Complete Tangent Stiffness for eXtended Finite Element Method by including crack growth parameters

DEFF Research Database (Denmark)

Mougaard, J.F.; Poulsen, P.N.; Nielsen, L.O.

2013-01-01

the crack geometry parameters, such as the crack length and the crack direction directly in the virtual work formulation. For efficiency, it is essential to obtain a complete tangent stiffness. A new method in this work is presented to include an incremental form the crack growth parameters on equal terms......The eXtended Finite Element Method (XFEM) is a useful tool for modeling the growth of discrete cracks in structures made of concrete and other quasi‐brittle and brittle materials. However, in a standard application of XFEM, the tangent stiffness is not complete. This is a result of not including...... with the degrees of freedom in the FEM‐equations. The complete tangential stiffness matrix is based on the virtual work together with the constitutive conditions at the crack tip. Introducing the crack growth parameters as direct unknowns, both equilibrium equations and the crack tip criterion can be handled...

Outcome quality of in-patient cardiac rehabilitation in elderly patients--identification of relevant parameters.

Science.gov (United States)

Salzwedel, Annett; Nosper, Manfred; Röhrig, Bernd; Linck-Eleftheriadis, Sigrid; Strandt, Gert; Völler, Heinz

2014-02-01

Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome. From February 2009 to June 2010 1253 patients (70.9 ± 7.0 years, 78.1% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation. The majority of patients (61.1%) were referred for rehabilitation after cardiac surgery, 38.9% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale). The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.

Revisiting Hansen Solubility Parameters by Including Thermodynamics

NARCIS (Netherlands)

Louwerse, Manuel J; Fernández-Maldonado, Ana María; Rousseau, Simon; Moreau-Masselon, Chloe; Roux, Bernard; Rothenberg, Gadi

2017-01-01

The Hansen solubility parameter approach is revisited by implementing the thermodynamics of dissolution and mixing. Hansen's pragmatic approach has earned its spurs in predicting solvents for polymer solutions, but for molecular solutes improvements are needed. By going into the details of entropy

Predicting the local outcome of glottic squamous cell carcinoma after definitive radiation therapy: value of computed tomography-determined tumour parameters

International Nuclear Information System (INIS)

Hermans, R.; Van den Bogaert, W.; Rijnders, A.; Doornaert, P.; Baert, A.L.

1999-01-01

Background and purpose: The T-classification has shortcomings in the prediction of local outcome of glottic squamous cell carcinoma (SCC) treated by definitive radiation therapy. In this regard, the value of several CT-derived tumour parameters as predictors of local outcome was investigated. Materials and methods: The pretreatment CT studies of 119 patients with glottic SCC (T1, n=61; T2, n=40; T3, n=14; T4, n=4) treated with curative intent by radiation therapy were reviewed for tumoral involvement of specific laryngeal anatomic subsites (including laryngeal cartilages). Tumour volume was calculated with the summation-of-areas technique. Actuarial (life-table) statistical analysis was done for each of the covariates; multivariate analysis was performed using the Cox proportional hazards model.Results: In the actuarial analysis tumour volume was significantly correlated with local recurrence rate (P=0.0062). Involvement of the cricoid cartilage (P=0.0052), anterior commissure (P=0.0203), subglottis (P=0.0481) and preepiglottic space (P=0.0134) and degree of involvement of the true vocal cord (P=0.0441) and paraglottic space at the level of the true vocal cord (P=0.0002) were also significantly correlated with local recurrence rate. In the multivariate analysis, only degree of involvement of the paraglottic space (at the level of the true vocal cord) (P=0.0001) and preepiglottic space (P=0.02) were found to be independent predictors of local recurrence. The T-category was significantly correlated with local outcome in the actuarial analysis (P=0.0001), but not in the multivariate analysis (P=0.5915). Conclusions: Several CT-derived parameters are powerful predictors of local outcome in glottic cancer treated with radiation therapy; some of these parameters are stronger linked to the local control rate than the T-classification. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

Weak lensing and CMB: Parameter forecasts including a running spectral index

International Nuclear Information System (INIS)

Ishak, Mustapha; Hirata, Christopher M.; McDonald, Patrick; Seljak, Uros

2004-01-01

We use statistical inference theory to explore the constraints from future galaxy weak lensing (cosmic shear) surveys combined with the current CMB constraints on cosmological parameters, focusing particularly on the running of the spectral index of the primordial scalar power spectrum, α s . Recent papers have drawn attention to the possibility of measuring α s by combining the CMB with galaxy clustering and/or the Lyman-α forest. Weak lensing combined with the CMB provides an alternative probe of the primordial power spectrum. We run a series of simulations with variable runnings and compare them to semianalytic nonlinear mappings to test their validity for our calculations. We find that a 'reference' cosmic shear survey with f sky =0.01 and 6.6x10 8 galaxies per steradian can reduce the uncertainty on n s and α s by roughly a factor of 2 relative to the CMB alone. We investigate the effect of shear calibration biases on lensing by including the calibration factor as a parameter, and show that for our reference survey, the precision of cosmological parameter determination is only slightly degraded even if the amplitude calibration is uncertain by as much as 5%. We conclude that in the near future weak lensing surveys can supplement the CMB observations to constrain the primordial power spectrum

Calculation of proton-deuteron phase parameters including the Coulomb force

International Nuclear Information System (INIS)

Alt, E.O.; Sandhas, W.; Ziegelmann, H.

1985-04-01

A previously proposed exact method for including the Coulomb force in three-body collisions is applied to proton-deuteron scattering. We present phase shifts for angular momenta up to L=9, from elastic threshold to 50 MeV proton laboratory energy. Separable rank-one potentials are taken for the nuclear interactions. A charge-independent and a charge-symmetric choise, while leading to different neutron-deuteron and proton-deuteron phase parameters, nevertheless yields practically the same Coulomb corrections. We, moreover, investigate the question of P-wave resonances.A critical comparison of our results with those obtained in a co-ordinate space formalism is performed. Furthermore, proposals for an approximate inclusion of the Coulomb potential are tested, and found unsatisfactory. (orig.)

Perioperative echocardiography-derived right ventricle function parameters and early outcomes after tetralogy of Fallot repair in mid-childhood: a single-center, prospective observational study.

Science.gov (United States)

Raj, Ravi; Puri, Goverdhan Dutt; Jayant, Aveek; Thingnam, Shyam Kumar Singh; Singh, Rana Sandip; Rohit, Manoj Kumar

2016-11-01

Right ventricular (RV) function alterations are invariably present in all patients after tetralogy of Fallot (TOF) repair. Unlike the developed world where most of the patients with TOF are corrected in infancy, average age of presentation and thus surgery for these patients in the developing world may be higher. We aimed to study the correlation between RV function parameters such as tricuspid annular peak systolic excursion (TAPSE), fractional area change (FAC), and tricuspid annular peak systolic velocity (S') with early outcome variables after intracardiac repair for TOF. Fifty patients with a preoperative diagnosis of tetralogy of Fallot scheduled for corrective surgery were included in this single-center, prospective observational study. A preoperative transthoracic echocardiogram was performed to measure RV function parameters (FAC0, TAPSE0, S'0). Transthoracic echocardiography was repeated postoperatively to measure FAC1, TAPSE1, S'1 (day 1) and FAC2, TAPSE2, and S'2 (day 3). The relationship between preoperative and postoperative RV function parameters with in-hospital mortality, duration of mechanical ventilation, and intensive care unit stay was studied. The median age of patients was 6 years (range 1-14 years). Multiple stepwise logistic regression analysis showed RV FAC as best predictor of clinical outcome. Area under the receiver operating characteristic curve for postoperative RV function parameters, that is, FAC, TAPSE, and S' to predict early or delayed recovery was 0.944, 0.875, and 0.655, respectively. Among the RV function parameters studied, RV FAC best predicted the early outcome variables after TOF repair, followed by TAPSE while lateral tricuspid annular velocity S' being the least predictive. © 2016, Wiley Periodicals, Inc.

Predictive value of semen parameters and age of the couple in pregnancy outcome after Intrauterine insemination

Directory of Open Access Journals (Sweden)

Marjan Sabbaghian

2013-11-01

Full Text Available Background: Intrauterine insemination (IUI is one the most common methods in infertility treatment, but its efficiency in infertile couples with male factor is controversial. This study is a retrospective study about correlation between semen parameters and male and female age with successful rate of IUI in patients attending to Royan Institute.Methods: A total of 998 consecutive couples in a period of 6 months undergoing IUI were included. They were classified into two groups: couples with successful and unsuccessful pregnancy. Main outcome was clinical pregnancy. Data about male and female ages and semen analysis including concentration, total sperm motility, class A motility, class B motility, class A+B motility and normal morphology was extracted from patients’ records. Semen samples were collected by masturbation or coitus after 2 to 7 days of abstinence. Their female partners were reported to have no chronic medi-cal conditions and have normal menstrual cycles.Results: One hundred and fifty seven of total 998 cycles (15.7% achieved pregnancy. The average of female age in successful and unsuccessful group was 28.95±4.19 and 30.00±4.56 years, respectively. Mean of male age was 33.97±4.85 years in successful group and 34.44±4.62 years in unsuccessful group. In successful and unsuccessful groups, average of sperm concentration was 53.62±38.45 and 46.26±26.59 (million sperm/ml, normal morphology of sperm was 8.98±4.31 (% and 8.68±4.81 (%, sperm total motility was 47.24±18.92 (% and 43.70±20.22 (% and total motile sperm count was 80.10±63.61 million and 78.57±68.22 million, respectively.Conclusion: There was no significant difference in mean of females’ age and males’ age between successful and unsuccessful groups (P<0.05. In addition, there was no significant difference in semen parameters including concentration, total sperm motility, class A motility, class B motility, class A+B motility and normal morphology between two

Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes.

Science.gov (United States)

Nelson, Michael H; Fierke, Kerry K; Sucher, Brandon J; Janke, Kristin K

2015-05-25

The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI experts for structuring and planning EI development. Finally, we make 9 recommendations' to inform the process of including EI in pharmacy curricula.

[Combined forecasting system of peritonitis outcome].

Science.gov (United States)

Lebedev, N V; Klimov, A E; Agrba, S B; Gaidukevich, E K

To create a reliable system for assessing of severity and prediction of the outcome of peritonitis. Critical analysis of the systems for peritonitis severity assessment is presented. The study included outcomes of 347 patients who admitted at the Department of Faculty Surgery of Peoples' Friendship University of Russia in 2015-2016. The cause of peritonitis were destructive forms of acute appendicitis, cholecystitis, perforated gastroduodenal ulcer, various perforation of small and large intestines (including tumor). Combined forecasting system for peritonitis severity assessment is created. The system includes clinical, laboratory data, assessment of systemic inflammatory response (SIRS) and severity of organ failure (qSOFA). The authors focused on easily identifiable parameters which are available in virtually any surgical hospital. Threshold value (lethal outcome probability over 50%) is 8 scores in this system. Sensitivity, specificity and accuracy were 93.3, 99.7 and 98.9%, respectively according to ROC-curve that exceeds those parameters of MPI and APACHE II.

Power extraction calculation improvement when local parameters are included

Science.gov (United States)

Flores-Mateos, L. M.; Hartnett, M.

2016-02-01

The improvement of the tidal resource assessment will be studied by comparing two approaches in a two-dimensional, finite difference, hydrodynamic model DIVAST-ADI; in a channel of non-varying cross-sectional area that connects two large basins. The first strategy, considers a constant trust coefficient; the second one, use the local field parameters around the turbine. These parameters are obtained after applying the open channel theory in the tidal stream and after considering the turbine as a linear momentum actuator disk. The parameters correspond to the upstream and downstream, with respect to the turbine, speeds and depths; also the blockage ratio, the wake velocity and the bypass coefficients and they have already been incorporated in the model. The figure (a) shows the numerical configuration at high tide developed with DIVAST-ADI. The experiment undertakes two open boundary conditions. The first one is a sinusoidal forcing introduced as a water level located at (I, J=1) and the second one, indicate that a zero velocity and a constant water depth were kept (I, J=362); when the turbine is introduced it is placed in the middle of the channel (I=161, J=181). The influence of the turbine in the velocity and elevation around the turbine region is evident; figure (b) and (c) shows that the turbine produces a discontinuity in the depth and velocity profile, when we plot a transect along the channel. Finally, the configuration implemented reproduced with satisfactory accuracy the quasi-steady flow condition, even without presenting shock-capturing capability. Also, the range of the parameters 0.01<α 4<0.55, $0

Comparison of clinical and laboratory parameters in patients with end-stage renal failure in the outcome of chronic glomerulonephritis and patients with end-stage renal failure in the outcome of other diseases.

Science.gov (United States)

Popova, J A; Yadrihinskaya, V N; Krylova, M I; Sleptsovа, S S; Borisovа, N V

frequent complications of hemodialysis treatments are coagulation disorders. This is due to activation of the coagulation of blood flow in the interaction with a dialysis membrane material vascular prostheses and extracorporeal circuit trunks. In addition, in hemodialysis patients receiving heparin for years, there is depletion of stocks in endothelial cells in tissue factor inhibitor, inhibits the activity of an external blood clotting mechanism. the aim of our study was to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure. to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure and hemodialysis treatment duration conducted a study that included 100 patients observed in the department of chronic hemodialysis and nephrology hospital №1 Republican National Medical Center in the period of 2013-2016. in patients with end-stage renal failure in the outcome of chronic glomerulonephritis, a great expression of activation of blood coagulation confirm increased the mean concentration of fibrinogen, whereas in the group, which included patients with end-stage renal failure in the outcome of other diseases, such is not different from the norm, and a higher rate of hyperfibrinogenemia, identified in 2/3 patients in this group. it was revealed that the state of homeostasis in patients with end-stage renal failure in increasingly characterizes the level of fibrinogen and the activation of the hemostatic markers: soluble fibrin monomer complexes, D-dimers.

Monitoring Tumor Response to Carbogen Breathing by Oxygen-Sensitive Magnetic Resonance Parameters to Predict the Outcome of Radiation Therapy: A Preclinical Study

International Nuclear Information System (INIS)

Cao-Pham, Thanh-Trang; Tran, Ly-Binh-An; Colliez, Florence; Joudiou, Nicolas; El Bachiri, Sabrina; Grégoire, Vincent; Levêque, Philippe; Gallez, Bernard; Jordan, Bénédicte F.

2016-01-01

Purpose: In an effort to develop noninvasive in vivo methods for mapping tumor oxygenation, magnetic resonance (MR)-derived parameters are being considered, including global R_1, water R_1, lipids R_1, and R_2*. R_1 is sensitive to dissolved molecular oxygen, whereas R_2* is sensitive to blood oxygenation, detecting changes in dHb. This work compares global R_1, water R_1, lipids R_1, and R_2* with pO_2 assessed by electron paramagnetic resonance (EPR) oximetry, as potential markers of the outcome of radiation therapy (RT). Methods and Materials: R_1, R_2*, and EPR were performed on rhabdomyosarcoma and 9L-glioma tumor models, under air and carbogen breathing conditions (95% O_2, 5% CO_2). Because the models demonstrated different radiosensitivity properties toward carbogen, a growth delay (GD) assay was performed on the rhabdomyosarcoma model and a tumor control dose 50% (TCD50) was performed on the 9L-glioma model. Results: Magnetic resonance imaging oxygen-sensitive parameters detected the positive changes in oxygenation induced by carbogen within tumors. No consistent correlation was seen throughout the study between MR parameters and pO_2. Global and lipids R_1 were found to be correlated to pO_2 in the rhabdomyosarcoma model, whereas R_2* was found to be inversely correlated to pO_2 in the 9L-glioma model (P=.05 and .03). Carbogen increased the TCD50 of 9L-glioma but did not increase the GD of rhabdomyosarcoma. Only R_2* was predictive (P<.05) for the curability of 9L-glioma at 40 Gy, a dose that showed a difference in response to RT between carbogen and air-breathing groups. "1"8F-FAZA positron emission tomography imaging has been shown to be a predictive marker under the same conditions. Conclusion: This work illustrates the sensitivity of oxygen-sensitive R_1 and R_2* parameters to changes in tumor oxygenation. However, R_1 parameters showed limitations in terms of predicting the outcome of RT in the tumor models studied, whereas R_2* was found to be

The Vulnerability of Some Networks including Cycles via Domination Parameters

Directory of Open Access Journals (Sweden)

Tufan Turaci

2016-01-01

Full Text Available Let G=(V(G,E(G be an undirected simple connected graph. A network is usually represented by an undirected simple graph where vertices represent processors and edges represent links between processors. Finding the vulnerability values of communication networks modeled by graphs is important for network designers. The vulnerability value of a communication network shows the resistance of the network after the disruption of some centers or connection lines until a communication breakdown. The domination number and its variations are the most important vulnerability parameters for network vulnerability. Some variations of domination numbers are the 2-domination number, the bondage number, the reinforcement number, the average lower domination number, the average lower 2-domination number, and so forth. In this paper, we study the vulnerability of cycles and related graphs, namely, fans, k-pyramids, and n-gon books, via domination parameters. Then, exact solutions of the domination parameters are obtained for the above-mentioned graphs.

Association of baseline vitamin D levels with clinical parameters and treatment outcomes in chronic hepatitis B.

Science.gov (United States)

Chan, Henry Lik-Yuen; Elkhashab, Magdy; Trinh, Huy; Tak, Won Young; Ma, Xiaoli; Chuang, Wan-Long; Kim, Yoon Jun; Martins, Eduardo B; Lin, Lanjia; Dinh, Phillip; Charuworn, Prista; Foster, Graham R; Marcellin, Patrick

2015-11-01

The relationship between vitamin D levels and chronic hepatitis B (CHB) infection and treatment outcomes are poorly elucidated. We measured pre-treatment serum vitamin D (25-hydroxyvitamin D3; 25[OH]D3) levels and determined their association with clinical parameters and treatment outcomes in active CHB patients without advanced liver disease enrolled in a global clinical trial. Patients were randomly assigned to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus peginterferon alfa-2a (PegIFN), TDF plus PegIFN for 16 weeks followed by TDF for 32 weeks, PegIFN for 48 weeks, or TDF for 120 weeks. Univariate and multivariate analyses were conducted to determine associations between vitamin D, baseline factors, and week 48 clinical outcome. Of 737 patients, 35% had insufficient (⩾20 but vitamin D levels. In univariate analysis, lower vitamin D levels were significantly associated with the following baseline parameters: younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood draw in winter or autumn, and HBV genotype D. On multivariate analysis, only HBV genotype, season of blood draw, calcium level, and age retained their association. High baseline level of vitamin D was associated with low HBV DNA, normal ALT and HBsAg at week 48 independent of treatment groups, but the association, with the exception of ALT, became statistically insignificant after adjusting for age, gender, HBeAg and HBV genotype. Abnormally low vitamin D levels are highly prevalent among untreated, active CHB patients. Baseline vitamin D levels are not associated with treatment outcomes, but were associated with normal ALT. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Calculation of the collective mass-parameter including RPA corrections

International Nuclear Information System (INIS)

Pal, M.K.; Zawischa, D.; Speth, J.

1975-01-01

A derivation of the vibrational mass-parameter B is given which makes the consistency with RPA calculations explicit. The expected enhancement by the residual particle-hole and particle-particle interaction is demonstrated by solving the quasiparticle-RPA for deformed nuclei in the rare earth region. (orig.) [de

Neoadjuvant chemoradiotherapy of rectal carcinoma. Baseline hematologic parameters influencing outcomes

Energy Technology Data Exchange (ETDEWEB)

Hodek, Miroslav; Sirak, Igor; Paluska, Petr; Kopecky, Jindrich; Petera, Jiri; Vosmik, Milan [University Hospital in Hradec Kralove, Department of Oncology and Radiotherapy, Hradec Kralove (Czech Republic); Ferko, Alexander; Oerhalmi, Julius [University Hospital in Hradec Kralove, Department of Surgery, Hradec Kralove (Czech Republic); Hovorkova, Eva; Hadzi Nikolov, Dimitar [University Hospital in Hradec Kralove, Fingerland Department of Pathology, Hradec Kralove (Czech Republic)

2016-09-15

The link between the blood count and a systemic inflammatory response (SIR) is indisputable and well described. Pretreatment hematological parameters may predict the overall clinical outcomes in many types of cancer. Thus, this study aims to systematically evaluate the relationship between baseline blood count levels and treatment response in rectal cancer patients treated with neoadjuvant chemoradiotherapy. From 2009-2015, 173 patients with locally advanced rectal cancer were retrospectively enrolled in the study and analyzed. The baseline blood count was recorded in all patients 1 week before chemoradiation. Tumor response was evaluated through pathologic findings. Blood count levels which included RBC (red blood cells), Hb (hemoglobin), PLT (platelet count), neutrophil count, WBC (white blood cells), NLR (neutrophil-to-lymphocyte ratio), and PLR (platelet-to-lymphocyte ratio) were analyzed in relation to tumor downstaging, pCR (pathologic complete response), OS (overall survival), and DFS (disease-free survival). Hb levels were associated with a response in logistic regression analysis: pCR (p = 0.05; OR 1.04, 95 % CI 1.00-1.07); T downstaging (p = 0.006; OR 1.03, 95 % CI 1.01-1.05); N downstaging (p = 0.09; OR 1.02, 95 % CI 1.00-1.04); T or N downstaging (p = 0.007; OR 1.04, 95 % CI 1.01-1.07); T and N downstaging (p = 0.02; OR 1.02, 95 % CI 1.00-1.04); Hb and RBC were the most significant parameters influencing OS; PLT was a negative prognostic factor for OS and DFS (p = 0.008 for OS); an NLR value of 2.8 was associated with the greatest significance for OS (p = 0.03) and primary tumor downstaging (p = 0.02). Knowledge of pretreatment hematological parameters appears to be an important prognostic factor in patients with rectal carcinoma. (orig.) [German] Die Verbindung zwischen dem Blutbild und der systemischen Entzuendungsreaktion (''systemic inflammatory response'', SIR) ist unbestreitbar und gut beschrieben. Aufgrund der

Monitoring Tumor Response to Carbogen Breathing by Oxygen-Sensitive Magnetic Resonance Parameters to Predict the Outcome of Radiation Therapy: A Preclinical Study

Energy Technology Data Exchange (ETDEWEB)

Cao-Pham, Thanh-Trang; Tran, Ly-Binh-An; Colliez, Florence; Joudiou, Nicolas [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium); El Bachiri, Sabrina [Université Catholique de Louvain, IMMAQ Technological Platform, Methodology and Statistical Support, Louvain-la-Neuve (Belgium); Grégoire, Vincent [Université Catholique de Louvain, Institute of Experimental and Clinical Research, Center for Molecular Imaging, Radiotherapy and Oncology, Brussels (Belgium); Levêque, Philippe; Gallez, Bernard [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium); Jordan, Bénédicte F., E-mail: benedicte.jordan@uclouvain.be [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium)

2016-09-01

Purpose: In an effort to develop noninvasive in vivo methods for mapping tumor oxygenation, magnetic resonance (MR)-derived parameters are being considered, including global R{sub 1}, water R{sub 1}, lipids R{sub 1}, and R{sub 2}*. R{sub 1} is sensitive to dissolved molecular oxygen, whereas R{sub 2}* is sensitive to blood oxygenation, detecting changes in dHb. This work compares global R{sub 1}, water R{sub 1}, lipids R{sub 1}, and R{sub 2}* with pO{sub 2} assessed by electron paramagnetic resonance (EPR) oximetry, as potential markers of the outcome of radiation therapy (RT). Methods and Materials: R{sub 1}, R{sub 2}*, and EPR were performed on rhabdomyosarcoma and 9L-glioma tumor models, under air and carbogen breathing conditions (95% O{sub 2}, 5% CO{sub 2}). Because the models demonstrated different radiosensitivity properties toward carbogen, a growth delay (GD) assay was performed on the rhabdomyosarcoma model and a tumor control dose 50% (TCD50) was performed on the 9L-glioma model. Results: Magnetic resonance imaging oxygen-sensitive parameters detected the positive changes in oxygenation induced by carbogen within tumors. No consistent correlation was seen throughout the study between MR parameters and pO{sub 2}. Global and lipids R{sub 1} were found to be correlated to pO{sub 2} in the rhabdomyosarcoma model, whereas R{sub 2}* was found to be inversely correlated to pO{sub 2} in the 9L-glioma model (P=.05 and .03). Carbogen increased the TCD50 of 9L-glioma but did not increase the GD of rhabdomyosarcoma. Only R{sub 2}* was predictive (P<.05) for the curability of 9L-glioma at 40 Gy, a dose that showed a difference in response to RT between carbogen and air-breathing groups. {sup 18}F-FAZA positron emission tomography imaging has been shown to be a predictive marker under the same conditions. Conclusion: This work illustrates the sensitivity of oxygen-sensitive R{sub 1} and R{sub 2}* parameters to changes in tumor oxygenation. However, R{sub 1

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...

Comparison of clinical outcome parameters, the Patient Benefit Index (PBI-k) and patient satisfaction after ablative fractional laser treatment of peri-orbital rhytides.

Science.gov (United States)

Karsai, Syrus; Raulin, Christian

2010-03-01

Laser treatment of facial rhytides has evolved as a major modality of aesthetic surgery. Published results, while generally encouraging, feature highly diverse evaluation methods, which makes an evidence-based assessment of treatment efficacy and safety all but impossible. To compare the results of different instruments of measurement. Twenty-eight patients were enrolled and completed the entire study. They received a single ablative fractional treatment of the peri-orbital region. The evaluation included the Fitzpatrick wrinkle score, the profilometric measurement of wrinkle depth and the Patient Benefit Index (both before and 3 months after treatment) as well as the assessment of patient satisfaction (1, 3, 6 days and 3 months after treatment). All assessment instruments showed a significant, albeit moderate, improvement. The agreement between assessment methods was poor. Despite claiming to assess basically the same parameter, the Fitzpatrick wrinkle score and profilometry differed significantly, and neither assessment instrument showed any appreciable correlation with any other. The outcome assessment of rhytide therapy-regardless of the method used-shows substantial room for improvement. Strict methodological precautions ought to be applied for 'objective' evaluation methods like photographic scoring and profilometry. Subjective methods of assessment are essential and might serve as a main outcome parameter. Finally, critical reappraisal of published treatment results seems warranted to review the quality of their methodology.

Pharmacokinetic parameters derived from dynamic contrast enhanced MRI of cervical cancers predict chemoradiotherapy outcome

International Nuclear Information System (INIS)

Andersen, Erlend K.F.; Hole, Knut Håkon; Lund, Kjersti V.; Sundfør, Kolbein; Kristensen, Gunnar B.; Lyng, Heidi; Malinen, Eirik

2013-01-01

Purpose: To assess the prognostic value of pharmacokinetic parameters derived from pre-chemoradiotherapy dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of cervical cancer patients. Materials and methods: Seventy-eight patients with locally advanced cervical cancer underwent DCE-MRI with Gd-DTPA before chemoradiotherapy. The pharmacokinetic Brix and Tofts models were fitted to contrast enhancement curves in all tumor voxels, providing histograms of several pharmacokinetic parameters (Brix: A Brix , k ep , k el , Tofts: K trans , ν e ). A percentile screening approach including log-rank survival tests was undertaken to identify the clinically most relevant part of the intratumoral parameter distribution. Clinical endpoints were progression-free survival (PFS) and locoregional control (LRC). Multivariate analysis including FIGO stage and tumor volume was used to assess the prognostic significance of the imaging parameters. Results: A Brix , k el , and K trans were significantly (P e was significantly positively correlated with PFS only. k ep showed no association with any endpoint. A Brix was positively correlated with K trans and ν e , and showed the strongest association with endpoint in the log-rank testing. k el and K trans were independent prognostic factors in multivariate analysis with LRC as endpoint. Conclusions: Parameters estimated by pharmacokinetic analysis of DCE-MR images obtained prior to chemoradiotherapy may be used for identifying patients at risk of treatment failure

Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score

Directory of Open Access Journals (Sweden)

Rishi Anil Aggarwal

2016-01-01

Full Text Available Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM. The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as "good" if the patient had mJOA score ≥16 and "poor" if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW, diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS (version 20.0 was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82% with a score below 5 had good outcome and all patients (100% with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings

Conducting Accessible Research: Including People With Disabilities in Public Health, Epidemiological, and Outcomes Studies.

Science.gov (United States)

Rios, Dianne; Magasi, Susan; Novak, Catherine; Harniss, Mark

2016-12-01

People with disabilities are largely absent from mainstream health research. Exclusion of people with disabilities may be explicit, attributable to poorly justified exclusion criteria, or implicit, attributable to inaccessible study documents, interventions, or research measures. Meanwhile, people with disabilities experience poorer health, greater incidence of chronic conditions, and higher health care expenditure than people without disabilities. We outline our approach to "accessible research design"-research accessible to and inclusive of people with disabilities. We describe a model that includes 3 tiers: universal design, accommodations, and modifications. Through our work on several large-scale research studies, we provide pragmatic examples of accessible research design. Making efforts to include people with disabilities in public health, epidemiological, and outcomes studies will enhance the interpretability of findings for a significant patient population.

Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment.

Science.gov (United States)

van der List, J P; Chawla, H; Villa, J C; Zuiderbaan, H A; Pearle, A D

2017-03-01

The predictive role of patient-specific characteristics and radiographic parameters on medial unicompartmental knee arthroplasty (UKA) outcomes is well known, but knowledge of these predictors is lacking in lateral UKA. Therefore, purpose of this study was to assess the predictive role of these parameters on short-term functional outcomes of lateral UKA. In this retrospective cohort study, Western Ontario and McMaster Universities Arthritis Index scores were collected at 2-year follow-up (median 2.2 years, range 2.0-4.0 years) in 39 patients who underwent lateral UKA. Patient-specific characteristics included age, BMI and gender, while radiographic parameters included osteoarthritis severity of all three compartments and both preoperative and postoperative hip-knee-ankle alignment. BMI, gender, age and preoperative valgus alignment were not correlated with functional outcomes, while postoperative valgus alignment was correlated with functional outcomes (0.561; p = 0.001). Postoperative valgus of 3°-7° was correlated with better outcomes than more neutral (-2° to 3° valgus) alignment (96.7 vs. 85.6; p = 0.011). Postoperative alignment was a predictor when corrected for patient-specific characteristics (regression coefficient 4.1; p coefficient 3.8; p = 0.002). Postoperative valgus alignment of 3°-7° was correlated with the best short-term functional outcomes in lateral UKA surgery, while patient-specific parameters and preoperative alignment were not correlated with functional outcomes. Based on these findings, a surgeon should aim for valgus alignment of 3°-7° when performing lateral UKA surgery for optimal functional outcomes. Prognostic study, Level II.

Semen molecular and cellular features: these parameters can reliably predict subsequent ART outcome in a goat model

Directory of Open Access Journals (Sweden)

Mereu Paolo

2009-11-01

Full Text Available Abstract Currently, the assessment of sperm function in a raw or processed semen sample is not able to reliably predict sperm ability to withstand freezing and thawing procedures and in vivo fertility and/or assisted reproductive biotechnologies (ART outcome. The aim of the present study was to investigate which parameters among a battery of analyses could predict subsequent spermatozoa in vitro fertilization ability and hence blastocyst output in a goat model. Ejaculates were obtained by artificial vagina from 3 adult goats (Capra hircus aged 2 years (A, B and C. In order to assess the predictive value of viability, computer assisted sperm analyzer (CASA motility parameters and ATP intracellular concentration before and after thawing and of DNA integrity after thawing on subsequent embryo output after an in vitro fertility test, a logistic regression analysis was used. Individual differences in semen parameters were evident for semen viability after thawing and DNA integrity. Results of IVF test showed that spermatozoa collected from A and B lead to higher cleavage rates (0

Preoperative nutrition status and postoperative outcome in elderly general surgery patients: a systematic review.

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van Stijn, Mireille F M; Korkic-Halilovic, Ines; Bakker, Marjan S M; van der Ploeg, Tjeerd; van Leeuwen, Paul A M; Houdijk, Alexander P J

2013-01-01

Poor nutrition status is considered a risk factor for postoperative complications in the adult population. In elderly patients, who often have a poor nutrition status, this relationship has not been substantiated. Thus, the aim of this systematic review was to assess the merit of preoperative nutrition parameters used to predict postoperative outcome in elderly patients undergoing general surgery. A systematic literature search of 10 consecutive years, 1998-2008, in PubMed, EMBASE, and Cochrane databases was performed. Search terms used were nutrition status, preoperative assessment, postoperative outcome, and surgery (hip or general), including their synonyms and MeSH terms. Limits used in the search were human studies, published in English, and age (65 years or older). Articles were screened using inclusion and exclusion criteria. All selected articles were checked on methodology and graded. Of 463 articles found, 15 were included. They showed profound heterogeneity in the parameters used for preoperative nutrition status and postoperative outcome. The only significant preoperative predictors of postoperative outcome in elderly general surgery patients were serum albumin and ≥ 10% weight loss in the previous 6 months. This systematic review revealed only 2 preoperative parameters to predict postoperative outcome in elderly general surgery patients: weight loss and serum albumin. Both are open to discussion in their use as a preoperative nutrition parameter. Nonetheless, serum albumin seems a reliable preoperative parameter to identify a patient at risk for nutrition deterioration and related complicated postoperative course.

The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment

International Nuclear Information System (INIS)

Hermans, Robert; Op de beeck, Katya; Bogaert, Walter van den; Rijnders, Alexis; Staelens, Lorenzo; Feron, Michel; Bellon, Erwin

2001-01-01

Purpose: To investigate the value of CT-derived tumor parameters as predictor of local and regional outcome of tonsillar squamous cell carcinoma treated by definitive radiation therapy. Methods and Materials: The pretreatment CT studies of 112 patients with tonsillar squamous cell carcinoma were reviewed. After redigitizing the films, primary and nodal tumor volume was calculated with the summation-of-areas technique. The nodal CT aspect was graded using a 3-point scale (homogenous, inhomogeneous, and necrotic). Mean follow-up time was 33 months. Actuarial statistical analysis of local and regional outcome was done for each of the covariates; multivariate analysis was performed using Cox's proportional hazards model. Results: In the actuarial analysis, CT-determined primary tumor volume was significantly correlated with local recurrence rate (p<0.05) when all patients were considered, but primary tumor volume did not predict local control within the T2, T3, and T4 category. CT-determined nodal volume was significantly related to regional outcome (p<0.01), but nodal density was not. Total tumor volume was not significantly related to locoregional outcome (p=0.1). In the multivariate analysis, the T and N categories were the independent predictors of local and regional outcomes, respectively. Conclusion: Compared to other head-and-neck sites, primary and nodal tumor volume have only marginal predictive value regarding local and regional outcome after radiation therapy in tonsillar cancer

Impact of imipenem and amikacin pharmacokinetic/pharmacodynamic parameters on microbiological outcome of Gram-negative bacilli ventilator-associated pneumonia.

