optical identifications, and to eliminate possible background sources. The results suggest that the environments around both classical double and head-tail radio sources are similar in rich and poor clusters. The majority of the poor cluster sources exhibit some signs of morphological distortion (i.e., head-tails) indicative of dynamic interaction with a relatively dense intracluster medium. A large fraction (60 to 100%) of all radio sources appear to be members of clusters of galaxies if one includes both poor and rich cluster sources. Detailed total intensity and polarization observations for a more restricted sample of two classical double sources and nine head-tail galaxies were also performed. The purpose was to examine the spatial distributions of spectral index and polarization. Thin streams of radio emission appear to connect the nuclear radio-point components to the more extended structures in the head-tail galaxies. It is suggested that a non-relativistic plasma beam can explain both the appearance of the thin streams and larger-scale structure as well as the energy needed to generate the observed radio emission. The rich and poor radio cluster samples are combined to investigate the relationship between source morphology and the scale sizes of clustering. There is some indication that a large fraction of radio sources, including those in these samples, are in superclusters of galaxies

  2. EAES: Extended Advanced Encryption Standard with Extended Security

    OpenAIRE

    Abul Kalam Azad; Md. Yamin Mollah

    2018-01-01

    Though AES is the highest secure symmetric cipher at present, many attacks are now effective against AES too which is seen from the review of recent attacks of AES. This paper describes an extended AES algorithm with key sizes of 256, 384 and 512 bits with round numbers of 10, 12 and 14 respectively. Data block length is 128 bits, same as AES. But unlike AES each round of encryption and decryption of this proposed algorithm consists of five stages except the last one which consists of four st...

  3. EAES: Extended Advanced Encryption Standard with Extended Security

    Directory of Open Access Journals (Sweden)

    Abul Kalam Azad

    2018-05-01

    Full Text Available Though AES is the highest secure symmetric cipher at present, many attacks are now effective against AES too which is seen from the review of recent attacks of AES. This paper describes an extended AES algorithm with key sizes of 256, 384 and 512 bits with round numbers of 10, 12 and 14 respectively. Data block length is 128 bits, same as AES. But unlike AES each round of encryption and decryption of this proposed algorithm consists of five stages except the last one which consists of four stages. Unlike AES, this algorithm uses two different key expansion algorithms with two different round constants that ensure higher security than AES. Basically, this algorithm takes one cipher key and divides the selected key of two separate sub-keys: FirstKey and SecondKey. Then expand them through two different key expansion schedules. Performance analysis shows that the proposed extended AES algorithm takes almost same amount of time to encrypt and decrypt the same amount of data as AES but with higher security than AES.

  4. Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma?

    Science.gov (United States)

    Kaiser, Joerg; Hackert, Thilo; Büchler, Markus W

    2017-01-01

    Pancreatic cancer is a low-incident but highly mortal disease. Surgery is still the preferred treatment option for resectable pancreatic cancer as it offers the only realistic chance for cure. As many patients present with locally advanced disease, which is generally considered as not amenable to surgical treatment, it is important to know the limits of surgical therapy in this disease. In this review, the indication and outcomes of extended pancreatectomies as well as the alternative treatment options for locally advanced pancreatic cancer are described. Furthermore, controversies as well as ongoing and future directions for the treatment options of locally advanced pancreatic cancer are discussed. Extended pancreatectomy can be performed with higher morbidity and mortality rates in patients with locally advanced pancreatic cancer compared to patients undergoing formal pancreatic resections. These procedures offer significant advantages with respect to both perioperative results and to long-term outcome when compared to chemotherapy. Due to the higher morbidity and mortality rates, these operations should be limited to specialist units with great experience in pancreatic surgery as well as experience in peri- and post-operative management of patients with pancreatic diseases. © 2017 S. Karger AG, Basel.

  5. Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis.

    Science.gov (United States)

    Chang, W C; Kwong, V W Y; Chan, G H K; Jim, O T T; Lau, E S K; Hui, C L M; Chan, S K W; Lee, E H M; Chen, E Y H

    2017-03-01

    Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments. Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation. Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Renormalization of Extended QCD2

    International Nuclear Information System (INIS)

    Fukaya, Hidenori; Yamamura, Ryo

    2015-01-01

    Extended QCD (XQCD), proposed by Kaplan [D. B. Kaplan, arXiv:1306.5818], is an interesting reformulation of QCD with additional bosonic auxiliary fields. While its partition function is kept exactly the same as that of original QCD, XQCD naturally contains properties of low-energy hadronic models. We analyze the renormalization group flow of 2D (X)QCD, which is solvable in the limit of a large number of colors N c , to understand what kind of roles the auxiliary degrees of freedom play and how the hadronic picture emerges in the low-energy region

  7. Axelrod Model with Extended Conservativeness

    Science.gov (United States)

    Dybiec, Bartłomiej

    2012-11-01

    Similarity of opinions and memory about recent interactions are two main factors determining likelihood of social contacts. Here, we explore the Axelrod model with an extended conservativeness which incorporates not only similarity between individuals but also a preference to the last source of accepted information. The additional preference given to the last source of information increases the initial decay of the number of ideas in the system, changes the character of the phase transition between homogeneous and heterogeneous final states and could increase the number of stable regions (clusters) in the final state.

  8. Key Performance Indicators for Primary Schools.

    Science.gov (United States)

    Strand, Steve

    Focusing mostly on their application for primary schools, this document describes the educational key performance indicators (KPI) employed by the Wendsworth, England, Local Educational Authority (LEA). Indicators are divided into 3 areas, educational context, resource development, and outcomes. Contextual indicators include pupil mobility, home…

  9. Prognostic indicators of assisted reproduction technology outcomes of cycles with ultralow serum antimüllerian hormone: a multivariate analysis of over 5,000 autologous cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for 2012-2013.

    Science.gov (United States)

    Seifer, David B; Tal, Oded; Wantman, Ethan; Edul, Preeti; Baker, Valerie L

    2016-02-01

    To assess cycle outcomes when antimüllerian hormone (AMH) is ultralow (≤0.16 ng/mL) and to determine which parameters contribute to the probability of cycle cancellation and/or outcome. Retrospective analysis. Not applicable. 5,087 (7.3%) fresh and 243 (1.5%) thawed cycles with ultralow AMH values. Linear and logistic regression, comparison with age-matched cycles with normal AMH concentrations. Cancellation rate; number of retrieved oocytes, embryos, transferred embryos, and cryopreserved embryos; clinical pregnancy, live-birth, and multiple birth rates. The total cancellation rate per cycle start for fresh cycles was 54%. Of these, 38.6% of the cycles were canceled before retrieval, and 3.3% of cycles obtained no oocytes at time of retrieval. Of all retrieval attempts, 50.7% had three oocytes or fewer retrieved, and 25.1% had no embryo transfer. The live-birth rates were 9.5% per cycle start. Cycles with ultralow AMH levels compared with age-matched normal AMH cycles demonstrated more than a fivefold greater pre-retrieval cancellation rate, a twofold less live-birth rate per cycle and a 4.5-fold less embryo cryopreservation rate. Refusing treatment solely on the basis of ultralow AMH levels is not advisable, but patients should be counseled appropriately about the prognostic factors for cancellation and outcomes. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Jordan Banks Financial Soundness Indicators

    Directory of Open Access Journals (Sweden)

    Imad Kutum

    2015-09-01

    Full Text Available The aim of this research paper is to examine the Jordanian banks using financial soundness indicators. This is to establish if Jordanian banks were affected because of the 2007/2008 financial crisis and determine the underlying reasons. The research paper was conducted on 25 banks in Jordan listed in the countries securities exchange. The research methodology used consisted of examining the banks financial records in order to derive four crucial Basel III ratio such as the capital adequacy ratio, the leverage ratio, the liquidity ratio and finally the Total Provisions (As % Of Non-Performing Loans %. The results revealed that out of the four hypotheses under examination Jordan Banks do not meet Basel financial Indicators for Capital Adequacy Ratio, Jordan Banks does not meet Basel financial Indicators for Liquidity Ratio , Jordan Banks do not meet Basel financial Indicators for Leverage Ratio and Jordan Banks do not meet Basel financial Indicators for Total Provisions (As % Of Non-Performing Loans ratio. Only one hypothesis was accepted based on the research outcomes. The rest of the hypothesis was rejected since the average trend line did not go below the Basel III required ratio level. The general outcome of the research revealed that Jordanian banks were not affected significantly by the financial crisis.

  11. Implications of Extended Solar Minima

    Science.gov (United States)

    Adams, Mitzi L.; Davis, J. M.

    2009-01-01

    Since the discovery of periodicity in the solar cycle, the historical record of sunspot number has been carefully examined, attempting to make predictions about the next cycle. Much emphasis has been on predicting the maximum amplitude and length of the next cycle. Because current space-based and suborbital instruments are designed to study active phenomena, there is considerable interest in estimating the length and depth of the current minimum. We have developed criteria for the definition of a minimum and applied it to the historical sunspot record starting in 1749. In doing so, we find that 1) the current minimum is not yet unusually long and 2) there is no obvious way of predicting when, using our definition, the current minimum may end. However, by grouping the data into 22- year cycles there is an interesting pattern of extended minima that recurs every fourth or fifth 22-year cycle. A preliminary comparison of this pattern with other records, suggests the possibility of a correlation between extended minima and lower levels of solar irradiance.