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Pajot, O; Burdet, C; Couffignal, C; Massias, L; Armand-Lefevre, L; Foucrier, A; Da Silva, D; Lasocki, S; Laouénan, C; Mentec, H; Mentré, F; Wolff, M

2015-05-01

Despite recent advances, antibiotic therapy of ventilator-associated pneumonia (VAP) in ICU patients is still challenging. We assessed the impact of imipenem and amikacin pharmacokinetic and pharmacodynamic parameters on microbiological outcome in these patients. Patients with Gram-negative bacilli (GNB) VAP were prospectively included. Blood samples for pharmacokinetic analysis were collected after empirical administration of a combination of imipenem three times daily and one single dose of amikacin. MICs were estimated for each GNB obtained from respiratory samples. Microbiological success was defined as a ≥10(3) cfu/mL decrease in bacterial count in quantitative cultures between baseline and the third day of treatment. Thirty-nine patients [median (min-max) age = 60 years (28-84) and median SAPS2 at inclusion = 40 (19-73)] were included. Median MICs of imipenem and amikacin were 0.25 mg/L (0.094-16) and 2 mg/L (1-32), respectively. Median times over MIC and over 5× MIC for imipenem were 100% (8-100) and 74% (3-100), respectively. The median C1/MIC ratio for amikacin was 23 (1-76); 34 patients (87%) achieved a C1/MIC ≥10. Microbiological success occurred in 29 patients (74%). No imipenem pharmacodynamic parameter was significantly associated with the microbiological success. For amikacin, C1/MIC was significantly higher in the microbiological success group: 26 (1-76) versus 11 (3-26) (P = 0.004). In ICU patients with VAP, classic imipenem pharmacodynamic targets are easily reached with usual dosing regimens. In this context, for amikacin, a higher C1/MIC ratio than previously described might be necessary. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

HIV Model Parameter Estimates from Interruption Trial Data including Drug Efficacy and Reservoir Dynamics

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Luo, Rutao; Piovoso, Michael J.; Martinez-Picado, Javier; Zurakowski, Ryan

2012-01-01

Mathematical models based on ordinary differential equations (ODE) have had significant impact on understanding HIV disease dynamics and optimizing patient treatment. A model that characterizes the essential disease dynamics can be used for prediction only if the model parameters are identifiable from clinical data. Most previous parameter identification studies for HIV have used sparsely sampled data from the decay phase following the introduction of therapy. In this paper, model parameters are identified from frequently sampled viral-load data taken from ten patients enrolled in the previously published AutoVac HAART interruption study, providing between 69 and 114 viral load measurements from 3–5 phases of viral decay and rebound for each patient. This dataset is considerably larger than those used in previously published parameter estimation studies. Furthermore, the measurements come from two separate experimental conditions, which allows for the direct estimation of drug efficacy and reservoir contribution rates, two parameters that cannot be identified from decay-phase data alone. A Markov-Chain Monte-Carlo method is used to estimate the model parameter values, with initial estimates obtained using nonlinear least-squares methods. The posterior distributions of the parameter estimates are reported and compared for all patients. PMID:22815727

Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis

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Gee, Bryan M.; Lloyd, Kimberly; Devine, Nancy; Tyrrell, Erin; Evans, Trisha; Hill, Rebekah; Dineen, Stacee; Magalogo, Kristin

2016-01-01

Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) M = 58.7, duration of plan of care (weeks) M = 12.1, session frequency (per week) M = 3.4, and total hours of therapy (hours) M = 18.1. This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed. PMID:26949547

Decision tree analysis in subarachnoid hemorrhage: prediction of outcome parameters during the course of aneurysmal subarachnoid hemorrhage using decision tree analysis.

Science.gov (United States)

Hostettler, Isabel Charlotte; Muroi, Carl; Richter, Johannes Konstantin; Schmid, Josef; Neidert, Marian Christoph; Seule, Martin; Boss, Oliver; Pangalu, Athina; Germans, Menno Robbert; Keller, Emanuela

2018-01-19

OBJECTIVE The aim of this study was to create prediction models for outcome parameters by decision tree analysis based on clinical and laboratory data in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS The database consisted of clinical and laboratory parameters of 548 patients with aSAH who were admitted to the Neurocritical Care Unit, University Hospital Zurich. To examine the model performance, the cohort was randomly divided into a derivation cohort (60% [n = 329]; training data set) and a validation cohort (40% [n = 219]; test data set). The classification and regression tree prediction algorithm was applied to predict death, functional outcome, and ventriculoperitoneal (VP) shunt dependency. Chi-square automatic interaction detection was applied to predict delayed cerebral infarction on days 1, 3, and 7. RESULTS The overall mortality was 18.4%. The accuracy of the decision tree models was good for survival on day 1 and favorable functional outcome at all time points, with a difference between the training and test data sets of decision trees enables exploration of dependent variables in the context of multiple changing influences over the course of an illness. The decision tree currently generated increases awareness of the early systemic stress response, which is seemingly pertinent for prognostication.

Optimum parameters in a model for tumour control probability, including interpatient heterogeneity: evaluation of the log-normal distribution

International Nuclear Information System (INIS)

Keall, P J; Webb, S

2007-01-01

The heterogeneity of human tumour radiation response is well known. Researchers have used the normal distribution to describe interpatient tumour radiosensitivity. However, many natural phenomena show a log-normal distribution. Log-normal distributions are common when mean values are low, variances are large and values cannot be negative. These conditions apply to radiosensitivity. The aim of this work was to evaluate the log-normal distribution to predict clinical tumour control probability (TCP) data and to compare the results with the homogeneous (δ-function with single α-value) and normal distributions. The clinically derived TCP data for four tumour types-melanoma, breast, squamous cell carcinoma and nodes-were used to fit the TCP models. Three forms of interpatient tumour radiosensitivity were considered: the log-normal, normal and δ-function. The free parameters in the models were the radiosensitivity mean, standard deviation and clonogenic cell density. The evaluation metric was the deviance of the maximum likelihood estimation of the fit of the TCP calculated using the predicted parameters to the clinical data. We conclude that (1) the log-normal and normal distributions of interpatient tumour radiosensitivity heterogeneity more closely describe clinical TCP data than a single radiosensitivity value and (2) the log-normal distribution has some theoretical and practical advantages over the normal distribution. Further work is needed to test these models on higher quality clinical outcome datasets

The 4-parameter Compressible Packing Model (CPM) including a critical cavity size ratio

Science.gov (United States)

Roquier, Gerard

2017-06-01

The 4-parameter Compressible Packing Model (CPM) has been developed to predict the packing density of mixtures constituted by bidisperse spherical particles. The four parameters are: the wall effect and the loosening effect coefficients, the compaction index and a critical cavity size ratio. The two geometrical interactions have been studied theoretically on the basis of a spherical cell centered on a secondary class bead. For the loosening effect, a critical cavity size ratio, below which a fine particle can be inserted into a small cavity created by touching coarser particles, is introduced. This is the only parameter which requires adaptation to extend the model to other types of particles. The 4-parameter CPM demonstrates its efficiency on frictionless glass beads (300 values), spherical particles numerically simulated (20 values), round natural particles (125 values) and crushed particles (335 values) with correlation coefficients equal to respectively 99.0%, 98.7%, 97.8%, 96.4% and mean deviations equal to respectively 0.007, 0.006, 0.007, 0.010.

Influence of structural parameter included in nonlocal rock mass model on stress concentration around circular tunnel

Science.gov (United States)

Lavrikov, SV; Mikenina, OA; Revuzhenko, AF

2018-03-01

A model of elastic body, including local curvature of elementary volume, is matched with a nonlocal model with a linear structural parameter in the differential approximation. The problem on deformation of rock mass around a circular cross section tunnel is solved numerically. The contours of the calculated stresses are plotted. It is shown that inclusion of local bends in the model results in expansion of influence zone of the tunnel and reduces stress concentration factor at the tunnel boundary.

Optimal Laser Phototherapy Parameters for Pain Relief.

Science.gov (United States)

Kate, Rohit J; Rubatt, Sarah; Enwemeka, Chukuka S; Huddleston, Wendy E

2018-03-27

Studies on laser phototherapy for pain relief have used parameters that vary widely and have reported varying outcomes. The purpose of this study was to determine the optimal parameter ranges of laser phototherapy for pain relief by analyzing data aggregated from existing primary literature. Original studies were gathered from available sources and were screened to meet the pre-established inclusion criteria. The included articles were then subjected to meta-analysis using Cohen's d statistic for determining treatment effect size. From these studies, ranges of the reported parameters that always resulted into large effect sizes were determined. These optimal ranges were evaluated for their accuracy using leave-one-article-out cross-validation procedure. A total of 96 articles met the inclusion criteria for meta-analysis and yielded 232 effect sizes. The average effect size was highly significant: d = +1.36 (confidence interval [95% CI] = 1.04-1.68). Among all the parameters, total energy was found to have the greatest effect on pain relief and had the most prominent optimal ranges of 120-162 and 15.36-20.16 J, which always resulted in large effect sizes. The cross-validation accuracy of the optimal ranges for total energy was 68.57% (95% CI = 53.19-83.97). Fewer and less-prominent optimal ranges were obtained for the energy density and duration parameters. None of the remaining parameters was found to be independently related to pain relief outcomes. The findings of meta-analysis indicate that laser phototherapy is highly effective for pain relief. Based on the analysis of parameters, total energy can be optimized to yield the largest effect on pain relief.

Noise in off-axis type holograms including reconstruction and CCD camera parameters

Energy Technology Data Exchange (ETDEWEB)

Voelkl, Edgar, E-mail: edgar.voelkl@fei.com [FEI Company, 5350 NE Dawson Creek Drive, Hillsboro, OR 97124-5793 (United States)

2010-02-15

Phase and amplitude images as contained in digital holograms are commonly extracted via a process called 'reconstruction'. Expressions for the expected noise in these images have been given in the past by several authors; however, the effect of the actual reconstruction process has not been fully appreciated. By starting with the Quantum Mechanical intensity distribution of the off-axis type interference pattern, then building the digital hologram on an electron-by-electron base while simultaneously reconstructing the phase/amplitude images and evaluating their noise levels, an expression is derived that consistently describes the noise in simulated and experimental phase/amplitude images and contains the reconstruction parameters. Because of the necessity to discretize the intensity distribution function, the digitization effects of an ideal CCD camera had to be included. Subsequently, this allowed a comparison between real and simulated holograms which then led to a comparison between the performance of an 'ideal' CCD camera versus a real device. It was concluded that significant improvement of the phase and amplitude noise may be obtained if CCD cameras were optimized for digitizing intensity distributions at low sampling rates.

A single parameter representation of hygroscopic growth and cloud condensation nucleus activity – Part 2: Including solubility

Directory of Open Access Journals (Sweden)

M. D. Petters

2008-10-01

Full Text Available The ability of a particle to serve as a cloud condensation nucleus in the atmosphere is determined by its size, hygroscopicity and its solubility in water. Usually size and hygroscopicity alone are sufficient to predict CCN activity. Single parameter representations for hygroscopicity have been shown to successfully model complex, multicomponent particles types. Under the assumption of either complete solubility, or complete insolubility of a component, it is not necessary to explicitly include that component's solubility into the single parameter framework. This is not the case if sparingly soluble materials are present. In this work we explicitly account for solubility by modifying the single parameter equations. We demonstrate that sensitivity to the actual value of solubility emerges only in the regime of 2×10⁻¹–5×10⁻⁴, where the solubility values are expressed as volume of solute per unit volume of water present in a saturated solution. Compounds that do not fall inside this sparingly soluble envelope can be adequately modeled assuming they are either infinitely soluble in water or completely insoluble.

Satisfactory patient-based outcomes after surgical treatment for idiopathic clubfoot: includes surgeon's individualized technique.

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Mahan, Susan T; Spencer, Samantha A; Kasser, James R

2014-09-01

Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon's series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up. A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon's operative technique. In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean = 95.2; SD = 7.427) and normal controls (mean = 86.3; SD = 12.5) in Happiness Scale (P = 0.0031). In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results. Level III.

Gait Parameters and Functional Outcomes After Total Knee Arthroplasty Using Persona Knee System With Cruciate Retaining and Ultracongruent Knee Inserts.

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Rajgopal, Ashok; Aggarwal, Kalpana; Khurana, Anshika; Rao, Arun; Vasdev, Attique; Pandit, Hemant

2017-01-01

Total knee arthroplasty is a well-established treatment for managing end-stage symptomatic knee osteoarthritis. Currently, different designs of prostheses are available with majority ensuring similar clinical outcomes. Altered surface geometry is introduced to strive toward gaining superior outcomes. We aimed to investigate any differences in functional outcomes between 2 different polyethylene designs namely the Persona CR (cruciate retaining) and Persona UC (ultracongruent) tibial inserts (Zimmer-Biomet, Warsaw, IN). This prospective single blind, single-surgeon randomized controlled trial reports on 105 patients, (66 female and 39 male), who underwent simultaneous bilateral total knee arthroplasty using the Persona knee system (Zimmer-Biomet) UC inserts in one side and CR inserts in the contralateral side. By a blind assessor, at regular time intervals patients were assessed in terms of function and gait. The functional knee scoring scales used were the Western Ontario and McMaster Universities Osteoarthritis Index and Modified Knee Society Score. The gait parameters evaluated were foot pressure and step length. During the study period, no patient was lost to follow-up or underwent revision surgery for any cause. Western Ontario and McMaster Universities Osteoarthritis Index scores, Modified Knee Society Score, and knee range of motion of all 105 patients assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years showed statistically better results (P < .05) for UC inserts. Gait analysis measuring foot pressures and step length, however, did not show any statistically significant differences at 2-year follow-up. Ultracongruent tibial inserts show significantly better functional outcomes as compared to CR inserts during a 2-year follow-up period. However, in this study these findings were not shown to be attributed to differences in gait parameters. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus.

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El Toony, Lobna F; Hamad, Dina Ali; Omar, Omar Mohammed

2018-04-25

Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting. To evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus. A prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes. Fasting blood glucose decreased significantly during, and after Ramadan in both groups (P patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups. There was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan. Copyright © 2018. Published by Elsevier Ltd.

Echocardiographic assessment of right ventricular function in routine practice: Which parameters are useful to predict one-year outcome in advanced heart failure patients with dilated cardiomyopathy?

Science.gov (United States)

Kawata, Takayuki; Daimon, Masao; Kimura, Koichi; Nakao, Tomoko; Lee, Seitetsu L; Hirokawa, Megumi; Kato, Tomoko S; Watanabe, Masafumi; Yatomi, Yutaka; Komuro, Issei

2017-10-01

Right ventricular (RV) function has recently gained attention as a prognostic predictor of outcome even in patients who have left-sided heart failure. Since several conventional echocardiographic parameters of RV systolic function have been proposed, our aim was to determine if any of these parameters (tricuspid annular plane systolic excursion: TAPSE, tissue Doppler derived systolic tricuspid annular motion velocity: S', fractional area change: FAC) are associated with outcome in advanced heart failure patients with dilated cardiomyopathy (DCM). We retrospectively enrolled 68 DCM patients, who were New York Heart Association (NYHA) Class III or IV and had a left ventricular (LV) ejection fraction functional class IV, plasma brain natriuretic peptide concentration, intravenous inotrope use, left atrial volume index, and FAC were associated with outcome, whereas TAPSE and S' were not. Receiver-operating characteristic curve analysis showed that the optimal FAC cut-off value to identify patients with an event was rights reserved.

The Effect of Dose-Volume Parameters and Interfraction Interval on Cosmetic Outcome and Toxicity After 3-Dimensional Conformal Accelerated Partial Breast Irradiation

International Nuclear Information System (INIS)

Leonard, Kara Lynne; Hepel, Jaroslaw T.; Hiatt, Jessica R.; Dipetrillo, Thomas A.; Price, Lori Lyn; Wazer, David E.

2013-01-01

Purpose: To evaluate dose-volume parameters and the interfraction interval (IFI) as they relate to cosmetic outcome and normal tissue effects of 3-dimensional conformal radiation therapy (3D-CRT) for accelerated partial breast irradiation (APBI). Methods and Materials: Eighty patients were treated by the use of 3D-CRT to deliver APBI at our institutions from 2003-2010 in strict accordance with the specified dose-volume constraints outlined in the National Surgical Adjuvant Breast and Bowel Project B39/Radiation Therapy Oncology Group 0413 (NSABP-B39/RTOG 0413) protocol. The prescribed dose was 38.5 Gy in 10 fractions delivered twice daily. Patients underwent follow-up with assessment for recurrence, late toxicity, and overall cosmetic outcome. Tests for association between toxicity endpoints and dosimetric parameters were performed with the chi-square test. Univariate logistic regression was used to evaluate the association of interfraction interval (IFI) with these outcomes. Results: At a median follow-up time of 32 months, grade 2-4 and grade 3-4 subcutaneous fibrosis occurred in 31% and 7.5% of patients, respectively. Subcutaneous fibrosis improved in 5 patients (6%) with extended follow-up. Fat necrosis developed in 11% of women, and cosmetic outcome was fair/poor in 19%. The relative volume of breast tissue receiving 5%, 20%, 50%, 80%, and 100% (V5-V100) of the prescribed dose was associated with risk of subcutaneous fibrosis, and the volume receiving 50%, 80%, and 100% (V50-V100) was associated with fair/poor cosmesis. The mean IFI was 6.9 hours, and the minimum IFI was 6.2 hours. The mean and minimum IFI values were not significantly associated with late toxicity. Conclusions: The incidence of moderate to severe late toxicity, particularly subcutaneous fibrosis and fat necrosis and resulting fair/poor cosmesis, remains high with continued follow-up. These toxicity endpoints are associated with several dose-volume parameters. Minimum and mean IFI values were

The effect of paternal factors on perinatal and paediatric outcomes

DEFF Research Database (Denmark)

Oldereid, Nan B; Wennerholm, Ulla-Britt; Pinborg, Anja

2018-01-01

BACKGROUND: Maternal factors, including increasing childbearing age and various life-style factors, are associated with poorer short- and long-term outcomes for children, whereas knowledge of paternal parameters is limited. Recently, increasing paternal age has been associated with adverse obstet...... IMPLICATIONS: Although the increased risks of adverse outcome in offspring associated with paternal factors and identified in this report represent serious health effects, the magnitude of these effects seems modest....

[Relationship experiences and therapeutic outcome in inpatient psychotherapy].

Science.gov (United States)

Sammet, Isa; Staats, Herrmann; Schauenburg, Henning

2004-01-01

Inpatient psychotherapy includes the patient's manifold contacts with different therapists, nurses and fellow patients. The present study investigated the association between these multiple relationships and therapy outcome. Pre-post measures of symptom load (Brief Symptom Inventory), interpersonal problems (IIP) and self-efficacy (SEB) were used to define three groups with positive (N=129), unchanged (N=44) or negative (N=40) outcome. These groups were compared 1) by their alliance with an individual therapist, their relationship to the therapeutic team, their experience of cohesion and climate concerning fellow patients in the ward (measured weekly by the "Stationserfahrungsbogen" SEB), and 2) by their differences in mean correlations between the courses of relationship experiences and symptom load. Cohesion and relationship to the therapeutic team were not associated with therapy outcome. Therapeutic alliance with the individual therapist and climate among fellow patients turned out to be moderate indicators of the therapeutic outcome. It is recommended to include these process parameters systematically into the process diagnostics of inpatient psychotherapy.

Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

Directory of Open Access Journals (Sweden)

Roman Mihai

2016-11-01

Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.

Predicting unfavourable outcome in herpetic meningoencephalitis

DEFF Research Database (Denmark)

Erdem, Hakan; Cag, Yasemin; Karaahmetoglu, Gokhan

BACKGROUND: Herpetic meningoencephalitis is the most frequent form of sporadic fatal encephalitis in the world and accounts for 10- 20% of all viral encephalitides. There were studies assessing the outcomes particularly by comparing the efficacies of antiviral drugs in the past. To the best of our...... knowledge, no datum exists in the literature on the mortality indicators of HME patients with definite microbiological diagnosis. Thus, our study makes use of the largest case series ever reported in the literature to provide data for the predictors of unfavorable outcome in HME cases. METHODS...... outcome in HME. Thus, it appears that both host and therapeutic parameters contribute to success in these cases. Table. Final model including independent predictors of unfavorable outcome 95% CIs OR [1] Low High p Age (years) 1.04 1.02 1.05 0.000 Glasgow coma scale 0.84 0.77 0.93 0.000 Elapsed time [2] >2...

Predicting Outcome in Patients with Anti-GBM Glomerulonephritis.

Science.gov (United States)

van Daalen, Emma E; Jennette, J Charles; McAdoo, Stephen P; Pusey, Charles D; Alba, Marco A; Poulton, Caroline J; Wolterbeek, Ron; Nguyen, Tri Q; Goldschmeding, Roel; Alchi, Bassam; Griffiths, Meryl; de Zoysa, Janak R; Vincent, Beula; Bruijn, Jan A; Bajema, Ingeborg M

2018-01-06

Large studies on long-term kidney outcome in patients with anti-glomerular basement membrane (anti-GBM) GN are lacking. This study aimed to identify clinical and histopathologic parameters that predict kidney outcome in these patients. This retrospective analysis included a total of 123 patients with anti-GBM GN between 1986 and 2015 from six centers worldwide. Their kidney biopsy samples were classified according to the histopathologic classification for ANCA-associated GN. Clinical data such as details of treatment were retrieved from clinical records. The primary outcome parameter was the occurrence of ESRD. Kidney survival was analyzed using the log-rank test and Cox regression analyses. The 5-year kidney survival rate was 34%, with an improved rate observed among patients diagnosed after 2007 ( P =0.01). In patients with anti-GBM GN, histopathologic class and kidney survival were associated ( P GBM GN. Kidney outcome has improved during recent years; the success rate doubled after 2007. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_11_21_CJASNPodcast_18_1_v.mp3. Copyright © 2018 by the American Society of Nephrology.

Multidetector-CT angiography in pulmonary embolism - can image parameters predict clinical outcome?

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Heyer, Christoph M.; Lemburg, Stefan P.; Nicolas, Volkmar; Roggenland, Daniela [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Bochum (Germany); Knoop, Heiko [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Medical Clinic III - Pneumology, Allergology, and Sleep Medicine, Bochum (Germany); Holland-Letz, Tim [Ruhr-University of Bochum, Department of Medical Informatics, Biometry and Epidemiology, Bochum (Germany)

2011-09-15

To assess if pulmonary CT angiography (CTA) can predict outcome in patients with pulmonary embolism (PE). Retrospective analysis of CTA studies of patients with PE and documentation of pulmonary artery (PA)/aorta ratio, right ventricular (RV)/left ventricular (LV) ratio, superior vena cava (SVC) diameter, pulmonary obstruction index (POI), ventricular septal bowing (VSB), venous contrast reflux (VCR), pulmonary infarction and pleural effusion. Furthermore, duration of total hospital stay, necessity for/duration of ICU therapy, necessity for mechanical ventilation and mortality were recorded. Comparison was performed by logistic/linear regression analysis with significance at 5%. 152 patients were investigated. Mean duration of hospital stay was 21 {+-} 24 days. 66 patients were admitted to the ICU; 20 received mechanical ventilation. Mean duration of ICU therapy was 3 {+-} 8 days. Mortality rate was 8%. Significant positive associations of POI, VCR and pulmonary infarction with necessity for ICU therapy were shown. VCR was significantly associated with necessity for mechanical ventilation and duration of ICU treatment. Pleural effusions were significantly associated with duration of total hospital stay whereas the RV/LV ratio correlated with mortality. Selected CTA findings showed significant associations with the clinical course of PE and may thus be used as predictive parameters. (orig.)

Refitting density dependent relativistic model parameters including Center-of-Mass corrections

International Nuclear Information System (INIS)

Avancini, Sidney S.; Marinelli, Jose R.; Carlson, Brett Vern

2011-01-01

Full text: Relativistic mean field models have become a standard approach for precise nuclear structure calculations. After the seminal work of Serot and Walecka, which introduced a model Lagrangian density where the nucleons interact through the exchange of scalar and vector mesons, several models were obtained through its generalization, including other meson degrees of freedom, non-linear meson interactions, meson-meson interactions, etc. More recently density dependent coupling constants were incorporated into the Walecka-like models, which are then extensively used. In particular, for these models a connection with the density functional theory can be established. Due to the inherent difficulties presented by field theoretical models, only the mean field approximation is used for the solution of these models. In order to calculate finite nuclei properties in the mean field approximation, a reference set has to be fixed and therefore the translational symmetry is violated. It is well known that in such case spurious effects due to the center-of-mass (COM) motion are present, which are more pronounced for light nuclei. In a previous work we have proposed a technique based on the Pierls-Yoccoz projection operator applied to the mean-field relativistic solution, in order to project out spurious COM contributions. In this work we obtain a new fitting for the density dependent parameters of a density dependent hadronic model, taking into account the COM corrections. Our fitting is obtained taking into account the charge radii and binding energies for He 4 , O 16 , Ca 40 , Ca 48 , Ni 56 , Ni 68 , Sn 100 , Sn 132 and Pb 208 . We show that the nuclear observables calculated using our fit are of a quality comparable to others that can be found in the literature, with the advantage that now a translational invariant many-body wave function is at our disposal. (author)

MALIGNANT OBSTRUCTIVE JAUNDICE: A STUDY OF INVESTIGATIVE PARAMETERS AND ITS OUTCOME

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Tilakdas S. Shetty

2016-08-01

Full Text Available BACKGROUND Obstructive jaundice is a surgical condition that occurs when there is an obstruction to the passage of conjugated bilirubin from the liver cells to the intestine. This study has studied five clinical and nine laboratory parameters in patients presenting with malignant obstructive jaundice along with their radiological findings. By studying these parameters, the prognosis of patients with malignant obstructive jaundice and the best possible intervention could be predicted. AIM To study the various aetiopathological aspects associated with obstructive jaundice and investigative parameters of these patients thereby evaluating the prognosis. MATERIALS AND METHODS This observational study has been conducted in a tertiary institute by collecting data of 50 cases of malignant obstructive jaundice admitted to the surgical wards of BYL Nair Hospital from August 2011 to August 2014 with followup of 3 months to obtain mortality data. Male and female patients above 18 years and below 80 years of age with histologically proven malignant obstructive jaundice were included as part of this study. Data of retrospective cases were obtained from Medical Record section without disclosing the address or identification of the patient. RESULTS In this study, a total of 50 cases of histologically proven malignant obstructive jaundice were evaluated. 50 patients were studied out of which 33 were male and 17 were female. Majority of the patients were in the age group of 61-70 years i.e. 21 of them. 11 patients were between 41-50 years of age, 10 were less than 40 years of age and 8 were between 51-60 years. The most common presentation of the patients was with yellowish discolouration of sclera and urine (YDS/YDU seen in 44 patients followed by pruritus seen in 38 patients. Dilated Common Bile Duct with/without pancreatic duct dilatation was the most common finding on sonography followed by a mass seen in the head of the pancreas. Moderately differentiated

The rank-heat plot is a novel way to present the results from a network meta-analysis including multiple outcomes.

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Veroniki, Areti Angeliki; Straus, Sharon E; Fyraridis, Alexandros; Tricco, Andrea C

2016-08-01

To present a novel and simple graphical approach to improve the presentation of the treatment ranking in a network meta-analysis (NMA) including multiple outcomes. NMA simultaneously compares many relevant interventions for a clinical condition from a network of trials, and allows ranking of the effectiveness and/or safety of each intervention. There are numerous ways to present the NMA results, which can challenge their interpretation by research users. The rank-heat plot is a novel graph that can be used to quickly recognize which interventions are most likely the best or worst interventions with respect to their effectiveness and/or safety for a single or multiple outcome(s) and may increase interpretability. Using empirical NMAs, we show that the need for a concise and informative presentation of results is imperative, particularly as the number of competing treatments and outcomes in an NMA increases. The rank-heat plot is an efficient way to present the results of ranking statistics, particularly when a large amount of data is available, and it is targeted to users from various backgrounds. Copyright © 2016 Elsevier Inc. All rights reserved.

Changes in bone mineral metabolism parameters, including FGF23, after discontinuing cinacalcet at kidney transplantation.

Science.gov (United States)

Barros, Xoana; Fuster, David; Paschoalin, Raphael; Oppenheimer, Federico; Rubello, Domenico; Perlaza, Pilar; Pons, Francesca; Torregrosa, Jose V

2015-05-01

Little is known about the effects of the administration of cinacalcet in dialytic patients who are scheduled for kidney transplantation, and in particular about the changes in FGF23 and other mineral metabolism parameters after surgery compared with recipients not on cinacalcet at kidney transplantation. We performed a prospective observational cohort study with recruitment of consecutive kidney transplant recipients at our institution. Patients were classified according to whether they were under treatment with cinacalcet before transplantation. Bone mineral metabolism parameters, including C-terminal FGF23, were measured at baseline, on day 15, and at 1, 3, and 6 months after transplantation. In previously cinacalcet-treated patients, cinacalcet therapy was discontinued on the day of surgery and was not restarted after transplantation. A total of 48 kidney transplant recipients, 20 on cinacalcet at surgery and 28 cinacalcet non-treated patients, completed the follow-up. Serum phosphate declined significantly in the first 15 days after transplantation with no differences between the two groups, whereas cinacalcet-treated patients showed higher FGF23 levels, although not significant. After transplantation, PTH and serum calcium were significantly higher in cinacalcet-treated patients. We conclude that patients receiving cinacalcet on dialysis presented similar serum phosphate levels but higher PTH and serum calcium levels during the initial six months after kidney transplantation than cinacalcet non-treated patients. The group previously treated with cinacalcet before transplantation showed higher FGF23 levels without significant differences, so further studies should investigate its relevance in the management of these patients.

A randomized controlled trial of Internet-Based Cognitive Behavior Therapy for perfectionism including an investigation of outcome predictors.

Science.gov (United States)

Rozental, Alexander; Shafran, Roz; Wade, Tracey; Egan, Sarah; Nordgren, Lise Bergman; Carlbring, Per; Landström, Andreas; Roos, Stina; Skoglund, Malin; Thelander, Elisabet; Trosell, Linnéa; Örtenholm, Alexander; Andersson, Gerhard

2017-08-01

Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68-1.00, 95% Confidence Interval (CI) [0.36-1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correlation between enamel morphological and dental pulp physiological outcomes as a function of lasing parameters

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Arcoria, Charles J.; Wagner, Martin J.; Vitasek, Bunny A.

1992-06-01

Previous oral medicine research has insufficiently quantified and correlated laser effects on calcified/soft-tissue combinations. The purpose of this study was to explain lasing effects on outcome variables (pulp response and enamel condition). Vital animal molars were irradiated using several mediums, with predetermined energy densities serving as independent variables. Predetermined safe-tissue thresholds, including pulp/enamel conditions, can be demonstrated to display linear relationships using several laser systems.

Climate change decision-making: Model & parameter uncertainties explored

Energy Technology Data Exchange (ETDEWEB)

Dowlatabadi, H.; Kandlikar, M.; Linville, C.

1995-12-31

A critical aspect of climate change decision-making is uncertainties in current understanding of the socioeconomic, climatic and biogeochemical processes involved. Decision-making processes are much better informed if these uncertainties are characterized and their implications understood. Quantitative analysis of these uncertainties serve to inform decision makers about the likely outcome of policy initiatives, and help set priorities for research so that outcome ambiguities faced by the decision-makers are reduced. A family of integrated assessment models of climate change have been developed at Carnegie Mellon. These models are distinguished from other integrated assessment efforts in that they were designed from the outset to characterize and propagate parameter, model, value, and decision-rule uncertainties. The most recent of these models is ICAM 2.1. This model includes representation of the processes of demographics, economic activity, emissions, atmospheric chemistry, climate and sea level change and impacts from these changes and policies for emissions mitigation, and adaptation to change. The model has over 800 objects of which about one half are used to represent uncertainty. In this paper we show, that when considering parameter uncertainties, the relative contribution of climatic uncertainties are most important, followed by uncertainties in damage calculations, economic uncertainties and direct aerosol forcing uncertainties. When considering model structure uncertainties we find that the choice of policy is often dominated by model structure choice, rather than parameter uncertainties.

Including Emotional Intelligence in Pharmacy Curricula to Help Achieve CAPE Outcomes

OpenAIRE

Nelson, Michael H.; Fierke, Kerry K.; Sucher, Brandon J.; Janke, Kristin K.

2015-01-01

The importance of emotional intelligence (EI) for effective teamwork and leadership within the workplace is increasingly apparent. As suggested by the 2013 CAPE Outcomes, we recommend that colleges and schools of pharmacy consider EI-related competencies to build self-awareness and professionalism among students. In this Statement, we provide two examples of the introduction of EI into pharmacy curricula. In addition, we provide a 4-phase process based on recommendations developed by EI exper...

A Comparison of Clinical Parameters and Outcomes over 1 Year in Home Hemodialysis Patients Using 2008K@home or NxStage System One.

Science.gov (United States)

Brunelli, Steven M; Wilson, Steven M; Ficociello, Linda H; Mullon, Claudy; Diaz-Buxo, Jose A

2016-01-01

The prevalence of home hemodialysis (HHD) in the United States is growing, driven in part by improvements in dialysis machines for home use. We assessed clinical parameters and outcomes in HHD patients using either Fresenius 2008K@home or NxStage System One over 1 year. Patients were 18 years or older and received HHD for ≥30 days between January 1, 2009, and June 30, 2010. A propensity score match was used to control for differences in baseline characteristics, and 2008K@home patients were stratified by frequency of use. Data for outcome measures were analyzed using generalized linear mixed models. Treatment frequency was lower for 2008K@home groups than System One. Mean standardized Kt/V (stdKt/V) was 2.75 for 2008K@home ≥3.5x/week users and 1.99 for System One users (p < 0.001). Erythropoiesis-stimulating agent use tended to be lower for patients using System One. There were no statistically significant differences across groups in serum albumin, calcium, phosphorus, hemoglobin, or parathyroid hormone levels, normalized protein catabolic rate, body mass index, number of hospitalizations, or hospitalized days. Clinical parameters and outcomes for HHD patients using 2008K@home and System One were largely equivalent, although 2008K@home use was associated with higher stdKt/V. Further studies will be required to establish whether these differences in stdKt/V relate to differences in technology, treatment schedule, or a combination thereof.

New onset status epilepticus in older patients: Clinical characteristics and outcome.

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Malter, M P; Nass, R D; Kaluschke, T; Fink, G R; Burghaus, L; Dohmen, C

2017-10-01

We here evaluated (1) the differential characteristics of status epilepticus (SE) in older (≥60 years) compared to younger adults (18-59 years). In particular, we were interested in (2) the proportion and characteristics of new onset SE in patients with no history of epilepsy (NOSE) in older compared to younger adults, and (3) predictive parameters for clinical outcome in older subjects with NOSE. We performed a monocentric retrospective analysis of all adult patients (≥18years) admitted with SE to our tertiary care centre over a period of 10 years (2006-2015) to evaluate clinical characteristics and short-time outcome at discharge. One-hundred-thirty-five patients with SE were included in the study. Mean age at onset was 64 years (range 21-90), eighty-seven of the patients (64%) were older than 60 years. In 76 patients (56%), SE occurred as NOSE, sixty-seven percent of them were aged ≥60 years. There was no age-dependent predominance for NOSE. NOSE was not a relevant outcome predictor, especially regarding age-related subgroups. Older patients with NOSE had less frequently general tonic clonic SE (GTCSE; p=0.001) and were more often female (p=0.01). Regarding outcome parameters and risk factors in older patients with NOSE, unfavourable outcome was associated with infections during in-hospital treatment (0.04), extended stay in ICU (p=0.001), and generally in hospital (p<0.001). In our cohort, older patients represented the predominant subgroup in patients with SE. Older patients suffered more often from non-convulsive semiology and had a less favourable short-time outcome. NOSE was not a predictive outcome parameter in older patients. Data suggest that avoiding infections should have a priority because higher infection rates were associated with unfavourable outcome. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Constraining cosmological parameters with observational data including weak lensing effects

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Li Hong [Institute of High Energy Physics, Chinese Academy of Science, PO Box 918-4, Beijing 100049 (China); Theoretical Physics Center for Science Facilities (TPCSF), Chinese Academy of Science (China)], E-mail: hongli@mail.ihep.ac.cn; Liu Jie [Institute of High Energy Physics, Chinese Academy of Science, PO Box 918-4, Beijing 100049 (China); Xia Junqing [Scuola Internazionale Superiore di Studi Avanzati, Via Beirut 2-4, I-34014 Trieste (Italy); Sun Lei; Fan Zuhui [Department of Astronomy, School of Physics, Peking University, Beijing 100871 (China); Tao Charling; Tilquin, Andre [Centre de Physique des Particules de Marseille, CNRS/IN2P3-Luminy and Universite de la Mediterranee, Case 907, F-13288 Marseille Cedex 9 (France); Zhang Xinmin [Institute of High Energy Physics, Chinese Academy of Science, PO Box 918-4, Beijing 100049 (China); Theoretical Physics Center for Science Facilities (TPCSF), Chinese Academy of Science (China)

2009-05-11

In this Letter, we study the cosmological implications of the 100 square degree Weak Lensing survey (the CFHTLS-Wide, RCS, VIRMOS-DESCART and GaBoDS surveys). We combine these weak lensing data with the cosmic microwave background (CMB) measurements from the WMAP5, BOOMERanG, CBI, VSA, ACBAR, the SDSS LRG matter power spectrum and the Type Ia Supernoave (SNIa) data with the 'Union' compilation (307 sample), using the Markov Chain Monte Carlo method to determine the cosmological parameters, such as the equation-of-state (EoS) of dark energy w, the density fluctuation amplitude {sigma}{sub 8}, the total neutrino mass {sigma}m{sub {nu}} and the parameters associated with the power spectrum of the primordial fluctuations. Our results show that the {lambda}CDM model remains a good fit to all of these data. In a flat universe, we obtain a tight limit on the constant EoS of dark energy, w=-0.97{+-}0.041 (1{sigma}). For the dynamical dark energy model with time evolving EoS parameterized as w{sub de}(a)=w{sub 0}+w{sub a}(1-a), we find that the best-fit values are w{sub 0}=-1.064 and w{sub a}=0.375, implying the mildly preference of Quintom model whose EoS gets across the cosmological constant boundary during evolution. Regarding the total neutrino mass limit, we obtain the upper limit, {sigma}m{sub {nu}}<0.471 eV (95% C.L.) within the framework of the flat {lambda}CDM model. Due to the obvious degeneracies between the neutrino mass and the EoS of dark energy model, this upper limit will be relaxed by a factor of 2 in the framework of dynamical dark energy models. Assuming that the primordial fluctuations are adiabatic with a power law spectrum, within the {lambda}CDM model, we find that the upper limit on the ratio of the tensor to scalar is r<0.35 (95% C.L.) and the inflationary models with the slope n{sub s}{>=}1 are excluded at more than 2{sigma} confidence level. In this Letter we pay particular attention to the contribution from the weak lensing data and

Histologic parameters predictive of disease outcome in women with advanced stage ovarian carcinoma treated with neoadjuvant chemotherapy.

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Samrao, Damanzoopinder; Wang, Dan; Ough, Faith; Lin, Yvonne G; Liu, Song; Menesses, Teodulo; Yessaian, Annie; Turner, Nicole; Pejovic, Tanja; Mhawech-Fauceglia, Paulette

2012-12-01

The use of neoadjuvant chemotherapy followed by tumor reduction surgery, also called interval debulking surgery (IDS), is considered an alternative therapeutic regimen for selected patients with advanced stage epithelial ovarian cancer (EOC). Although minimal residual disease has been proven to be a prognostic factor in traditional cytoreduction for advanced stage EOC, predictive factors after IDS still remain unexplored. The aim of this study was to determine the prognostic value of post-neoadjuvant histologic changes with clinical outcome. Three pathologists evaluated 67 cases for the following parameters: fibrosis, necrosis, residual tumor, and inflammation. The Cohen's kappa statistic was used to measure agreement among pathologists. Univariate and multivariate Cox proportional hazards models were used to determine the association between histologic parameters and recurrence-free survival (RFS) and overall survival (OS). There was substantial to almost perfect agreement among the three pathologists in all four histologic parameters (k ranged from 0.65 to 0.97). Fibrosis was associated with longer RFS (P = 0.0257) with a median of 20 months for tumors with fibrosis (3+) versus 12 months for tumors with fibrosis (1+, 2+) and longer OS (P = 0.0249) with a median of 51 months for tumors with fibrosis (3+) versus 32 months for tumors with fibrosis (1+, 2+). Our results revealed that patients with tumors exhibiting fibrosis (1+, 2+), as well as necrosis (0, 1+), had significant shorter RFS and OS (P = 0.059 and P = 0.0234, respectively). We suggest that the assessment of fibrosis and necrosis should be implemented in pathologic evaluation and prospectively validated in future studies.

Poor outcome prediction by burst suppression ratio in adults with post-anoxic coma without hypothermia.

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Yang, Qinglin; Su, Yingying; Hussain, Mohammed; Chen, Weibi; Ye, Hong; Gao, Daiquan; Tian, Fei

2014-05-01

Burst suppression ratio (BSR) is a quantitative electroencephalography (qEEG) parameter. The purpose of our study was to compare the accuracy of BSR when compared to other EEG parameters in predicting poor outcomes in adults who sustained post-anoxic coma while not being subjected to therapeutic hypothermia. EEG was registered and recorded at least once within 7 days of post-anoxic coma onset. Electrodes were placed according to the international 10-20 system, using a 16-channel layout. Each EEG expert scored raw EEG using a grading scale adapted from Young and scored amplitude-integrated electroencephalography tracings, in addition to obtaining qEEG parameters defined as BSR with a defined threshold. Glasgow outcome scales of 1 and 2 at 3 months, determined by two blinded neurologists, were defined as poor outcome. Sixty patients with Glasgow coma scale score of 8 or less after anoxic accident were included. The sensitivity (97.1%), specificity (73.3%), positive predictive value (82.5%), and negative prediction value (95.0%) of BSR in predicting poor outcome were higher than other EEG variables. BSR1 and BSR2 were reliable in predicting death (area under the curve > 0.8, P coma who do not undergo therapeutic hypothermia when compared to other qEEG parameters.

Measuring Outcomes in Adult Weight Loss Studies That Include Diet and Physical Activity: A Systematic Review

Directory of Open Access Journals (Sweden)

Rachel A. Millstein

2014-01-01

Full Text Available Background. Measuring success of obesity interventions is critical. Several methods measure weight loss outcomes but there is no consensus on best practices. This systematic review evaluates relevant outcomes (weight loss, BMI, % body fat, and fat mass to determine which might be the best indicator(s of success. Methods. Eligible articles described adult weight loss interventions that included diet and physical activity and a measure of weight or BMI change and body composition change. Results. 28 full-text articles met inclusion criteria. Subjects, settings, intervention lengths, and intensities varied. All studies measured body weight (−2.9 to −17.3 kg, 9 studies measured BMI (−1.1 to −5.1 kg/m2, 20 studies measured % body fat (−0.7 to −10.2%, and 22 studies measured fat mass (−0.9 to −14.9 kg. All studies found agreement between weight or BMI and body fat mass or body fat % decreases, though there were discrepancies in degree of significance between measures. Conclusions. Nearly all weight or BMI and body composition measures agreed. Since body fat is the most metabolically harmful tissue type, it may be a more meaningful measure of health change. Future studies should consider primarily measuring % body fat, rather than or in addition to weight or BMI.

Transitions of interaction outcomes in a uni-directional consumer-resource system

Science.gov (United States)

Wang, Y.; DeAngelis, D.L.

2011-01-01

A uni-directional consumer-resource system of two species is analyzed. Our aim is to understand the mechanisms that determine how the interaction outcomes depend on the context of the interaction; that is, on the model parameters. The dynamic behavior of the model is described and, in particular, it is demonstrated that no periodic orbits exist. Then the parameter (factor) space is shown to be divided into four regions, which correspond to the four forms of interaction outcomes; i.e. mutualism, commensalism, parasitism and amensalism. It is shown that the interaction outcomes of the system transition smoothly among these four forms when the parameters of the system are varied continuously. Varying each parameter individually or varying pairs of parameters can also lead to smooth transitions between the interaction outcomes. The analysis leads to both conditions for which each species achieves its maximal density, and situations in which periodic oscillations of the interaction outcomes emerge. ?? 2011 Elsevier Ltd.

Magnetic Resonance Imaging-DRAGON score: 3-month outcome prediction after intravenous thrombolysis for anterior circulation stroke.

Science.gov (United States)

Turc, Guillaume; Apoil, Marion; Naggara, Olivier; Calvet, David; Lamy, Catherine; Tataru, Alina M; Méder, Jean-François; Mas, Jean-Louis; Baron, Jean-Claude; Oppenheim, Catherine; Touzé, Emmanuel

2013-05-01

The DRAGON score, which includes clinical and computed tomographic scan parameters, showed a high specificity to predict 3-month outcome in patients with acute ischemic stroke treated by intravenous tissue plasminogen activator. We adapted the score for patients undergoing MRI as the first-line diagnostic tool. We reviewed patients with consecutive anterior circulation ischemic stroke treated ≤ 4.5 hour by intravenous tissue plasminogen activator between 2003 and 2012 in our center, where MRI is systematically implemented as first-line diagnostic work-up. We derived the MRI-DRAGON score keeping all clinical parameters of computed tomography-DRAGON (age, initial National Institutes of Health Stroke Scale and glucose level, prestroke handicap, onset to treatment time), and considering the following radiological variables: proximal middle cerebral artery occlusion on MR angiography instead of hyperdense middle cerebral artery sign, and diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI ASPECTS) ≤ 5 instead of early infarct signs on computed tomography. Poor 3-month outcome was defined as modified Rankin scale >2. We calculated c-statistics as a measure of predictive ability and performed an internal cross-validation. Two hundred twenty-eight patients were included. Poor outcome was observed in 98 (43%) patients and was significantly associated with all parameters of the MRI-DRAGON score in multivariate analysis, except for onset to treatment time (nonsignificant trend). The c-statistic was 0.83 (95% confidence interval, 0.78-0.88) for poor outcome prediction. All patients with a MRI-DRAGON score ≤ 2 (n=22) had a good outcome, whereas all patients with a score ≥ 8 (n=11) had a poor outcome. The MRI-DRAGON score is a simple tool to predict 3-month outcome in acute stroke patients screened by MRI then treated by intravenous tissue plasminogen activator and may help for therapeutic decision.

Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity.

Science.gov (United States)

Chopra, S; Moerenhout, K; Crevoisier, X

2016-02-01

Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6-12 months postoperatively. However, contrasting results were reported by gait studies at 12-24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments. We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, Phallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anthropometrics parameters and neonatal outcomes from newborns of deliveries women with low weight

Directory of Open Access Journals (Sweden)

Joe Luiz Vieira Garcia Novo

2012-04-01

Full Text Available ABSTRACT Objectives: to assess the anthropometrics assets and outcomes of birthplace newborns from patients classified how low weight through the body weight index. Methods: a retrospective study of patients in labor and newborns from Hospital Santa Lucinda since 03/2009 to 02/2010: 19 of the study group (low weight and 50 of the control group (normal weight. The maternal variables included were: age, parity, puerperium; in the newborns were observed: sex, vitality, anthropometrics values, and outcomes. The statistical analysis involved the use Bioestat 5.0 program. Results: the middle perimeter head of newborns from low weight patients were 33,3 cm, and in the control group were 33,7 cm (p = 0,098; middle left arm perimeter were 10,0 cm and 10,3 cm (p = 0, 097; average weight: 2986,84 and 3165,32 g (p = 0, 0423, average length: 48,37 and 48, 77 cm (p = 0,2165 respectively. The average vitality from newborns after 1 and 5 minutes were: 8,1 - 8,1 (p = 0,9144 and 8,9 - 9,0 (p = 0,911. Conclusion: the weights of newborns from low weight patients in labor denote lower than normal weight patients. Low weight patients signify a risk group during the prenatal care, because there is more probability to be born low weight newborns. Prophylactics educating programs must be realized in order to avoid probable risks in low weight pregnant patients. Support PIBIC - CEPE

Psychometric Consequences of Subpopulation Item Parameter Drift

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Huggins-Manley, Anne Corinne

2017-01-01

This study defines subpopulation item parameter drift (SIPD) as a change in item parameters over time that is dependent on subpopulations of examinees, and hypothesizes that the presence of SIPD in anchor items is associated with bias and/or lack of invariance in three psychometric outcomes. Results show that SIPD in anchor items is associated…

Consumer-resource theory predicts dynamic transitions between outcomes of interspecific interactions

Science.gov (United States)

Holland, J. Nathaniel; DeAngelis, Donald L.

2009-01-01

Interactions between two populations are often defined by their interaction outcomes; that is, the positive, neutral, or negative effects of species on one another. Yet, signs of outcomes are not absolute, but vary with the biotic and abiotic contexts of interactions. Here, we develop a general theory for transitions between outcomes based on consumer-resource (C-R) interactions in which one or both species exploit the other as a resource. Simple models of C-R interactions revealed multiple equilibria, including one for species coexistence and others for extinction of one or both species, indicating that species densities alone could determine the fate of interactions. All possible outcomes (+ +), (+ -), (- -), (+ 0), (- 0), (0 0) of species coexistence emerged merely through changes in parameter values of C-R interactions, indicating that variation in C-R interactions resulting from biotic and abiotic conditions could determine shifts in outcomes. These results suggest that C-R interactions can provide a broad mechanism for understanding context- and density-dependent transitions between interaction outcomes.

Donor management parameters and organ yield: single center results.

Science.gov (United States)

Marshall, George Ryne; Mangus, Richard S; Powelson, John A; Fridell, Jonathan A; Kubal, Chandrashekhar A; Tector, A Joseph

2014-09-01

Management of organ donors in the intensive care unit is an emerging subject in critical care and transplantation. This study evaluates organ yield outcomes for a large number of patients managed by the Indiana Organ Procurement Organization. This is a retrospective review of intensive care unit records from 2008-2012. Donor demographic information and seven donor management parameters (DMP) were recorded at admission, consent, 12 h after consent, and before procurement. Three study groups were created: donors meeting 0-3, 4, or 5-7 DMP. Active donor Organ Procurement Organization management began at consent; so, data analysis focuses on the 12-h postconsent time point. Outcomes included organs transplanted per donor (OTPD) and transplantation of individual solid organs. Complete records for 499 patients were reviewed. Organ yield was 1415 organs of 3992 possible (35%). At 12 h, donors meeting more DMP had more OTPD: 2.2 (0-3) versus 3.0 (4) versus 3.5 (5-7) (P organ except intestine. Oxygen tension, vasopressor use, and central venous pressure were the most frequent independent predictors of organ usage. There were significantly more organs transplanted for donors meeting all three of these parameters (4.5 versus 2.7, P organs, with analysis of individual parameters suggesting that appropriate management of oxygenation, volume status, and vasopressor use could lead to more organs procured per donor. Copyright © 2014 Elsevier Inc. All rights reserved.

Statistical MOSFET Parameter Extraction with Parameter Selection for Minimal Point Measurement

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Marga Alisjahbana

2013-11-01

Full Text Available A method to statistically extract MOSFET model parameters from a minimal number of transistor I(V characteristic curve measurements, taken during fabrication process monitoring. It includes a sensitivity analysis of the model, test/measurement point selection, and a parameter extraction experiment on the process data. The actual extraction is based on a linear error model, the sensitivity of the MOSFET model with respect to the parameters, and Newton-Raphson iterations. Simulated results showed good accuracy of parameter extraction and I(V curve fit for parameter deviations of up 20% from nominal values, including for a process shift of 10% from nominal.

Systematic review of dose-volume parameters in the prediction of esophagitis in thoracic radiotherapy

International Nuclear Information System (INIS)

Rose, Jim; Rodrigues, George; Yaremko, Brian; Lock, Michael; D'Souza, David

2009-01-01

Purpose: With dose escalation and increasing use of concurrent chemoradiotherapy, radiation esophagitis (RE) remains a common treatment-limiting acute side effect in the treatment of thoracic malignancies. The advent of 3DCT planning has enabled investigators to study esophageal dose-volume histogram (DVH) parameters as predictors of RE. The purpose of this study was to assess published dosimetric parameters and toxicity data systematically in order to define reproducible predictors of RE, both for potential clinical use, and to provide recommendations for future research in the field. Materials and methods: We performed a systematic literature review of published studies addressing RE in the treatment of lung cancer and thymoma. Our search strategy included a variety of electronic medical databases, textbooks and bibliographies. Both prospective and retrospective clinical studies were included. Information relating to the relationship among measured dosimetric parameters, patient demographics, tumor characteristics, chemotherapy and RE was extracted and analyzed. Results: Eighteen published studies were suitable for analysis. Eleven of these assessed acute RE, while the remainder assessed both acute and chronic RE together. Heterogeneity of esophageal contouring practices, individual differences in information reporting and variability of RE outcome definitions were assessed. Well-described clinical and logistic modeling directly related V 35Gy , V 60Gy and SA 55Gy to clinically significant RE. Conclusions: Several reproducible dosimetric parameters exist in the literature, and these may be potentially relevant in the prediction of RE in the radiotherapy of thoracic malignancies. Further clarification of the predictive relationship between such standardized dosimetric parameters and observed RE outcomes is essential to develop efficient radiation treatment planning in locally advanced NSCLC in the modern concurrent chemotherapy and image-guided IMRT era.

Parameters leading to a successful radiographic outcome following surgical treatment for Lenke 2 curves.

Science.gov (United States)

Koller, Heiko; Meier, Oliver; McClung, Anna; Hitzl, Wolfgang; Mayer, Michael; Sucato, Daniel

2015-07-01

In Lenke 2 curves, there are conflicting data when to include the PTC into the fusion. Studies focusing on Lenke 2 curves are scant. The number of patients with significant postoperative shoulder height difference (SHD) or trunk shift (TS) is as high as 30 % indicating further research. Therefore, the purpose of the current study was to improve understanding of curve resolution and shoulder balance following surgical correction of Lenke 2 curves as well as the identification of radiographic parameters predicting postoperative curve resolution, shoulder and trunk balance in perspective of inclusion/exclusion of the proximal thoracic curve (PTC). This is a retrospective study of a 158 Lenke 2 curves. Serial radiographs were analyzed for the main thoracic curve (MTC), PTC, and lumbar curve (LC), SHD, clavicle angle (CA), T-1 tilt, deviation of the central sacral vertical line (CSVL) off the C7 plumb line.Patients were stratified whether the PTC was included in the fusion (+PTC group, n = 60) or not (-PTC group, n = 98). Intergroup results were studied. Compensatory mechanisms for SHD were studied in detail. Adding-on distally was defined as an increase of the lowest instrumented vertebra adjacent disc angle (LIVDA) >3°. Stepwise regression analyses were performed to establish predictive radiographic parameters. At follow-up averaging 24 months significant differences between the +PTC and -PTC group existed for the PTC (24° vs 28°, p 5° (27 vs 53 %, p 2 cm) was 9 (6 %): 7 in the -PTC vs 2 in the +PTC group (p = .03). Utilization of compensatory mechanisms (99 vs 83 %, p Statistics showed postoperative SHD improvement in both the +PTC and -PTC groups. There were no significant differences regarding SHD, CA and T1-Tilt between groups. However, only in the -PTC group, a significant change between postoperative and follow-up SHD existed (p = .02). Statistics identified a preoperative 'left shoulder up' (p statistical model only for the -PTC group showed 9 parameters

Variant mannose-binding lectin alleles are not associated with susceptibility to or outcome of invasive pneumococcal infection in randomly included patients

DEFF Research Database (Denmark)

Kronborg, Gitte; Weis, Nina; Madsen, Hans O

2002-01-01

for pneumococcal infections. To assess the influence of MBL genotypes on the course and outcome of invasive pneumococcal disease, clinical data for 141 adult patients were collected prospectively and their genotypes were determined. All patients included had positive blood cultures for Streptococcus pneumoniae....... The distribution of variant MBL alleles related to low MBL serum concentrations was similar among the patients and healthy individuals, and MBL genotype was not associated with infection outcome. Thus, in a random adult population with invasive pneumococcal infection, MBL does not seem to play a role......Invasive pneumococcal disease is a serious infection that primarily affects very young children and elderly or immunocompromised individuals but also affects previously healthy people. Variant mannose-binding lectin (MBL) alleles are associated with recurrent infections and may be a risk factor...

Non-Contrast Computed Tomography Scan Based Parameters of Ureteric Stones Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy

Science.gov (United States)

Ayaz Khan, Mohammad; Waqas Iqbal, Muhammad; Akbar, Mian Khalid; Saqib, Imad-ud-din; Akhter, Saeed

2017-01-01

Objective  To compare the non-contrast computed tomography (NCCT) scan-based parameters of ureteric stones affecting the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and methods We retrospectively evaluated the pre-procedure NCCT of 74 patients who had ESWL for solitary ureteric calculi of 5-20 mm in diameter. We assessed the age, sex, basal metabolic index (BMI), laterality, location, presence of double 'J' (DJ) stent, skin to stone distance (SSD), stone maximum diameter, Hounsfield unit (HU), Hounsfield density (HD), area, and volume. All those who had no stone on follow-up imaging within 30 days were declared successful while those who had residual stone were declared failures. Results The overall success rate was 78% (58/74). Sixty (81.1%) patients were male. The success of ESWL was correlated with lower SSD, Hounsfield units (HU) and Hounsfield density (HD). However, in multivariate analysis, SSD, Hounsfield unit, and stone area showed correlation with success of procedure but Hounsfield density failed to show correlation. The success rate in patients with stone HU 1000 were 93.9%, 69%, and 58.3%, respectively. Patients with lower BMI (30 kg/m2) and higher HD (>76 HU/mm). Conclusion BMI, SSD, stone Hounsfield units and Hounsfield unit density were strong predictors of outcome of ESWL for ureteric stone. PMID:28589076

Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

Directory of Open Access Journals (Sweden)

Rebecka Rubenson Wahlin

2018-04-01

Full Text Available BackgroundPrehospital intubation in traumatic brain injury (TBI focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients who undergo prehospital intubation and, in turn, if these parameters affect outcome.Material and methodsPatients ≥15 years admitted to the Department of Neurosurgery, Stockholm, Sweden with TBI from 2008 through 2014 were included. Data were extracted from prehospital and hospital charts, including prospectively collected Glasgow Outcome Score (GOS after 12 months. Univariate and multivariable logistic regression models were employed to examine parameters independently correlated to prehospital intubation and outcome.ResultsA total of 458 patients were included (n = 178 unconscious, among them, n = 61 intubated. Multivariable analyses indicated that high energy trauma, prehospital hypotension, pupil unresponsiveness, mode of transportation, and distance to the hospital were independently correlated with intubation, and among them, only pupil responsiveness was independently associated with outcome. Prehospital intubation did not add independent information in a step-up model versus GOS (p = 0.154. Prehospital reports revealed that hypoxia was not the primary cause of prehospital intubation, and that the procedure did not improve oxygen saturation during transport, while an increasing distance from the hospital increased the intubation frequency.ConclusionIn this modern trauma cohort, prehospital intubation was not independently associated with outcome; however, hypoxia was not a common reason for prehospital intubation. Prospective trials to assess efficacy of prehospital airway intubation will be difficult due to logistical and ethical considerations.

CORRELATION BETWEEN OBESITY, SAGITTAL BALANCE AND CLINICAL OUTCOME IN SPINAL FUSION

Directory of Open Access Journals (Sweden)

Marcel Machado da Motta

2015-09-01

Full Text Available Objective:To correlate obesity with radiographic parameters of spinal and spinopelvic balance in patients undergoing spinal arthrodesis, and to correlate obesity with clinical outcome of these patients.Methods:Observational retrospective study including patients who underwent spinal arthrodesis, with minimum follow-up period of three months. We measured waist circumference, as well as height and weight to calculate body mass index (BMI and obtained radiographs of the total column. The clinical parameters studied were pain by visual analog scale (VAS and the Oswestry questionnaire (ODI. Obesity correlated with radiographic parameters of the sagittal and spinopelvic balance and postoperative clinical parameters.Results:32 patients were analyzed. The higher the BMI, the greater the value of VAS found, but without statistical significance (p=0.83. There was also no correlation between BMI and the ODI questionnaire. Analyzing the abdominal circumference, there was no correlation between the VAS and ODI. There was no correlation between BMI or waist circumference and the radiographic parameters of global spinopelvic sagittal alignment. Regarding the postoperative results, there was no correlation between the mean BMI and waist circumference and the postoperative results for ODI and VAS (p=0.75 and p=0.7, respectively.Conclusions:The clinical outcomes of patients who undergone spinal fusion were not affected by the BMI and waist circumference. Also, there was no correlation between radiographic parameters of spinal and spinopelvic sagittal balance with obesity in patients previously treated with arthrodesis of the spine.

Predicting outcome of status epilepticus.

Science.gov (United States)

Leitinger, M; Kalss, G; Rohracher, A; Pilz, G; Novak, H; Höfler, J; Deak, I; Kuchukhidze, G; Dobesberger, J; Wakonig, A; Trinka, E

2015-08-01

Status epilepticus (SE) is a frequent neurological emergency complicated by high mortality and often poor functional outcome in survivors. The aim of this study was to review available clinical scores to predict outcome. Literature review. PubMed Search terms were "score", "outcome", and "status epilepticus" (April 9th 2015). Publications with abstracts available in English, no other language restrictions, or any restrictions concerning investigated patients were included. Two scores were identified: "Status Epilepticus Severity Score--STESS" and "Epidemiology based Mortality score in SE--EMSE". A comprehensive comparison of test parameters concerning performance, options, and limitations was performed. Epidemiology based Mortality score in SE allows detailed individualization of risk factors and is significantly superior to STESS in a retrospective explorative study. In particular, EMSE is very good at detection of good and bad outcome, whereas STESS detecting bad outcome is limited by a ceiling effect and uncertainty of correct cutoff value. Epidemiology based Mortality score in SE can be adapted to different regions in the world and to advances in medicine, as new data emerge. In addition, we designed a reporting standard for status epilepticus to enhance acquisition and communication of outcome relevant data. A data acquisition sheet used from patient admission in emergency room, from the EEG lab to intensive care unit, is provided for optimized data collection. Status Epilepticus Severity Score is easy to perform and predicts bad outcome, but has a low predictive value for good outcomes. Epidemiology based Mortality score in SE is superior to STESS in predicting good or bad outcome but needs marginally more time to perform. Epidemiology based Mortality score in SE may prove very useful for risk stratification in interventional studies and is recommended for individual outcome prediction. Prospective validation in different cohorts is needed for EMSE, whereas

Lumped-parameter models

Energy Technology Data Exchange (ETDEWEB)

Ibsen, Lars Bo; Liingaard, M.

2006-12-15

A lumped-parameter model represents the frequency dependent soil-structure interaction of a massless foundation placed on or embedded into an unbounded soil domain. In this technical report the steps of establishing a lumped-parameter model are presented. Following sections are included in this report: Static and dynamic formulation, Simple lumped-parameter models and Advanced lumped-parameter models. (au)

Booster parameter list

International Nuclear Information System (INIS)

Parsa, Z.

1986-10-01

The AGS Booster is designed to be an intermediate synchrotron injector for the AGS, capable of accelerating protons from 200 MeV to 1.5 GeV. The parameters listed include beam and operational parameters and lattice parameters, as well as parameters pertaining to the accelerator's magnets, vacuum system, radio frequency acceleration system, and the tunnel. 60 refs., 41 figs

Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

Science.gov (United States)

Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

2017-10-01

Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn's disease

DEFF Research Database (Denmark)

Levine, Arie; Turner, Dan; Pfeffer Gik, Tamar

2014-01-01

BACKGROUND: Robust evaluation of induction therapies using both clinical and inflammatory outcomes in pediatric Crohn's disease (CD) are sparse. We attempted to evaluate clinical, inflammatory, and composite outcomes of induction of remission therapies (normal C reactive protein [CRP] remission) ...

The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke.

Science.gov (United States)

Rasmussen, M; Espelund, U S; Juul, N; Yoo, A J; Sørensen, L H; Sørensen, K E; Johnsen, S P; Andersen, G; Simonsen, C Z

2018-06-01

Observational studies have suggested that low blood pressure and blood pressure variability may partially explain adverse neurological outcome after endovascular therapy with general anaesthesia (GA) for acute ischaemic stroke. The aim of this study was to further examine whether blood pressure related parameters during endovascular therapy are associated with neurological outcome. The GOLIATH trial randomised 128 patients to either GA or conscious sedation for endovascular therapy in acute ischaemic stroke. The primary outcome was 90 day modified Rankin Score. The haemodynamic protocol aimed at keeping the systolic blood pressure >140 mm Hg and mean blood pressure >70 mm Hg during the procedure. Blood pressure related parameters of interest included 20% reduction in mean blood pressure; mean blood pressure blood pressure blood pressure; mean blood pressure at the time of groin puncture; postreperfusion mean blood pressure; blood pressure variability; and use of vasopressors. Sensitivity analyses were performed in the subgroup of reperfused patients. Procedural average mean and systolic blood pressures were higher in the conscious sedation group (Pblood pressure blood pressure blood pressure variability, and use of vasopressors were all higher in the GA group (Pblood pressure related parameters and the modified Rankin Score in the overall patient population, and in the subgroup of patients with full reperfusion. We found no statistically significant association between blood pressure related parameters during endovascular therapy and neurological outcome. NCT 02317237. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

Science.gov (United States)

Lim, Chor-Kuan; Ruan, Sheng-Yuan; Lin, Feng-Ching; Wu, Chao-Ling; Chang, Hou-Tai; Jerng, Jih-Shuin; Wu, Huey-Dong; Yu, Chong-Jen

2015-01-01

Background and Objective Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, Ptracheostomy than those who were unsuccessfully weaned. Conclusions In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial Registration ClinicalTrials.gov NCT01312142 PMID:26379127

Continuous oscillation: outcome in critically ill patients.

Science.gov (United States)

Traver, G A; Tyler, M L; Hudson, L D; Sherrill, D L; Quan, S F

1995-09-01

To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. One hundred and three intensive care patients were randomly assigned to standard turning or turning by an oscillating bed. Data, collected at baseline, daily for 7 days, and then three times weekly until study discharge, included demographics, initial Acute Physiology and Chronic Health Evaluation (APACHE II) score, ventilatory/gas exchange parameters, indicators of pneumonia, nursing measures, and chest roentgenograph. There were no significant differences for LOS, duration of ventilation, nor incidence of pneumonia. Higher survival for subjects on the oscillating bed reached borderline significance (P = .056) for subjects with APACHE II greater than or equal to 20. Longitudinal data were analyzed using the random effects model. No differences in ventilatory or gas exchange parameters were identified. Among subjects who developed pneumonia there was a significantly higher respiratory score (nursing acuity scale) for subjects on the oscillating bed. In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.

A new peak shear strength criterion for rock joints which includes spectral parameters as roughness measures

International Nuclear Information System (INIS)

Kulatilake, P.H.S.W.; Shou, G.; Huang, T.H.

1996-01-01

Most of the natural rock joint surface profiles do not belong to the self similar fractal category. In general, roughness profiles of rock joints consist of non-stationary and stationary components. At the simplest level, only one parameter is sufficient to quantify non-stationary joint roughness. The average inclination angle I, along with the direction considered for the joint surface, is suggested to capture the non-stationary roughness. It is shown that even though the fractal dimension D is a useful parameter, it alone is insufficient to quantify the stationary roughness of non-self similar profiles

Is more lordosis associated with improved outcomes in cervical laminectomy and fusion when baseline alignment is lordotic?

Science.gov (United States)

Sielatycki, John A; Armaghani, Sheyan; Silverberg, Arnold; McGirt, Matthew J; Devin, Clinton J; O'Neill, Kevin

2016-08-01

In cervical spondylotic myelopathy (CSM), cervical sagittal alignment (CSA) is associated with disease severity. Increased kyphosis and C2-C7 sagittal vertical axis (SVA) correlate with worse myelopathy and poor outcomes. However, when alignment is lordotic, it is unknown whether these associations persist. The study aimed to investigate the associations between CSA parameters and patient-reported outcomes (PROs) following posterior decompression and fusion for CSM when baseline lordosis is maintained. This is an analysis of a prospective surgical cohort at a single academic institution. The sample includes adult patients undergoing primary cervical laminectomy and fusion for CSM over a 3-year period. The PROs included EuroQol-5D, Short-Form-12 (SF-12) physical composite (PCS) and mental composite scales (MCS), Neck Disability Index, and the modified Japanese Orthopaedic Association scores. Radiographic CSA parameters measured included C1-C2 Cobb, C2-C7 Cobb, C1-C7 Cobb, C2-C7 SVA, C1-C7 SVA, and T1 slope. The PROs were recorded at baseline and at 3 and 12 months postoperatively. The CSA parameters were measured on standing radiographs in the neutral position at baseline and 3 months. Wilcoxon rank test was used to test for changes in PROs and CSA parameters, and Pearson correlation coefficients were calculated for CSA parameters and PROs preoperatively and at 12 months. No external sources of funding were used for this work. There were 45 patients included with an average age of 63 years who underwent posterior decompression and fusion of 3.7±1.3 levels. Significant improvements were found in all PROs except SF-12 MCS (p=.06). Small but statistically significant changes were found in C2-C7 Cobb (mean change: +3.6°; p=.03) and C2-C7 SVA (mean change: +3 mm; p=.01). At baseline, only C2-C7 SVA associated with worse SF-12 PCS scores (r=-0.34, p=.02). Postoperatively, there were no associations found between PROs and any CSA parameters. Similarly, no CSA

Outcome of decompressive craniectomy (DC) for severe traumatic brain injury (stbi) in adults

International Nuclear Information System (INIS)

Qasmi, S.A.; Ghaffar, A.; Akram, M.

2015-01-01

To evaluate the outcomes of decompressive craniectomy (DC) in adults with severe traumatic brain injury (STBI). Study Design: Observational cross-sectional. Place and Duration of Study: Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Material and Methods: Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 (32.03 +- 8.01) years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid (CSF) leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Results: Favourable neurological outcome was seen in 21 patients (53.85%) where as 6 patients (15.38%) had moderate to severe disability and 3 patients (7.69%) were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale (GCS) range 6-8 had better outcome. Overall 9 patients (23.08%) did not survive the injury and procedure. Conclusion: As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome. (author)

Remote health monitoring: predicting outcome success based on contextual features for cardiovascular disease.

Science.gov (United States)

Alshurafa, Nabil; Eastwood, Jo-Ann; Pourhomayoun, Mohammad; Liu, Jason J; Sarrafzadeh, Majid

2014-01-01

Current studies have produced a plethora of remote health monitoring (RHM) systems designed to enhance the care of patients with chronic diseases. Many RHM systems are designed to improve patient risk factors for cardiovascular disease, including physiological parameters such as body mass index (BMI) and waist circumference, and lipid profiles such as low density lipoprotein (LDL) and high density lipoprotein (HDL). There are several patient characteristics that could be determining factors for a patient's RHM outcome success, but these characteristics have been largely unidentified. In this paper, we analyze results from an RHM system deployed in a six month Women's Heart Health study of 90 patients, and apply advanced feature selection and machine learning algorithms to identify patients' key baseline contextual features and build effective prediction models that help determine RHM outcome success. We introduce Wanda-CVD, a smartphone-based RHM system designed to help participants with cardiovascular disease risk factors by motivating participants through wireless coaching using feedback and prompts as social support. We analyze key contextual features that secure positive patient outcomes in both physiological parameters and lipid profiles. Results from the Women's Heart Health study show that health threat of heart disease, quality of life, family history, stress factors, social support, and anxiety at baseline all help predict patient RHM outcome success.

Long-term outcome in patients with juvenile dermatomyositis

DEFF Research Database (Denmark)

Mathiesen, P; Hegaard, H; Herlin, Troels

2012-01-01

To evaluate a group of 53 patients with juvenile dermatomyositis (JDM), on average 13.9 years after disease onset, in order to describe the long-term disease outcome and to identify disease-related parameters associated with poor disease outcome....

[Long-term outcome analysis of subjective and objective parameters after breast reduction in 159 cases: Patients judge differently from plastic surgeons].