  12. Extended inflation with induced gravity

    International Nuclear Information System (INIS)

    Accetta, F.S.; Trester, J.J.; Department of Physics, Yale University, New Haven, Connecticut 06520)

    1989-01-01

    We consider a recently proposed extended model of inflation which improves upon the original old inflation scenario by achieving a graceful exit from the false-vacuum phase. In this paper extended inflation is generalized to include a potential V(phi) for the Brans-Dicke-type field phi. We find that whereas a graceful exit can still be had, the inclusion of a potential places constraints on the percolation time scale for exiting the inflationary phase. Additional constraints on V(phi) and the false-vacuum energy density rho /sub F/ from density and gravitational-wave perturbations are discussed. For initially small values of phi the false vacuum undergoes power-law inflation, while for initially large values of phi the expansion is exponential. Within true-vacuum regions slow-rolling inflation can occur. As a result, this model generically leads to multiple episodes of inflation. We discuss the significance these multiple episodes of inflation may have on the formation of large-scale structure and the production of voids

  13. Extended suicide with a pet.

    Science.gov (United States)

    Cooke, Brian K

    2013-01-01

    The combination of the killing of a pet and a suicide is a perplexing scenario that is largely unexplored in the literature. Many forensic psychiatrists and psychologists may be unaccustomed to considering the significance of the killing of a pet. The subject is important, however, because many people regard their pets as members of their family. A case is presented of a woman who killed her pet dog and herself by carbon monoxide poisoning. The purpose of this article is to provide an initial exploration of the topic of extended suicide with a pet. Forensic mental health evaluations may have a role in understanding the etiology of this event and in opining as to the culpability of individuals who attempt to or successfully kill a pet and then commit suicide. Because the scientific literature is lacking, there is a need to understand this act from a variety of perspectives. First, a social and anthropological perspective will be presented that summarizes the history of the practice of killing of one's pet, with a focus on the ancient Egyptians. A clinical context will examine what relationship animals have to mental illness. A vast body of existing scientific data showing the relevance of human attachment to pets suggests that conclusions from the phenomena of homicide-suicide and filicide-suicide are applicable to extended suicide with a pet. Finally, recommendations will be proposed for both clinical and forensic psychiatrists faced with similar cases.

  14. Pipe crawler with extendable legs

    International Nuclear Information System (INIS)

    Zollinger, W.T.

    1992-01-01

    A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs

  15. Pipe crawler with extendable legs

    Science.gov (United States)

    Zollinger, W.T.

    1992-06-16

    A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs.

  16. Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma.

    Science.gov (United States)

    Locatelli, D; Pozzi, F; Agresta, G; Padovan, S; Karligkiotis, A; Castelnuovo, P

    2018-02-01

    Objectives  We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design  Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component. Considering the absence of lateral extension and the suprasellar location of the lesion, an EEEA is preferred. Setting  University Hospital "Ospedale di Circolo," Department of Neurosurgery, Varese, Italy. Participants  Neurosurgical and ENT Skull Base Team. Main Outcome Measures  A bilateral parasagittal approach is performed using a four-hand technique. The first step of the surgery is the preparation of the Hadad's flap. The approach is extended to the planum sphenoidalis to expose the suprasellar region. The lesion is completely removed employing also an ultrasound aspirator. Skull base reconstruction is performed with three-layer technique: graft of fat tissue, fascia lata, and nasoseptal flap. Results  No postoperative complications occurred. In the post-op, the patient presents a panhypopituitarism and an improvement in neurological status. The visual deficit remains stable. Post-op magnetic resonance imaging at 1 year documents the complete absence of pathological contrast enhancement. Conclusions  EEEA is a feasible approach in treating craniopharyngioma with suprasellar extension. The advantages include optimal visualization, good resection rate, and absence of brain retraction. The link to the video can be found at: https://youtu.be/IYm-8P1jbBo .

  17. Relieving Pain using Dose-Extending Placebos: A Scoping Review

    Science.gov (United States)

    Colloca, Luana; Enck, Paul; DeGrazia, David

    2017-01-01

    Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. PMID:27023425

  18. Extended infusion versus intermittent infusion of imipenem in the treatment of ventilator-associated pneumonia.

    Science.gov (United States)

    Ibrahim, Mohamed M; Tammam, Tarek Fouad; Ebaed, Mohy El Deen; Sarhan, Hatem A; Gad, Gamal F; Hussein, Amal K

    2017-01-01

    Mechanical ventilation support can be the main source of ventilator-associated pneumonia (VAP). VAP is a serious infection that may be associated with dangerous gram-negative bacteria mainly, and it leads to an increase in the mortality in the intensive care unit (ICU). Imipenem is one of the strongest antibiotics now available for treating VAP which is associated with gram-negative and gram-positive bacteria, and it belongs to beta-lactam antibiotic group (carbapenem). This study tried to investigate the efficacy of imipenem against VAP when it was infused within 180 min versus the efficacy when it was infused within 30-60 min. This study was conducted in main ICU in general hospital which consists of surgical and medical beds within 2 years. One hundred and eighty-seven patients were enrolled on it. This study is a retrospective cohort which was conducted within 2 years. The efficacy of imipenem which was administered by intermittent infusion (30-60 min) within first year was compared with the efficacy of imipenem which was administered by extended infusion (180 min) within second year in the field of VAP curing and cost reduction. All data were collected retrospectively from patient medical files and were statistically analyzed by SPSS version 20. The study was designed to measure clinical and cost reduction outcomes, mortality and hospital stay. The results indicated that there is a significant decrease in mortality, number of recurrent infection, and ICU stay length, and the number of mechanical ventilator days was associated with extended imipenem infusion during the second year of the study. The use of imipenem with extended infusion over 3 hours enhances its clinical outcomes in the treatment of VAP.

  19. Harmonic superspaces of extended supersymmetry

    International Nuclear Information System (INIS)

    Ivanov, E.; Kalitzin, S.; Nguyen Ai Viet; Ogievetsky, V.

    1984-01-01

    The main technical apparatus of the harmonic superspace approach to extended SUSY, the calculus of harmonic variables on homogeneous spaces of the SUSY automorphism groups, is presented in detail for N=2, 3, 4. The basic harmonics for the coset manifolds G/H with G=SU(2), H=U(1); G=SU(3), H=SU(2)xU(1) and H=U(1)xU(1); G=SU(4), H=SU(3)xU(1), H=SU(2)xSU(2)xU(1), H=SU(2)xU(1)xU(1) and H=U(1)xU(1)xU(1); G=USp(2), H=SU(2)xSU(2), H=SU(2)xU(1) and H=U(1)xU(1) are tabulated a number of useful relations among them

  20. Learning Extended Finite State Machines

    Science.gov (United States)

    Cassel, Sofia; Howar, Falk; Jonsson, Bengt; Steffen, Bernhard

    2014-01-01

    We present an active learning algorithm for inferring extended finite state machines (EFSM)s, combining data flow and control behavior. Key to our learning technique is a novel learning model based on so-called tree queries. The learning algorithm uses the tree queries to infer symbolic data constraints on parameters, e.g., sequence numbers, time stamps, identifiers, or even simple arithmetic. We describe sufficient conditions for the properties that the symbolic constraints provided by a tree query in general must have to be usable in our learning model. We have evaluated our algorithm in a black-box scenario, where tree queries are realized through (black-box) testing. Our case studies include connection establishment in TCP and a priority queue from the Java Class Library.

  1. Hamiltonian dynamics of extended objects

    Science.gov (United States)

    Capovilla, R.; Guven, J.; Rojas, E.

    2004-12-01

    We consider relativistic extended objects described by a reparametrization-invariant local action that depends on the extrinsic curvature of the worldvolume swept out by the object as it evolves. We provide a Hamiltonian formulation of the dynamics of such higher derivative models which is motivated by the ADM formulation of general relativity. The canonical momenta are identified by looking at boundary behaviour under small deformations of the action; the relationship between the momentum conjugate to the embedding functions and the conserved momentum density is established. The canonical Hamiltonian is constructed explicitly; the constraints on the phase space, both primary and secondary, are identified and the role they play in the theory is described. The multipliers implementing the primary constraints are identified in terms of the ADM lapse and shift variables and Hamilton's equations are shown to be consistent with the Euler Lagrange equations.

  2. Center for Extended Magnetohydrodynamics Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, Jesus [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States)

    2017-02-14

    This researcher participated in the DOE-funded Center for Extended Magnetohydrodynamics Modeling (CEMM), a multi-institutional collaboration led by the Princeton Plasma Physics Laboratory with Dr. Stephen Jardin as the overall Principal Investigator. This project developed advanced simulation tools to study the non-linear macroscopic dynamics of magnetically confined plasmas. The collaborative effort focused on the development of two large numerical simulation codes, M3D-C1 and NIMROD, and their application to a wide variety of problems. Dr. Ramos was responsible for theoretical aspects of the project, deriving consistent sets of model equations applicable to weakly collisional plasmas and devising test problems for verification of the numerical codes. This activity was funded for twelve years.