Science.gov (United States)

Osinga, Rik; Babst, Doris; Bodmer, Elvira S; Link, Bjoern C; Fritsche, Elmar; Hug, Urs

2017-12-01

This work assessed both subjective and objective postoperative parameters after breast reduction surgery and compared between patients and plastic surgeons. After an average postoperative observation period of 6.7 ± 2.7 (2 - 13) years, 159 out of 259 patients (61 %) were examined. The mean age at the time of surgery was 37 ± 14 (15 - 74) years. The postoperative anatomy of the breast and other anthropometric parameters were measured in cm with the patient in an upright position. The visual analogue scale (VAS) values for symmetry, size, shape, type of scar and overall satisfaction both from the patient's and from four plastic surgeons' perspectives were assessed and compared. Patients rated the postoperative result significantly better than surgeons. Good subjective ratings by patients for shape, symmetry and sensitivity correlated with high scores for overall assessment. Shape had the strongest influence on overall satisfaction (regression coefficient 0.357; p reduction surgery, long-term outcome is rated significantly better by patients than by plastic surgeons. Good subjective ratings by patients for shape, symmetry and sensitivity correlated with high scores for overall assessment. Shape had the strongest influence on overall satisfaction, followed by symmetry and sensitivity of the breast. Postoperative size of the breast, resection weight, type of scar, age or BMI was not of significant influence. Symmetry was the only assessed subjective parameter of this study that could be objectified by postoperative measurements. Georg Thieme Verlag KG Stuttgart · New York.

Numerical calculation of electromagnetic properties including chirality parameters for uniaxial bianisotropic media

International Nuclear Information System (INIS)

Amirkhizi, Alireza V; Nemat-Nasser, Sia

2008-01-01

Through the use of conductive straight wires or coils the electromagnetic properties of a composite material can be modified. The asymmetric geometry of the coils creates an overall chiral response. The polarization vectors rotate as an electromagnetic wave travels through such a medium. To calculate the chirality of a medium prior to its manufacturing, we developed a method to extract all four electromagnetic material parameter tensors for a general uniaxial bianisotropic composite based on the numerical simulation of the electromagnetic fields. Our method uses appropriate line and surface field averages in a single unit cell of the periodic structure of the composite material. These overall field quantities have physical meaning only when the microscopic variation of the electromagnetic fields in the scale of the unit cell is not important, that is when the wavelength of interest is significantly larger than the maximum linear dimension of the unit cell. The overall constitutive relations of the periodic structure can then be obtained from the relations among the average quantities

Measuring Population Health Outcomes

OpenAIRE

Parrish, R. Gibson

2010-01-01

An ideal population health outcome metric should reflect a population's dynamic state of physical, mental, and social well-being. Positive health outcomes include being alive; functioning well mentally, physically, and socially; and having a sense of well-being. Negative outcomes include death, loss of function, and lack of well-being. In contrast to these health outcomes, diseases and injuries are intermediate factors that influence the likelihood of achieving a state of health. On the basis...

Genetic parameter estimates for carcass traits and visual scores including or not genomic information.

Science.gov (United States)

Gordo, D G M; Espigolan, R; Tonussi, R L; Júnior, G A F; Bresolin, T; Magalhães, A F Braga; Feitosa, F L; Baldi, F; Carvalheiro, R; Tonhati, H; de Oliveira, H N; Chardulo, L A L; de Albuquerque, L G

2016-05-01

The objective of this study was to determine whether visual scores used as selection criteria in Nellore breeding programs are effective indicators of carcass traits measured after slaughter. Additionally, this study evaluated the effect of different structures of the relationship matrix ( and ) on the estimation of genetic parameters and on the prediction accuracy of breeding values. There were 13,524 animals for visual scores of conformation (CS), finishing precocity (FP), and muscling (MS) and 1,753, 1,747, and 1,564 for LM area (LMA), backfat thickness (BF), and HCW, respectively. Of these, 1,566 animals were genotyped using a high-density panel containing 777,962 SNP. Six analyses were performed using multitrait animal models, each including the 3 visual scores and 1 carcass trait. For the visual scores, the model included direct additive genetic and residual random effects and the fixed effects of contemporary group (defined by year of birth, management group at yearling, and farm) and the linear effect of age of animal at yearling. The same model was used for the carcass traits, replacing the effect of age of animal at yearling with the linear effect of age of animal at slaughter. The variance and covariance components were estimated by the REML method in analyses using the numerator relationship matrix () or combining the genomic and the numerator relationship matrices (). The heritability estimates for the visual scores obtained with the 2 methods were similar and of moderate magnitude (0.23-0.34), indicating that these traits should response to direct selection. The heritabilities for LMA, BF, and HCW were 0.13, 0.07, and 0.17, respectively, using matrix and 0.29, 0.16, and 0.23, respectively, using matrix . The genetic correlations between the visual scores and carcass traits were positive, and higher correlations were generally obtained when matrix was used. Considering the difficulties and cost of measuring carcass traits postmortem, visual scores of

Populations and outcome measures used in ongoing research in sarcopenia.

Science.gov (United States)

Peña Ordóñez, Gloria Gabriela; Bustamante Montes, Lilia Patricia; Ramírez Duran, Ninfa; Sánchez Castellano, Carmen; Cruz-Jentoft, Alfonso J

2017-08-01

Sarcopenia research may be hampered by the heterogeneity of populations and outcome measures used in clinical studies. The aim of this study was to describe the inclusion/exclusion criteria and outcome measures used in ongoing research in sarcopenia. All active intervention studies registered in the World Health Organization with the keyword sarcopenia were included. Study design, type of intervention, inclusion/exclusion criteria and outcome measures were registered and classified. In April 2014, 151 studies on sarcopenia were registered in the WHO database. One hundred twenty-three were intervention studies. Most trials (94.3 %) were single centre and randomized (93.5 %), 51.2 % were double blind. Nutritional interventions (36.6 %), physical exercise (12.2 %) or both (19.5 %) were the most common interventions tested. Only 54.4 % included subjects of both genders, and 46.3 % had an upper age limit. Definition of the target populations was heterogeneous, with 57.7 % including healthy subjects and none using recent definitions of sarcopenia. Lifestyle and the degree of physical activity of subjects were not described or considered in most cases (79.7 %). Subjects with cardiovascular, neuropsychiatric or metabolic disorders and those with physical disability were usually excluded. Muscle mass and muscle strength were the primary outcome variables in 28.5 and 29.5 % of studies and physical performance in 19.5 %, but only 4.1 % used the three variables used the three of them. An additional 26.8 % used biological outcome variables. Little information and agreement existed in the way muscle and physical performance parameters were measured. We found a large heterogeneity in trial design, definition of populations and outcome measures in present research.

Do psychopathic traits assessed in mid-adolescence predict mental health, psychosocial, and antisocial, including criminal outcomes, over the subsequent 5 years?

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Hemphälä, Malin; Hodgins, Sheilagh

2014-01-01

To determine whether psychopathic traits assessed in mid-adolescence predicted mental health, psychosocial, and antisocial (including criminal) outcomes 5 years later and would thereby provide advantages over diagnosing conduct disorder (CD). Eighty-six women and 61 men were assessed in mid-adolescence when they first contacted a clinic for substance misuse and were reassessed 5 years later. Assessments in adolescence include the Psychopathy Checklist-Youth Version (PCL-YV), and depending on their age, either the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children or the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). Assessments in early adulthood included the SCID, self-reports of psychosocial functioning, aggressive behaviour, and criminality and official criminal records. The antisocial facet score positively predicted the number of anxiety symptoms and likelihood of receiving treatment for substance use disorders (SUDs). Lifestyle and antisocial facet scores negatively predicted Global Assessment of Functioning scores. By contrast, the interpersonal score and male sex independently and positively predicted the number of months worked or studied, as did the interaction of Lifestyle × Sex indicating that among men, but not women, an increase in lifestyle facet score was associated with less time worked or studied. Interpersonal and antisocial scores positively predicted school drop-out. Antisocial facet scores predicted the number of symptoms of antisocial personality disorder, alcohol and SUDs, and violent and nonviolent criminality but much more strongly among males than females. Predictions from numbers of CD symptoms were similar. Psychopathic traits among adolescents who misuse substances predict an array of outcomes over the subsequent 5 years. Information on the levels of these traits may be useful for planning treatment.

Health literacy and patient outcomes in chronic kidney disease: a systematic review.

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Taylor, Dominic M; Fraser, Simon; Dudley, Chris; Oniscu, Gabriel C; Tomson, Charles; Ravanan, Rommel; Roderick, Paul

2017-11-20

Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18 300 patients were studied: 4367 non-dialysis CKD; 13 202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92-238)], but 480 (IQR 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters and 'hard' clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of

The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review

Directory of Open Access Journals (Sweden)

Saberi P

2012-04-01

Full Text Available Parya Saberi1, Betty J Dong2, Mallory O Johnson1, Ruth M Greenblatt2, Jennifer M Cocohoba21Department of Medicine, 2Department of Clinical Pharmacy, University of California, San Francisco, CA, USAObjective: Due to the rapid proliferation of human immunodeficiency virus (HIV treatment options, there is a need for health care providers with knowledge of antiretroviral therapy intricacies. In a HIV multidisciplinary care team, the HIV pharmacist is well-equipped to provide this expertise. We conducted a systematic review to assess the impact of HIV pharmacists on HIV clinical outcomes.Methods: We searched six electronic databases from January 1, 1980 to June 1, 2011 and included all quantitative studies that examined pharmacist's roles in the clinical care of HIV-positive adults. Primary outcomes were antiretroviral adherence, viral load, and CD4+ cell count and secondary outcomes included health care utilization parameters, antiretroviral modifications, and other descriptive variables.Results: Thirty-two publications were included. Despite methodological limitation, the involvement of HIV pharmacists was associated with statistically significant adherence improvements and positive impact on viral suppression in the majority of studies.Conclusion: This systematic review provides evidence of the beneficial impact of HIV pharmacists on HIV treatment outcomes and offers suggestions for future research.Keywords: pharmacist, HIV/AIDS, clinical, adherence, impact

WE-G-9A-01: Radiation Oncology Outcomes Informatics

International Nuclear Information System (INIS)

Mayo, C; Miller, R; Sloan, J; Wu, Q; Howell, R

2014-01-01

The construction of databases and support software to enable routine and systematic aggregation, analysis and reporting of patient outcomes data is emerging as an important area. “How have results for our patients been affected by the improvements we have made in our practice and in the technologies we use?” To answer this type of fundamental question about the overall pattern of efficacy observed, it is necessary to systematically gather and analyze data on all patients treated within a clinic. Clinical trials answer, in great depth and detail, questions about outcomes for the subsets of patients enrolled in a given trial. However, routine aggregation and analysis of key treatment parameter data and outcomes information for all patients is necessary to recognize emergent patterns that would be of interest from a public health or practice perspective and could better inform design of clinical trials or the evolution of best practice principals. To address these questions, Radiation Oncology outcomes databases need to be constructed to enable combination essential data from a broad group of data types including: diagnosis and staging, dose volume histogram metrics, patient reported outcomes, toxicity metrics, performance status, treatment plan parameters, demographics, DICOM data and demographics. Developing viable solutions to automate aggregation and analysis of this data requires multidisciplinary efforts to define nomenclatures, modify clinical processes and develop software and database tools requires detailed understanding of both clinical and technical issues. This session will cover the developing area of Radiation Oncology Outcomes Informatics. Learning Objectives: Audience will be able to speak to the technical requirements (software, database, web services) which must be considered in designing an outcomes database. Audience will be able to understand the content and the role of patient reported outcomes as compared to traditional toxicity measures

WE-G-9A-01: Radiation Oncology Outcomes Informatics

Energy Technology Data Exchange (ETDEWEB)

Mayo, C; Miller, R; Sloan, J [Mayo Clinic, Rochester, MN (United States); Wu, Q [Duke University Medical Center, Durham, NC (United States); Howell, R [UT MD Anderson Cancer Center, Houston, TX (United States)

2014-06-15

The construction of databases and support software to enable routine and systematic aggregation, analysis and reporting of patient outcomes data is emerging as an important area. “How have results for our patients been affected by the improvements we have made in our practice and in the technologies we use?” To answer this type of fundamental question about the overall pattern of efficacy observed, it is necessary to systematically gather and analyze data on all patients treated within a clinic. Clinical trials answer, in great depth and detail, questions about outcomes for the subsets of patients enrolled in a given trial. However, routine aggregation and analysis of key treatment parameter data and outcomes information for all patients is necessary to recognize emergent patterns that would be of interest from a public health or practice perspective and could better inform design of clinical trials or the evolution of best practice principals. To address these questions, Radiation Oncology outcomes databases need to be constructed to enable combination essential data from a broad group of data types including: diagnosis and staging, dose volume histogram metrics, patient reported outcomes, toxicity metrics, performance status, treatment plan parameters, demographics, DICOM data and demographics. Developing viable solutions to automate aggregation and analysis of this data requires multidisciplinary efforts to define nomenclatures, modify clinical processes and develop software and database tools requires detailed understanding of both clinical and technical issues. This session will cover the developing area of Radiation Oncology Outcomes Informatics. Learning Objectives: Audience will be able to speak to the technical requirements (software, database, web services) which must be considered in designing an outcomes database. Audience will be able to understand the content and the role of patient reported outcomes as compared to traditional toxicity measures

Constraining dark energy with Hubble parameter measurements: an analysis including future redshift-drift observations

International Nuclear Information System (INIS)

Guo, Rui-Yun; Zhang, Xin

2016-01-01

The nature of dark energy affects the Hubble expansion rate (namely, the expansion history) H(z) by an integral over w(z). However, the usual observables are the luminosity distances or the angular diameter distances, which measure the distance.redshift relation. Actually, the property of dark energy affects the distances (and the growth factor) by a further integration over functions of H(z). Thus, the direct measurements of the Hubble parameter H(z) at different redshifts are of great importance for constraining the properties of dark energy. In this paper, we show how the typical dark energy models, for example, the ΛCDM, wCDM, CPL, and holographic dark energy models, can be constrained by the current direct measurements of H(z) (31 data used in total in this paper, covering the redshift range of z @ element of [0.07, 2.34]). In fact, the future redshift-drift observations (also referred to as the Sandage-Loeb test) can also directly measure H(z) at higher redshifts, covering the range of z @ element of [2, 5]. We thus discuss what role the redshift-drift observations can play in constraining dark energy with the Hubble parameter measurements. We show that the constraints on dark energy can be improved greatly with the H(z) data from only a 10-year observation of redshift drift. (orig.)

Analysis of Spinopelvic Parameters with L5 as the New Sacrum after Fusion in High-Grade Spondylolisthesis: A Possible Explanation for Satisfactory Results with In-Situ Fusion.

Science.gov (United States)

Rajasekaran, Shanmuganathan; Das, Gurudip; Aiyer, Siddharth Narasimhan; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad

2018-02-01

Retrospective case series. To correlate functional outcomes with spinopelvic parameters in patients with high-grade spondylolisthesis (HGS) treated with instrumented in-situ surgery or reduction and fusion. Satisfactory functional outcomes are reported with reduction and in-situ fusion strategies in HGS. However, reasons for this are unclear. We hypothesize that following lumbosacral fusion, the L5 becomes part of the sacrum, which improves spinopelvic parameters, resulting in equivalent functional outcomes in both surgical methods. Twenty-six patients undergoing HGS (reduction group A, 13; in-situ group B, 13) were clinically evaluated using the Oswestry Disability Index (ODI), short form-12 (SF-12), and Visual Analogue Scale (VAS) scores. Spinopelvic parameters, including pelvic incidence, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbosacral kyphosis (LSK) angle, and sacrofemoral distance (SFD) were measured preoperatively from S1 and postoperatively from L5 as the new sacrum at 1 year follow-up. Sagittal alignment was assessed using the sagittal vertical axis. Both groups were comparable in terms of age, sex, severity of slip, and preoperative spinopelvic parameters ( p >0.05). Postoperative VAS, SF-12, and ODI scores significantly improved in both groups ( p 0.05). After fusion, the L5 becomes the new sacrum and influences spinopelvic parameters to change favorably. This possibly explains why reduction and in-situ fusion achieve equivalent functional outcomes in HGS.

A description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes.

Science.gov (United States)

Papachristos, Alexander; Edwards, Elton; Dowrick, Adam; Gosling, Cameron

2014-09-01

Despite a number of injury prevention campaigns and interventions, horse riding continues to be a dangerous activity, resulting in more accidents per hour than motorcycling, skiing and football. Injuries are often serious, with one in four patients requiring admission to hospital. This study aims to describe the severity of equestrian-related injuries (ERIs) using both clinical parameters and patient-reported outcomes. A retrospective study of all patients aged ≥18 years admitted to The Alfred Hospital between January 2003 and January 2008 with an ERI was performed. Specific clinical data were extracted from the medical record. In addition, a questionnaire was conducted identifying the details of the accident, the required recovery time and levels of ongoing pain and physical disability. During the study period 172 patients met the inclusion criteria. There were three deaths (2%). Eighty-two patients (48%) suffered head injuries. Forty-one patients (24%) were admitted to the ICU and 31 patients (18%) required mechanical ventilation. On discharge, 41 patients (24%) required transfer to a sub-acute rehabilitation facility. One-hundred-and-twenty-four patients (72%) completed the questionnaire. Thirty-nine respondents (31%) were not wearing a helmet. Among patients injured for more than 6 months, 38 (35%) still experienced moderate or severe pain or disability. Ninety-five patients had returned to work at the time of review, among which 47(50%) required longer than 6 months to recover, and 40 (42%) returned at a reduced capacity. The clinical and patient-reported outcomes of ERIs requiring hospital admission are poor. Persistent pain and disability are common, even up to 5 years post-injury. A large proportion of patients required longer than 6 months to return to work and many return at a reduced capacity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Spillover effects in epidemiology: parameters, study designs and methodological considerations

Science.gov (United States)

Benjamin-Chung, Jade; Arnold, Benjamin F; Berger, David; Luby, Stephen P; Miguel, Edward; Colford Jr, John M; Hubbard, Alan E

2018-01-01

Abstract Many public health interventions provide benefits that extend beyond their direct recipients and impact people in close physical or social proximity who did not directly receive the intervention themselves. A classic example of this phenomenon is the herd protection provided by many vaccines. If these ‘spillover effects’ (i.e. ‘herd effects’) are present in the same direction as the effects on the intended recipients, studies that only estimate direct effects on recipients will likely underestimate the full public health benefits of the intervention. Causal inference assumptions for spillover parameters have been articulated in the vaccine literature, but many studies measuring spillovers of other types of public health interventions have not drawn upon that literature. In conjunction with a systematic review we conducted of spillovers of public health interventions delivered in low- and middle-income countries, we classified the most widely used spillover parameters reported in the empirical literature into a standard notation. General classes of spillover parameters include: cluster-level spillovers; spillovers conditional on treatment or outcome density, distance or the number of treated social network links; and vaccine efficacy parameters related to spillovers. We draw on high quality empirical examples to illustrate each of these parameters. We describe study designs to estimate spillovers and assumptions required to make causal inferences about spillovers. We aim to advance and encourage methods for spillover estimation and reporting by standardizing spillover parameter nomenclature and articulating the causal inference assumptions required to estimate spillovers. PMID:29106568

Saskatchewan resources. [including uranium

Energy Technology Data Exchange (ETDEWEB)

1979-09-01

The production of chemicals and minerals for the chemical industry in Saskatchewan are featured, with some discussion of resource taxation. The commodities mentioned include potash, fatty amines, uranium, heavy oil, sodium sulfate, chlorine, sodium hydroxide, sodium chlorate and bentonite. Following the successful outcome of the Cluff Lake inquiry, the uranium industry is booming. Some developments and production figures for Gulf Minerals, Amok, Cenex and Eldorado are mentioned.

Impact of body fat distribution on neoadjuvant chemotherapy outcomes in advanced breast cancer patients

International Nuclear Information System (INIS)

Iwase, Toshiaki; Sangai, Takafumi; Nagashima, Takeshi; Sakakibara, Masahiro; Sakakibara, Junta; Hayama, Shouko; Ishigami, Emi; Masuda, Takahito; Miyazaki, Masaru

2015-01-01

Obesity is known to decrease the efficacy of neoadjuvant chemotherapy (NAC) against breast cancer; however, the relationship between actual body composition and NAC outcomes remains unknown. Therefore, we determined the effect of body composition on NAC outcomes. A total of 172 advanced breast cancer patients who underwent surgery after NAC were retrospectively analyzed. Body composition parameters including abdominal circumference (AC), subcutaneous fat area (SFA), visceral fat area (VFA), and skeletal muscle area (SMA) were calculated using computed tomography volume-analyzing software. VFA/SFA ratio was used to evaluate visceral obesity. The associations of body composition parameters with pathological complete remission (pCR) and survival were analyzed. AC, SFA, and VFA were significantly correlated with body mass index (BMI) (all P < 0.05; r = 0.82, r = 0.71, and r = 0.78, respectively). AC, SFA, and VFA increased significantly and SMA decreased significantly after menopause (all P < 0.05). VFA/SFA ratio increased significantly after menopause, even though BMI remained unchanged. Body composition parameters were not associated with pCR. Distant disease-free survival (DDFS) was significantly worse in the high VFA group than in the low VFA group (P < 0.05). Furthermore, in the high VFA group, postmenopausal patients had significantly shorter DDFS than premenopausal patients (P < 0.05). VFA was independently associated with DDFS in the multivariate analysis (P < 0.05). High visceral fat is associated with worse NAC outcomes in breast cancer patients, especially postmenopausal patients. Interventions targeting visceral fat accumulation will likely improve NAC outcomes

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

Science.gov (United States)

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

Cosmological Parameters and Hyper-Parameters: The Hubble Constant from Boomerang and Maxima

Science.gov (United States)

Lahav, Ofer

Recently several studies have jointly analysed data from different cosmological probes with the motivation of estimating cosmological parameters. Here we generalise this procedure to allow freedom in the relative weights of various probes. This is done by including in the joint likelihood function a set of `Hyper-Parameters', which are dealt with using Bayesian considerations. The resulting algorithm, which assumes uniform priors on the log of the Hyper-Parameters, is very simple to implement. We illustrate the method by estimating the Hubble constant H0 from different sets of recent CMB experiments (including Saskatoon, Python V, MSAM1, TOCO, Boomerang and Maxima). The approach can be generalised for a combination of cosmic probes, and for other priors on the Hyper-Parameters. Reference: Lahav, Bridle, Hobson, Lasenby & Sodre, 2000, MNRAS, in press (astro-ph/9912105)

Parameter Optimization for Selected Correlation Analysis of Intracranial Pathophysiology

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Rupert Faltermeier

2015-01-01

Full Text Available Recently we proposed a mathematical tool set, called selected correlation analysis, that reliably detects positive and negative correlations between arterial blood pressure (ABP and intracranial pressure (ICP. Such correlations are associated with severe impairment of the cerebral autoregulation and intracranial compliance, as predicted by a mathematical model. The time resolved selected correlation analysis is based on a windowing technique combined with Fourier-based coherence calculations and therefore depends on several parameters. For real time application of this method at an ICU it is inevitable to adjust this mathematical tool for high sensitivity and distinct reliability. In this study, we will introduce a method to optimize the parameters of the selected correlation analysis by correlating an index, called selected correlation positive (SCP, with the outcome of the patients represented by the Glasgow Outcome Scale (GOS. For that purpose, the data of twenty-five patients were used to calculate the SCP value for each patient and multitude of feasible parameter sets of the selected correlation analysis. It could be shown that an optimized set of parameters is able to improve the sensitivity of the method by a factor greater than four in comparison to our first analyses.

Parameter Optimization for Selected Correlation Analysis of Intracranial Pathophysiology.

Science.gov (United States)

Faltermeier, Rupert; Proescholdt, Martin A; Bele, Sylvia; Brawanski, Alexander

2015-01-01

Recently we proposed a mathematical tool set, called selected correlation analysis, that reliably detects positive and negative correlations between arterial blood pressure (ABP) and intracranial pressure (ICP). Such correlations are associated with severe impairment of the cerebral autoregulation and intracranial compliance, as predicted by a mathematical model. The time resolved selected correlation analysis is based on a windowing technique combined with Fourier-based coherence calculations and therefore depends on several parameters. For real time application of this method at an ICU it is inevitable to adjust this mathematical tool for high sensitivity and distinct reliability. In this study, we will introduce a method to optimize the parameters of the selected correlation analysis by correlating an index, called selected correlation positive (SCP), with the outcome of the patients represented by the Glasgow Outcome Scale (GOS). For that purpose, the data of twenty-five patients were used to calculate the SCP value for each patient and multitude of feasible parameter sets of the selected correlation analysis. It could be shown that an optimized set of parameters is able to improve the sensitivity of the method by a factor greater than four in comparison to our first analyses.

Occupant Perceptions and a Health Outcome in Retail Stores

Energy Technology Data Exchange (ETDEWEB)

Zhao, Mingjie; Kim, Yang-Seon; Srebric, Jelena

2015-11-02

Indoor Environmental Quality (IEQ) in commercial buildings, such as retail stores, can affect employee satisfaction, productivity, and health. This study administered an IEQ survey to retail employees and found correlations between measured IEQ parameters and the survey responses. The survey included 611 employees in 14 retail stores located in Pennsylvania (climate zone 5A) and Texas (climate zone 2A). The survey questionnaire featured ratings of different aspects of IEQ, including thermal comfort, lighting and noise level, indoor smells, overall cleanness, and environmental quality. Simultaneously with the survey, on-site physical measurements were taken to collect data of relative humidity levels, air exchange rates, dry bulb temperatures, and contaminant concentrations. This data was analyzed using multinomial logit regression with independent variables being the measured IEQ parameters, employees’ gender, and age. This study found that employee perception of stuffy smells is related to formaldehyde and PM10 concentrations. Furthermore, the survey also asked the employees to report an annual frequency of common colds as a health indicator. The regression analysis showed that the cold frequency statistically correlates with the measured air exchange rates, outdoor temperatures, and indoor PM concentrations. Overall, the air exchange rate is the most influential parameter on the employee perception of the overall environmental quality and self-reported health outcome.

Impact of cardiovascular risk factors on the outcome of renal transplantation

Directory of Open Access Journals (Sweden)

Moghimi Mehrdad

2010-01-01

Full Text Available Cardiovascular diseases are common in renal transplant recipients and renal insuf-ficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 20-85 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplan-tation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors and 40 controls (transplant recipients without identifiable risk factors. The mean serum creatinine in the case and control groups were 1.33 ± 0.13 and 1.29 ± 0.36 mg/dL respectively (P= 0.493. Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P= 0.009, while frequency of partial response to grafting was higher in the case group (0.008. A history of chronic obstructive pulmonary diseases (COPD could significantly predict the outcome of grafting (P= 0.008 as could the occurrence of renal failure (P= 0.022. Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation.

Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

Directory of Open Access Journals (Sweden)

HUGO KARLING MORESCHI

2015-02-01

Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

Association between Promoter Hypomethylation and Overexpression of Autotaxin with Outcome Parameters in Biliary Atresia.

Directory of Open Access Journals (Sweden)

Wanvisa Udomsinprasert

Full Text Available Biliary atresia (BA is a progressive fibroinflammatory liver disease. Autotaxin (ATX has a profibrotic effect resulting from lysophosphatidic acid activity. The purpose of this study was to examine ATX expression and ATX promoter methylation in peripheral blood leukocytes and liver tissues from BA patients and controls and investigate their associations with outcome parameters in BA patients.A total of 130 subjects (65 BA patients and 65 age-matched controls were enrolled. DNA was extracted from circulating leukocytes and liver tissues of BA patients and from and age-matched controls. ATX promoter methylation status was determined by bisulfite pyrosequencing. ATX expression was analyzed using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay.Decreased methylation of specific CpGs were observed at the ATX promoter in BA patients. Subsequent analysis revealed that BA patients with advanced stage had lower methylation levels of ATX promoter than those with early stage. ATX promoter methylation levels were found to be associated with hepatic dysfunction in BA. In addition, ATX expression was significantly elevated and correlated with a decrease in ATX promoter methylation in BA patients compared to the controls. Furthermore, promoter hypomethylation and overexpression of ATX were inversely associated with jaundice status, hepatic dysfunction, and liver stiffness in BA patients.Accordingly, it has been hypothesized that ATX promoter methylation and ATX expression in peripheral blood may serve as possible biomarkers reflecting the progression of liver fibrosis in postoperative BA. These findings suggest that the promoter hypomethylation and overexpression of ATX might play a contributory role in the pathogenesis of liver fibrosis in BA.

Uncertainties in model-based outcome predictions for treatment planning

International Nuclear Information System (INIS)

Deasy, Joseph O.; Chao, K.S. Clifford; Markman, Jerry

2001-01-01

Purpose: Model-based treatment-plan-specific outcome predictions (such as normal tissue complication probability [NTCP] or the relative reduction in salivary function) are typically presented without reference to underlying uncertainties. We provide a method to assess the reliability of treatment-plan-specific dose-volume outcome model predictions. Methods and Materials: A practical method is proposed for evaluating model prediction based on the original input data together with bootstrap-based estimates of parameter uncertainties. The general framework is applicable to continuous variable predictions (e.g., prediction of long-term salivary function) and dichotomous variable predictions (e.g., tumor control probability [TCP] or NTCP). Using bootstrap resampling, a histogram of the likelihood of alternative parameter values is generated. For a given patient and treatment plan we generate a histogram of alternative model results by computing the model predicted outcome for each parameter set in the bootstrap list. Residual uncertainty ('noise') is accounted for by adding a random component to the computed outcome values. The residual noise distribution is estimated from the original fit between model predictions and patient data. Results: The method is demonstrated using a continuous-endpoint model to predict long-term salivary function for head-and-neck cancer patients. Histograms represent the probabilities for the level of posttreatment salivary function based on the input clinical data, the salivary function model, and the three-dimensional dose distribution. For some patients there is significant uncertainty in the prediction of xerostomia, whereas for other patients the predictions are expected to be more reliable. In contrast, TCP and NTCP endpoints are dichotomous, and parameter uncertainties should be folded directly into the estimated probabilities, thereby improving the accuracy of the estimates. Using bootstrap parameter estimates, competing treatment

Investigation of optimized experimental parameters including laser wavelength for boron measurement in photovoltaic grade silicon using laser-induced breakdown spectroscopy

International Nuclear Information System (INIS)

Darwiche, S.; Benmansour, M.; Eliezer, N.; Morvan, D.

2010-01-01

The quantification of boron and other impurities in photovoltaic grade silicon was investigated using the LIBS technique with attention to the laser wavelength employed, temporal parameters, and the nature of the ambient gas. The laser wavelength was found to have a moderate effect on the performance of the process, while the type of purge gas and temporal parameters had a strong effect on the signal-to-background ratio (SBR) of the boron spectral emission, which was used to determine the boron concentration in silicon. The three parameters are not independent, meaning that for each different purge gas, different optimal temporal parameters are observed. Electron density was also calculated from Stark broadening of the 390.5 nm silicon emission line in order to better understand the different performances observed when using different gases and gating parameters. Calibration curves were made for boron measurement in silicon using certified standards with different purge gases while using the temporal parameters which had been optimized for that gas. By comparing the calibration curves, it was determined that argon is superior to helium or air for use as the analysis chamber purge gas with an UV laser.

Èlectroneuromyographiс parameters as prognostic criteria in facial nerve palsy outcome

Directory of Open Access Journals (Sweden)

N. G. Savitskaya

2012-01-01

Full Text Available In the article we present the results of the retrospective clinico-electrophysiological analysis of 182 patients suffering from the idiopathic neuropathy of the facial nerve (Bell`s palsy. The comparison of the most common electromyographical (ENMG predictors of outcomes was made. It was demonstrated that the most sensitive method in the acutest period (less then 5 days is the level of excitability of the nerve, in the acute period (less then 14 days – estimation of M-answer amplitude loss, and from the 21st day – the presence of denervation in muscles. The most specific electromyographical approach to estimate the therapy efficiency is an analysis of the M-answer amplitude and latency. In conclusion, neurologists have the possibility to predict the outcome and to control the therapy efficiency in any period of the disease. The correlation dynamics ÈNMG sensitivity settings – NLN on different dates can be used to determine the volume of ÈNMG – the NLN study depending on the timing for the treatment of patients.

Test-Retest Intervisit Variability of Functional and Structural Parameters in X-Linked Retinoschisis.

Science.gov (United States)

Jeffrey, Brett G; Cukras, Catherine A; Vitale, Susan; Turriff, Amy; Bowles, Kristin; Sieving, Paul A

2014-09-01

To examine the variability of four outcome measures that could be used to address safety and efficacy in therapeutic trials with X-linked juvenile retinoschisis. Seven men with confirmed mutations in the RS1 gene were evaluated over four visits spanning 6 months. Assessments included visual acuity, full-field electroretinograms (ERG), microperimetric macular sensitivity, and retinal thickness measured by optical coherence tomography (OCT). Eyes were separated into Better or Worse Eye groups based on acuity at baseline. Repeatability coefficients were calculated for each parameter and jackknife resampling used to derive 95% confidence intervals (CIs). The threshold for statistically significant change in visual acuity ranged from three to eight letters. For ERG a-wave, an amplitude reduction greater than 56% would be considered significant. For other parameters, variabilities were lower in the Worse Eye group, likely a result of floor effects due to collapse of the schisis pockets and/or retinal atrophy. The criteria for significant change (Better/Worse Eye) for three important parameters were: ERG b/a-wave ratio (0.44/0.23), point wise sensitivity (10.4/7.0 dB), and central retinal thickness (31%/18%). The 95% CI range for visual acuity, ERG, retinal sensitivity, and central retinal thickness relative to baseline are described for this cohort of participants with X-linked juvenile retinoschisis (XLRS). A quantitative understanding of the variability of outcome measures is vital to establishing the safety and efficacy limits for therapeutic trials of XLRS patients.

Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes.

Science.gov (United States)

Achana, Felix A; Cooper, Nicola J; Bujkiewicz, Sylwia; Hubbard, Stephanie J; Kendrick, Denise; Jones, David R; Sutton, Alex J

2014-07-21

Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on

Clinical and neurocognitive outcome in symptomatic isovaleric acidemia

Directory of Open Access Journals (Sweden)

Grünert Sarah C

2012-01-01

Full Text Available Abstract Background Despite its first description over 40 years ago, knowledge of the clinical course of isovaleric acidemia (IVA, a disorder predisposing to severe acidotic episodes during catabolic stress, is still anecdotal. We aimed to investigate the phenotypic presentation and factors determining the neurological and neurocognitive outcomes of patients diagnosed with IVA following clinical manifestation. Methods Retrospective data on 21 children and adults with symptomatic IVA diagnosed from 1976 to 1999 were analyzed for outcome determinants including age at diagnosis and number of catabolic episodes. Sixteen of 21 patients were evaluated cross-sectionally focusing on the neurological and neurocognitive status. Additionally, 155 cases of patients with IVA published in the international literature were reviewed and analyzed for outcome parameters including mortality. Results 57% of study patients (12/21 were diagnosed within the first weeks of life and 43% (9/21 in childhood. An acute metabolic attack was the main cause of diagnostic work-up. 44% of investigated study patients (7/16 showed mild motor dysfunction and only 19% (3/16 had cognitive deficits. No other organ complications were found. The patients' intelligence quotient was not related to the number of catabolic episodes but was inversely related to age at diagnosis. In published cases, mortality was high (33% if associated with neonatal diagnosis, following manifestation at an average age of 7 days. Conclusions Within the group of "classical" organic acidurias, IVA appears to be exceptional considering its milder neuropathologic implications. The potential to avoid neonatal mortality and to improve neurologic and cognitive outcome under early treatment reinforces IVA to be qualified for newborn screening.

Biotropic parameters of magnetic fields

Energy Technology Data Exchange (ETDEWEB)

Shishlo, M.A.

The use of magnetic fields (MF) in biology and medicine to control biological systems has led to appearance of the term, biotropic parameters of MF. They include the physical characteristics of MF, which determine the primary biologically significant physicochemical mechanisms of field action causing formation of corresponding reactions on the level of the integral organism. These parameters include MF intensity, gradient, vector, pulse frequency and shape, and duration of exposure. Factors that elicit responses by the biological system include such parameter of MF interaction with the integral organism as localization of exposure and volume of tissues interacting with the field, as well as the initial state of the organism. In essence, the findings of experimental studies of biotropic parameters of MF make it possible to control physiological processes and will aid in optimizing methods of MF therapy.

Neutrino oscillation parameter sampling with MonteCUBES

Science.gov (United States)

Blennow, Mattias; Fernandez-Martinez, Enrique

2010-01-01

We present MonteCUBES ("Monte Carlo Utility Based Experiment Simulator"), a software package designed to sample the neutrino oscillation parameter space through Markov Chain Monte Carlo algorithms. MonteCUBES makes use of the GLoBES software so that the existing experiment definitions for GLoBES, describing long baseline and reactor experiments, can be used with MonteCUBES. MonteCUBES consists of two main parts: The first is a C library, written as a plug-in for GLoBES, implementing the Markov Chain Monte Carlo algorithm to sample the parameter space. The second part is a user-friendly graphical Matlab interface to easily read, analyze, plot and export the results of the parameter space sampling. Program summaryProgram title: MonteCUBES (Monte Carlo Utility Based Experiment Simulator) Catalogue identifier: AEFJ_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEFJ_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: GNU General Public Licence No. of lines in distributed program, including test data, etc.: 69 634 No. of bytes in distributed program, including test data, etc.: 3 980 776 Distribution format: tar.gz Programming language: C Computer: MonteCUBES builds and installs on 32 bit and 64 bit Linux systems where GLoBES is installed Operating system: 32 bit and 64 bit Linux RAM: Typically a few MBs Classification: 11.1 External routines: GLoBES [1,2] and routines/libraries used by GLoBES Subprograms used:Cat Id ADZI_v1_0, Title GLoBES, Reference CPC 177 (2007) 439 Nature of problem: Since neutrino masses do not appear in the standard model of particle physics, many models of neutrino masses also induce other types of new physics, which could affect the outcome of neutrino oscillation experiments. In general, these new physics imply high-dimensional parameter spaces that are difficult to explore using classical methods such as multi-dimensional projections and minimizations, such as those

Predictability of psychic outcome for exercise training and exercise training including relaxation therapy after myocardial infarction

NARCIS (Netherlands)

H.J. Duivenvoorden (Hugo); J. van Dixhoorn (J.)

1991-01-01

markdownabstractAbstract Predictability of the psychic outcome for two cardiac rehabilitation programmes was investigated in 119 myocardial infarction patients. They were randomly assigned to either a five-week daily exercise training or to an identical training in combination with six sessions

The surgery of peripheral nerves (including tumors)

DEFF Research Database (Denmark)

Fugleholm, Kåre

2013-01-01

Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...... surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral...... nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter...

Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy?

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Simsek, Gulnihal Gokce; Zincir, Selma; Gulec, Huseyin; Eksioglu, Sevgin; Semiz, Umit Basar; Kurtulmus, Yasemin Sipka

2015-08-01

The aim of this study is to investigate the relationship between features of electroencephalography (EEG), including seizure time, energy threshold level and post-ictal suppression time, and clinical variables, including treatment outcomes and side-effects, among schizophrenia inpatients undergoing electroconvulsive therapy (ECT). This is a naturalistic follow-up study on schizophrenia patients, diagnosed using DSM-IV-TR criteria, treated by a psychosis inpatient service. All participants completed the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) scale, the Frontal Assessment Battery (FAB) and a Data Collection Form. Assessments were made before treatment, during ECT and after treatment. Statistically significant improvements in both clinical and cognitive outcome were noted after ECT in all patients. Predictors of improvement were sought by evaluating electrophysiological variables measured at three time points (after the third, fifth and seventh ECT sessions). Logistic regression analysis showed that clinical outcome/improvement did not differ by seizure duration, threshold energy level or post-ictal suppression time. We found that ictal EEG parameters measured at several ECT sessions did not predict clinical recovery/outcomes. This may be because our centre defensively engages in "very specific patient selection" when ECT is contemplated. ECT does not cause short-term cognitive functional impairment and indeed improves cognition, because symptoms of the schizophrenic episode are alleviated.

Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review.

Science.gov (United States)

Tran, Vi Do; Dario, Paolo; Mazzoleni, Stefano

2018-03-01

This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

Influence of body habitus on feasibility and outcome of laparoscopic liver resections: a prospective study.

Science.gov (United States)

Ratti, Francesca; D'Alessandro, Valentina; Cipriani, Federica; Giannone, Fabio; Catena, Marco; Aldrighetti, Luca

2016-06-01

The aim of the present study was to prospectively investigate whether the anthropometric measures of A Body Shape Index (ABSI, taking into account waist circumference adjusted for height and weight) affects feasibility and outcome of laparoscopic liver resections. One hundred patients undergoing laparoscopic liver resection were prospectively included in the study (2014-2015). Preoperative clinical parameters, including body mass index (BMI) and ABSI were evaluated for associations with intraoperative outcome and postoperative results (morbidity, mortality and functional recovery). Twenty-two and 78 patients underwent major and minor hepatectomies, respectively. Conversion rate was 9%, mean blood loss was 210 ± 115 ml. Postoperative morbidity was 15% and mortality was nil. Mean length of stay was 4 days. When considering the entire series, ABSI was not associated with intra and postoperative outcome. After stratification of patients according to difficulty score, Pearson's correlation demonstrated an association between ABSI and intraoperative blood loss (P = 0.03) and time for functional recovery (P = 0.05) in patients undergoing resections with high score of difficulty. Body habitus has an influence on outcome of laparoscopic liver resections with high degree of difficulty, while feasibility and outcome of low difficulty resections seem not to be affected by anthropometric measures. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia.

Science.gov (United States)

Englum, Brian R; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M; Jason Smithers, C; Brown, Rebeccah L; Kalfa, Theodosia; Langer, Jacob C; Cada, Michaela; Oldham, Keith T; Scott, J Paul; St Peter, Shawn D; Sharma, Mukta; Davidoff, Andrew M; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E; Dassinger, Melvin S; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L; Rice, Henry E

2016-01-01

The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p<0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS. Copyright © 2016 Elsevier Inc. All rights reserved.

Long-term Clinical and Radiographic Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance: Does Level of Proximal Fusion Affect the Outcome? Minimum 5-Year Follow-up.

Science.gov (United States)

Yagi, Mitsuru; King, Akilah B; Cunningham, Matthew E; Boachie-Adjei, Oheneba

2013-03-01

Retrospective case series of surgically treated adult patients with fixed sagittal imbalance. To assess clinical and radiographic changes after pedicle subtraction osteotomy (PSO) to treat adult fixed sagittal imbalance. Although recent reports have shown favorable clinical outcomes for PSO, few reports have published long-term follow-up outcomes. It is also unknown whether long-term outcomes are correlated with the level of proximal fusion and the radiographic changes that are observed after PSO. We reviewed the charts, X-rays, and postoperative SRS-22 and Oswestry Disability Index (ODI) scores of 32 adult patients who presented with fixed sagittal imbalance and were treated with lumbar PSO. Long fusions were defined as those proximal to T6, and short fusions were defined as those below T8. Measured radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), sacral slope, pelvic incidence, and sagittal balance (SVA). Statistical analysis included Student t test and chi-square test. A p value of imbalance, PSO provided good sagittal balance and maintained favorable clinical outcomes in both the short and long fusion groups despite a slight decrease in the SVA and a high complication rate. The data suggest that the loss of sagittal balance may be attributed to increase global and junctional kyphosis in short fusion groups, and should be monitored for long-term outcomes. Particular attention should be paid to the long-term deterioration of the SVA in adults who present with fixed sagittal imbalance after PSO. Copyright © 2013 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation.

Science.gov (United States)

de Gregorio, Nikolaus; Friedl, Thomas; Schramm, Amelie; Reister, Frank; Janni, Wolfgang; Ebner, Florian

2017-08-25

Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure. © 2017 S. Karger AG, Basel.

An impossibility theorem for parameter independent hidden variable theories

Science.gov (United States)

Leegwater, Gijs

2016-05-01

Recently, Roger Colbeck and Renato Renner (C&R) have claimed that '[n]o extension of quantum theory can have improved predictive power' (Colbeck & Renner, 2011, 2012b). If correct, this is a spectacular impossibility theorem for hidden variable theories, which is more general than the theorems of Bell (1964) and Leggett (2003). Also, C&R have used their claim in attempt to prove that a system's quantum-mechanical wave function is in a one-to-one correspondence with its 'ontic' state (Colbeck & Renner, 2012a). C&R's claim essentially means that in any hidden variable theory that is compatible with quantum-mechanical predictions, probabilities of measurement outcomes are independent of these hidden variables. This makes such variables otiose. On closer inspection, however, the generality and validity of the claim can be contested. First, it is based on an assumption called 'Freedom of Choice'. As the name suggests, this assumption involves the independence of an experimenter's choice of measurement settings. But in the way C&R define this assumption, a no-signalling condition is surreptitiously presupposed, making the assumption less innocent than it sounds. When using this definition, any hidden variable theory violating parameter independence, such as Bohmian Mechanics, is immediately shown to be incompatible with quantum-mechanical predictions. Also, the argument of C&R is hard to follow and their mathematical derivation contains several gaps, some of which cannot be closed in the way they suggest. We shall show that these gaps can be filled. The issue with the 'Freedom of Choice' assumption can be circumvented by explicitly assuming parameter independence. This makes the result less general, but better founded. We then obtain an impossibility theorem for hidden variable theories satisfying parameter independence only. As stated above, such hidden variable theories are impossible in the sense that any supplemental variables have no bearing on outcome probabilities

Gender, renal function, and outcomes on the liver transplant waiting list: assessment of revised MELD including estimated glomerular filtration rate.

Science.gov (United States)

Myers, Robert P; Shaheen, Abdel Aziz M; Aspinall, Alexander I; Quinn, Robert R; Burak, Kelly W

2011-03-01

The Model for End-Stage Liver Disease (MELD) allocation system for liver transplantation (LT) may present a disadvantage for women by including serum creatinine, which is typically lower in females. Our objectives were to investigate gender disparities in outcomes among LT candidates and to assess a revised MELD, including estimated glomerular filtration rate (eGFR), for predicting waiting list mortality. Adults registered for LT between 2002 and 2007 were identified using the UNOS database. We compared components of MELD, MDRD-derived eGFR, and the 3-month probability of LT and death between genders. Discrimination of MELD, MELDNa, and revised models including eGFR for mortality were compared using c-statistics. A total of 40,393 patients (36% female) met the inclusion criteria; 9% died and 24% underwent LT within 3 months of listing. Compared with men, women had lower median serum creatinine (0.9 vs. 1.0 mg/dl), eGFR (72 vs. 83 ml/min/1.73 m(2)), and mean MELD (16.5 vs. 17.2; all p discrimination for 3-month mortality (c-statistics: MELD 0.896, MELD-eGFR 0.894, MELDNa 0.911, MELDNa-eGFR 0.905). Women are disadvantaged under MELD potentially due to its inclusion of creatinine. However, since including eGFR in MELD does not improve mortality prediction, alternative refinements are necessary. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia☆☆☆

Science.gov (United States)

Englum, Brian R.; Rothman, Jennifer; Leonard, Sarah; Reiter, Audra; Thornburg, Courtney; Brindle, Mary; Wright, Nicola; Heeney, Matthew M.; Smithers, C. Jason; Brown, Rebeccah L.; Kalfa, Theodosia; Langer, Jacob C.; Cada, Michaela; Oldham, Keith T.; Scott, J. Paul; St Peter, Shawn D; Sharma, Mukta; Davidoff, Andrew M.; Nottage, Kerri; Bernabe, Kathryn; Wilson, David B.; Dutta, Sanjeev; Glader, Bertil; Crary, Shelley E.; Dassinger, Melvin S.; Dunbar, Levette; Islam, Saleem; Kumar, Manjusha; Rescorla, Fred; Bruch, Steve; Campbell, Andrew; Austin, Mary; Sidonio, Robert; Blakely, Martin L.; Rice, Henry E.

2016-01-01

Purpose The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). Methods The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. Results The analysis included 130 children, with 62.3% (n = 81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1 g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p < 0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. Conclusion Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS. PMID:26613837

New fundamental parameters for attitude representation

Science.gov (United States)

Patera, Russell P.

2017-08-01

A new attitude parameter set is developed to clarify the geometry of combining finite rotations in a rotational sequence and in combining infinitesimal angular increments generated by angular rate. The resulting parameter set of six Pivot Parameters represents a rotation as a great circle arc on a unit sphere that can be located at any clocking location in the rotation plane. Two rotations are combined by linking their arcs at either of the two intersection points of the respective rotation planes. In a similar fashion, linking rotational increments produced by angular rate is used to derive the associated kinematical equations, which are linear and have no singularities. Included in this paper is the derivation of twelve Pivot Parameter elements that represent all twelve Euler Angle sequences, which enables efficient conversions between Pivot Parameters and any Euler Angle sequence. Applications of this new parameter set include the derivation of quaternions and the quaternion composition rule, as well as, the derivation of the analytical solution to time dependent coning motion. The relationships between Pivot Parameters and traditional parameter sets are included in this work. Pivot Parameters are well suited for a variety of aerospace applications due to their effective composition rule, singularity free kinematic equations, efficient conversion to and from Euler Angle sequences and clarity of their geometrical foundation.

Outcome Prediction in Mathematical Models of Immune Response to Infection.

Directory of Open Access Journals (Sweden)

Manuel Mai

Full Text Available Clinicians need to predict patient outcomes with high accuracy as early as possible after disease inception. In this manuscript, we show that patient-to-patient variability sets a fundamental limit on outcome prediction accuracy for a general class of mathematical models for the immune response to infection. However, accuracy can be increased at the expense of delayed prognosis. We investigate several systems of ordinary differential equations (ODEs that model the host immune response to a pathogen load. Advantages of systems of ODEs for investigating the immune response to infection include the ability to collect data on large numbers of 'virtual patients', each with a given set of model parameters, and obtain many time points during the course of the infection. We implement patient-to-patient variability v in the ODE models by randomly selecting the model parameters from distributions with coefficients of variation v that are centered on physiological values. We use logistic regression with one-versus-all classification to predict the discrete steady-state outcomes of the system. We find that the prediction algorithm achieves near 100% accuracy for v = 0, and the accuracy decreases with increasing v for all ODE models studied. The fact that multiple steady-state outcomes can be obtained for a given initial condition, i.e. the basins of attraction overlap in the space of initial conditions, limits the prediction accuracy for v > 0. Increasing the elapsed time of the variables used to train and test the classifier, increases the prediction accuracy, while adding explicit external noise to the ODE models decreases the prediction accuracy. Our results quantify the competition between early prognosis and high prediction accuracy that is frequently encountered by clinicians.

Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies?

Science.gov (United States)

Abraham, George P; Das, Krishanu; Ramaswami, Krishnamohan; Siddaiah, Avinash T; George, Datson P; Abraham, Jisha J; Thampan, Oppukeril S

2012-05-01

To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2). The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared. Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42). The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable. Copyright © 2012 Elsevier Inc. All rights reserved.

Functional outcomes in patients with chronic obstructive pulmonary disease: a multivariate analysis

Directory of Open Access Journals (Sweden)

Filipe T. S. Athayde

2014-01-01

Full Text Available Background: Multiple factors can influence the severity of chronic obstructive pulmonary disease (COPD and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. Objective: To evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ in COPD patients. Method: Participants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second - FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score were considered. Results: The best regression model for predicting the SGRQ activity score (r2=0.477 included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r2=0.426 included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions: The results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters.

Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study.

Science.gov (United States)

Knowles, Rachel Louise; Tadic, Valerija; Hogan, Ailbhe; Bull, Catherine; Rahi, Jugnoo Sangeeta; Dezateux, Carol

2016-01-01

Understanding children's views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a 'heart problem'. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10-14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling 'different', whereas children with less severe diagnoses often characterised their CHD as 'not a big thing'. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD 'in the past' or experienced a sense of survivorship. Children's reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children's concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to optimising participation. We highlight the potential for informing

Levothyroxine Poisoning - Symptoms and Clinical Outcome

DEFF Research Database (Denmark)

Nygaard, Birgitte; Saedder, Eva A; Dalhoff, Kim

2015-01-01

Levothyroxine (LT), T4, poisoning is rarely associated with a severe outcome. However, cases with significant complications have been reported. The aim of this study was to identify factors associated with symptoms of poisoning including late-onset symptoms. All enquiries to the Danish Poison...... Information Centre (DPIC) concerning LT poisoning between March 2007 and September 2012 were reviewed and the following parameters were recorded: age, dose, time from ingestion, multiple drug intake and symptoms. To evaluate the frequency of late-onset symptoms, a subgroup of patients without initial symptoms...... patients, neither in children nor in adults (age 16-92 years) (p poisoning at the time of enquiry; however, in 9 of 21 (43%) patients, we were able to contact, late-onset symptoms existed. In none of the cases...

Volumetric and MGMT parameters in glioblastoma patients: Survival analysis

International Nuclear Information System (INIS)

Iliadis, Georgios; Kotoula, Vassiliki; Chatzisotiriou, Athanasios; Televantou, Despina; Eleftheraki, Anastasia G; Lambaki, Sofia; Misailidou, Despina; Selviaridis, Panagiotis; Fountzilas, George

2012-01-01

In this study several tumor-related volumes were assessed by means of a computer-based application and a survival analysis was conducted to evaluate the prognostic significance of pre- and postoperative volumetric data in patients harboring glioblastomas. In addition, MGMT (O 6 -methylguanine methyltransferase) related parameters were compared with those of volumetry in order to observe possible relevance of this molecule in tumor development. We prospectively analyzed 65 patients suffering from glioblastoma (GBM) who underwent radiotherapy with concomitant adjuvant temozolomide. For the purpose of volumetry T1 and T2-weighted magnetic resonance (MR) sequences were used, acquired both pre- and postoperatively (pre-radiochemotherapy). The volumes measured on preoperative MR images were necrosis, enhancing tumor and edema (including the tumor) and on postoperative ones, net-enhancing tumor. Age, sex, performance status (PS) and type of operation were also included in the multivariate analysis. MGMT was assessed for promoter methylation with Multiplex Ligation-dependent Probe Amplification (MLPA), for RNA expression with real time PCR, and for protein expression with immunohistochemistry in a total of 44 cases with available histologic material. In the multivariate analysis a negative impact was shown for pre-radiochemotherapy net-enhancing tumor on the overall survival (OS) (p = 0.023) and for preoperative necrosis on progression-free survival (PFS) (p = 0.030). Furthermore, the multivariate analysis confirmed the importance of PS in PFS and OS of patients. MGMT promoter methylation was observed in 13/23 (43.5%) evaluable tumors; complete methylation was observed in 3/13 methylated tumors only. High rate of MGMT protein positivity (> 20% positive neoplastic nuclei) was inversely associated with pre-operative tumor necrosis (p = 0.021). Our findings implicate that volumetric parameters may have a significant role in the prognosis of GBM patients. Furthermore

Methodological issues in radiation dose-volume outcome analyses: Summary of a joint AAPM/NIH workshop

International Nuclear Information System (INIS)

Deasy, Joseph O.; Niemierko, Andrzej; Herbert, Donald; Yan, Di; Jackson, Andrew; Ten Haken, Randall K.; Langer, Mark; Sapareto, Steve

2002-01-01

This report represents a summary of presentations at a joint workshop of the National Institutes of Health and the American Association of Physicists in Medicine (AAPM). Current methodological issues in dose-volume modeling are addressed here from several different perspectives. Areas of emphasis include (a) basic modeling issues including the equivalent uniform dose framework and the bootstrap method, (b) issues in the valid use of statistics, including the need for meta-analysis, (c) issues in dealing with organ deformation and its effects on treatment response, (d) evidence for volume effects for rectal complications, (e) the use of volume effect data in liver and lung as a basis for dose escalation studies, and (f) implications of uncertainties in volume effect knowledge on optimized treatment planning. Taken together, these approaches to studying volume effects describe many implications for the development and use of this information in radiation oncology practice. Areas of significant interest for further research include the meta-analysis of clinical data; interinstitutional pooled data analyses of volume effects; analyses of the uncertainties in outcome prediction models, minimal parameter number outcome models for ranking treatment plans (e.g., equivalent uniform dose); incorporation of the effect of motion in the outcome prediction; dose-escalation/isorisk protocols based on outcome models; the use of functional imaging to study radio-response; and the need for further small animal tumor control probability/normal tissue complication probability studies

Hashimoto's thyroiditis predicts outcome in intrathyroidal papillary thyroid cancer.

Science.gov (United States)

Marotta, Vincenzo; Sciammarella, Concetta; Chiofalo, Maria Grazia; Gambardella, Claudio; Bellevicine, Claudio; Grasso, Marica; Conzo, Giovanni; Docimo, Giovanni; Botti, Gerardo; Losito, Simona; Troncone, Giancarlo; De Palma, Maurizio; Giacomelli, Laura; Pezzullo, Luciano; Colao, Annamaria; Faggiano, Antongiulio

2017-09-01

Hashimoto's thyroiditis (HT) seems to have favourable prognostic impact on papillary thyroid cancer (PTC), but data were obtained analysing all disease stages. Given that HT-related microenvironment involves solely the thyroid, we aimed to assess the relationship between HT, as detected through pathological assessment, and outcome in intrathyroidal PTC. This was a multicentre, retrospective, observational study including 301 PTC with no evidence of extrathyroidal disease. Primary study endpoint was the rate of clinical remission. Auxiliary endpoint was recurrence-free survival (RFS). HT was detected in 42.5% of the cohort and was associated to female gender, smaller tumour size, lower rate of aggressive PTC variants and less frequent post-surgery radio-iodine administration. HT showed relationship with significantly higher rate of clinical remission ( P  < 0.001, OR 4, 95% CI 1.78-8.94). PTCs with concomitant HT had significantly longer RFS, as compared with non-HT tumours ( P  = 0.004). After adjustment for other parameters affecting disease outcome at univariate analysis (age at diagnosis, histology, tumour size and multifocality), prognostic effect of HT remained significant ( P  = 0.006, OR 3.28, 95% CI 1.39-7.72). To verify whether HT could optimise the identification of PTCs with unfavourable outcome, we assessed the accuracy of 'non-HT status' as negative prognostic marker, demonstrating poor capability of identifying patients not maintaining clinical remission until final follow-up (probability of no clinical remission in PTCs without HT: 21.05%, 95% CI 15.20-27.93). In conclusion, our data show that HT represents an independent prognostic parameter in intrathyroidal PTC, but cannot improve prognostic specificity. © 2017 Society for Endocrinology.

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.

Significance of combined nutritional and morphological precaecal parameters for feed evaluations in non-ruminants

NARCIS (Netherlands)

Leeuwen, van P.

2002-01-01

In this thesis the hypothesis is tested that the nutritional evaluation of dietary formulations in non-ruminants requires both functional-nutritional and functional-morphological parameters. The functional-nutritional parameters provide data on the outcome of the

Outcome in Chronic Subdural Hematoma After Subdural vs. Subgaleal Drain.

Science.gov (United States)

Ishfaq, Asim

2017-07-01

To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. Quasi experimental study. Combined Military Hospital, Lahore, from July 2015 to June 2016. Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space (Group 1), and subdual space (Group 2), (n=31 patients each). Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p hematoma was 15 ±6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 (35.4%) vs. 6 (19.3%), and intracerebral hemorrhage 4 (12.9%) vs. 2 (6.4%). Clinical outcome was good in both groups 27 (87%) in Group 1 and 28 (90%) in Group 2. Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another.

Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease.

Science.gov (United States)

Hanlon, I; Hewitt, C; Bell, K; Phillips, A; Mikocka-Walus, A

2018-06-14

Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases. © 2018 John Wiley & Sons Ltd.

A longitudinal analysis of nursing home outcomes.

Science.gov (United States)

Porell, F; Caro, F G; Silva, A; Monane, M

1998-10-01

To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures.

A comparison between two powder compaction parameters of plasticity: the effective medium A parameter and the Heckel 1/K parameter.

Science.gov (United States)

Mahmoodi, Foad; Klevan, Ingvild; Nordström, Josefina; Alderborn, Göran; Frenning, Göran

2013-09-10

The purpose of the research was to introduce a procedure to derive a powder compression parameter (EM A) representing particle yield stress using an effective medium equation and to compare the EM A parameter with the Heckel compression parameter (1/K). 16 pharmaceutical powders, including drugs and excipients, were compressed in a materials testing instrument and powder compression profiles were derived using the EM and Heckel equations. The compression profiles thus obtained could be sub-divided into regions among which one region was approximately linear and from this region, the compression parameters EM A and 1/K were calculated. A linear relationship between the EM A parameter and the 1/K parameter was obtained with a strong correlation. The slope of the plot was close to 1 (0.84) and the intercept of the plot was small in comparison to the range of parameter values obtained. The relationship between the theoretical EM A parameter and the 1/K parameter supports the interpretation of the empirical Heckel parameter as being a measure of yield stress. It is concluded that the combination of Heckel and EM equations represents a suitable procedure to derive a value of particle plasticity from powder compression data. Copyright © 2013 Elsevier B.V. All rights reserved.

The influence of age, duration of symptoms and duration of operation on outcome after appendicitis in children

DEFF Research Database (Denmark)

Bech-Larsen, Sandra Julia; Lalla, Marianna; Thorup, Jørgen M

2013-01-01

The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis.......The aim of the study was to evaluate the impact of any perioperative parameters on the outcome of treatment for appendicitis....

Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era.

Science.gov (United States)

Daviaud, Fabrice; Dumas, Florence; Demars, Nadège; Geri, Guillaume; Bouglé, Adrien; Morichau-Beauchant, Tristan; Nguyen, Yên-Lan; Bougouin, Wulfran; Pène, Frédéric; Charpentier, Julien; Cariou, Alain

2014-06-01

The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors. We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome. Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1-2). Median BG level was 7.6 mmol/L (6.3-9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1-10.6) for patients with an unfavorable outcome (p level variation was 7.1 (4.2-11) and 9.6 (5.9-13.6) mmol/L in patients with and without a favorable outcome, respectively (p level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24-0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome. We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.

Use of artificial neural networks to predict biological outcomes for patients receiving radical radiotherapy of the prostate

International Nuclear Information System (INIS)

Gulliford, Sarah L.; Webb, Steve; Rowbottom, Carl G.; Corne, David W.; Dearnaley, David P.

2004-01-01

Background and purpose: This paper discusses the application of artificial neural networks (ANN) in predicting biological outcomes following prostate radiotherapy. A number of model-based methods have been developed to correlate the dose distributions calculated for a patient receiving radiotherapy and the radiobiological effect this will produce. Most widely used are the normal tissue complication probability and tumour control probability models. An alternative method for predicting specific examples of tumour control and normal tissue complications is to use an ANN. One of the advantages of this method is that there is no need for a priori information regarding the relationship between the data being correlated. Patients and methods: A set of retrospective clinical data from patients who received radical prostate radiotherapy was used to train ANNs to predict specific biological outcomes by learning the relationship between the treatment plan prescription, dose distribution and the corresponding biological effect. The dose and volume were included as a differential dose-volume histogram in order to provide a holistic description of the available data. Results: It was shown that the ANNs were able to predict biochemical control and specific bladder and rectum complications with sensitivity and specificity of above 55% when the outcomes were dichotomised. It was also possible to analyse information from the ANNs to investigate the effect of individual treatment parameters on the outcome. Conclusion: ANNs have been shown to learn something of the complex relationship between treatment parameters and outcome which, if developed further, may prove to be a useful tool in predicting biological outcomes

Impact of cachexia on outcomes in aggressive lymphomas.

Science.gov (United States)

Karmali, Reem; Alrifai, Taha; Fughhi, Ibtihaj A M; Ng, Ronald; Chukkapalli, Vineela; Shah, Palmi; Basu, Sanjib; Nathan, Sunita; Szymanski-Grant, Kelly; Gordon, Leo I; Venugopal, Parameswaran; Penedo, Frank J; Borgia, Jeffrey A

2017-06-01

Cancer cachexia is defined as a state of involuntary weight loss, attributed to altered body composition with muscle mass loss and/or loss of adiposity. Identifying the association between cancer cachexia and outcomes may pave the way for novel agents that target the cancer cachexia process. Clinical parameters for measurement of cancer cachexia are needed. We conducted a single-institution retrospective analysis that included 86 NHL patients with the aim of identifying an association between cancer cachexia and outcomes in aggressive lymphomas using the cachexia index (CXI) suggested by Jafri et al. (Clin Med Insights Oncol 9:87-93, 15). Impact of cachexia factors on progression-free survival (PFS) and overall survival (OS) were assessed using log-rank test and Cox proportional hazards regression. Patients were dichotomized around the median CXI into "non-cachectic" (CXI ≥49.8, n = 41) and "cachectic" (CXI Cachexia as defined by the CXI is prognostic in aggressive lymphomas and implies that novel therapeutic strategies directed at reversing cachexia may improve survival in this population.

Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-11-01

Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal achalasia. The subjects were 36 patients with sigmoid esophageal achalasia who had been observed for >1 year after surgery. The subjects were divided into sigmoid type (Sg) and advanced sigmoid type (aSg) groups based on the flexion level of the lower esophagus to compare their clinical parameters and surgical outcomes. The Sg and aSg groups included 26 (72%) and 10 subjects, respectively. There were no marked differences in the clinical parameters or surgical outcomes between the two groups. However, the clearance rate calculated using the timed barium esophagogram was lower in the aSg group than in the Sg group. No differences were found in the postoperative symptom scores between the two groups, and both reported a high level of satisfaction. Although laparoscopic surgery for symptoms of sigmoid esophageal achalasia was highly successful regardless of the flexion level, the improvement in esophageal clearance was lower when the flexion level was higher.

Dataset for Phase I randomized clinical trial for safety and tolerability of GET 73 in single and repeated ascending doses including preliminary pharmacokinetic parameters.

Science.gov (United States)

Haass-Koffler, Carolina L; Goodyear, Kimberly; Long, Victoria M; Tran, Harrison H; Loche, Antonella; Cacciaglia, Roberto; Swift, Robert M; Leggio, Lorenzo

2017-12-01

The data in this article outline the methods used for the administration of GET 73 in the first time-in-human manuscript entitled "Phase I randomized clinical trial for the safety, tolerability and preliminary pharmacokinetics of the mGluR5 negative allosteric modulator GET 73 following single and repeated doses in healthy male volunteers" (Haass-Koffler et al., 2017) [1]. Data sets are provided in two different manners. The first series of tables provided includes procedural information about the experiments conducted. The next series of tables provided includes Pharmacokinetic (PK) parameters for GET 73 and its main metabolite MET 2. This set of data is comprised by two experiments: Experiment 1 references a single ascending dose administration of GET 73 and Experiment 2 references a repeated ascending dose administration of GET 73.

The association between smoking and breast cancer characteristics and outcome.

Science.gov (United States)

Goldvaser, Hadar; Gal, Omer; Rizel, Shulamith; Hendler, Daniel; Neiman, Victoria; Shochat, Tzippy; Sulkes, Aaron; Brenner, Baruch; Yerushalmi, Rinat

2017-09-06

Smoking is associated with an increased incidence of hormone receptor positive breast cancer. Data regarding worse breast cancer outcome in smokers are accumulating. Current literature regarding the impact of smoking on breast cancer characteristics is limited. We evaluated the impact of smoking on breast cancer characteristics and outcome. This was a retrospective single center study. All women diagnosed from 4/2005 through 3/2012 and treated in our institute for early, estrogen receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer, whose tumors were sent for Oncotype DX analysis were included. Medical records were reviewed for demographics, clinico-pathological parameters, treatment and outcome. Data regarding smoking were retrieved according to patients' history at the first visit in the oncology clinic. Patients were grouped and compared according to smoking history (ever smokers vs. never smokers), smoking status (current vs. former and never smokers) and smoking intensity (pack years ≥30 vs. the rest of the cohort). Outcomes were adjusted in multivariate analyses and included age, menopausal status, ethnicity, tumor size, nodal status and grade. A total of 662 women were included. 28.2% had a history of smoking, 16.6% were current smokers and 11.3% were heavy smokers. Smoking had no impact on tumor size, nodal involvement and Oncotype DX recurrence score. Angiolymphatic and perineural invasion rates were higher in current smokers than in the rest of the cohort (10.4% vs. 5.1%, p = 0.045, 8.3% vs. 3.5%, p = 0.031, respectively). Smoking had no other impact on histological characteristics. Five-year disease free survival and overall survival rates were 95.7% and 98.5%, respectively. Smoking had no impact on outcomes. Adjusted disease free survival and overall survival did not influence the results. Smoking had no clinically significant influence on tumor characteristics and outcome among women with estrogen receptor

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

Directory of Open Access Journals (Sweden)

Koen Degeling

2017-12-01

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

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

Science.gov (United States)

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

2017-12-15

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

outcome of laparotomy for peritonitis in 302 consecutive patients in ...

African Journals Online (AJOL)

2012-12-31

Dec 31, 2012 ... an adverse outcome and presentation with shock, anaemia, jaundice and oliguria. Conclusion: The factors influencing .... Cancer of the ascending colon. 3. 1.0. Ruptured mesenteric cyst ... 75(25.0%). Table 3: Pre and post-operative clinical and biochemical parameters of the patients. Parameters. P Value.

A reanalysis of a behavioral intervention to prevent incident HIV infections: Including indirect effects in modeling outcomes of Project EXPLORE

Science.gov (United States)

Eaton, Lisa A.; Kalichman, Seth C.; Kenny, David A.; Harel, Ofer

2013-01-01

Background Project EXPLORE -- a large-scale, behavioral intervention tested among men who have sex with men (MSM) at-risk for HIV infection --was generally deemed as ineffective in reducing HIV incidence. Using novel and more precise data analytic techniques we reanalyzed Project EXPLORE by including both direct and indirect paths of intervention effects. Methods Data from 4,296 HIV negative MSM who participated in Project EXPLORE, which included ten sessions of behavioral risk reduction counseling completed from 1999-2005, were included in the analysis. We reanalyzed the data to include parameters that estimate the overtime effects of the intervention on unprotected anal sex and the over-time effects of the intervention on HIV status mediated by unprotected anal sex simultaneously in a single model. Results We found the indirect effect of intervention on HIV infection through unprotected anal sex to be statistically significant up through 12 months post-intervention, OR=.83, 95% CI=.72-.95. Furthermore, the intervention significantly reduced unprotected anal sex up through 18 months post-intervention, OR=.79, 95% CI=.63-.99. Discussion Our results reveal effects not tested in the original model that offer new insight into the effectiveness of a behavioral intervention for reducing HIV incidence. Project EXPLORE demonstrated that when tested against an evidence-based, effective control condition can result in reductions in rates of HIV acquisition at one year follow-up. Findings highlight the critical role of addressing behavioral risk reduction counseling in HIV prevention. PMID:23245226

Modifying the Sleep Treatment Education Program for Students to include technology use (STEPS-TECH): Intervention effects on objective and subjective sleep outcomes.