  3. Hamiltonian dynamics of extended objects

    International Nuclear Information System (INIS)

    Capovilla, R; Guven, J; Rojas, E

    2004-01-01

    We consider relativistic extended objects described by a reparametrization-invariant local action that depends on the extrinsic curvature of the worldvolume swept out by the object as it evolves. We provide a Hamiltonian formulation of the dynamics of such higher derivative models which is motivated by the ADM formulation of general relativity. The canonical momenta are identified by looking at boundary behaviour under small deformations of the action; the relationship between the momentum conjugate to the embedding functions and the conserved momentum density is established. The canonical Hamiltonian is constructed explicitly; the constraints on the phase space, both primary and secondary, are identified and the role they play in the theory is described. The multipliers implementing the primary constraints are identified in terms of the ADM lapse and shift variables and Hamilton's equations are shown to be consistent with the Euler-Lagrange equations

  4. Hamiltonian dynamics of extended objects

    Energy Technology Data Exchange (ETDEWEB)

    Capovilla, R [Departamento de FIsica, Centro de Investigacion y de Estudios Avanzados del IPN, Apdo Postal 14-740, 07000 Mexico, DF (Mexico); Guven, J [School of Theoretical Physics, Dublin Institute for Advanced Studies, 10 Burlington Road, Dublin 4 (Ireland); Rojas, E [Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, Apdo Postal 70-543, 04510 Mexico, DF (Mexico)

    2004-12-07

    We consider relativistic extended objects described by a reparametrization-invariant local action that depends on the extrinsic curvature of the worldvolume swept out by the object as it evolves. We provide a Hamiltonian formulation of the dynamics of such higher derivative models which is motivated by the ADM formulation of general relativity. The canonical momenta are identified by looking at boundary behaviour under small deformations of the action; the relationship between the momentum conjugate to the embedding functions and the conserved momentum density is established. The canonical Hamiltonian is constructed explicitly; the constraints on the phase space, both primary and secondary, are identified and the role they play in the theory is described. The multipliers implementing the primary constraints are identified in terms of the ADM lapse and shift variables and Hamilton's equations are shown to be consistent with the Euler-Lagrange equations.

  5. THE EXTENDED VIRGO CLUSTER CATALOG

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Suk; Rey, Soo-Chang; Lee, Youngdae; Chung, Jiwon; Pak, Mina; Yi, Wonhyeong; Lee, Woong [Department of Astronomy and Space Science, Chungnam National University, 99 Daehak-ro, Daejeon 305-764 (Korea, Republic of); Jerjen, Helmut [Research School of Astronomy and Astrophysics, The Australian National University, Cotter Road, Weston, ACT 2611 (Australia); Lisker, Thorsten [Astronomisches Rechen-Institut, Zentrum für Astronomie der Universität Heidelberg (ZAH), Mönchhofstraße 12-14, D-69120 Heidelberg (Germany); Sung, Eon-Chang [Korea Astronomy and Space Science institute, 776 Daedeokdae-ro, Daejeon 305-348 (Korea, Republic of)

    2015-01-01

    We present a new catalog of galaxies in the wider region of the Virgo cluster, based on the Sloan Digital Sky Survey (SDSS) Data Release 7. The Extended Virgo Cluster Catalog (EVCC) covers an area of 725 deg{sup 2} or 60.1 Mpc{sup 2}. It is 5.2 times larger than the footprint of the classical Virgo Cluster Catalog (VCC) and reaches out to 3.5 times the virial radius of the Virgo cluster. We selected 1324 spectroscopically targeted galaxies with radial velocities less than 3000 km s{sup –1}. In addition, 265 galaxies that have been overlooked in the SDSS spectroscopic survey but have available redshifts in the NASA Extragalactic Database are also included. Our selection process secured a total of 1589 galaxies, 676 of which are not included in the VCC. The certain and possible cluster members are defined by means of redshift comparison with a cluster infall model. We employed two independent and complementary galaxy classification schemes: the traditional morphological classification based on the visual inspection of optical images and a characterization of galaxies from their spectroscopic features. SDSS u, g, r, i, and z passband photometry of all EVCC galaxies was performed using Source Extractor. We compare the EVCC galaxies with the VCC in terms of morphology, spatial distribution, and luminosity function. The EVCC defines a comprehensive galaxy sample covering a wider range in galaxy density that is significantly different from the inner region of the Virgo cluster. It will be the foundation for forthcoming galaxy evolution studies in the extended Virgo cluster region, complementing ongoing and planned Virgo cluster surveys at various wavelengths.

  6. Extended Power Up-rates

    International Nuclear Information System (INIS)

    Jon Ball

    2006-01-01

    Full text of publication follows: Nuclear energy is a reliable and cost-competitive global source of power. With rising oil and gas prices, nuclear continues to provide economic and environmental benefits. Extended Power Up-rate (EPU) provides a means for existing nuclear assets to generate increased power and substantially reduce electrical generation costs. GE Energy's Nuclear Business is the global leader in boiling water reactor (BWR) technology. The experience-base of plants that have successfully achieved EPU includes Spain, Switzerland, Sweden, Germany and the United States. The GE experience-base includes fourteen BWRs with over fifty-eight reactor-years of operating experience at EPU conditions. Other than the expected plant modifications needed to accommodate higher steam flows, flow-induced vibration (FIV) has been identified as the major area of concern when up-rating. Two plants have experienced damage to their steam dryers that has lead to an extensive program to improve the understanding of the effects of up-rates. This program includes extensive in-plant data collection, the development of a scale model test facility to study components susceptible to FIV and improvements in analytical techniques for evaluating loading on reactor internals. As global energy demands increase, oil and gas prices escalate, and environmental concerns over greenhouse effects challenge us to find environmentally friendly sources of energy, Nuclear is the most viable and economical source of power in the world. With a focused effort on plant reliability, existing plants can undergo Extended Power Up-rate, and continue to meet the ever-increasing energy demands in the world. (author)

  7. Geomagnetic Indices Bulletin (GIB)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Geomagnetic Indices Bulletin is a one page sheet containing the magnetic indices Kp, Ap, Cp, An, As, Am and the provisional aa indices. The bulletin is published...

  8. Extended investigation on road fatality in Brunei.

    Science.gov (United States)

    Yusof, N B; Hoque, M A; Steele, M C; Yong, S Y

    2018-06-08

    Road fatality is one of the leading causes of death in Brunei with 79 deaths in 1993, the highest ever recorded. The Brunei government has been trying to reduce this by implementing new traffic measures and successfully reduced fatalities to 24 fatalities in 2014. Yearly road fatality has been fluctuating, but there has been a declining tendency overall. The aim of this study is to investigate road fatality in Brunei by extending the research. We developed a multiple regression model and carried out an analysis on road fatality in Brunei. Our analysis indicates that the road fatality appears to rise depending on the increase in the number of young drivers between 15 to 24 years and the number of unemployed people. Comparisons of Brunei road fatality rate per 10,000 vehicles are made with some other countries and we conclude that Brunei has approximately the same rate as Australia in 2014.

  9. From Covert Processes to Overt Outcomes of Refutation Text Reading: The Interplay of Science Text Structure and Working Memory Capacity through Eye Fixations

    Science.gov (United States)

    Ariasi, Nicola; Mason, Lucia

    2014-01-01

    This study extends current research on the refutation text effect by investigating it in learners with different levels of working memory capacity. The purpose is to outline the link between online processes (revealed by eye fixation indices) and off-line outcomes in these learners. In science education, unlike a standard text, a refutation text…

  10. Review of Urban Sustainability Indicators Assessment

    DEFF Research Database (Denmark)

    Michael, Florianna Lendai; Noor, Zainura Zainon; Figueroa, Maria Josefina

    2015-01-01

    This paper examines and compares the processes, methodologies and resulting sets of indicators for urban sustainability carried out in three of Asia's developing countries; Malaysia, Taiwan and China. The paper analytically discusses the challenges of developing urban sustainability indicators...... among the developing countries. The comparison reveals the urban indicators development's processes, contents and outcomes and whether the resulting set of urban indicators is operational and has changed the way things were....

  11. Extended radio emission and the nature of blazars

    International Nuclear Information System (INIS)

    Antonucci, R.R.J.; Ulvestad, J.S.

    1985-01-01

    The VLA has been used at 20 cm to map all 23 of the 54 confirmed blazars listed in the Angel and Stockman review paper that had not been mapped before at high resolution. (Blazars include BL Lac objects and optically violently variable quasars.) In addition, data on most of the previously mapped blazars have been reprocessed in order to achieve higher dynamic range. Extended emission has been detected associated with 49 of the 54 objects. The extended radio emission has been used to test the hypothesis that blazars are normal radio galaxies and radio quasars viewed along the jet axes. We find that blazars have substantial extended power, consistent with this hypothesis. Many have extended powers as high as the luminous Fanaroff-Riley class 2 radio doubles. The projected linear sizes are small, as expected from foreshortening of the extended sources, and many blazars have the expected core-halo morphology. There are also several small doubles, a head-tail source, and some one-sided sources, and these could be in cases where the line of sight is slightly off the jet axis, or projections of asymmetrical radio galaxies and quasars. The ratio of core to extended radio emission has been studied as a possible indicator of viewing aspect or beaming intensity. It is found to correlate with optical polarization, optical and radio core variability, and one-sided radio morphology. We can go beyond these consistency checks and work toward a proof of the hypothesis under discussion. The flux from the extended emission alone is sufficient in some blazars to qualify them for inclusion in the 3C and 4C catalogs. Suppose that the radio core emission is anisotropic, but the extended emission is predominantly isotropic. The isotropy of the extended emission implies that these blazars would be in the catalogs even if viewed from the side

  12. indications and outcome of admission of diabetic patients into

    African Journals Online (AJOL)

    FOBUR

    The determination of the burden of diabetes in hospitals will help in designing an ... developed countries of the world . The estimated ... mortality rates of all chronic noninfective diseases . .... The world. Health Report 2002-Reducing risks,. Promoting Healthy Lifestyle. World ... for the year 2000 and projections for 2030.