Science.gov (United States)

Barber, Larissa K; Cucalon, Maria S

2017-12-01

University students often have sleep issues that arise from poor sleep hygiene practices and technology use patterns. Yet, technology-related behaviors are often neglected in sleep hygiene education. This study examined whether the Sleep Treatment Education Program for Students-modified to include information regarding managing technology use (STEPS-TECH)-helps improve both subjective and objective sleep outcomes among university students. Results of an experimental study among 78 university students showed improvements in objective indicators of sleep quantity (total sleep time) and sleep quality (less awakenings) during the subsequent week for students in the STEPS-TECH intervention group compared to a control group. Exploratory analyses indicated that effects were driven by improvements in weekend days immediately following the intervention. There were also no intervention effects on subjective sleep quality or quantity outcomes. In terms of self-reported behavioral responses to educational content in the intervention, there were no group differences in sleep hygiene practices or technology use before bedtime. However, the intervention group reported less technology use during sleep periods than the control group. These preliminary findings suggest that STEPS-TECH may be a useful educational tool to help improve objective sleep and reduce technology use during sleep periods among university students. Copyright © 2017 John Wiley & Sons, Ltd.

Relationship between Peeled Internal Limiting Membrane Area and Anatomic Outcomes following Macular Hole Surgery: A Quantitative Analysis

Directory of Open Access Journals (Sweden)

Yasin Sakir Goker

2016-01-01

Full Text Available Purpose. To quantitatively evaluate the effects of peeled internal limiting membrane (ILM area and anatomic outcomes following macular hole surgery using spectral domain optical coherence tomography (SD-OCT. Methods. Forty-one eyes in 37 consecutive patients with idiopathic, Gass stage 3-4 macular hole (MH were enrolled in this retrospective comparative study. All patients were divided into 2 groups according to anatomic success or failure. Basal MH diameter, peeled ILM area, and MH height were calculated using SD-OCT. Other prognostic parameters, including age, stage, preoperative BCVA, and symptom duration were also assessed. Results. Thirty-two cases were classified as anatomic success, and 9 cases were classified as anatomic failure. Peeled ILM area was significantly wider and MH basal diameter was significantly less in the anatomic success group (p=0.024 and 0.032, resp.. Other parameters did not demonstrate statistical significance. Conclusion. The findings of the present study show that the peeled ILM area can affect the anatomic outcomes of MH surgery.

HEMODYNAMIC DOPPLER PARAMETERS IN THE FETUS FETOPLACENTAL UNIT WITH INTRAUTERINE GROWTH RESTRICTIONWITHIN PREGNANCY INDUCED HYPERTENSION

Directory of Open Access Journals (Sweden)

Snezana Stamenovic

2005-04-01

Full Text Available Based on the spectral analysis of Doppler velocity waveform in uteroplacental and fetoplacental circulation, a Doppler parameters diagnostic efficiency was examined in fetus prenatal detection with intrauterine growth restriction (IUGR within Pregnancy Induced Hypertension (PIH and their respiratory menace.A prospective analysis was performed in 141 third-trimester pregnancies. The control group included 65 normal pregnancies and the expeimental group included 76 high-risk pregnancies, which was divided into three sub-groups, namely, 31 with IUGR within PIH, 24 with PIH only and 21 with IUGR only. The uterine artery was examined in uteroplacental circulation and umbilical artery was examined in fetoplacental circulation. Perinatal outcome and birth weight were recorded in each case.Uteroplacental circulation analysis showed statistically higer values of Pourcelot resistance index Ri in uterine artery in IUGR within PIH pregnancies. Statistically higher pulsatility index in umbilical artery was recorded in IUGR pregnancies compared to the control group and PIH subgroup. Higher values of pulsatility index were particulary noticed in IUGR within PIH subgroup. Doppler parameters in uteroplacental and fetoplacental circulation showed a significant negative correlation in relation to Apgar score of the newborn.In combination with biophysical profile and CTG, Doppler parameters diagnostic efficiency is increased on the evaluation of the fetus respiratory menace with IUGR and PIH.

Uncertainty analysis of flexible rotors considering fuzzy parameters and fuzzy-random parameters

Directory of Open Access Journals (Sweden)

Fabian Andres Lara-Molina

Full Text Available Abstract The components of flexible rotors are subjected to uncertainties. The main sources of uncertainties include the variation of mechanical properties. This contribution aims at analyzing the dynamics of flexible rotors under uncertain parameters modeled as fuzzy and fuzzy random variables. The uncertainty analysis encompasses the modeling of uncertain parameters and the numerical simulation of the corresponding flexible rotor model by using an approach based on fuzzy dynamic analysis. The numerical simulation is accomplished by mapping the fuzzy parameters of the deterministic flexible rotor model. Thereby, the flexible rotor is modeled by using both the Fuzzy Finite Element Method and the Fuzzy Stochastic Finite Element Method. Numerical simulations illustrate the methodology conveyed in terms of orbits and frequency response functions subject to uncertain parameters.

Relationship between brain function (aEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants.

Science.gov (United States)

Hüning, Britta; Storbeck, Tobias; Bruns, Nora; Dransfeld, Frauke; Hobrecht, Julia; Karpienski, Julia; Sirin, Selma; Schweiger, Bernd; Weiss, Christel; Felderhoff-Müser, Ursula; Müller, Hanna

2018-05-22

To improve the prediction of neurodevelopmental outcome in very preterm infants, this study used the combination of amplitude-integrated electroencephalography (aEEG) within the first 72 h of life and cranial magnetic resonance imaging (MRI) at term equivalent age. A single-center cohort of 38 infants born before 32 weeks of gestation was subjected to both investigations. Structural measurements were performed on MRI. Multiple regression analysis was used to identify independent factors including functional and structural brain measurements associated with outcome at a corrected age of 24 months. aEEG parameters significantly correlated with MRI measurements. Reduced deep gray matter volume was associated with low Burdjalov Score on day 3 (p neurodevelopmental outcome: intraventricular hemorrhage (p = 0.0060) and interhemispheric distance (p = 0.0052) for mental developmental index; Burdjalov Score day 1 (p = 0.0201) and interhemispheric distance (p = 0.0142) for psychomotor developmental index. Functional aEEG parameters were associated with altered brain maturation on MRI. The combination of aEEG and MRI contributes to the prediction of outcome at 24 months. What is Known: • Prematurity remains a risk factor for impaired neurodevelopment. • aEEG is used to measure brain activity in preterm infants and cranial MRI is performed to identify structural gray and white matter abnormalities with impact on neurodevelopmental outcome. What is New: • aEEG parameters observed within the first 72 h of life were associated with altered deep gray matter volumes, biparietal width, and transcerebellar diameter at term equivalent age. • The combination of aEEG and MRI contributes to the prediction of neurodevelopmental outcome at 2 years of corrected age in very preterm infants.

Renal mass anatomic characteristics and perioperative outcomes of laparoscopic partial nephrectomy: a critical analysis.

Science.gov (United States)

Tsivian, Matvey; Ulusoy, Said; Abern, Michael; Wandel, Ayelet; Sidi, A Ami; Tsivian, Alexander

2012-10-01

Anatomic parameters determining renal mass complexity have been used in a number of proposed scoring systems despite lack of a critical analysis of their independent contributions. We sought to assess the independent contribution of anatomic parameters on perioperative outcomes of laparoscopic partial nephrectomy (LPN). Preoperative imaging studies were reviewed for 147 consecutive patients undergoing LPN for a single renal mass. Renal mass anatomy was recorded: Size, growth pattern (endo-/meso-/exophytic), centrality (central/hilar/peripheral), anterior/posterior, lateral/medial, polar location. Multivariable models were used to determine associations of anatomic parameters with warm ischemia time (WIT), operative time (OT), estimated blood loss (EBL), intra- and postoperative complications, as well as renal function. All models were adjusted for the learning curve and relevant confounders. Median (range) tumor size was 3.3 cm (1.5-11 cm); 52% were central and 14% hilar. While 44% were exophytic, 23% and 33% were mesophytic and endophytic, respectively. Anatomic parameters did not uniformly predict perioperative outcomes. WIT was associated with tumor size (P=0.068), centrality (central, P=0.016; hilar, P=0.073), and endophytic growth pattern (P=0.017). OT was only associated with tumor size (Panatomic parameter predicted EBL. Tumor centrality increased the odds of overall and intraoperative complications, without reaching statistical significance. Postoperative renal function was not associated with any of the anatomic parameters considered after adjustment for baseline function and WIT. Learning curve, considered as a confounder, was independently associated with reduced WIT and OT as well as reduced odds of intraoperative complications. This study provides a detailed analysis of the independent impact of renal mass anatomic parameters on perioperative outcomes. Our findings suggest diverse independent contributions of the anatomic parameters to the

Methods for measurement of durability parameters

DEFF Research Database (Denmark)

Hansen, Ernst Jan De Place

1996-01-01

Present selected methods for measurement of durabilty parameters relating to chlorides, corrosion, moisture and freeze-thaw, primarly on concrete. Advantages and drawbacks of the different methods are included.......Present selected methods for measurement of durabilty parameters relating to chlorides, corrosion, moisture and freeze-thaw, primarly on concrete. Advantages and drawbacks of the different methods are included....

Outcome prediction in pneumonia induced ALI/ARDS by clinical features and peptide patterns of BALF determined by mass spectrometry.

Science.gov (United States)

Frenzel, Jochen; Gessner, Christian; Sandvoss, Torsten; Hammerschmidt, Stefan; Schellenberger, Wolfgang; Sack, Ulrich; Eschrich, Klaus; Wirtz, Hubert

2011-01-01

Peptide patterns of bronchoalveolar lavage fluid (BALF) were assumed to reflect the complex pathology of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) better than clinical and inflammatory parameters and may be superior for outcome prediction. A training group of patients suffering from ALI/ARDS was compiled from equal numbers of survivors and nonsurvivors. Clinical history, ventilation parameters, Murray's lung injury severity score (Murray's LISS) and interleukins in BALF were gathered. In addition, samples of bronchoalveolar lavage fluid were analyzed by means of hydrophobic chromatography and MALDI-ToF mass spectrometry (MALDI-ToF MS). Receiver operating characteristic (ROC) analysis for each clinical and cytokine parameter revealed interleukin-6>interleukin-8>diabetes mellitus>Murray's LISS as the best outcome predictors. Outcome predicted on the basis of BALF levels of interleukin-6 resulted in 79.4% accuracy, 82.7% sensitivity and 76.1% specificity (area under the ROC curve, AUC, 0.853). Both clinical parameters and cytokines as well as peptide patterns determined by MALDI-ToF MS were analyzed by classification and regression tree (CART) analysis and support vector machine (SVM) algorithms. CART analysis including Murray's LISS, interleukin-6 and interleukin-8 in combination was correct in 78.0%. MALDI-ToF MS of BALF peptides did not reveal a single identifiable biomarker for ARDS. However, classification of patients was successfully achieved based on the entire peptide pattern analyzed using SVM. This method resulted in 90% accuracy, 93.3% sensitivity and 86.7% specificity following a 10-fold cross validation (AUC = 0.953). Subsequent validation of the optimized SVM algorithm with a test group of patients with unknown prognosis yielded 87.5% accuracy, 83.3% sensitivity and 90.0% specificity. MALDI-ToF MS peptide patterns of BALF, evaluated by appropriate mathematical methods can be of value in predicting outcome in pneumonia induced

Vision Problems and Reduced Reading Outcomes in Queensland Schoolchildren.

Science.gov (United States)

Hopkins, Shelley; Sampson, Geoff P; Hendicott, Peter L; Wood, Joanne M

2017-03-01

To assess the relationship between vision and reading outcomes in Indigenous and non-Indigenous schoolchildren to determine whether vision problems are associated with lower reading outcomes in these populations. Vision testing and reading assessments were performed on 508 Indigenous and non-Indigenous schoolchildren in Queensland, Australia divided into two age groups: Grades 1 and 2 (6-7 years of age) and Grades 6 and 7 (12-13 years of age). Vision parameters measured included cycloplegic refraction, near point of convergence, heterophoria, fusional vergence range, rapid automatized naming, and visual motor integration. The following vision conditions were then classified based on the vision findings: uncorrected hyperopia, convergence insufficiency, reduced rapid automatized naming, and delayed visual motor integration. Reading accuracy and reading comprehension were measured with the Neale reading test. The effect of uncorrected hyperopia, convergence insufficiency, reduced rapid automatized naming, and delayed visual motor integration on reading accuracy and reading comprehension were investigated with ANCOVAs. The ANCOVAs explained a significant proportion of variance in both reading accuracy and reading comprehension scores in both age groups, with 40% of the variation in reading accuracy and 33% of the variation in reading comprehension explained in the younger age group, and 27% and 10% of the variation in reading accuracy and reading comprehension, respectively, in the older age group. The vision parameters of visual motor integration and rapid automatized naming were significant predictors in all ANCOVAs (P reading results were explained by reduced visual motor integration and rapid automatized naming results. Both reduced rapid automatized naming and visual motor integration were associated with poorer reading outcomes in Indigenous and non-Indigenous children. This is an important finding given the recent emphasis placed on Indigenous children

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

Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).

Science.gov (United States)

Herthel, T D; Rick, M C; Judy, C E; Cohen, N D; Herthel, D J

2016-09-01

Outcomes associated with arthrodesis of the proximal interphalangeal (PIP) joint in Quarter Horses used for Western performance activities are well documented but little is known regarding outcomes for other types of horses. To identify factors associated with outcomes, including breed and activity, after arthrodesis of the PIP joint in Warmbloods, Thoroughbreds and Quarter Horses. Retrospective case series. Surgical case records of 82 Quarter Horses principally engaged in Western performance and Thoroughbred or Warmblood breeds principally engaged in showing, showjumping and dressage, with arthrodesis of the PIP joint were reviewed. Arthrodesis was performed with either 3 transarticular cortex bone screws placed in lag fashion, a dynamic compression plate (DCP) with 2 transarticular cortex bone screws placed in lag fashion, or a locking compression plate (LCP) with 2 transarticular cortex bone screws placed in lag fashion. Demographic data, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow-up was obtained for all 82 horses. Osteoarthritis of the PIP joint was the most common presenting condition requiring arthrodesis, which was performed with either the 3 screw technique (n = 41), DCP fixation (n = 22), or LCP fixation (n = 19). Post operatively, 23/31 (74%) Warmbloods/Thoroughbreds and 44/51 (87%) Quarter Horses achieved successful outcomes. Thirteen of 23 (57%) Warmbloods/Thoroughbreds and 24 of 38 (63%) Quarter Horses, used for athletic performance, returned to successful competition. Within this subgroup of horses engaged in high-level activity, regardless of breed type, horses undergoing hindlimb arthrodesis were significantly more likely to return to successful competition (73%; 33/45) than those with forelimb arthrodesis (25%; 4/16, P = 0.002). Arthrodesis of the PIP joint in Warmbloods/Thoroughbreds and Quarter Horses results in a favourable outcome for return to

Effects of Mindfulness Practice on Performance-Relevant Parameters and Performance Outcomes in Sports: A Meta-Analytical Review.

Science.gov (United States)

Bühlmayer, Lucia; Birrer, Daniel; Röthlin, Philipp; Faude, Oliver; Donath, Lars

2017-11-01

-distance runners, shooters, sprinters, volleyball players) were included. Intervention time varied from 4 weeks to over 2 years. The practice frequency lasted from twice daily to just once a week, and the mean session time covered 50-60 min. In favor of mindfulness practice compared with the control condition, large effects with narrow confidence limits and low heterogeneity were found for mindfulness scores [SMD 1.03, 90% confidence interval (CI) 0.67-1.40, p performance indices depicted wide confidence limits accompanied with very large heterogeneity. However, the effect sizes remained very large, with confidence limits that did not overlap zero (SMD 3.62, 90% CI 0.03-7.21, p = 0.10, I 2  = 98%). Moderate to large effects were observed for both psychological performance surrogates (SMD 0.72, 90% CI 0.46-0.98, p performance outcomes in shooting and dart throwing (SMD 1.35, 90% CI 0.61-2.09, p = 0.003, I 2  = 82%). Mindfulness practice consistently and beneficially modulates mindfulness scores. Furthermore, physiological and psychological surrogates improved to a meaningful extent following mindfulness practice, as well as performance outcomes in shooting and dart throwing. It seems reasonable to consider mindfulness practice strategies as a regular complementary mental skills training approach for athletes, at least in precision sports; however, more high-quality, randomized, controlled trials on mindfulness practice and performance improvements in diverse sport settings are needed.

Verification of the security analysis including uncertainty in uncertain parameters; Verificacion del Analisis de Seguridad incluyendo la Incertidumbre en Parametros Inciertos

Energy Technology Data Exchange (ETDEWEB)

Gomez-Magan, J. J.; Fernandez, I.; Gil, J.; Marrao, H.

2013-07-01

Work has been applied DAKOTA-SCAIS-MAAP-R for a loss of coolant in the primary sequence analysis, considering parameters and times uncertain, in a 3L-PWR plant Westinghouse design; which allows to verify the security analysis where temporary uncertainty represents an important parameter.

Sample Size Calculation: Inaccurate A Priori Assumptions for Nuisance Parameters Can Greatly Affect the Power of a Randomized Controlled Trial.

Directory of Open Access Journals (Sweden)

Elsa Tavernier

Full Text Available We aimed to examine the extent to which inaccurate assumptions for nuisance parameters used to calculate sample size can affect the power of a randomized controlled trial (RCT. In a simulation study, we separately considered an RCT with continuous, dichotomous or time-to-event outcomes, with associated nuisance parameters of standard deviation, success rate in the control group and survival rate in the control group at some time point, respectively. For each type of outcome, we calculated a required sample size N for a hypothesized treatment effect, an assumed nuisance parameter and a nominal power of 80%. We then assumed a nuisance parameter associated with a relative error at the design stage. For each type of outcome, we randomly drew 10,000 relative errors of the associated nuisance parameter (from empirical distributions derived from a previously published review. Then, retro-fitting the sample size formula, we derived, for the pre-calculated sample size N, the real power of the RCT, taking into account the relative error for the nuisance parameter. In total, 23%, 0% and 18% of RCTs with continuous, binary and time-to-event outcomes, respectively, were underpowered (i.e., the real power was 90%. Even with proper calculation of sample size, a substantial number of trials are underpowered or overpowered because of imprecise knowledge of nuisance parameters. Such findings raise questions about how sample size for RCTs should be determined.

Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy:

DEFF Research Database (Denmark)

Bakkegaard, Mads; Johannsen, Finn E; Højgaard, Betina

2015-01-01

eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow...... was statistically associated with a decrease in palpatory pain. CONCLUSION: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT....... intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. RESULTS: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4±2.3mm. Heterogeneity...

Scrub typhus: Clinical spectrum and outcome.

Science.gov (United States)

Venkategowda, Pradeep M; Rao, S Manimala; Mutkule, Dnyaneshwar P; Rao, Mallela V; Taggu, Alai N

2015-04-01

Scrub typhus is one of the differential diagnoses for fever with thrombocytopenia. ARDS associated with Scrub typhus has high morbidity and mortality. To evaluate clinical features, lab values, and outcome in patients with scrub typhus and comparison in patients with or without ARDS. A prospective observational study was conducted on 109 patients with febrile illness and thrombocytopenia during a period of 12 months. All 109 patients were tested with both Immune-chromatography test and Weil felix test. Patients having either Immune-chromatography test/Weil felix test positive have been included and considered as scrub typhus positive whereas negative for both Immune-chromatography and Weil felix test were excluded. Clinical features, lab parameters, and outcome were evaluated in all patients with scrub typhus. Statistical analysis used in this study was T-test. Among 58 patients who were included (After exclusion of 51 patients among total of 109 patients) 34 patients had no ARDS and 24 patients had ARDS. The clinical feature like dyspnoea, cough, low blood pressure (MAPscrub typhus patients group with ARDS. The higher titers of Weil-felix can be correlated with more severe form of disease according to our observation. All 34 Scrub typhus patients without ARDS recovered completely. Among 24 Scrub typhus patients with ARDS, 22 patients recovered, and 2 patients died. Scrub typhus is an important differential diagnosis in a patients having fever with thrombocytopenia. Scrub typhus associated with ARDS has high morbidity and mortality. Early diagnosis and treatment with doxycycline can prevent the occurrence of ARDS.

Including Organizational Cultural Parameters in Work Processes

National Research Council Canada - National Science Library

Handley, Holly A; Heacox, Nancy J

2004-01-01

... between decision-makers of different nationalities. In addition to nationality, a decision-maker is also a member of an organization and brings this organizational culture to his role in the work process, where it may also affect his task performance...

Input parameters and scenarios, including economic inputs

DEFF Research Database (Denmark)

Boklund, Anette; Hisham Beshara Halasa, Tariq

2012-01-01

scenarios, we excluded hobby-type farms1 In the vaccination scenarios, herds within the vaccination zone were simulated to be vaccinated 14 days after detection of the first herd or when 10, 20, 30 or 50 herds were infected. All herds within the zones were simulated to be vaccinated. We used vaccination...... zones of either a 1, 2, 3 or 5 km. In some scenarios, hobby herds were not vaccinated. In one scenario, no sheep were vaccinated, and in another scenario no swine were vaccinated. from depopulation in zones. The resources for depopulation were estimated to 4,800 swine and 2,000 ruminants a day...

Bomb parameters

International Nuclear Information System (INIS)

Kerr, George D.; Young, Rebert W.; Cullings, Harry M.; Christry, Robert F.

2005-01-01

The reconstruction of neutron and gamma-ray doses at Hiroshima and Nagasaki begins with a determination of the parameters describing the explosion. The calculations of the air transported radiation fields and survivor doses from the Hiroshima and Nagasaki bombs require knowledge of a variety of parameters related to the explosions. These various parameters include the heading of the bomber when the bomb was released, the epicenters of the explosions, the bomb yields, and the tilt of the bombs at time of explosion. The epicenter of a bomb is the explosion point in air that is specified in terms of a burst height and a hypocenter (or the point on the ground directly below the epicenter of the explosion). The current reassessment refines the energy yield and burst height for the Hiroshima bomb, as well as the locations of the Hiroshima and Nagasaki hypocenters on the modern city maps used in the analysis of the activation data for neutrons and TLD data for gamma rays. (J.P.N.)

Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients.

Science.gov (United States)

Lopes, Ana Martins; Silva, Diana; Sousa, Gabriela; Silva, Joana; Santos, Alice; Abelha, Fernando José

2017-08-31

Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes. This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression. A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001). A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients. Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive Patients.

Science.gov (United States)

Chowdhury, Enayet K; Jennings, Garry L R; Dewar, Elizabeth; Wing, Lindon M H; Reid, Christopher M

2016-07-01

Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure. Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height(2.7): >115/95g/m(2) (LVH-BSA(115/95)) or ≥49/45g/m(2.7) (LVH-ht(49/45)) in males/females, respectively, and ≥125g/m(2) (LVH-BSA(125)) or ≥51g/m(2.7) (LVH-ht(51)) for both sexes. In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%-70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA(115/95) predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA(115/95) (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12-3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21-3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height(2.7) predicted cardiovascular events over both short and longer term. In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA(115/95) is a reliable predictor of future cardiovascular outcomes in the elderly. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Demographics, Microbiology and Outcome in Necrotizing Soft Tissue Infections

Directory of Open Access Journals (Sweden)

Chance Witt

2013-01-01

Full Text Available Background: Necrotizing soft tissue infections (NSTI are potentially severe infections that have a high morbidity and mortality even with modern medical care. This study examines factors associated with outcomes in patients with NSTI in an academic tertiary care hospital. Design: This is a retrospective cohort study of patients admitted with NSTI between 2003 and 2008. Baseline demographics and comorbid conditions, laboratory and clinical parameters, timing of surgery, and outcomes, including length of stay and mortality, were compared with univariate analysis; significant factors were then analyzed for their effects on mortality using binary logistic regression analysis. Results: Sixty-nine patients with NSTI were analyzed; 61% were men. Diabetes (39% was the most common comorbid condition. Most infections (55% were polymicrobial. The most common organism in monomicrobial infections was Staphylococcus aureus, and 50 % of these isolates were methicillin resistant. Nine patients (13% required amputation. Mortality was 20%, and the most significant predictor of mortality was a higher respiratory rate on admission (p=0.02. Conclusion: Patients in this series frequently had diabetes, usually had polymicrobial infections, and had a 20% mortality rate.

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer

International Nuclear Information System (INIS)

Tamandl, Dietmar; Baltzer, Pascal A.; Ba-Ssalamah, Ahmed; Paireder, Matthias; Asari, Reza; Schoppmann, Sebastian F.

2016-01-01

To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC). 200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery. 130 patients (65 %) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95 % confidence interval [CI] 1.15-3.03, p = 0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95 % CI 1.12-3.28, p = 0.019) and increased FMi (HR 3.47, 95 % CI 1.27-9.50, p = 0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS. Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC. (orig.)

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer

Energy Technology Data Exchange (ETDEWEB)

Tamandl, Dietmar; Baltzer, Pascal A.; Ba-Ssalamah, Ahmed [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center GET-Unit, Vienna (Austria); Paireder, Matthias; Asari, Reza; Schoppmann, Sebastian F. [Medical University of Vienna, Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Vienna (Austria)

2016-05-15

To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC). 200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery. 130 patients (65 %) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95 % confidence interval [CI] 1.15-3.03, p = 0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95 % CI 1.12-3.28, p = 0.019) and increased FMi (HR 3.47, 95 % CI 1.27-9.50, p = 0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS. Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC. (orig.)

Learning Process and Learning Outcomes of Video Podcasts Including the Instructor and PPT Slides: A Chinese Case

Science.gov (United States)

Pi, Zhongling; Hong, Jianzhong

2016-01-01

Video podcasts have become one of the fastest developing trends in learning and teaching. The study explored the effect of the presenting mode of educational video podcasts on the learning process and learning outcomes. Prior to viewing a video podcast, the 94 Chinese undergraduates participating in the study completed a demographic questionnaire…

Triple blind intervention field trial to compare the outcome parameters of the preventive package being administered by community animal health workers

International Nuclear Information System (INIS)

Nazir, F.; Khan, M.A.; Mahmood, A.; Rahman, Z.U.

2009-01-01

A randomized triple blind intervention field/community trial was conducted to compare different outcome parameters like morbidity rate, mortality rate, conception rate, prophylactic/ therapeutic efficacy rate and cost benefit ratio in a dairy cluster of district Kasur and Okara where the community based animal health delivery system was being practiced. In a cluster of 30 villages, 15 villages were selected as interventional group comprising of 1101 dairy animals and rest of the 15 villages as non- interventional control (placebo) group comprising of 9513 dairy animals. In the non-interventional group of villages, vaccinations anthelmintic and mineral mixture administration as a package was not practiced by the community animal health workers(CAHWS). In the intervention villages group, the preventive package was administered at the rate ranging from 95 to 100 %. The result with respect to morbidity rate, morality rate, conception rate and cost- benefit ratio was significantly better (P< 0.05) in the interventional group as compared to the non-interventional group. In both the groups the ratio of cattle and buffaloes ranged between 1:2.72 and 1: 2.82. (author)

Center-size as a predictor of weight-loss outcome in multicenter trials including a low-calorie diet

DEFF Research Database (Denmark)

Gasteyger, Christoph Rolf; Christensen, Robin; Larsen, Thomas Meinert

2010-01-01

weight loss. This is a post hoc analysis of an existing database: 701 obese subjects (77% women, 23% men, mean BMI: 38.9 kg/m(2)) were enrolled at 22 sites (4-85 subjects/site) in five countries to follow a LCD providing 800-1,000 kcal/day during 8 weeks. The main outcome measure was the percentage...

Basal Testosterone and Sex Hormone Binding Globulin Levels in the Prediction of Stimulation Parameters and Cycle Outcome in Cycling Patients Undergoing in Vitro Fertilization

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Özlem Moraloğlu

2010-12-01

CONCLUSION: Basal serum T levels during IVF have a positive correlation with part of the stimulation parameters including number of oocytes retrieved and the number of oocytes transferred. However, neither T nor SHBG has any affect on fertilization or pregnancy rates.

A parameter study to determine the optimal source neutron energy in boron neutron capture therapy of brain tumours

Energy Technology Data Exchange (ETDEWEB)

Nievaart, V A [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Moss, R L [Joint Research Centre of the European Commission, Postbus 2, 1755ZG Petten (Netherlands); Kloosterman, J L [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Hagen, T H J J van der [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands); Dam, H van [Reactor Physics Department, Delft University of Technology, Mekelweg 15, 2629JB Delft (Netherlands)

2004-09-21

The values of the parameters used in boron neutron capture therapy (BNCT) to calculate a given dose to human tissue vary with patients due to different physical, biological and/or medical circumstances. Parameters include the tissue dimensions, the {sup 10}B concentration and the relative biological effectiveness (RBE) factors for the different dose components associated with BNCT. Because there is still no worldwide agreement on RBE values, more often than not, average values for these parameters are used. It turns out that the RBE-problem can be circumvented by taking into account all imaginable parameter values. Approaching this quest from another angle: the outcome will also provide the parameters (and values) which influence the optimal source neutron energy. For brain tumours it turns out that the {sup 10}B concentration, the RBE factors for {sup 10}B as well as fast neutrons, together with the dose limit set for healthy tissue, affect the optimal BNCT source neutron energy. By using source neutrons of a few keV together with neutrons of a few eV, it ensures that, under all imaginable circumstances, a maximum of alpha (and lithium) particles can be delivered in the tumour.

[Outcome-quality of treatment for headache on primary care conditions].

Science.gov (United States)

Lang, E; Eisele, R; Jankowsky, H; Kastner, S; Bickel, A; Martus, P; Neundörfer, B

2000-12-01

Little is known about the outcome-quality of treatment for headache on primary care conditions in Germany. All physicians (2100) of middle franconia, a bavarian greater district with 1,6 Mio. inhabitants, involved in outpatient management were asked to include consecutively patients in the study which suffer from migraine (at least 2 attacks/month) and/or tension type headache (at least 8 days/month) of at least 4 weeks duration. Before and after a 6 months interval patients documented the following outcome data in a questionnaire: pain intensity during the last attack (numeric rating scale), pain dependent disability (Brief Pain Inventory, German version), health related quality of life (SF-36, German version) and depressivity (Allgemeine Depressionsskala). The pain chronification state (Mainz Pain Staging System) has been assessed by the physician. Therapy was not standardized and included the natural spectrum of medicamental and non-medicamental therapy of headache. Agreement of therapy with recommendations of the "Arzneimittelkommission der Deutschen Aerzteschaft" has been assessed. 24 physicians participated in the study. Pre-post-data of 80 patients (46+/-14 y) could be analysed. Initially 67% were classified in pain chronification state I, 27% in state II and 6% in state III. Medicamental therapy agreed with recommendations in approximately 50% of patients, non-medicamental therapy has been used rarely. The pain intensity, pain dependent disability, depression and quality of life improved significantly. 45% and 55% of patients improved in at least 2 of 6 outcome-parameters by 30% of baseline value or by half standard deviation of the corresponding pre-post-differences, respectively. The latter outcome-measure reflects a medium effect size. On primary care conditions about 50% of patients suffering from migraine and/or tension type headache (predominantly low chronification stae) perceive a therapy effect that corresponds to a medium effect size.

Safeguards systems parameters

International Nuclear Information System (INIS)

Avenhaus, R.; Heil, J.

1979-01-01

In this paper analyses are made of the values of those parameters that characterize the present safeguards system that is applied to a national fuel cycle; those values have to be fixed quantitatively so that all actions of the safeguards authority are specified precisely. The analysis starts by introducing three categories of quantities: The design parameters (number of MBAs, inventory frequency, variance of MUF, verification effort and false-alarm probability) describe those quantities whose values have to be specified before the safeguards system can be implemented. The performance criteria (probability of detection, expected detection time, goal quantity) measure the effectiveness of a safeguards system; and the standards (threshold amount and critical time) characterize the magnitude of the proliferation problem. The means by which the values of the individual design parameters can be determined with the help of the performance criteria; which qualitative arguments can narrow down the arbitrariness of the choice of values of the remaining parameters; and which parameter values have to be fixed more or less arbitrarily, are investigated. As a result of these considerations, which include the optimal allocation of a given inspection effort, the problem of analysing the structure of the safeguards system is reduced to an evaluation of the interplay of only a few parameters, essentially the quality of the measurement system (variance of MUF), verification effort, false-alarm probability, goal quantity and probability of detection

Dataset for Phase I randomized clinical trial for safety and tolerability of GET 73 in single and repeated ascending doses including preliminary pharmacokinetic parameters

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Carolina L. Haass-Koffler

2017-12-01

Full Text Available The data in this article outline the methods used for the administration of GET 73 in the first time-in-human manuscript entitled “Phase I randomized clinical trial for the safety, tolerability and preliminary pharmacokinetics of the mGluR5 negative allosteric modulator GET 73 following single and repeated doses in healthy male volunteers” (Haass-Koffler et al., 2017 [1]. Data sets are provided in two different manners. The first series of tables provided includes procedural information about the experiments conducted. The next series of tables provided includes Pharmacokinetic (PK parameters for GET 73 and its main metabolite MET 2. This set of data is comprised by two experiments: Experiment 1 references a single ascending dose administration of GET 73 and Experiment 2 references a repeated ascending dose administration of GET 73. Keywords: Glutamate receptor subtype 5 (mGlu5, Allosteric modulator, GET 73, Safety, Tolerability

Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel.

Science.gov (United States)

Cushen, Samantha J; Power, Derek G; Murphy, Kevin P; McDermott, Ray; Griffin, Brendan T; Lim, Marvin; Daly, Louise; MacEneaney, Peter; O' Sullivan, Kathleen; Prado, Carla M; Ryan, Aoife M

2016-06-01

Body composition may influence clinical outcomes of certain chemotherapeutic agents. We examined the prognostic significance of skeletal muscle mass and adipose tissue on docetaxel toxicity and overall survival in patients with metastatic castrate resistant prostate cancer (mCRPC). A retrospective review of patients medical records with mCRPC, treated with docetaxel was conducted. Body composition parameters (skeletal muscle mass, muscle attenuation [MA], visceral and subcutaneous adipose tissue) were measured at L3 by computed tomography (CT) and defined using previously established cut points. Toxicity profile was assessed after 3 cycles of the drug and graded according to the National Cancer Institute Common Toxicity Criteria (version 4). Overall survival was analysed. Overall 63 patients, mean age 69 years (SD 8.3), were included. Sarcopenia was present in 47% (n = 30) and of these 26.7% (8/30) were sarcopenic obese. Common toxicities (all grades) observed included fatigue (80.9%), pain (46%), and constipation (34.9%). DLT occurred in 22 (34.9%) patients; of these 10 patients (15.8%) experienced dose reductions and 12 patients (19%) experienced dose terminations. Measurements of adiposity were not predictive of DLT, however 59.1% patients who had a combination of both sarcopenia and low MA experienced DLT compared to 29.3% of patients without sarcopenia and low MA (p = 0.021). Skeletal muscle index and MA were significantly lower in patients who experienced neutropenia (grade I-II) (46.5 cm 2 /m 2 vs. 51.2 cm 2 /m 2 , p = 0.005) compared to their counterparts (24.6 HU vs. 32.2 HU, p = 0.044). Neither sarcopenia nor sarcopenic obesity was associated with overall survival. In multivariate analysis, BMI ≥25 kg/m 2 (HR: 0.349, CI: 0.156-0.782, p = 0.010) was a significant predictor of longer overall survival and both visceral fat index ≥ median 58.7 cm 2 /m 2 (HR: 2.266 CI: 1.066-4.814, p = 0.033) and anaemia (HR: 2.81, CI: 1.297-6.091, p

Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

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Nishit Palo

2017-10-01

Full Text Available Introduction: Intact surgical gloves are a barrier to microorganisms migration between surgical team members and the patient. The surgical gloves are changed at various junctures but the effects of changing gloves during surgical procedures on various surgical parameters or clinical outcomes are not established. Aim: To determine rationale of glove change during orthopaedic procedures, differences amongst surgical parameters with and without changing the surgical gloves and whether frequent glove change affected surgical parameters or clinical outcomes. Materials and Methods: A prospective multicenter study conducted at three centers from January 2014 to January 2016. A 250 patients were divided into 2 groups (n=125 each in Group 1, surgical team operated with regular changing of gloves. In Group 2, only 1 set of double gloves were worn throughout the procedure. Surgical parameters or clinical outcomes were assessed for both the groups. Statistical analyses included the median, mode, range, Interquartile Range (IQR and sample standard deviation (s and independent-samples t-test. Bacterial counts were expressed as median with (IQR. Results: Surgical Timing Difference was 10 (S.D.- 4.2 minutes more in Group-1 (<0.05, Surgical Cost was higher in Group-1 by Rs.150-450 (<0.05. Outer glove micro-perforation rate was 5.85% and 8.15% in group-1 and 2 respectively with no inner glove perforation or Surgical Site Infections. Outer glove micro perforations were proportional to duration of surgery; operations lasting 120-210 and 61-120 minutes had 66.6% and 37.2% micro perforation rates respectively (p<0.05. Conclusion: Under standard operating conditions, procedures performed without glove change are shorter and cost effective than procedures performed with regular glove change with similar surgical and functional results. Judicious use of surgical gloves is a patient and environment friendly option, thereby reducing the hospital’s biomedical waste load.