  13. Indications for and outcomes of tertiary referrals in refractive surgery

    NARCIS (Netherlands)

    Patryn, Eliza K.; Vrijman, Violette; Nieuwendaal, Carla P.; van der Meulen, Ivanka J. E.; Mourits, Maarten P.; Lapid-Gortzak, Ruth

    2014-01-01

    To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of

  14. Indications and Outcome of Mandibular Condylar and Ramus ...

    African Journals Online (AJOL)

    ... do with the excision or resection of the fused condyle and the articular surface of the .... documented in literature[25,26] and we felt our patients will benefit from ORIF because of .... Distraction osteogenesis has also been found useful.[10‑12].

  15. The Circle of Courage: Critical Indicators of Successful Life Outcomes

    Science.gov (United States)

    Brendtro, Larry K.; Mitchell, Martin L.; Jackson, William C.

    2014-01-01

    In the behavioral science literature, successful childhood socialization is termed Positive Youth Development (PYD). Young people themselves are active agents in charting their own life course (Jackson, in press). However, the responsibility for socialization begins with families and is shared by neighbors, faith communities, educators, youth…

  16. Density fluctuations in extended inflation

    International Nuclear Information System (INIS)

    Guth, A.H.; Jain, B.

    1992-01-01

    We estimate the density perturbation spectrum δρ/ρ in the extended inflationary model, in which the scalar curvature is coupled to a Brans-Dicke field. Through a conformal transformation and a redefinition of the Brans-Dicke field, the action of the theory is cast into a form with no coupling to the scalar curvature and a canonical kinetic term for the redefined field. Following Kolb, Salopek, and Turner, we calculate δρ/ρ using the transformed action and the standard recipe developed for conventional inflation. This recipe is expected to give a valid order-of-magnitude estimate, but a precise calculation would require a more careful treatment of several aspects of the problem. The spectrum behaves as a positive power of the wavelength, a feature that might be useful in building models to account for the observed large-scale structure of the universe. Our result for the overall amplitude of density perturbations differs slightly from that of the previous authors, and the reasons for these differences are discussed. We also point out that the conformal transformation method can be applied to a wider class of generalized gravity theories

  17. A quantum extended Kalman filter

    International Nuclear Information System (INIS)

    Emzir, Muhammad F; Woolley, Matthew J; Petersen, Ian R

    2017-01-01

    In quantum physics, a stochastic master equation (SME) estimates the state (density operator) of a quantum system in the Schrödinger picture based on a record of measurements made on the system. In the Heisenberg picture, the SME is a quantum filter. For a linear quantum system subject to linear measurements and Gaussian noise, the dynamics may be described by quantum stochastic differential equations (QSDEs), also known as quantum Langevin equations, and the quantum filter reduces to a so-called quantum Kalman filter. In this article, we introduce a quantum extended Kalman filter (quantum EKF), which applies a commutative approximation and a time-varying linearization to systems of nonlinear QSDEs. We will show that there are conditions under which a filter similar to a classical EKF can be implemented for quantum systems. The boundedness of estimation errors and the filtering problem with ‘state-dependent’ covariances for process and measurement noises are also discussed. We demonstrate the effectiveness of the quantum EKF by applying it to systems that involve multiple modes, nonlinear Hamiltonians, and simultaneous jump-diffusive measurements. (paper)

  18. Geometric construction of extended supergravity

    International Nuclear Information System (INIS)

    Kostelecky, V.A.

    1982-01-01

    This work describes the explict construction of the locally SO(4)-invariant, on-shell de Sitter supergravity. First, aspects of classical differential geometry used in the construction of local gauge theories are reviewed. Emphasis is placed on fiber bundles and their uses in Yang-Mills and Einstein theories. Next, the extension of the formalism to differential supergeometry is outlined. Applications to extended supergravities are discussed. Finally, the O(4) deSitter supergravity is obtained by considering a bundle of frames constructed using the orthosymplectic superalgebra osp(4/4). The structure group of this bundle is Sl(2C) x SO(4) and the tangent space to the base supermanifold is homeomorphic to the coset osp(4/4)/sl(2C) x so(4). Constraints taken into the Bianchi identifies yield a realization of the superalgebra in the function space of connections, vielbeins, curvatures and torsions of the bundle. Auxiliary fields, transformation laws and equations of motion are determined. Consistency of the realization is verified, proving closure of the algebra. The associated Poincare supergravity is obtained by a contraction

  19. Extended analysis of Mo VI

    International Nuclear Information System (INIS)

    Edlen, B.; Rahimullah, K.; Tauheed, A.; Chaghtai, M.S.Z.

    1985-01-01

    The analysis of the RbI-like spectrum Mo VI has been extended to include a total of some 110 classified lines and 44 energy levels belonging to the one-electron configurations 4s 2 4p 6 ( 1 S)nl with n ranging up to 9 and l up to 7. The analysis is based on recordings of vacuum spark spectra made at Lund in the region 230-2350 A, complemented by a list of lines from 2193 to 6336 A observed and identified by Romanov and Striganov in a Penning type arc discharge. The one-electron level system is partly mixed with core-excited configurations, not treated in the present paper. Especially the nf series is strongly perturbed by 4s 2 4p 5 4d 2 , and an anomalous behaviour of the ng series is explained by interaction with the 2 G term of 4s4p 6 4d 2 . The ionization limit, derived from 6h, 7i and 8k by means of the polarization formula, is found to be 555 132+-2 cm -1 . (orig.)

  20. A quantum extended Kalman filter

    Science.gov (United States)

    Emzir, Muhammad F.; Woolley, Matthew J.; Petersen, Ian R.

    2017-06-01

    In quantum physics, a stochastic master equation (SME) estimates the state (density operator) of a quantum system in the Schrödinger picture based on a record of measurements made on the system. In the Heisenberg picture, the SME is a quantum filter. For a linear quantum system subject to linear measurements and Gaussian noise, the dynamics may be described by quantum stochastic differential equations (QSDEs), also known as quantum Langevin equations, and the quantum filter reduces to a so-called quantum Kalman filter. In this article, we introduce a quantum extended Kalman filter (quantum EKF), which applies a commutative approximation and a time-varying linearization to systems of nonlinear QSDEs. We will show that there are conditions under which a filter similar to a classical EKF can be implemented for quantum systems. The boundedness of estimation errors and the filtering problem with ‘state-dependent’ covariances for process and measurement noises are also discussed. We demonstrate the effectiveness of the quantum EKF by applying it to systems that involve multiple modes, nonlinear Hamiltonians, and simultaneous jump-diffusive measurements.

  1. Technological Packages Extended To Farmers by Non ...

    African Journals Online (AJOL)

    Global Approaches to Extension Practice: A Journal of Agricultural Extension ... extended to farmers by Non Governmental Organizations in the Niger Delta area of Nigeria. ... Modern snailery was the only identified agro forestry technology extended, ... technologies were the significant soil management practices extended.

  2. Construction of extended exponential general linear methods 524 ...

    African Journals Online (AJOL)

    This paper introduces a new approach for constructing higher order of EEGLM which have become very popular and novel due to its enviable stability properties. This paper also shows that methods 524 is stable with its characteristics root lies in a unit circle. Numerical experiments indicate that Extended Exponential ...

  3. Extended storage of spent fuel

    International Nuclear Information System (INIS)

    1992-10-01

    This document is the final report on the IAEA Co-ordinated Research Programme on the Behaviour of Spent Fuel and Storage Facility Components during Long Term Storage (BEFAST-II, 1986-1991). It contains the results on wet and dry spent fuel storage technologies obtained from 16 organizations representing 13 countries who participated in the co-ordinated research programme. Considerable quantities of spent fuel continue to arise and accumulate. Many countries are investigating the option of extended spent fuel storage prior to reprocessing or fuel disposal. Wet storage continues to predominate as an established technology with the construction of additional away-from-reactor storage pools. However, dry storage is increasingly used with most participants considering dry storage concepts for the longer term. Depending on the cladding type options of dry storage in air or inert gas are proposed. Dry storage is becoming widely used as a supplement to wet storage for zirconium alloy clad oxide fuels. Storage periods as long as under wet conditions appear to be feasible. Dry storage will also continue to be used for Al clad and Magnox type fuel. Enhancement of wet storage capacity will remain an important activity. Rod consolidation to increase wet storage capacity will continue in the UK and is being evaluated for LWR fuel in the USA, and may start in some other countries. High density storage racks have been successfully introduced in many existing pools and are planned for future facilities. For extremely long wet storage (≥50 years), there is a need to continue work on fuel integrity investigations and LWR fuel performance modelling. it might be that pool component performance in some cases could be more limiting than the FA storage performance. It is desirable to make concerted efforts in the field of corrosion monitoring and prediction of fuel cladding and poll component behaviour in order to maintain good experience of wet storage. Refs, figs and tabs

  4. Extending solid state laser performance

    Science.gov (United States)

    Miesak, Ed

    2017-02-01

    Coherent Diode-Pumped Solid-State Orlando (CDO), formerly known as Lee Laser, headquartered in Orlando Florida produces CW and pulsed solid state lasers. Primary wavelengths include 1064 nm, 532 nm, and 355 nm. Other wavelengths produced include 1320 nm, 15xx nm, and 16xx nm. Pulse widths are in the range of singles to hundreds of nanoseconds. Average powers are in the range of a few watts to 1000 watts. Pulse repetition rates are typically in the range of 100 Hz to 100 KHz. Laser performance parameters are often modified according to customer requests. Laser parameters that can be adjusted include average power, pulse repetition rate, pulse length, beam quality, and wavelength. Laser parameters are typically cross-coupled such that adjusting one may change some or all of the others. Customers often request one or more parameters be changed without changing any of the remaining parameters. CDO has learned how to accomplish this successfully with rapid turn-around times and minimal cost impact. The experience gained by accommodating customer requests has produced a textbook of cause and effect combinations of laser components to accomplish almost any parameter change request. Understanding the relationships between component combinations provides valuable insight into lasing effects allowing designers to extend laser performance beyond what is currently available. This has led to several break through products, i.e. >150W average power 355 nm, >60W average power 6 ps 1064 nm, pulse lengths longer than 400 ns at 532 nm with average power >100W, >400W 532 nm with pulse lengths in the 100 ns range.

  5. Indicators and their functions

    DEFF Research Database (Denmark)

    Gudmundsson, Henrik; Joumard, Robert; Aschemann, Ralf

    2010-01-01

    indicators? How can several indicators be jointly considered? And how can indicators be used in planning and decision making? Firstly we provide definition of 'indicator of environmental sustainability in transport'. The functions, strengths and weaknesses of indicators as measurement tools, and as decision...... for indicators and assessments. As the decision making context influences the perceived and actual needs for indicators and methods, we also analysed the dimensions and context of decision making. We derived criteria and methods for the assessment and selection of indicators of environmental sustainability......This report is the final report of the action COST 356 'EST - Towards the definition of a measurable environmentally sustainable transport'. It tries to answer the following questions: How can environmental impacts of transport be measured? How can measurements be transformed into operational...

  6. Geomagnetic aa Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The geomagnetic aa indices are the continuation of the series beginning in the year 1868. A full description of these indices is given in the International...

  7. Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey.

    Science.gov (United States)

    Nappi, Rossella E; Lete, Iñaki; Lee, Lulu K; Flores, Natalia M; Micheletti, Marie-Christine; Tang, Boxiong

    2018-01-18

    The real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported. Data were from the United States 2013 National Health and Wellness Survey. Eligible women (18-50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 "extremely dissatisfied" to 7 "extremely satisfied"), adherence (8-item Morisky Medication Adherence Scale © ), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates). Participants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.

  8. Academic Major as a Perceived Stress Indicator: Extending Stress Management Intervention

    Science.gov (United States)

    May, Ross W.; Casazza, Stephen P.

    2012-01-01

    Previous research that has explored stress differences between "hard" and "soft" academic majors did not provide clear criteria for categorizing "hard" and "soft" majors, used a single item to measure reported stress, and reported contradictory stress differences between academic majors (Myrtek, Hilgenberg,…

  9. NRC performance indicator program

    International Nuclear Information System (INIS)

    Singh, R.N.

    1987-01-01

    The performance indicator development work of the US Nuclear Regulatory Commission (NRC) interoffice task group involved several major activities that included selection of candidate indicators for a trial program, data collection and review, validation of the trial indicators, display method development, interactions with the industry, and selection of an optimum set of indicators for the program. After evaluating 27 potential indicators against certain ideal attributes, the task group selected 17 for the trial program. The pertinent data for these indicators were then collected from 50 plants at 30 sites. The validation of the indicators consisted of two primary processes: logical validity and statistical analysis. The six indicators currently in the program are scrams, safety system actuations, significant events, safety system failures, forced outage rate, and equipment forced outages per 100 critical hours. A report containing data on the six performance indicators and some supplemental information is issued on a quarterly basis. The NRC staff is also working on refinements of existing indicators and development of additional indicators as directed by the commission

  10. Advanced and extended scope practice of radiographers: The Scottish perspective

    International Nuclear Information System (INIS)

    Henderson, I.; Mathers, S.A.; McConnell, J.; Minnoch, D.

    2016-01-01

    Purpose: The impact of changing roles, skill mix and a shortage of consultant radiologists on the profession of diagnostic radiography is not clearly understood in Scotland although the anecdotal perspective suggests the situation in many areas does not equate to that of England. Method: A questionnaire survey was administered to ‘lead diagnostic radiographers’ across all Health Boards in Scotland and this was supplemented with telephone interviews. Results: The implementation of skill mix initiatives and particularly advanced/extended scope practice was found to be geographically variable with limited evidence of change in some areas. Lack of effective funding and backfill for training was found to be a major barrier to change, although it was also acknowledged that opposition from some professional groups could be a major factor. Conclusion: Although there is some optimism and evidence of accelerating change, development of the radiographic workforce in Scotland does not in general compare favourably to the findings of Price et al., in 2007. The reasons are multi-factorial including fiscal, professional and geographical elements. - Highlights: • Implementation of extended scope practice is geographically inconsistent. • AfC banding of radiographers in extended scope roles is inconsistent. • Funding and backfill for training is a recognised difficulty for many managers. • Professional opposition, primarily from radiologists is a barrier to implementation. • Extended scope roles make a notable contribution to enhanced outcomes.

  11. eHealth indicators

    DEFF Research Database (Denmark)

    HYPPÖNEN, Hannele; AMMENWERTH, Elske; Nøhr, Christian

    2012-01-01

    eHealth indicators are needed to measure defined aspects of national eHealth implementations. However, until now, eHealth indicators are ambiguous or unclear. Therefore, an expert workshop "Towards an International Minimum Dataset for Monitoring National Health Information System Implementations......" was organized. The objective was to develop ideas for a minimum eHealth indicator set. The proposed ideas for indicators were classified based on EUnetHTA and De-Lone & McClean, and classification was compared with health IT evaluation criteria classification by Ammenwerth & Keizer. Analysis of the workshop...... results emphasized the need for a common methodological framework for defining and classifying eHealth indicators. It also showed the importance of setting the indicators into context. The results will benefit policy makers, developers and researchers in pursuit of provision and use of evidence...

  12. Float level indicator

    International Nuclear Information System (INIS)

    Grishchuk, M.Kh.; Laptev, A.G.; Pashkov, V.A.

    1980-01-01

    Specially developed level indicator is suggested with differential to-transformer converter of the float motion, operating in line with a movable electronic block, intended for indicating the level of the dissociating nitrogen tetroxide liquid phase. On the basis of the indicator elements the device is realized to measure the time of calibrated volume fillino. in by liquid nitrogen tetroxide in steady state operation of the experimental bench-marks [ru

  13. Climate Change Indicators

    Science.gov (United States)

    Presents information, charts and graphs showing measured climate changes across 40 indicators related to greenhouse gases, weather and climate, oceans, snow and ice, heath and society, and ecosystems.

  14. VP Ellipsis without Indices

    DEFF Research Database (Denmark)

    Hardt, Daniel; Asher, Nicholas; Hunter, Julie

    2013-01-01

    This paper compares two views on the status of indices in syntactic and logical representations. On a structural view, indices are syntactic formants on a par with node labels and phrase bracketings, and are thus a part of the logical forms that are derived from syntactic representations. On the ......This paper compares two views on the status of indices in syntactic and logical representations. On a structural view, indices are syntactic formants on a par with node labels and phrase bracketings, and are thus a part of the logical forms that are derived from syntactic representations...

  15. Website quality indicators for consumers.

    Science.gov (United States)

    Griffiths, Kathleen M; Christensen, Helen

    2005-11-15

    The rating tool DISCERN was designed for use by consumers without content expertise to evaluate the quality of health information. There is some evidence that DISCERN may be a valid indicator of evidence-based website quality when applied by health professionals. However, it is not known if the tool is a valid measure of evidence-based quality when used by consumers. Since it is a lengthy instrument requiring training in its use, DISCERN may prove impractical for use by the typical consumer. It is therefore important to explore the validity of other simpler potential indicators of site quality such as Google PageRank. This study aimed to determine (1) whether the instrument DISCERN is a valid indicator of evidence-based Web content quality for consumers without specific mental health training, and (2) whether Google PageRank is an indicator of website content quality as measured by an evidence-based gold standard. This was a cross-sectional survey of depression websites using consumer and health professional raters. The main outcome measures were (1) site characteristics, (2) evidence-based quality of content as measured by evidence-based depression guidelines, (3) DISCERN scores, (4) Google PageRank, and (5) user satisfaction. There was a significant association between evidence-based quality ratings and average DISCERN ratings both for consumers (r = 0.62, P = .001) and health professionals (r = 0.80, P PageRank (r = 0.59, P = .002). However, the correlation between DISCERN scores and user satisfaction was higher than the correlation between Google PageRank and user satisfaction. DISCERN has potential as an indicator of content quality when used either by experts or by consumers. Google PageRank shows some promise as an automatic indicator of quality.