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Energy Technology Data Exchange (ETDEWEB)

Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

2016-10-15

AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

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Jahagirdar Deepa

2012-11-01

Full Text Available Abstract Background Patient reported outcome measures (PROMs are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Methods Taking PROMs recommended for chronic obstructive pulmonary disease (COPD as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Results Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Conclusions Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

Vocational outcome of intervention for low-back pain

NARCIS (Netherlands)

van der Weide, W. E.; Verbeek, J. H.; van Tulder, M. W.

1997-01-01

Practical management guidelines for occupational health physicians are needed for the individual support of employees with low-back pain. In this study the level of evidence regarding the efficacy of intervention with vocational outcome parameters was assessed. In a systematic literature search, 40

Discrete event simulation: Modeling simultaneous complications and outcomes

NARCIS (Netherlands)

Quik, E.H.; Feenstra, T.L.; Krabbe, P.F.M.

2012-01-01

OBJECTIVES: To present an effective and elegant model approach to deal with specific characteristics of complex modeling. METHODS: A discrete event simulation (DES) model with multiple complications and multiple outcomes that each can occur simultaneously was developed. In this DES model parameters,

Do pigeons prefer alternatives that include near-hit outcomes?

Science.gov (United States)

Stagner, Jessica P; Case, Jacob P; Sticklen, Mary F; Duncan, Amanda K; Zentall, Thomas R

2015-07-01

Pigeons show suboptimal choice on a gambling-like task similar to that shown by humans. Humans also show a preference for gambles in which there are near hits (losses that come close to winning). In the present research, we asked if pigeons would show a preference for alternatives with near-hit-like trials. In Experiment 1, we included an alternative that presented a near hit, in which a stimulus associated with reinforcement (a presumed conditioned reinforcer) changed to a stimulus associated with the absence of reinforcement (a presumed conditioned inhibitor). The pigeons tended to avoid this alternative. In Experiment 2, we varied the duration of the presumed conditioned reinforcer (2 vs. 8 s) that changed to a presumed conditioned inhibitor (8 vs. 2 s) and found that the longer the conditioned reinforcer was presented, the more the pigeons avoided it. In Experiment 3, the near-hit alternative involved an ambiguous stimulus for 8 s that changed to a presumed conditioned reinforcer (or a presumed conditioned inhibitor) for 2 s, but the pigeons still avoided it. In Experiment 4, we controlled for the duration of the conditioned reinforcer by presenting it first for 2 s followed by the ambiguous stimulus for 8 s. Once again, the pigeons avoided the alternative with the near-hit trials. In all 4 experiments, the pigeons tended to avoid alternatives that provided near-hit-like trials. We concluded that humans may be attracted to near-hit trials because near-hit trials give them the illusion of control, whereas this does not appear to be a factor for pigeons. (c) 2015 APA, all rights reserved).

Neural signatures of economic parameters during decision-making: a functional MRI (FMRI), electroencephalography (EEG) and autonomic monitoring study.

Science.gov (United States)

Minati, Ludovico; Grisoli, Marina; Franceschetti, Silvana; Epifani, Francesca; Granvillano, Alice; Medford, Nick; Harrison, Neil A; Piacentini, Sylvie; Critchley, Hugo D

2012-01-01

Adaptive behaviour requires an ability to obtain rewards by choosing between different risky options. Financial gambles can be used to study effective decision-making experimentally, and to distinguish processes involved in choice option evaluation from outcome feedback and other contextual factors. Here, we used a paradigm where participants evaluated 'mixed' gambles, each presenting a potential gain and a potential loss and an associated variable outcome probability. We recorded neural responses using autonomic monitoring, electroencephalography (EEG) and functional neuroimaging (fMRI), and used a univariate, parametric design to test for correlations with the eleven economic parameters that varied across gambles, including expected value (EV) and amount magnitude. Consistent with behavioural economic theory, participants were risk-averse. Gamble evaluation generated detectable autonomic responses, but only weak correlations with outcome uncertainty were found, suggesting that peripheral autonomic feedback does not play a major role in this task. Long-latency stimulus-evoked EEG potentials were sensitive to expected gain and expected value, while alpha-band power reflected expected loss and amount magnitude, suggesting parallel representations of distinct economic qualities in cortical activation and central arousal. Neural correlates of expected value representation were localized using fMRI to ventromedial prefrontal cortex, while the processing of other economic parameters was associated with distinct patterns across lateral prefrontal, cingulate, insula and occipital cortices including default-mode network and early visual areas. These multimodal data provide complementary evidence for distributed substrates of choice evaluation across multiple, predominantly cortical, brain systems wherein distinct regions are preferentially attuned to specific economic features. Our findings extend biologically-plausible models of risky decision-making while providing

Singleton pregnancy outcomes after assisted and non-assisted reproductive technology in infertile patients.

Science.gov (United States)

Tsutsumi, Ryo; Fujimoto, Akihisa; Osuga, Yutaka; Ooi, Nagisa; Takemura, Yuri; Koizumi, Minako; Yano, Tetsu; Taketani, Yuji

2012-07-01

Singleton pregnancy after assisted reproductive technology (ART) has been associated with higher risks of adverse pregnancy outcome than naturally conceived singleton pregnancy. This study was to elucidate whether the ART procedure is responsible for abnormal pregnancy outcome comparing those after ART and non-ART in infertile patients. We compare the singleton pregnancy outcome of infertile patients in our university hospital between 2000 and 2008 following ART (351 pregnancies) and non-ART (213 pregnancies) procedures. Pregnancy outcome parameters were incidence of pregnancy induced hypertension, placenta previa, placental abruption, cesarean delivery, preterm birth, very preterm birth, stillbirth, low birth weight and very low birth weight. Most of the pregnancy outcome parameters were not significantly different between the ART group and the non-ART group. Only placenta previa was significantly higher in the ART group than in the non-ART group (odds ratio 4.0; 95 % CI 1.2-13.7). ART procedure may itself be a risk factor for the development of placenta previa. Some of the abnormal perinatal outcomes that had been previously attributed to ART, however, may be due to the baseline characteristics of infertile patients.

Relating Bioavailability Parameters to the Sorbent Characteristics of PAH Polluted Soils

DEFF Research Database (Denmark)

Bartolome, N.; Hilber, I.; Schulin, R.

2015-01-01

Regulation of Hydrophobic Organic Contaminants (HOC) such as polycyclic aromatic hydrocarbons (PAHs) in soil is still based on total concentrations. However, many studies have demonstrated that not all of a pollutant’s content in soil is equally available to organisms (Reichenberg & Mayer 2006...... to several sorbent characteristics including organic and black carbon content. The results will provide a better understanding of bioavailability of PAHs in soils. Moreover, the outcomes will be discussed regarding to the potential application of chemical proxies in soil pollution risk assessment......). Over the last decade, intensive effort has been made to incorporate bioavailability into risk assessment (Cachada et al. 2014). Here, we compare total concentrations of PAH with two bioavailability parameters in 30 different soil samples from the archive of the standardized National and Zurich Cantonal...

Outcome-based ventilation: A framework for assessing performance, health, and energy impacts to inform office building ventilation decisions.

Science.gov (United States)

Rackes, A; Ben-David, T; Waring, M S

2018-04-23

This article presents an outcome-based ventilation (OBV) framework, which combines competing ventilation impacts into a monetized loss function ($/occ/h) used to inform ventilation rate decisions. The OBV framework, developed for U.S. offices, considers six outcomes of increasing ventilation: profitable outcomes realized from improvements in occupant work performance and sick leave absenteeism; health outcomes from occupant exposure to outdoor fine particles and ozone; and energy outcomes from electricity and natural gas usage. We used the literature to set low, medium, and high reference values for OBV loss function parameters, and evaluated the framework and outcome-based ventilation rates using a simulated U.S. office stock dataset and a case study in New York City. With parameters for all outcomes set at medium values derived from literature-based central estimates, higher ventilation rates' profitable benefits dominated negative health and energy impacts, and the OBV framework suggested ventilation should be ≥45 L/s/occ, much higher than the baseline ~8.5 L/s/occ rate prescribed by ASHRAE 62.1. Only when combining very low parameter estimates for profitable impacts with very high ones for health and energy impacts were all outcomes on the same order. Even then, however, outcome-based ventilation rates were often twice the baseline rate or more. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Bayesian Approach to Functional Mixed Effect Modeling for Longitudinal Data with Binomial Outcomes

Science.gov (United States)

Kliethermes, Stephanie; Oleson, Jacob

2014-01-01

Longitudinal growth patterns are routinely seen in medical studies where individual and population growth is followed over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear, quadratic); however, these relationships may not accurately capture growth over time. Functional mixed effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well-developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible and thus estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. PMID:24723495

Olfactory neuroblastoma: the long-term outcome and late toxicity of multimodal therapy including radiotherapy based on treatment planning using computed tomography

International Nuclear Information System (INIS)

Mori, Takashi; Onimaru, Rikiya; Onodera, Shunsuke; Tsuchiya, Kazuhiko; Yasuda, Koichi; Hatakeyama, Hiromitsu; Kobayashi, Hiroyuki; Terasaka, Shunsuke; Homma, Akihiro; Shirato, Hiroki

2015-01-01

Olfactory neuroblastoma (ONB) is a rare tumor originating from olfactory epithelium. Here we retrospectively analyzed the long-term treatment outcomes and toxicity of radiotherapy for ONB patients for whom computed tomography (CT) and three-dimensional treatment planning was conducted to reappraise the role of radiotherapy in the light of recent advanced technology and chemotherapy. Seventeen patients with ONB treated between July 1992 and June 2013 were included. Three patients were Kadish stage B and 14 were stage C. All patients were treated with radiotherapy with or without surgery or chemotherapy. The radiation dose was distributed from 50 Gy to 66 Gy except for one patient who received 40 Gy preoperatively. The median follow-up time was 95 months (range 8–173 months). The 5-year overall survival (OS) and relapse-free survival (RFS) rates were estimated at 88% and 74%, respectively. Five patients with stage C disease had recurrence with the median time to recurrence of 59 months (range 7–115 months). Late adverse events equal to or above Grade 2 in CTCAE v4.03 were observed in three patients. Multimodal therapy including radiotherapy with precise treatment planning based on CT simulation achieved an excellent local control rate with acceptable toxicity and reasonable overall survival for patients with ONB

LMFBR plant parameters 1991

International Nuclear Information System (INIS)

1991-03-01

The document has been prepared on the basis of information provided by the members of the IAEA International Working Group on Fast Reactors (IWGFR). It contains updated parameters of 27 experimental, prototype and commercial size liquid metal fast breeder reactors (LMFBRs). Most of the reactors are currently in operation, under construction or in an advanced planning stage. Parameters of the Clinch River Breeder Reactor (USA), PEC (Italy), RAPSODIE (France), DFR (UK) and EFFBR (USA) are included in the report because of their important role in the development of LMFBR technology from first LMFBRs to the prototype size fast reactors. Two more reactors appeared in the list: European Fast Reactor (EFR) and PRISM (USA). Parameters of these reactors included in this publication are based on the data from the papers presented at the 23rd Annual Meeting of the IWGFR. All in all more than four hundred corrections and additions have been made to update the document. The report is intended for specialists and institutions in industrialized and developing countries who are responsible for the design and operation of liquid metal fast breeder reactors

Reliability of computerized cephalometric outcome predictions of mandibular set-back surgery

Directory of Open Access Journals (Sweden)

Stefanović Neda

2011-01-01

Full Text Available Introduction. A successful treatment outcome in dentofacial deformity patients commonly requires combined orthodontic-surgical therapy. This enables us to overcome functional, aesthetic and psychological problems. Since most patients state aesthetics as the primary motive for seeking therapy, cephalometric predictions of treatment outcome have become the essential part of treatment planning, especially in combined orthodontic-surgical cases. Objective. The aim of this study was to evaluate the validity and reliability of computerized orthognathic surgery outcome predictions generated using the Nemotec Dental Studio NX 2005 software. Methods. The sample of the study consisted of 31 patients diagnosed with mandibular prognathism who were surgically treated at the Hospital for Maxillofacial Surgery in Belgrade. Investigation was done on lateral cephalograms made before and after surgical treatment. Cephalograms were digitized and analyzed using computer software. According to measurements made on superimposed pre- and postsurgical cephalograms, the patients were retreated within the software and the predictions were assessed by measuring seven angular and three linear parameters. Prediction measurements were then compared with the actual outcome. Results. Results showed statistically significant changes between posttreatment and predicted values for parameters referring to lower lip and mentolabial sulcus position. Conclusion. Computerized cephalometric predictions for hard-tissue structures in the sagittal and vertical planes, as well as the VTO parameters, generated using the Nemotec Dental Studio NX 2005 software are reliable, while lower lip and mentolabial sulcus position predictions are not reliable enough.

Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study.

Science.gov (United States)

Keenswijk, Werner; Vanmassenhove, Jill; Raes, Ann; Dhont, Evelyn; Vande Walle, Johan

2017-03-01

Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome. What is Known: • Oliguria is a predictor of poor long-term outcome in D+HUS What is New: • BUN-to-serum Creatinine ratio at admission is an entirely novel and accurate predictor of poor outcome and complicated clinical outcome in D+HUS • Early detection of the high risk group in D+HUS enabling early treatment and adequate monitoring.

Health-related quality of life outcomes after cholecystectomy.

Science.gov (United States)

Carraro, Amedeo; Mazloum, Dania El; Bihl, Florian

2011-12-07

Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.

Incorporating outcome uncertainty and prior outcome beliefs in stated preferences

DEFF Research Database (Denmark)

Lundhede, Thomas; Jacobsen, Jette Bredahl; Hanley, Nick

2015-01-01

Stated preference studies tell respondents that policies create environmental changes with varying levels of uncertainty. However, respondents may include their own a priori assessments of uncertainty when making choices among policy options. Using a choice experiment eliciting respondents......’ preferences for conservation policies under climate change, we find that higher outcome uncertainty reduces utility. When accounting for endogeneity, we find that prior beliefs play a significant role in this cost of uncertainty. Thus, merely stating “objective” levels of outcome uncertainty...

Clinical predictors of outcome in vitiligo

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Dave Shriya

2002-11-01

Full Text Available The significant inter-patient variability in progression, and response to therapy makes it a great challenge for the physician to predict the outcome of vitiligo at the very outset. Subjective factors like stress, pregnancy, sunburn and illness have been identified as aggravating factors for vitiligo. However, a few studies have evaluated the statistical significance of objective clinical parameters in predicting the outcome of vitiligo. Our retrospective analysis of 199 consecutive patients with vitiligo who presented to our OPD was aimed at evaluation of these objective clinical parameters utilizing a standard proforma. Patients already on treatment, and those with duration of disease less than 6 months were excluded from the study. Progression was defined as an increase in size or number of lesions in the 3 months prior to presentation. In all 76. 9% patients had progression of vitiligo. The clinical parameters significantly associated with progression were a positive family history (p=0. 027, mucosal involvement (p=0. 032, Koebner′s phenomenon (p=0. 036 and nonsegmental vitiligo (p=0. 033. Thrichrome sign, leucotrichia, longer duration and higher age at onset did not correlate significantly with progression. The one significant observation that we found to have the poor prognostic implication in vitiligo is the presence of mucosal vitiligo. The clinical prediction of disease progression at the outset enables the physician to set realistic treatment goals and optimize the therapeutic regimen for the individual patient.

Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization

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Assis, André Moreira de, E-mail: andre.assis@criep.com.br, E-mail: andre.maa@gmail.com; Maciel, Macello Sampaio, E-mail: macielmjs@gmail.com; Moreira, Airton Mota, E-mail: airton.mota@criep.com.br; Paula Rodrigues, Vanessa Cristina de, E-mail: vanessapaular@yahoo.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@uol.com.br [University of Sao Paulo Medical School, Urology Department (Brazil); Cerri, Giovanni Guido, E-mail: giovanni-cerri@uol.com.br [University of Sao Paulo Medical School, Radiology Institute (Brazil); Carnevale, Francisco Cesar, E-mail: francisco.carnevale@criep.com.br [University of Sao Paulo Medical School, Vascular and Interventional Radiology Unit, Radiology Institute (Brazil)

2017-02-15

PurposeTo determine prostate baseline zonal volumetry and correlate these findings with clinical outcomes for patients who underwent prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Materials and MethodsThis is a retrospective study that included patients treated by PAE from 2010 to 2014. Baseline and 6-month follow-up evaluations included prostate MRI with whole prostate (WP) and central gland (CG) volume measurements—as well as prostate zonal volumetry index (ZVi) calculation, defined as the CG/WP volumes relation—the International Prostate Symptom Score (IPSS), and the Quality of life (QoL) index. Baseline WP, CG, and ZVi were statistical compared to IPSS and QoL values at 6 months.ResultsA total of 93 consecutive patients were included, with mean age of 63.4 years (range, 51–86). Clinical failure, defined as IPSS > 7 or QoL > 2, was seen in four cases (4.3%). Mean reductions in prostate volumes after PAE were of 30.6% and 31.2% for WP and CG, respectively (p < 0.0001). Clinical parameters had mean decrease from 21 to 3.3 points for IPSS, and from 4.7 to 1.2 points for QoL (p < 0.0001). Baseline WP, CG, and ZVi correlated to the degree of clinical improvement (p < 0.05 for all). The baseline ZVi cut-off calculated for better clinical outcomes was > 0.45, with 85% sensitivity and 75% specificity.ConclusionsBaseline CG and WP volumes as well as ZVi presented strong correlation with clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible. Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi < 0.45.

Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization

International Nuclear Information System (INIS)

Assis, André Moreira de; Maciel, Macello Sampaio; Moreira, Airton Mota; Paula Rodrigues, Vanessa Cristina de; Antunes, Alberto Azoubel; Srougi, Miguel; Cerri, Giovanni Guido; Carnevale, Francisco Cesar

2017-01-01

PurposeTo determine prostate baseline zonal volumetry and correlate these findings with clinical outcomes for patients who underwent prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Materials and MethodsThis is a retrospective study that included patients treated by PAE from 2010 to 2014. Baseline and 6-month follow-up evaluations included prostate MRI with whole prostate (WP) and central gland (CG) volume measurements—as well as prostate zonal volumetry index (ZVi) calculation, defined as the CG/WP volumes relation—the International Prostate Symptom Score (IPSS), and the Quality of life (QoL) index. Baseline WP, CG, and ZVi were statistical compared to IPSS and QoL values at 6 months.ResultsA total of 93 consecutive patients were included, with mean age of 63.4 years (range, 51–86). Clinical failure, defined as IPSS > 7 or QoL > 2, was seen in four cases (4.3%). Mean reductions in prostate volumes after PAE were of 30.6% and 31.2% for WP and CG, respectively (p < 0.0001). Clinical parameters had mean decrease from 21 to 3.3 points for IPSS, and from 4.7 to 1.2 points for QoL (p < 0.0001). Baseline WP, CG, and ZVi correlated to the degree of clinical improvement (p < 0.05 for all). The baseline ZVi cut-off calculated for better clinical outcomes was > 0.45, with 85% sensitivity and 75% specificity.ConclusionsBaseline CG and WP volumes as well as ZVi presented strong correlation with clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible. Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi < 0.45.

LMFBR plant parameters

International Nuclear Information System (INIS)

1985-07-01

This document has been prepared on the basis of information compiled by the members of the IAEA International Working Group on Fast Reactors (IWGFR). It contains parameters of 25 experimental, prototype and commercial size liquid metal fast breeder reactors (LMFBR). Most of the reactors are currently in operation, under construction or in an advanced planning stage. Parameters of the Clinch River Breeder Reactor (USA) are presented because its design was nearly finished and most of the components were fabricated at the time when the project was terminated. Three reactors (RAPSODIE (France), DFR (UK) and EFFBR (USA)) have been shut down. However, they are included in the report because of their important role in the development of LMFBR technology from first LMFBRs to the prototype size fast reactors. The first LMFBRs (CLEMENTINE (USA), EBR-1 (USA), BR-2 (USSR), BR-5 (USSR)) and very special reactors (LAMPRE (USA), SEFOR (USA)) were not recommended by the members of the IWGFR to be included in the report

Parental Socioeconomic Status as a Predictor of Physical and Mental Health Outcomes in Children - Literature Review.

Science.gov (United States)

Vukojević, Mladenka; Zovko, Ana; Talić, Ivana; Tanović, Merima; Rešić, Biserka; Vrdoljak, Ivana; Splavski, Bruno

2017-12-01

Parental socioeconomic status is a multidimensional concept of special importance for the growth, development, health outcomes and education of children. Its definition generally refers to the amount of parents' income, their employment status and level of education. Hence, lack of economic resources and poverty of parents affect all aspects of the child's life, health outcomes and education, as well as his/her social inclusion. Accordingly, the consequences of a reduced parental socioeconomic status leave long-term effects on their children. Therefore, in order to create interventional programs for children of parents with low income and lower socioeconomic status, as well as with lower level of education, it is important to address the direct aspects of poverty. This review contributes to the evidence indicating that the parental socioeconomic status is highly influential in determining the child's physical and mental health and future outcomes including his/her academic achievements and education, as well as the parameters of his/her physical abilities, cognitive function and fundamental neurobiology affecting brain development.

Biochemical liver function test parameter levels in relation to treatment response in liver metastatic colorectal patients treated with FOLFOX4 with or without bevacizumab

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Denić Kristina

2016-01-01

Full Text Available Introduction. Combined use of bevacizumab and conventional anticancer drugs leads to a significant improvement of treatment response in patients with metastatic colorectal carcinoma (CRC. Conventional treatment protocols exert undesired effects on the liver tissue. Hepatotoxic effects are manifested as a disturbance of liver function test parameters. The relation between clinical outcome and disorder of biochemical parameters has not been completely evaluated. Objective. The objective of our study was to examine whether clinical outcome in patients with liver metastatic CRC correlates with the level of liver function test parameters. Methods. The study included 96 patients with untreated liver metastatic CRC who received FOLFOX4 protocol with or without bevacizumab. Biochemical liver parameters were performed before and after the treatment completion. Treatment response was evaluated as disease regression, stable disease, and disease progression. The patients were divided into three groups according to the accomplished treatment response. Results. In the group of patients with disease regression the post-treatment levels of aspartate aminotransferase, alanine aminotransferase, and bilirubin were statistically significantly increased. In contrast to this, gamma-glutamyltransferase and protein post-treatment values were significantly lower in relation to initial values. In patients with stable disease, difference was found only in the level of proteins being lower after the treatment. In patients with disease progression, values of aspartate aminotransferase and bilirubin were significantly increased after completed treatment. Conclusion. Treatment responses are not completely associated with the level of liver function test parameters. The only parameter which correlated with treatment response is gamma-glutamyltransferase. Its decrease is accompanied with disease regression.

Outcome prediction in pneumonia induced ALI/ARDS by clinical features and peptide patterns of BALF determined by mass spectrometry.

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Jochen Frenzel

Full Text Available BACKGROUND: Peptide patterns of bronchoalveolar lavage fluid (BALF were assumed to reflect the complex pathology of acute lung injury (ALI/acute respiratory distress syndrome (ARDS better than clinical and inflammatory parameters and may be superior for outcome prediction. METHODOLOGY/PRINCIPAL FINDINGS: A training group of patients suffering from ALI/ARDS was compiled from equal numbers of survivors and nonsurvivors. Clinical history, ventilation parameters, Murray's lung injury severity score (Murray's LISS and interleukins in BALF were gathered. In addition, samples of bronchoalveolar lavage fluid were analyzed by means of hydrophobic chromatography and MALDI-ToF mass spectrometry (MALDI-ToF MS. Receiver operating characteristic (ROC analysis for each clinical and cytokine parameter revealed interleukin-6>interleukin-8>diabetes mellitus>Murray's LISS as the best outcome predictors. Outcome predicted on the basis of BALF levels of interleukin-6 resulted in 79.4% accuracy, 82.7% sensitivity and 76.1% specificity (area under the ROC curve, AUC, 0.853. Both clinical parameters and cytokines as well as peptide patterns determined by MALDI-ToF MS were analyzed by classification and regression tree (CART analysis and support vector machine (SVM algorithms. CART analysis including Murray's LISS, interleukin-6 and interleukin-8 in combination was correct in 78.0%. MALDI-ToF MS of BALF peptides did not reveal a single identifiable biomarker for ARDS. However, classification of patients was successfully achieved based on the entire peptide pattern analyzed using SVM. This method resulted in 90% accuracy, 93.3% sensitivity and 86.7% specificity following a 10-fold cross validation (AUC = 0.953. Subsequent validation of the optimized SVM algorithm with a test group of patients with unknown prognosis yielded 87.5% accuracy, 83.3% sensitivity and 90.0% specificity. CONCLUSIONS/SIGNIFICANCE: MALDI-ToF MS peptide patterns of BALF, evaluated by appropriate

Changes in spatiotemporal gait parameters following intravenous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy.

Science.gov (United States)

Vo, Mary L; Chin, Russell L; Miranda, Caroline; Latov, Norman

2017-10-01

Gait impairment is a common presenting symptom in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). However, gait parameters have not previously been evaluated in detail as potential independent outcome measures. We prospectively measured changes in spatiotemporal gait parameters of 20 patients with CIDP at baseline and following treatment with intravenous immunoglobulin (IVIG), using GAITRite® a computerized walkway system with embedded sensors. Overall, study patients showed significant improvements in gait velocity, cadence, stride length, double support time, stance phase, and swing phase following IVIG treatment. Mean changes in velocity, stance phase, and swing phase, exhibited the greatest statistical significance among the subgroup that exhibited clinically meaningful improvement in Inflammatory Neuropathy Cause and Treatment disability score, Medical Research Council sum score, and grip strength. Assessment of gait parameters, in particular velocity, step phase and swing phase, is a potentially sensitive outcome measure for evaluating treatment response in CIDP. Muscle Nerve 56: 732-736, 2017. © 2017 Wiley Periodicals, Inc.

Coupled 1D-2D hydrodynamic inundation model for sewer overflow: Influence of modeling parameters

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Adeniyi Ganiyu Adeogun

2015-10-01

Full Text Available This paper presents outcome of our investigation on the influence of modeling parameters on 1D-2D hydrodynamic inundation model for sewer overflow, developed through coupling of an existing 1D sewer network model (SWMM and 2D inundation model (BREZO. The 1D-2D hydrodynamic model was developed for the purpose of examining flood incidence due to surcharged water on overland surface. The investigation was carried out by performing sensitivity analysis on the developed model. For the sensitivity analysis, modeling parameters, such as mesh resolution Digital Elevation Model (DEM resolution and roughness were considered. The outcome of the study shows the model is sensitive to changes in these parameters. The performance of the model is significantly influenced, by the Manning's friction value, the DEM resolution and the area of the triangular mesh. Also, changes in the aforementioned modeling parameters influence the Flood characteristics, such as the inundation extent, the flow depth and the velocity across the model domain. Keywords: Inundation, DEM, Sensitivity analysis, Model coupling, Flooding

Quantitative outcome measures for systemic sclerosis-related Microangiopathy - Reliability of image acquisition in Nailfold Capillaroscopy.

Science.gov (United States)

Dinsdale, Graham; Moore, Tonia; O'Leary, Neil; Berks, Michael; Roberts, Christopher; Manning, Joanne; Allen, John; Anderson, Marina; Cutolo, Maurizio; Hesselstrand, Roger; Howell, Kevin; Pizzorni, Carmen; Smith, Vanessa; Sulli, Alberto; Wildt, Marie; Taylor, Christopher; Murray, Andrea; Herrick, Ariane L

2017-09-01

Nailfold capillaroscopic parameters hold increasing promise as outcome measures for clinical trials in systemic sclerosis (SSc). Their inclusion as outcomes would often naturally require capillaroscopy images to be captured at several time points during any one study. Our objective was to assess repeatability of image acquisition (which has been little studied), as well as of measurement. 41 patients (26 with SSc, 15 with primary Raynaud's phenomenon) and 10 healthy controls returned for repeat high-magnification (300×) videocapillaroscopy mosaic imaging of 10 digits one week after initial imaging (as part of a larger study of reliability). Images were assessed in a random order by an expert blinded observer and 4 outcome measures extracted: (1) overall image grade and then (where possible) distal vessel locations were marked, allowing (2) vessel density (across the whole nailfold) to be calculated (3) apex width measurement and (4) giant vessel count. Intra-rater, intra-visit and intra-rater inter-visit (baseline vs. 1week) reliability were examined in 475 and 392 images respectively. A linear, mixed-effects model was used to estimate variance components, from which intra-class correlation coefficients (ICCs) were determined. Intra-visit and inter-visit reliability estimates (ICCs) were (respectively): overall image grade, 0.97 and 0.90; vessel density, 0.92 and 0.65; mean vessel width, 0.91 and 0.79; presence of giant capillary, 0.68 and 0.56. These estimates were conditional on each parameter being measurable. Within-operator image analysis and acquisition are reproducible. Quantitative nailfold capillaroscopy, at least with a single observer, provides reliable outcome measures for clinical studies including randomised controlled trials. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

International Nuclear Information System (INIS)

Bakkegaard, Mads; Johannsen, Finn E.; Højgaard, Betina; Langberg, Henning

2015-01-01

Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT

Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

Energy Technology Data Exchange (ETDEWEB)

Bakkegaard, Mads, E-mail: mbakkegaard@hotmail.com [Department of Rheumatology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk (Denmark); Johannsen, Finn E., E-mail: f.e.johannsen@dadlnet.dk [Private Department of Rheumatology, Furesø-reumatologerne, Farum and ISMC, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, 2. Tværvej, Indgang 8, 1. sal, 2400 København NV (Denmark); Højgaard, Betina, E-mail: beho@kora.dk [Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150 København K (Denmark); Langberg, Henning, E-mail: henninglangberg@gmail.com [Institute of Social Medicine, Department of Public Health and Centre for Healthy Ageing, Faculty of Heath Sciences, University of Copenhagen, Øster Farimagsgade 5, bygn. 24, postboks 2099, 1014 København (Denmark)

2015-03-15

Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.

INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

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Marcela Almeida Campos Coutinho

2016-03-01

Full Text Available ABSTRACT Objective: Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion. Methods: We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance. Results: There was no significant correlation between parameters pelvic incidence (PI, pelvic tilt (PT, lumbar lordosis (LL and difference between PI and LL (PI-LL and clinical parameters (p > 0.05 and r <0.2. Significant correlation were identified only between Sagittal Vertical Axis (SVA and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023 and between thoracic kyphosis (TK and the total SRS-30 (r = 0.419 and p = 0.017. Conclusions: According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

Cellular islet autoimmunity associates with clinical outcome of islet cell transplantation.

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Volkert A L Huurman

2008-06-01

Full Text Available Islet cell transplantation can cure type 1 diabetes (T1D, but only a minority of recipients remains insulin-independent in the following years. We tested the hypothesis that allograft rejection and recurrent autoimmunity contribute to this progressive loss of islet allograft function.Twenty-one T1D patients received cultured islet cell grafts prepared from multiple donors and transplanted under anti-thymocyte globulin (ATG induction and tacrolimus plus mycophenolate mofetil (MMF maintenance immunosuppression. Immunity against auto- and alloantigens was measured before and during one year after transplantation. Cellular auto- and alloreactivity was assessed by lymphocyte stimulation tests against autoantigens and cytotoxic T lymphocyte precursor assays, respectively. Humoral reactivity was measured by auto- and alloantibodies. Clinical outcome parameters--including time until insulin independence, insulin independence at one year, and C-peptide levels over one year--remained blinded until their correlation with immunological parameters. All patients showed significant improvement of metabolic control and 13 out of 21 became insulin-independent. Multivariate analyses showed that presence of cellular autoimmunity before and after transplantation is associated with delayed insulin-independence (p = 0.001 and p = 0.01, respectively and lower circulating C-peptide levels during the first year after transplantation (p = 0.002 and p = 0.02, respectively. Seven out of eight patients without pre-existent T-cell autoreactivity became insulin-independent, versus none of the four patients reactive to both islet autoantigens GAD and IA-2 before transplantation. Autoantibody levels and cellular alloreactivity had no significant association with outcome.In this cohort study, cellular islet-specific autoimmunity associates with clinical outcome of islet cell transplantation under ATG-tacrolimus-MMF immunosuppression. Tailored immunotherapy targeting cellular

Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

Science.gov (United States)

Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B

2015-09-01

An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to

Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies

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Jeffrey M. Pearson

2018-01-01

Full Text Available Introduction. Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods. Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results. Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis. Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171 cc versus 538 cc; p=0.0013. There were no significant differences in surgical site infections (p=0.48 or operating room time (p=0.66. Conclusion. Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.

Perinatal outcome after ultrasound diagnosis of anhydramnios at term.

LENUS (Irish Health Repository)

Visvalingam, G

2012-01-01

The aim was to assess the maternal and fetal outcome in women who had labour induced for anhydramnios after 37 completed weeks of gestation. A retrospective study was conducted at the Rotunda Hospital from 1 January 2003 to 31 December 2007. All women with anhydramnios at term were identified from a review of ViewPoint® (computer software for antenatal scans performed), hospital data and the labour ward register. All women with a history of previous lower segment caesarean section (LSCS), current significant medical illness such as diabetes, hypertension, pre-eclampsia or ruptured membranes were excluded because the aim of the study was to focus specifically on low risk pregnancies with an incidental diagnosis of anhydramnios after 37 weeks\\' gestation. The maternal and fetal outcome parameters reviewed included: maternal age, parity, gestation, method of induction, mode of delivery, Apgar score and the requirement for obstetric or neonatal intervention. This study showed that anhydramnios is associated with a 56.6% LSCS rate in primigravida and a 19.0% LSCS rate in multigravida. Our study did not show any significant neonatal morbidity and there were no cases of mortality.