  16. Quality indicators in radiotherapy

    International Nuclear Information System (INIS)

    Cionini, Luca; Gardani, Gianstefano; Gabriele, Pietro; Magri, Secondo; Morosini, Pier Luigi; Rosi, Antonella; Viti, Vincenza

    2007-01-01

    Background and purpose: There is a widespread and increasing tendency to develop hospital performance indicators in the field of accreditation/certification systems and quality benchmarking. A study has been undertaken to develop a set of performance indicators for a typical radiotherapy Centre and to evaluate their ability to provide a continuous quality improvement. Materials and methods: A working group consisting of radiation oncologists, medical physicists and radiation technologists under the coordination of experts in health technology assessment has elaborated a set of general indicators able to monitor performances and the quality level of a typical radiotherapy Centre. The work has been carried out through four steps: a preliminary set of indicators was selected; data on these indicators were collected in a number of Italian radiotherapy Centres and medical physics Services; problems in collection and analysis of data were discussed; a final set of indicators was developed. Results: A final set of 13 indicators is here presented. They concern general structural and/or operational features, health physics activities and accuracy and technical complexity of the treatment. Conclusions: The indicators tested in a few Italian Centres of radiotherapy and medical physics Services are now ready to be utilized by a larger community

  17. Indicators of sustainable tourism

    Directory of Open Access Journals (Sweden)

    Jovičić Dobrica

    2010-01-01

    Full Text Available The indicators, precisely describing the linkages between tourism and the environment, social and cultural base, are not easily available. How ever, some relevant organizations (WTO, EU, OECD, etc., institutions and experts, have been hardly working to create the indicators of sustainable tourism. Whereas the economic objectives are easily defined by the use of the traditional indicators used in national and business economics, it is very difficult to identify widely applicable environmental, social and cultural indicators. In order to stimulate and alleviate the process of sustainable tourism development, EU created the list of comparative indicators of sustainable tourism. In preparing this list, special attention is paid to identification of valid indicators of real tourism impacts on the social and cultural environment (the entire set of traditions, customs, history, hospitality and culture that characterize a given area, that is a very complex task. Assuming the fact that the related indicators have been analyzed in many European countries, this paper is focused on applying the related indicators in research of tourism development in villages of the Kosjerić community. .

  18. Key performance indicators

    NARCIS (Netherlands)

    Zwetsloot, G.I.J.M.

    2014-01-01

    This paper addresses how organisations can use OSH performance indicators. This is an important way to mainstream OSH into business management. Key performance indicators (KPIs) should provide objective data on the OSH situation. It is often said that ‘what gets measured gets managed’. Without

  19. Indicators for environmental sustainability

    DEFF Research Database (Denmark)

    Dong, Yan; Hauschild, Michael Zwicky

    2017-01-01

    . In this study, we reviewed indicators applied in life cycle assessment (LCA), planetary boundary framework (PB), and Sustainable Development Goals (SDGs) developed under United Nation. The aim is to 1) identify their applications and relevant decision context; 2) Review their indicators and categorize them...

  20. Evaluating Living Standard Indicators

    Directory of Open Access Journals (Sweden)

    Birčiaková Naďa

    2015-09-01

    Full Text Available This paper deals with the evaluation of selected available indicators of living standards, divided into three groups, namely economic, environmental, and social. We have selected six countries of the European Union for analysis: Bulgaria, the Czech Republic, Hungary, Luxembourg, France, and Great Britain. The aim of this paper is to evaluate indicators measuring living standards and suggest the most important factors which should be included in the final measurement. We have tried to determine what factors influence each indicator and what factors affect living standards. We have chosen regression analysis as our main method. From the study of factors, we can deduce their impact on living standards, and thus the value of indicators of living standards. Indicators with a high degree of reliability include the following factors: size and density of population, health care and spending on education. Emissions of carbon dioxide in the atmosphere also have a certain lower degree of reliability.

  1. An extended chemical analysis of gallstone.

    Science.gov (United States)

    Chandran, P; Kuchhal, N K; Garg, P; Pundir, C S

    2007-09-01

    Chemical composition of gall stones is essential for aetiopathogensis of gallstone disease. We have reported quantitative chemical analysis of total cholesterol bilirubin, calcium, iron and inorganic phosphate in 120 gallstones from haryana. To extend this chemical analysis of gall stones by studying more cases and by analyzing more chemical constituents. A quantitative chemical analysis of total cholesterol, total bilirubin, fatty acids, triglycerides, phospholipids, bile acids, soluble proteins, sodium potassium, magnesium, copper, oxalate and chlorides of biliary calculi (52 cholesterol, 76 mixed and 72 pigment) retrieved from surgical operation of 200 patients from Haryana state was carried out. Total cholesterol as the major component and total bilirubin, phospholipids, triglycerides, bile acids, fatty acids (esterified), soluble protein, calcium, magnesium, iron, copper, sodium, potassium, inorganic phosphate, oxalate and chloride as minor components were found in all types of calculi. The cholesterol stones had higher content of total cholesterol, phospholipids, fatty acids (esterified), inorganic phosphate and copper compared to mixed and pigment stones. The mixed stones had higher content of iron and triglycerides than to cholesterol and pigment stones. The pigment stones were richer in total bilirubin, bile acids, calcium, oxalate, magnesium, sodium, potassium, chloride and soluble protein compared to cholesterol and mixed stones. Although total cholesterol was a major component of cholesterol, mixed and pigment gall stone in Haryana, the content of most of the other lipids, cations and anions was different in different gall stones indicating their different mechanism of formation.

  2. Longitudinal changes in extended roles in radiography

    International Nuclear Information System (INIS)

    Price, R.C.; Miller, L.R.; Mellor, F.

    2002-01-01

    Purpose: The purpose of this research was to identify the extent and scope of changes to radiography practice. Method: Questionnaires were sent to radiology managers at acute National Health Service (NHS) hospitals in 2000 as a follow-up to an initial survey conducted in 1998. Information was sought on region, teaching/non-teaching status, the nature of extended role tasks undertaken and the year in which these tasks were first undertaken. Results: Some 172 questionnaires were returned from a total of 253 dispatched (68%). In 161 hospitals radiographers administered intravenous injections and performed barium enemas in 119 hospitals, while a red-dot system was in operation in 141 hospitals. Reporting by radiographers had increased since 1998. Replies indicated that, at 124 hospitals, radiographers were reporting in ultrasound. Skeletal reporting was the second most-frequently-reported activity, with 63 hospitals indicating that radiographers reported in this modality, while barium enemas were reported by radiographers in 34 hospitals. Reporting was also undertaken by radiographers in mammography, nuclear medicine, paediatrics and chest radiography in a small minority of hospitals. There was no statistically significant difference between the adoption of tasks in non-teaching and teaching hospitals with the exception of radiographer-performed barium enemas (P=0.014) and red-dot systems (P=0.05). Radiographers were more likely to undertake both of these activities at non-teaching hospitals than in teaching hospitals. Regional differences were apparent in reporting, with a greater prevalence in the English regions than Northern Ireland, Scotland and Wales. Conclusion: The study provided data that demonstrated the extent to which hospitals are utilizing the developing skills of radiographers. This has important implications for future education and training needs for radiographers and for delivery of imaging services

  3. Core damage risk indicators

    International Nuclear Information System (INIS)

    Szikszai, T.

    1994-01-01

    The purpose of this document is to show a method for the fast recalculation of the PSA. To avoid the information loose, it is necessary to simplify the PSA models, or at least reorganize them. The method, introduced in this document, require that preparation, so we try to show, how to do that. This document is an introduction. This is the starting point of the work related to the development of the risk indicators. In the future, with the application of this method, we are going to show an everyday use of the PSA results to produce the indicators of the core damage risk. There are two different indicators of the plant safety performance, related to the core damage risk. The first is the core damage frequency indicator (CDFI), and the second is the core damage probability indicator (CDPI). Of course, we cannot describe all of the possible ways to use these indicators, rather we will try to introduce the requirements to establish such an indicator system and the calculation process

  4. Safety performance indicators program

    International Nuclear Information System (INIS)

    Vidal, Patricia G.

    2004-01-01

    In 1997 the Nuclear Regulatory Authority (ARN) initiated a program to define and implement a Safety Performance Indicators System for the two operating nuclear power plants, Atucha I and Embalse. The objective of the program was to incorporate a set of safety performance indicators to be used as a new regulatory tool providing an additional view of the operational performance of the nuclear power plants, improving the ability to detect degradation on safety related areas. A set of twenty-four safety performance indicators was developed and improved throughout pilot implementation initiated in July 1998. This paper summarises the program development, the main criteria applied in each stage and the results obtained. (author)

  5. Extended, Embodied Cognition and Second Language Acquisition

    Science.gov (United States)

    Atkinson, Dwight

    2010-01-01

    A "cognitivist" approach to cognition has traditionally dominated second language acquisition (SLA) studies. In this article, I examine two alternative approaches--"extended cognition" and "embodied cognition"--for how they might help us conceptualize SLA. More specifically, I present: (i) summaries of extended and embodied cognition, followed by…

  6. Impacts of extended working hours in logging

    Science.gov (United States)

    Dana Mitchell; Tom Gallagher

    2008-01-01

    Last year at the 2007 AIM in Minneapolis, MN, the authors presented the human factors impacts to consider when implementing extended working hours in the logging industry. In a continuation of this project, we have researched existing literature to identify possible actions that logging business owners can take to reduce the impact of extended working hours on their...

  7. Extended Producer Responsibility in the Aviation Sector

    OpenAIRE

    Brito, Marisa; Laan, Erwin; Irion, B.D.

    2007-01-01

    textabstractIn this paper we investigate recent initiatives with respect to extended producer responsibility in the aviation sector. We compare those with the existing practices in the automobile sector and the emerging regulations in the shipping sector. We describe the challenges and the lessons to be learned from the evolution and state of extended producer responsibility in these two industries.

  8. Solar Indices - Solar Flares

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  9. NOHSS Child Indicators

    Data.gov (United States)

    U.S. Department of Health & Human Services — Data for School year-end 1994 through year-end 2016. State oral health surveys are the data sources for these indicators. States periodically conduct independent...

  10. NOHSS Adult Indicators

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2012-2014 (even years). Data from BRFSS for indicators of adult oral health for even years from 2012 through 2014. National estimates are represented by the median...

  11. Environmental indicators for buildings

    DEFF Research Database (Denmark)

    Dammann, Sven

    Environmental Indicators for Buildings are studied using two different perspectives: with a technological, environmental scientific departing point and with a social scientific departing point. Different relevant groups in the building sector are identified and analysed, using the Social...

  12. Solar Indices - Sunspot Numbers

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  13. Solar Indices Bulletin

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Solar Indices Bulletin is a prompt monthly information product that is distributed within two weeks after the observation month closes. For the month just ended,...

  14. Indicators and SEA

    DEFF Research Database (Denmark)

    Gao, Jingjing; Kørnøv, Lone; Christensen, Per

    Abstract: Indicators are widely used in SEA to measure, communicate and monitor impacts from a proposed policy, plan or programme, and can improve the effectiveness for the SEA by simplifying the complexity of both assessment and presentation. Indicators can be seen as part of the implementation...... and if the information requirement for different target groups is not addressed. Indicators are widely used in SEA to measure, communicate and monitor impacts from a proposed policy, plan or programme, and can improve the effectiveness for the SEA by simplifying the complexity of both assessment and presentation...... process helping to understand, communicate and, integrate important environmental issues in planning and decision-making. On the other hand, use of indicators can also limit SEA effectiveness, if the ones chosen are biased or limited, if the aggregation gives incorrect interpretation...

  15. Fishery Performance Indicators

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Performance indicators for landings, effort, revenue and distribution of revenue are collected for various fisheries nation-wide. The fisheries include catch and...

  16. Indicators: Sediment Enzymes

    Science.gov (United States)

    Sediment enzymes are proteins that are produced by microorganisms living in the sediment or soil. They are indicators of key ecosystem processes and can help determine which nutrients are affecting the biological community of a waterbody.

  17. Solar Indices - Plage Regions

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  18. Solar Indices - Solar Ultraviolet

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  19. Solar Indices - Solar Corona

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  20. Solar Indices - Solar Irradiance

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  1. NOHSS Child Indicators

    Data.gov (United States)

    U.S. Department of Health & Human Services — Data for School year-end 1994 through year-end 2017. State oral health surveys are the data sources for these indicators. States periodically conduct independent...

  2. Indicators of Ecological Change

    Science.gov (United States)

    2005-03-01

    H. 1990. Strategy for monitoring the effects of land use change on atmospheric CO2 concentrations . In Proceedings of “Global Natural Resource...Working Group in Santiago , Chile , February 1995, ten nations agreed to a comprehensive set of criteria and indicators for forest conservation and...chemistry variables, the concentrations of total and inorganic suspended sediments during baseflow and storm periods were excellent indicators of

  3. Energy indicators for sustainable development

    International Nuclear Information System (INIS)

    Vera, Ivan; Langlois, Lucille

    2007-01-01

    Energy is an essential factor in overall efforts to achieve sustainable development. Countries striving to this end are seeking to reassess their energy systems with a view toward planning energy programmes and strategies in line with sustainable development goals and objectives. This paper summarizes the outcome of an international partnership initiative on indicators for sustainable energy development that aims to provide an analytical tool for assessing current energy production and use patterns at a national level. The proposed set of energy indicators represents a first step of a consensus reached on this subject by five international agencies-two from the United Nations system (the Department of Economic and Social Affairs and the International Atomic Energy Agency), two from the European Union (Eurostat and the European Environment Agency) and one from the Organization for Economic Cooperation and Development (the International Energy Agency). Energy and environmental experts including statisticians, analysts, policy makers and academics have started to implement general guidelines and methodologies in the development of national energy indicators for use in their efforts to monitor the effects of energy policies on the social, economic and environmental dimensions of sustainable development

  4. Formulation and Evaluation of Extended- Release Tablet of Zolpidem Tartrate by Wet Granulation Technique

    OpenAIRE

    Fatemeh Pourhashem; Mohammad Reza Avadi

    2016-01-01

    The goal of this study was to design and evaluate extended - release system of the hypnotic agent, Zolpidem tartrate usefulness for the treatment of insomnia. The half-life of this drug is about 1.9 - 3 hours that indicating it a candidate for the extended release formulation. Our investigation relates to development of extended drug delivery system based on Hydroxy propyl methyl cellulose (HPMCK4M) as release retardant, polyvinyl pyrrolidone (PVP k30) as binder and Magnesium S...

  5. Computed tomography and clinical outcome in patients with severe traumatic brain injury.

    Science.gov (United States)

    Stenberg, Maud; Koskinen, Lars-Owe D; Jonasson, Per; Levi, Richard; Stålnacke, Britt-Marie

    2017-01-01

    To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). Initial CT (CT i ) and CT 24 hours post-trauma (CT 24 ) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. Thirty-seven patients were included. Marshall CT i and CT 24 were significantly correlated with RLAS-R at three months. Rotterdam CT 24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year. Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

  6. Air quality indicators

    International Nuclear Information System (INIS)

    Clench-Aas, Jocelyn; Guerreiro, Cristina; Bartonova, Alena

    1999-06-01

    This report proposes and describes in detail several air quality indicators that may be used to describe population exposure. The suggested indicators account for temporal and spatial patterns of pollution and movements of individuals between different micro-environments. The Air Quality Indicator /AQI) should represent both the spatial and temporal aspects of pollution exposure that may have important effects on health. Two indicators are needed, the Population Air Quality Indicator and the Individual Air Quality Indicator. Mean concentrations, 98th percentile and maximum values are the traditional indicators for estimating exposure. the temporal variability of PM-10 and NO 2 , however, is here described by means of: 1) The rate of change of pollution as the difference between two consecutive hourly values and of 2) episodes, described in terms of number, duration and winter episode period, maximum concentration in the episode and integrated episode exposure (episode AOT50/100). The spatial variation of AQIs can be described in several ways, e.g.: 1) Concentrations in neighbouring grid squares can be compared as an indication of spatial variation and 2) point estimates can be compared to grid values for a description of variation within a grid. Both methods are presented here. A test of the representativity of static point estimates for pollution exposure is to compare them to an estimate of air pollution exposure accounting for movements between different locations, obtained using diaries. The ultimate aim of AQIs is to describe the population exposure to ambient pollution. This is done by estimating the number of people exposed using different characteristics of AQIs. The data used to describe these indicators originates from dispersion modelling of short-term air pollution concentrations in Oslo. Two series of data are used. One represents hour-for hour concentrations in the 1 km 2 grid system covering the city of Oslo, winter 1994/95, calculated by the grid

  7. Effect of extended infusion of meropenem and nebulized amikacin on Gram-negative multidrug-resistant ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    Mona Ahmed Ammar

    2018-01-01

    Conclusions: Adding nebulized amikacin to systemic antibiotics in patients with VAP caused by Gram-negative MDRO may offer efficacy benefits, and the use of extended infusions of meropenem could improve the clinical outcomes in critically ill populations.

  8. Indicators for energy security

    International Nuclear Information System (INIS)

    Kruyt, Bert; Van Vuuren, D.P.; De Vries, H.J.M.; Groenenberg, H.

    2009-01-01

    The concept of energy security is widely used, yet there is no consensus on its precise interpretation. In this research, we have provided an overview of available indicators for long-term security of supply (SOS). We distinguished four dimensions of energy security that relate to the availability, accessibility, affordability and acceptability of energy and classified indicators for energy security according to this taxonomy. There is no one ideal indicator, as the notion of energy security is highly context dependent. Rather, applying multiple indicators leads to a broader understanding. Incorporating these indicators in model-based scenario analysis showed accelerated depletion of currently known fossil resources due to increasing global demand. Coupled with increasing spatial discrepancy between consumption and production, international trade in energy carriers is projected to have increased by 142% in 2050 compared to 2008. Oil production is projected to become increasingly concentrated in a few countries up to 2030, after which production from other regions diversifies the market. Under stringent climate policies, this diversification may not occur due to reduced demand for oil. Possible benefits of climate policy include increased fuel diversity and slower depletion of fossil resources. (author)

  9. CREDIT Performance Indicator Framework

    DEFF Research Database (Denmark)

    Frandsen, Anne Kathrine; Bertelsen, Niels Haldor; Haugbølle, Kim

    2010-01-01

    During the past two years the Nordic Baltic research project CREDIT (Construction and Real Estate – Developing Indicators for Transparency) has worked with the aim to improve transparency of value creation in building and real estate. One of the central deliverables of the CREDIT project was a fr......During the past two years the Nordic Baltic research project CREDIT (Construction and Real Estate – Developing Indicators for Transparency) has worked with the aim to improve transparency of value creation in building and real estate. One of the central deliverables of the CREDIT project...... was a framework of indicators relevant in building and real estate and applicable in the Nordic and Baltic countries as well as a proposal for a set of key indicators. The study resulting in CREDIT Performance Indicator Framework has been based on 28 case studies of evaluation practises in the building and real...... estate sector each addressing three interlinked levels: building/ projects level, company or enterprise level and benchmarking system level. Additionally it has been based on dialogue with researchers and professional organisation, international research and standardisation work and national building...

  10. Publication point indicators

    DEFF Research Database (Denmark)

    Elleby, Anita; Ingwersen, Peter

    2010-01-01

    ; the Cumulated Publication Point Indicator (CPPI), which graphically illustrates the cumulated gain of obtained vs. ideal points, both seen as vectors; and the normalized Cumulated Publication Point Index (nCPPI) that represents the cumulated gain of publication success as index values, either graphically......The paper presents comparative analyses of two publication point systems, The Norwegian and the in-house system from the interdisciplinary Danish Institute of International Studies (DIIS), used as case in the study for publications published 2006, and compares central citation-based indicators...... with novel publication point indicators (PPIs) that are formalized and exemplified. Two diachronic citation windows are applied: 2006-07 and 2006-08. Web of Science (WoS) as well as Google Scholar (GS) are applied to observe the cite delay and citedness for the different document types published by DIIS...

  11. Minimum risk trigger indices

    International Nuclear Information System (INIS)

    Tingey, F.H.

    1979-01-01

    A viable safeguards system includes among other things the development and use of indices which trigger various courses of action. The usual limit of error calculation provides such an index. The classical approach is one of constructing tests which, under certain assumptions, make the likelihood of a false alarm small. Of concern also is the test's failure to indicate a loss (diversion) when in fact one has occurred. Since false alarms are usually costly and losses both costly and of extreme strategic sinificance, there remains the task of balancing the probability of false alarm and its consequences against the probability of undetected loss and its consequences. The application of other than classical hypothesis testing procedures are considered in this paper. Using various consequence models, trigger indices are derived which have certain optimum properties. Application of the techniques would enhance the material control function

  12. Quality indicators for hip fracture care, a systematic review.

    Science.gov (United States)

    Voeten, S C; Krijnen, P; Voeten, D M; Hegeman, J H; Wouters, M W J M; Schipper, I B

    2018-05-17

    Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

  13. Temperature indicating device

    International Nuclear Information System (INIS)

    Angus, J.P.; Salt, D.

    1988-01-01

    A temperature indicating device comprises a plurality of planar elements some undergoing a reversible change in appearance at a given temperature the remainder undergoing an irreversible change in appearance at a given temperature. The device is useful in indicating the temperature which an object has achieved as well as its actual temperature. The reversible change is produced by liquid crystal devices. The irreversible change is produced by an absorbent surface carrying substances e.g. waxes which melt at predetermined temperatures and are absorbed by the surface; alternatively paints may be used. The device is used for monitoring processes of encapsulation of radio active waste. (author)

  14. Injector of solid indicator

    Energy Technology Data Exchange (ETDEWEB)

    Chernyshev, G.I.; Luk' yanov, E.P.; Pruslin, Y.A.; Zabrodin, P.I.

    1981-04-25

    The injector can be used with remote introduction of indicators into a borehole for study in an oil well of the parameters of movement of fluid currents, control of the state of the equipment, and study of the properties of the rocks. Proposed is a method of increasing the reliability of operation of the injector by stabilizing the rate of its dispersing. Introduced to the injector of a solid indicator are auxiliary brackets and a cathode made from nonmetallic electrical conducting material and reinforced at the end by an elastic bracket. The auxillary cathode is attached to the end surface of the anode and cathode.

  15. Economic Indicators Selected Countries.

    Science.gov (United States)

    1987-12-01

    DEFENCE I ECONOMIC INDICATORS SELECTED COUNTRIES DECEMBER QUARTER 1987 . ’-H ISSUED BY MANPOWER POLICY & STRATEGIES BRANCH " "’ :.S S ’,1l f ,am -m mW...100 Sour:e: Main Economic Indicators (OECD) Manufactured Basic Metal Year Goods Chemicals Metals Products 1980 100 100 100 100 1981 110 117 102 107...Earnings of all 1982 1986 7.4 Male Employees (a) Aug 1986 Aug 1987 4.8 Hourly Wace Rates 3 1979 1987 lt.2 Garden Island 1983 1987 6.7 Dockyards Dec

  16. Indications for coronary angiography

    International Nuclear Information System (INIS)

    Kaltenbach, M.; Vallbracht, C.

    1985-01-01

    Today selective coronary angiography, introduced by Sones in 1957, is used as clinical routine for diagnosing morphological changes in the coronary arteries. Hitherto, more recent techniques such as digital subtraction angiography cannot provide comparable information. Strict criteria for its indication depending on possible therapeutic consequences, have to be applied, although the risk is low with a letality of 0.01 to 0.05 percent. Radionuclear investigations can be used as additional tool in selected cases. The careful indication for coronary angiography usually implies the possible need for coronary bypass graft surgery of balloon angioplasty. (orig./MG) [de

  17. The symmetric extendibility of quantum states

    International Nuclear Information System (INIS)

    Nowakowski, Marcin L

    2016-01-01

    Studies on the symmetric extendibility of quantum states have become particularly important in the context of the analysis of one-way quantum measures of entanglement, and the distillability and security of quantum protocols. In this paper we analyze composite systems containing a symmetric extendible part, with particular attention devoted to the one-way security of such systems. Further, we introduce a new one-way entanglement monotone based on the best symmetric approximation of a quantum state and the extendible number of a quantum state. We underpin these results with geometric observations about the structures of multi-party settings which posses substantial symmetric extendible components in their subspaces. The impossibility of reducing the maximal symmetric extendibility by means of the one-way local operations and classical communication method is pointed out on multiple copies. Finally, we state a conjecture linking symmetric extendibility with the one-way distillability and security of all quantum states, analyzing the behavior of a private key in the neighborhood of symmetric extendible states. (paper)

  18. Extended Cognitive System and Epistemic Subject

    Directory of Open Access Journals (Sweden)

    Trybulec Barbara

    2015-03-01

    Full Text Available The concept of an extended cognitive system is central to contemporary studies of cognition. In the paper I analyze the place of the epistemic subject within the extended cognitive system. Is it extended as well? In answering this question I focus on the differences between the first and the second wave of arguments for the extended mind thesis. I argue that the position of Cognitive Integration represented by Richard Menary is much more intuitive and fruitful in analyses of cognition and knowledge than the early argument formulated by Andy Clark and David Chalmers. Cognitive Integration is compatible with virtue epistemology of John Greco’s agent reliabilism. The epistemic subject is constituted by its cognitive character composed of an integrated set of cognitive abilities and processes. Some of these processes are extended, they are a manipulation of external informational structures and, as such, they constitute epistemic practices. Epistemic practices are normative; to conduct them correctly the epistemic subject needs to obey epistemic norms embedded in the cultural context. The epistemic subject is not extended because of the casual coupling with external informational artifacts which extend his mind from inside the head and into the world. Rather, cognitive practices constitute the subject’s mind, they transform his cognitive abilities, and this is what makes the mind and epistemic subject “extended”.

  19. Children's Environmental Health Indicators in Australia.

    Science.gov (United States)

    Sly, J Leith; Moore, Sophie E; Gore, Fiona; Brune, Marie Noel; Neira, Maria; Jagals, Paul; Sly, Peter D

    2016-01-01

    Adverse environmental exposures in early life increase the risk of chronic disease but do not attract the attention nor receive the public health priority warranted. A safe and healthy environment is essential for children's health and development, yet absent in many countries. A framework that aids in understanding the link between environmental exposures and adverse health outcomes are environmental health indicators-numerical estimates of hazards and outcomes that can be applied at a population level. The World Health Organization (WHO) has developed a set of children's environmental health indicators (CEHI) for physical injuries, insect-borne disease, diarrheal diseases, perinatal diseases, and respiratory diseases; however, uptake of steps necessary to apply these indicators across the WHO regions has been incomplete. A first indication of such uptake is the management of data required to measure CEHI. The present study was undertaken to determine whether Australia has accurate up-to-date, publicly available, and readily accessible data on each CEHI for indigenous and nonindigenous Australian children. Data were not readily accessible for many of the exposure indicators, and much of the available data were not child specific or were only available for Australia's indigenous population. Readily accessible data were available for all but one of the outcome indicators and generally for both indigenous and nonindigenous children. Although Australia regularly collects data on key national indicators of child health, development, and well-being in several domains mostly thought to be of more relevance to Australians and Australian policy makers, these differ substantially from the WHO CEHI. The present study suggests that the majority of these WHO exposure and outcome indicators are relevant and important for monitoring Australian children's environmental health and establishing public health interventions at a local and national level and collection of appropriate

  20. On Extended Exponential General Linear Methods PSQ with S>Q ...

    African Journals Online (AJOL)

    This paper is concerned with the construction and Numerical Analysis of Extended Exponential General Linear Methods. These methods, in contrast to other methods in literatures, consider methods with the step greater than the stage order (S>Q).Numerical experiments in this study, indicate that Extended Exponential ...