Supersymmetry Parameter Analysis : SPA Convention and Project

CERN Document Server

Aguilar-Saavedra, J A; Allanach, Benjamin C; Arnowitt, R; Baer, H A; Bagger, J A; Balázs, C; Barger, V; Barnett, M; Bartl, Alfred; Battaglia, M; Bechtle, P; Belyaev, A; Berger, E L; Blair, G; Boos, E; Bélanger, G; Carena, M S; Choi, S Y; Deppisch, F; Desch, Klaus; Djouadi, A; Dutta, B; Dutta, S; Díaz, M A; Eberl, H; Ellis, Jonathan Richard; Erler, Jens; Fraas, H; Freitas, A; Fritzsche, T; Godbole, Rohini M; Gounaris, George J; Guasch, J; Gunion, J F; Haba, N; Haber, Howard E; Hagiwara, K; Han, L; Han, T; He, H J; Heinemeyer, S; Hesselbach, S; Hidaka, K; Hinchliffe, Ian; Hirsch, M; Hohenwarter-Sodek, K; Hollik, W; Hou, W S; Hurth, Tobias; Jack, I; Jiang, Y; Jones, D R T; Kalinowski, Jan; Kamon, T; Kane, G; Kang, S K; Kernreiter, T; Kilian, W; Kim, C S; King, S F; Kittel, O; Klasen, M; Kneur, J L; Kovarik, K; Kraml, Sabine; Krämer, M; Lafaye, R; Langacker, P; Logan, H E; Ma, W G; Majerotto, Walter; Martyn, H U; Matchev, K; Miller, D J; Mondragon, M; Moortgat-Pick, G; Moretti, S; Mori, T; Moultaka, G; Muanza, S; Mukhopadhyaya, B; Mühlleitner, M M; Nauenberg, U; Nojiri, M M; Nomura, D; Nowak, H; Okada, N; Olive, Keith A; Oller, W; Peskin, M; Plehn, T; Polesello, G; Porod, Werner; Quevedo, Fernando; Rainwater, D L; Reuter, J; Richardson, P; Rolbiecki, K; de Roeck, A; Weber, Ch.

2006-01-01

High-precision analyses of supersymmetry parameters aim at reconstructing the fundamental supersymmetric theory and its breaking mechanism. A well defined theoretical framework is needed when higher-order corrections are included. We propose such a scheme, Supersymmetry Parameter Analysis SPA, based on a consistent set of conventions and input parameters. A repository for computer programs is provided which connect parameters in different schemes and relate the Lagrangian parameters to physical observables at LHC and high energy e+e- linear collider experiments, i.e., masses, mixings, decay widths and production cross sections for supersymmetric particles. In addition, programs for calculating high-precision low energy observables, the density of cold dark matter (CDM) in the universe as well as the cross sections for CDM search experiments are included. The SPA scheme still requires extended efforts on both the theoretical and experimental side before data can be evaluated in the future at the level of the d...

A Bayesian approach to functional mixed-effects modeling for longitudinal data with binomial outcomes.

Science.gov (United States)

Kliethermes, Stephanie; Oleson, Jacob

2014-08-15

Longitudinal growth patterns are routinely seen in medical studies where individual growth and population growth are followed up over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear and quadratic); however, these relationships may not accurately capture growth over time. Functional mixed-effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible, and thus, estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. Copyright © 2014 John Wiley & Sons, Ltd.

Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery

International Nuclear Information System (INIS)

Massager, Nicolas; Nissim, Ouzi; Delbrouck, Carine; Devriendt, Daniel; David, Philippe; Desmedt, Francoise; Wikler, David; Hassid, Sergio; Brotchi, Jacques; Levivier, Marc

2006-01-01

Purpose: To analyze the relationship between hearing preservation after gamma knife radiosurgery (GKR) for vestibular schwannoma (VS) and some volumetric and dosimetric parameters of the intracanalicular components of VS. Methods and Materials: This study included 82 patients with a VS treated by GKR; all patients had no NF2 disease, a Gardner-Robertson hearing class 1-4 before treatment, a marginal dose of 12 Gy, and a radiologic and audiologic follow-up ≥1 year post-GKR. The volume of both the entire tumor and the intracanalicular part of the tumor and the mean and integrated dose of these two volumes were correlated to the auditory outcomes of patients. Results: At last hearing follow-up, 52 patients had no hearing worsening, and 30 patients had an increase of ≥1 class on Gardner-Robertson classification. We found that hearing preservation after GKR is significantly correlated with the intracanalicular tumor volume, as well as with the integrated dose delivered to the intracanalicular tumor volume. Conclusions: Some volumetric and dosimetric parameters of the intracanalicular part of the tumor influence hearing preservation after GKR of VS. Consequently, we advise the direct treatment of patients with preserved functional hearing and a VS including a small intracanalicular volume

Statistics of Parameter Estimates: A Concrete Example

KAUST Repository

Aguilar, Oscar; Allmaras, Moritz; Bangerth, Wolfgang; Tenorio, Luis

2015-01-01

© 2015 Society for Industrial and Applied Mathematics. Most mathematical models include parameters that need to be determined from measurements. The estimated values of these parameters and their uncertainties depend on assumptions made about noise

Incorporating Nuisance Parameters in Likelihoods for Multisource Spectra

CERN Document Server

Conway, J.S.

2011-01-01

We describe here the general mathematical approach to constructing likelihoods for fitting observed spectra in one or more dimensions with multiple sources, including the effects of systematic uncertainties represented as nuisance parameters, when the likelihood is to be maximized with respect to these parameters. We consider three types of nuisance parameters: simple multiplicative factors, source spectra "morphing" parameters, and parameters representing statistical uncertainties in the predicted source spectra.

Weight Status in Persons with Multiple Sclerosis: Implications for Mobility Outcomes

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Pilutti, Lara A.; Dlugonski, Deirdre; Pula, John H.; Motl, Robert W.

2012-01-01

The accumulation of excess body weight may have important health and disease consequences for persons with multiple sclerosis (MS). This study examined the effect of weight status on mobility using a comprehensive set of mobility outcomes including ambulatory performance (timed 25-foot walk, T25FW; 6-minute walk, 6MW; oxygen cost of walking, Cw; spatiotemporal parameters of gait; self-reported walking impairment, Multiple Sclerosis Walking Scale-12 (MSWS-12); and free-living activity, accelerometry) in 168 ambulatory persons with MS. Mean (SD) BMI was 27.7 (5.1) kg/m2. Of the 168 participants, 31.0% were classified as normal weight (BMI = 18.5–24.9 kg/m2), 36.3% were classified as overweight (BMI = 25.0–29.9 kg/m2), and 32.7% were classified as obese, classes I and II (BMI = 30–39.9 kg/m2). There were no significant differences among BMI groups on T25FW and 6MW, Cw, spatiotemporal gait parameters, MSWS-12, or daily step and movement counts. The prevalence of overweight and obesity in this sample was almost 70%, but there was not a consistent nor significant impact of BMI on outcomes of mobility. The lack of an effect of weight status on mobility emphasizes the need to focus on and identify other factors which may be important targets of ambulatory performance in persons with MS. PMID:23050129

EU Framework 6 Project: Predictive Toxicology (PredTox)-overview and outcome

International Nuclear Information System (INIS)

Suter, Laura; Schroeder, Susanne; Meyer, Kirstin; Gautier, Jean-Charles; Amberg, Alexander; Wendt, Maria; Gmuender, Hans; Mally, Angela; Boitier, Eric; Ellinger-Ziegelbauer, Heidrun; Matheis, Katja; Pfannkuch, Friedlieb

2011-01-01

In this publication, we report the outcome of the integrated EU Framework 6 Project: Predictive Toxicology (PredTox), including methodological aspects and overall conclusions. Specific details including data analysis and interpretation are reported in separate articles in this issue. The project, partly funded by the EU, was carried out by a consortium of 15 pharmaceutical companies, 2 SMEs, and 3 universities. The effects of 16 test compounds were characterized using conventional toxicological parameters and 'omics' technologies. The three major observed toxicities, liver hypertrophy, bile duct necrosis and/or cholestasis, and kidney proximal tubular damage were analyzed in detail. The combined approach of 'omics' and conventional toxicology proved a useful tool for mechanistic investigations and the identification of putative biomarkers. In our hands and in combination with histopathological assessment, target organ transcriptomics was the most prolific approach for the generation of mechanistic hypotheses. Proteomics approaches were relatively time-consuming and required careful standardization. NMR-based metabolomics detected metabolite changes accompanying histopathological findings, providing limited additional mechanistic information. Conversely, targeted metabolite profiling with LC/GC-MS was very useful for the investigation of bile duct necrosis/cholestasis. In general, both proteomics and metabolomics were supportive of other findings. Thus, the outcome of this program indicates that 'omics' technologies can help toxicologists to make better informed decisions during exploratory toxicological studies. The data support that hypothesis on mode of action and discovery of putative biomarkers are tangible outcomes of integrated 'omics' analysis. Qualification of biomarkers remains challenging, in particular in terms of identification, mechanistic anchoring, appropriate specificity, and sensitivity.

Neonatal health including congenital malformation risk of 1072 children born after vitrified embryo transfer.

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Belva, F; Bonduelle, M; Roelants, M; Verheyen, G; Van Landuyt, L

2016-07-01

Does vitrification of Day 3 and Day 5 embryos adversely affect birth outcomes of singletons and twins in comparison with peers born after fresh embryo transfer? Neonatal health parameters, including the prevalence of congenital malformations, in singletons and twins born after embryo vitrification are similar to or slightly better than after fresh embryo transfer. Although vitrification, rather than slow-freezing, of embryos is routine practice nowadays, convincing evidence regarding the safety for the offspring is sparse. Literature data comprise results from mostly small-sized studies or studies including only Day 3 or only Day 5 vitrified embryo transfers. Overall, better or comparable perinatal outcomes, in terms of higher birthweight and lower risk for small-for-gestational age or for low birthweight, have been reported for singletons born after vitrified embryo transfer compared with fresh embryo transfer. According to the single available study with sufficient sample size, the congenital malformation rate was found to be comparable after vitrified and fresh embryo transfers. Data were collected from 960 cycles after transfer of embryos vitrified on Day 3 (n = 457) or Day 5 (n = 503) and from 1644 cycles after fresh embryo transfer on Day 3 (n = 853) or Day 5 (n = 791), performed between 2008 and 2013 at the Centre for Reproductive Medicine of the university hospital UZ Brussel. Outcome measures were neonatal health in terms of birthweight, small-for-gestational age, prematurity rate, perinatal death and major/minor/total malformation rate. Perinatal health parameters of 11 stillborns and 1061 live borns (827 singletons and 234 twins) in the vitrified group and of 28 stillborns and 1838 live borns (1374 singletons and 464 twins) in the fresh embryo group are reported. Within 3 months after birth, children in the two study groups were assessed clinically with special attention to congenital malformations by a paediatrician blinded to the type of embryo

Headache symptoms and indoor environmental parameters: Results from the EPA BASE study

Directory of Open Access Journals (Sweden)

Gretchen E Tietjen

2012-01-01

Full Text Available Objective: The objective of this investigation was to determine the prevalence of migraine and headache symptoms in a national sample of US office employees. Also, we explored the association of headache symptoms with indoor environmental parameters of the work place. Background: Sick building syndrome (SBS, which includes headache, is a common global phenomenon, but the underlying environmental cause is uncertain. Materials and Methods: We used data from the 1994-1998 US Environmental Protection Agency′s (EPA Building Assessment and Survey Evaluation, a cross-sectional study of workers employed in 100 public and private office buildings across 25 states. The study used a self-administered questionnaire to assess headache frequency and prevalence of self-reported physician-diagnosed (SRPD migraine. Indoor environmental parameters (IEP were collected per EPA protocol from each building over a 1-week period and included carbon dioxide, carbon monoxide, temperature, relative humidity, particulate matter, volatile organic compound, illuminance, and sound level. The standards of American Society of Heating, Refrigerating and Air Conditioning Engineers were used to categorize IEP as either within- or out-of-comfort range for human dwelling. These limits delineate whether a parameter value is safe for human dwelling. Out-of-comfort range IEPs are associated with SBS and other human diseases. SRPD migraine and headache frequency were the primary outcome measures of the study. Multivariate logistic regression analyses were employed for the purpose of assessing the association between the outcome variable and IEPs. Results: Of the 4326 participants, 66% were females and 60% were between 30 and 49 years. Headache frequency during the last 4 weeks was as follows: None in 31%, 1-3 days in 38%, 1-3 days per week in 18%, and every or almost every workday in 8%. Females had higher SRPD migraine prevalence compared to males (27% vs. 11%, P<0.001 and were more

Influence of different test parameters on in vitro drug release from topical diclofenac formulations in a vertical diffusion cell setup.

Science.gov (United States)

Klein, S

2013-07-01

In the past decades, the vertical diffusion cell has emerged as a useful device for testing drug release of topical dosage forms. However, to date neither a general USP method nor formulation-related monographs have been published in international pharmacopoeia. The purpose of the present work was to examine the influence of different test parameters in a vertical diffusion cell setup on in vitro drug release from semi-solid preparations for cutaneous application. Diclofenac was selected as the model compound. Release experiments were performed in a 7 ml Microett vertical diffusion cell system. Various test parameters, including the media composition and pH, degassing, membrane material and pore size, stirring speed and stirrer type, were varied. Results obtained with different test parameter settings clearly indicate that both drug properties and instrumental details can have a huge impact on the outcome of in vitro diffusion/drug release studies with the vertical diffusion cell. Thus, the selection of adequate test parameters is crucial for the success of the release experiments and, as shown in the present study, optimal test parameters/conditions need to be established and validated on a case by case study.

Statistical Machines for Trauma Hospital Outcomes Research: Application to the PRospective, Observational, Multi-Center Major Trauma Transfusion (PROMMTT Study.

Directory of Open Access Journals (Sweden)

Sara E Moore

Full Text Available Improving the treatment of trauma, a leading cause of death worldwide, is of great clinical and public health interest. This analysis introduces flexible statistical methods for estimating center-level effects on individual outcomes in the context of highly variable patient populations, such as those of the PRospective, Observational, Multi-center Major Trauma Transfusion study. Ten US level I trauma centers enrolled a total of 1,245 trauma patients who survived at least 30 minutes after admission and received at least one unit of red blood cells. Outcomes included death, multiple organ failure, substantial bleeding, and transfusion of blood products. The centers involved were classified as either large or small-volume based on the number of massive transfusion patients enrolled during the study period. We focused on estimation of parameters inspired by causal inference, specifically estimated impacts on patient outcomes related to the volume of the trauma hospital that treated them. We defined this association as the change in mean outcomes of interest that would be observed if, contrary to fact, subjects from large-volume sites were treated at small-volume sites (the effect of treatment among the treated. We estimated this parameter using three different methods, some of which use data-adaptive machine learning tools to derive the outcome models, minimizing residual confounding by reducing model misspecification. Differences between unadjusted and adjusted estimators sometimes differed dramatically, demonstrating the need to account for differences in patient characteristics in clinic comparisons. In addition, the estimators based on robust adjustment methods showed potential impacts of hospital volume. For instance, we estimated a survival benefit for patients who were treated at large-volume sites, which was not apparent in simpler, unadjusted comparisons. By removing arbitrary modeling decisions from the estimation process and concentrating

An Envelope Correlation Formula for (N,N MIMO Antenna Arrays Using Input Scattering Parameters, and Including Power Losses

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Y. A. S. Dama

2011-01-01

Full Text Available The scattering parameter formulation for the envelope correlation in an (N,N MIMO antenna array has been modified to take the intrinsic antenna power losses into account. This method of calculation provides a major simplification over the use of antenna radiation field patterns. Its accuracy is illustrated in three examples, which also show that the locations of the correlation minima are sensitive to the intrinsic losses.

J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results.

Science.gov (United States)

Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, Mustafa

2017-11-01

To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Predictors of outcome in World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients

NARCIS (Netherlands)

van den Berg, René; Foumani, Mahrouz; Schröder, Rosalie D.; Peerdeman, Saskia M.; Horn, Janneke; Bipat, Shandra; Vandertop, W. Peter

2011-01-01

Only a small percentage of World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients have a favorable outcome. The influence of clinical parameters on outcome was assessed. Retrospective evaluation of consecutive patients admitted from 2000-2007 with grade V

Exploring the outcomes in studies of primary frozen shoulder

DEFF Research Database (Denmark)

Rodgers, Sara; Brealey, Stephen; Jefferson, Laura

2014-01-01

PURPOSE: In our study we explored the need to define a core outcome set for primary frozen shoulder. METHODS: We investigated the outcomes used by studies included in a systematic review of the management of primary frozen shoulder; surveyed which primary outcome measures health care professionals...... and 104 respondents, respectively) were most often cited by health care professionals as the primary outcome measure that should be used. Searches identified one paper that included patients' views. Outcomes of importance to patients were pain at night, general pain, reduced mobility (resulting...

Outcome in Chronic Subdural Hematoma After Subdural vs. Subgaleal Drain

International Nuclear Information System (INIS)

Ishfaq, A.

2017-01-01

Objective: To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Lahore, from July 2015 to June 2016. Methodology: Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space (Group 1), and subdual space (Group 2), (n=31 patients each). Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p <0.05 was utilized using Statistical Package of Social Sciences (SPSS version 17). Results: Median age of the 62 patients was 72 +-12.5 years. Headache was the most common symptom reported in both groups, (n=47,75.8%) patients. Median thickness of hematoma was 15 +-6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 (35.4%) vs. 6 (19.3%), and intracerebral hemorrhage 4 (12.9%) vs. 2 (6.4%). Clinical outcome was good in both groups 27 (87%) in Group 1 and 28 (90%) in Group 2. Conclusion: Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another. (author)

Integral data analysis for resonance parameters determination

International Nuclear Information System (INIS)

Larson, N.M.; Leal, L.C.; Derrien, H.

1997-09-01

Neutron time-of-flight experiments have long been used to determine resonance parameters. Those resonance parameters have then been used in calculations of integral quantities such as Maxwellian averages or resonance integrals, and results of those calculations in turn have been used as a criterion for acceptability of the resonance analysis. However, the calculations were inadequate because covariances on the parameter values were not included in the calculations. In this report an effort to correct for that deficiency is documented: (1) the R-matrix analysis code SAMMY has been modified to include integral quantities of importance, (2) directly within the resonance parameter analysis, and (3) to determine the best fit to both differential (microscopic) and integral (macroscopic) data simultaneously. This modification was implemented because it is expected to have an impact on the intermediate-energy range that is important for criticality safety applications

The LIPAR-5 resonance parameter library

International Nuclear Information System (INIS)

Abagyan, L.P.

1997-08-01

The LIPAR-5 neutron resolved resonance parameter library has been elaborated. It contains data for 94 isotopes. The author's evaluations are included in LIPAR. Other authors' results are also included after re-evaluation. The codes used for the evaluation are described briefly. Tables of results are included for every isotope: the boundaries of the resolved resonance region, the numbers of s- and p-resonances, the thermal neutron partial cross-sections and the resonance integrals. The parameters are presented in ENDF/B-6 format. LIPAR is part of the nuclear data library of the MCU Monte Carlo code for neutron transport calculations. LIPAR was verified by comparing the benchmark experiment and Monte Carlo calculation results. (author). 44 refs, 6 tabs

18F-FDG-PET/CT parameters as imaging biomarkers in oral cavity squamous cell carcinoma, is visual analysis of PET and contrast enhanced CT better than the numbers?

Energy Technology Data Exchange (ETDEWEB)

Kendi, A.Tuba, E-mail: ayse.kendi@emory.edu [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA (United States); Corey, Amanda [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA (United States); Magliocca, Kelly R. [Department of Pathology, Emory University, Atlanta, GA (United States); Nickleach, Dana C. [Biostatistics & Bioinformatics Shared Resource at Winship Cancer Institute of Emory University, Atlanta, GA (United States); Galt, James [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA (United States); Switchenko, Jeffrey M. [Biostatistics & Bioinformatics Shared Resource at Winship Cancer Institute of Emory University, Atlanta, GA (United States); El-Deiry, Mark W.; Wadsworth, J. Trad [Otolaryngology Head and Neck Surgery, Emory University, Atlanta, GA (United States); Hudgins, Patricia A. [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA (United States); Saba, Nabil F. [Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA (United States); Schuster, David M. [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA (United States)

2015-06-15

Highlights: • Highlights of our study were the significant association of higher T stage of oral cavity squamous cell carcinoma with PET/CT parameters. • This could be an important finding in cases where it is difficult to decide on T stage by CT only. • We found a significant association between ring/heterogeneous enhancement pattern of (either primary or nodal or both) oral cavity squamous cell carcinoma at contrast enhanced CT and poor prognosis. • This could be related to hypoxia, which is a known reason for therapy resistance. Hence therapies can be tailored in the feature depending on enhancement pattern on contrast enhanced CT. - Abstract: Purpose: This study was designed to seek associations between positron emission tomography/computed tomography (PET/CT) parameters, contrast enhanced neck computed tomography (CECT) and pathological findings, and to determine the potential prognostic value of PET/CT and CECT parameters in oral cavity squamous cell carcinoma (OCSCC). Materials and method: 36 OCSCC patients underwent staging PET/CT and 30/36 of patients had CECT. PET/CT parameters were measured for the primary tumor and the hottest involved node, including maximum, mean, and peak standardized uptake values (SUV max, SUV mean, and SUV peak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized added metabolic activity (SAM), and normalized standardized added metabolic activity (N SAM). Qualitative assessment of PET/CT and CECT were also performed. Pathological outcomes included: perineural invasion, lymphovascular invasion, nodal extracapsular spread, grade, pathologic T and N stages. Multivariable logistic regression models were fit for each parameter and outcome adjusting for potentially confounding variables. Multivariable Cox proportional hazards models were used for progression free survival (PFS), locoregional recurrence free survival (LRFS), overall survival (OS) and distant metastasis free survival (DMFS). Results: In

18F-FDG-PET/CT parameters as imaging biomarkers in oral cavity squamous cell carcinoma, is visual analysis of PET and contrast enhanced CT better than the numbers?

International Nuclear Information System (INIS)

Kendi, A.Tuba; Corey, Amanda; Magliocca, Kelly R.; Nickleach, Dana C.; Galt, James; Switchenko, Jeffrey M.; El-Deiry, Mark W.; Wadsworth, J. Trad; Hudgins, Patricia A.; Saba, Nabil F.; Schuster, David M.

2015-01-01

Highlights: • Highlights of our study were the significant association of higher T stage of oral cavity squamous cell carcinoma with PET/CT parameters. • This could be an important finding in cases where it is difficult to decide on T stage by CT only. • We found a significant association between ring/heterogeneous enhancement pattern of (either primary or nodal or both) oral cavity squamous cell carcinoma at contrast enhanced CT and poor prognosis. • This could be related to hypoxia, which is a known reason for therapy resistance. Hence therapies can be tailored in the feature depending on enhancement pattern on contrast enhanced CT. - Abstract: Purpose: This study was designed to seek associations between positron emission tomography/computed tomography (PET/CT) parameters, contrast enhanced neck computed tomography (CECT) and pathological findings, and to determine the potential prognostic value of PET/CT and CECT parameters in oral cavity squamous cell carcinoma (OCSCC). Materials and method: 36 OCSCC patients underwent staging PET/CT and 30/36 of patients had CECT. PET/CT parameters were measured for the primary tumor and the hottest involved node, including maximum, mean, and peak standardized uptake values (SUV max, SUV mean, and SUV peak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized added metabolic activity (SAM), and normalized standardized added metabolic activity (N SAM). Qualitative assessment of PET/CT and CECT were also performed. Pathological outcomes included: perineural invasion, lymphovascular invasion, nodal extracapsular spread, grade, pathologic T and N stages. Multivariable logistic regression models were fit for each parameter and outcome adjusting for potentially confounding variables. Multivariable Cox proportional hazards models were used for progression free survival (PFS), locoregional recurrence free survival (LRFS), overall survival (OS) and distant metastasis free survival (DMFS). Results: In

Embedding Affective Learning Outcomes in Library Instruction

Directory of Open Access Journals (Sweden)

Ellysa Stern Cahoy

2012-12-01

Full Text Available While information literacy in higher education has long been focused on cognitive learning outcomes, attention must be paid to students’ affective, emotional needs throughout the research process. This article identifies models for embedding affective learning outcomes within information literacy instruction, and provides strategies to help librarians discover, articulate, and address students’ self-efficacy, motivation, emotions and attitudes. Worksheets to assist in creating affective learning outcomes are included to bring structure to an area of learning that is often challenging to articulate and measure. Also included in the article are the results of a recent survey of instruction librarians’ familiarity and inclusion of affective learning outcomes within teaching and learning initiatives.

Esthetic outcome and alterations of soft tissue around single implant crowns: a 2-year prospective study.

Science.gov (United States)

Gu, Ying-Xin; Shi, Jun-Yu; Zhuang, Long-Fei; Qiao, Shi-Chong; Xu, You-You; Lai, Hong-Chang

2015-08-01

The aim of this prospective study was to assess the esthetic outcome and alterations of peri-implant soft tissue using tissue-level implants. Furthermore, the influencing factors, including grafting and gingival biotype, of esthetic outcome of peri-implant soft tissue were also evaluated. Of 38 patients with single missing anterior tooth in maxilla were treated with a Straumann (®) Standard Plus SLA implant. Bone augmentation was performed in 24 patients. Follow-up was conducted at 12 and 24 months after definitive crowns placement. Esthetic outcome using the pink esthetic score/white esthetic score (PES/WES) and clinical parameters were evaluated. The mean PES/WES value at baseline, 1-year, and 2-year examination was 13.79, 14.87, and 14.96. Significant improvement was found between baseline and 1-year examination (P esthetic area. Favorable short-term esthetic outcome and stability of soft tissue around single implant crowns can be expected in patients with or without graft. However, graft procedures might have an unfavorable effect on the esthetic outcome. Gingival biotype can be considered as prognostic factor for esthetic outcome. RCTs with long-term follow-up are needed to provide evidence for the long-term stability of peri-implant soft tissue using tissue-level implant systems. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Meaningful Effect Sizes, Intraclass Correlations, and Proportions of Variance Explained by Covariates for Planning Two- and Three-Level Cluster Randomized Trials of Social and Behavioral Outcomes.

Science.gov (United States)

Dong, Nianbo; Reinke, Wendy M; Herman, Keith C; Bradshaw, Catherine P; Murray, Desiree W

2016-09-30

There is a need for greater guidance regarding design parameters and empirical benchmarks for social and behavioral outcomes to inform assumptions in the design and interpretation of cluster randomized trials (CRTs). We calculated the empirical reference values on critical research design parameters associated with statistical power for children's social and behavioral outcomes, including effect sizes, intraclass correlations (ICCs), and proportions of variance explained by a covariate at different levels (R 2 ). Children from kindergarten to Grade 5 in the samples from four large CRTs evaluating the effectiveness of two classroom- and two school-level preventive interventions. Teacher ratings of students' social and behavioral outcomes using the Teacher Observation of Classroom Adaptation-Checklist and the Social Competence Scale-Teacher. Two types of effect size benchmarks were calculated: (1) normative expectations for change and (2) policy-relevant demographic performance gaps. The ICCs and R 2 were calculated using two-level hierarchical linear modeling (HLM), where students are nested within schools, and three-level HLM, where students were nested within classrooms, and classrooms were nested within schools. Comprehensive tables of benchmarks and ICC values are provided to inform prevention researchers in interpreting the effect size of interventions and conduct power analyses for designing CRTs of children's social and behavioral outcomes. The discussion also provides a demonstration for how to use the parameter reference values provided in this article to calculate the sample size for two- and three-level CRTs designs. © The Author(s) 2016.

Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus.

Science.gov (United States)

Chaturvedi, Hemant; Khanna, Vikram; Bhargava, Rakesh; Vaishya, Raju

2018-03-01

Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria. Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score. Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.

Migration of antioxidants from polylactic acid films, a parameter estimation approach: Part I - A model including convective mass transfer coefficient.

Science.gov (United States)

Samsudin, Hayati; Auras, Rafael; Burgess, Gary; Dolan, Kirk; Soto-Valdez, Herlinda

2018-03-01

A two-step solution based on the boundary conditions of Crank's equations for mass transfer in a film was developed. Three driving factors, the diffusion (D), partition (K p,f ) and convective mass transfer coefficients (h), govern the sorption and/or desorption kinetics of migrants from polymer films. These three parameters were simultaneously estimated. They provide in-depth insight into the physics of a migration process. The first step was used to find the combination of D, K p,f and h that minimized the sums of squared errors (SSE) between the predicted and actual results. In step 2, an ordinary least square (OLS) estimation was performed by using the proposed analytical solution containing D, K p,f and h. Three selected migration studies of PLA/antioxidant-based films were used to demonstrate the use of this two-step solution. Additional parameter estimation approaches such as sequential and bootstrap were also performed to acquire a better knowledge about the kinetics of migration. The proposed model successfully provided the initial guesses for D, K p,f and h. The h value was determined without performing a specific experiment for it. By determining h together with D, under or overestimation issues pertaining to a migration process can be avoided since these two parameters are correlated. Copyright © 2017 Elsevier Ltd. All rights reserved.

Some hematological and biochemical parameters in smokeless ...

African Journals Online (AJOL)

AJB SERVER

2007-01-04

Jan 4, 2007 ... The effect of Jharda powder (smokeless tobacco) on some hematological and biochemical parameters in consumers was investigated. Hematological parameters including hemoglobin content and white blood cell and leukocyte counts were higher in jharda powder consumers, while monocytes and.

Core Outcomes for Colorectal Cancer Surgery: A Consensus Study.

Directory of Open Access Journals (Sweden)

Angus G K McNair

2016-08-01

Full Text Available Colorectal cancer (CRC is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs; however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods. Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78% centers, including 90 professionals, and 97 out of 267 (35% patients. Second round response rates were high for all stakeholders (>80%. Analysis of responses lead to 45 and 23 outcome domains being retained after the first and

Some properties of 2-D dielectric-based ENG/MNG material parameters extracted using the S-parameter method

DEFF Research Database (Denmark)

Wu, Yunqiu; Arslanagic, Samel

This work presents a systematic investigation of material parameters for two-dimensional epsilon-negative (ENG) and mu-negative (MNG) materials as obtained by the scattering parameter method. The unit cell consists of infinite dielectric cylinders, their sizes and permittivities are chosen...... to enable the ENG and MNG behaviors. For the both configurations, the permittivity and the permeability is reported. Influence of several effects on the extracted material parameters is examined, including the loss inside the cylinders and the size of the unit cells...

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

Science.gov (United States)

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C; O'Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny I; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C

2017-01-01

Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Consensus Workshop

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C.; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C.; O’Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C.

2017-01-01

Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes. PMID:27497527

Correlation between the histological features of corneal surface pannus following ocular surface burns and the final outcome of cultivated limbal epithelial transplantation.

Science.gov (United States)

Sati, Alok; Basu, Sayan; Sangwan, Virender S; Vemuganti, Geeta K

2015-04-01

To report the influence of histological features of corneal surface pannus following ocular surface burn on the outcome of cultivated limbal epithelial transplantation (CLET). On retrospectively reviewing the medical records of the patients who underwent autologous CLET from April 2002 to June 2012 at L V Prasad Eye Institute, Hyderabad, India, we could trace the histological reports in only 90 records. These 90 records, besides clinical parameters, were reviewed for the influence of various histological features on the final outcome of CLET. The histological features include epithelial hyperplasia (21.1%), surface ulceration (2.2%), goblet cells (62.2%), squamous metaplasia (11.1%), active fibrosis (31.1%), severe inflammation (8.9%), multinucleated giant cells (3.3%), stromal calcification (8.9%) and active proliferating vessels (5.6%). Among these histological features, patients with either hyperplasia or calcification in their excised corneal pannus show an unfavourable outcome compared with patients without hyperplasia (p=0.003) or calcification (p=0.018). A similar unfavourable outcome was not seen with other histological features and various clinical parameters. Presence of either calcific deposits or hyperplasia in the excised corneal pannus provides poor prognostication; hence, a proper counselling of such patients is mandatory along with a close follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Correlation between thromboelastography and traditional coagulation test parameters in hospitalized dogs

Directory of Open Access Journals (Sweden)

Rubanick JV

2017-02-01

Full Text Available Jean V Rubanick, Medora B Pashmakova, Micah A Bishop, James W Barr Department of Veterinary Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA Abstract: A hospital-based, prospective cross-sectional study was used to compare kaolin-activated thromboelastography (TEG parameters with traditional coagulation tests in 29 hospitalized dogs. Cases were included if the attending clinician requested coagulation testing. Blood was obtained from each dog and coagulation (prothrombin time, partial thromboplastin time, antithrombin activity, d-dimer concentration, and fibrinogen concentration and TEG analyses were performed. Hematocrit (Hct was also measured. Traditional coagulation results were evaluated for correlation with those from kaolin-activated TEG. Spearman’s correlation was used to calculate correlation coefficients. Fibrinogen was positively correlated with maximum amplitude (Pearson r=0.72, P<0.001 and global clot strength (Pearson r=0.72, P<0.001. There was no correlation between any of the remaining coagulation variables, TEG parameters, or Hct. Results of kaolin-activated TEG and traditional coagulation tests are not interchangeable means of monitoring coagulation derangements in this intensive care unit patient population. Determination of a true outcome measure is necessary to establish TEG’s clinical relevance to veterinary medicine. Keywords: TEG, thromboelastography, coagulation, hemostasis

Some hematological and biochemical parameters in smokeless ...

African Journals Online (AJOL)

The effect of Jharda powder (smokeless tobacco) on some hematological and biochemical parameters in consumers was investigated. Hematological parameters including hemoglobin content and white blood cell and leukocyte counts were higher in jharda powder consumers, while monocytes and basophiles counts were ...

Changes in haematological parameters of Tilapia guineensis ...

African Journals Online (AJOL)

Changes in haematological parameters of Tilapia guineensis exposed to different concentrations of detergent under laboratory conditions. ... The experiment evaluated sub-lethal effect of the exposure on some haematological parameters including haemoglobin (Hb), red blood cell (RBC), packed cell volume (PCV), white ...

One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

Directory of Open Access Journals (Sweden)

Daphne Eschbach

2016-01-01

Full Text Available Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU treatment, including invasive ventilatory management (IVM and hemodiafiltration (CVVHDF, is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA classification, and the Barthel index (BI were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (p=0.001. Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.

The incidence of significant relationships between selected parameters of feet and parameters of trunk in children aged 4, 5 and 6 years

Directory of Open Access Journals (Sweden)

Mirosław Mrozkowiak

2018-02-01

2. Foot parameters revealed the most frequent significant relationship with trunk parameters in the sagittal and frontal planes. Trunk parameters with which foot parameters correlated most often included: asymmetry in the height of both scapulas with the right scapula up, inclination of thoracolumbar region and asymmetry in the height of waist triangles with the right triangle up.

Injection Molding Parameters Calculations by Using Visual Basic (VB) Programming

Science.gov (United States)

Tony, B. Jain A. R.; Karthikeyen, S.; Alex, B. Jeslin A. R.; Hasan, Z. Jahid Ali

2018-03-01

Now a day’s manufacturing industry plays a vital role in production sectors. To fabricate a component lot of design calculation has to be done. There is a chance of human errors occurs during design calculations. The aim of this project is to create a special module using visual basic (VB) programming to calculate injection molding parameters to avoid human errors. To create an injection mold for a spur gear component the following parameters have to be calculated such as Cooling Capacity, Cooling Channel Diameter, and Cooling Channel Length, Runner Length and Runner Diameter, Gate Diameter and Gate Pressure. To calculate the above injection molding parameters a separate module has been created using Visual Basic (VB) Programming to reduce the human errors. The outcome of the module dimensions is the injection molding components such as mold cavity and core design, ejector plate design.

Impact of the Radiation Boost on Outcomes After Breast-Conserving Surgery and Radiation

International Nuclear Information System (INIS)

Murphy, Colin; Anderson, Penny R.; Li Tianyu; Bleicher, Richard J.; Sigurdson, Elin R.; Goldstein, Lori J.; Swaby, Ramona; Denlinger, Crystal; Dushkin, Holly; Nicolaou, Nicos; Freedman, Gary M.

2011-01-01

Purpose: We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. Methods and Materials: A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). Results: The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. Conclusions: Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.

Pediatric hydrocephalus outcomes: a review

Directory of Open Access Journals (Sweden)

Vinchon Matthieu

2012-08-01

Full Text Available Abstract The outcome of pediatric hydrocephalus, including surgical complications, neurological sequelae and academic achievement, has been the matter of many studies. However, much uncertainty remains, regarding the very long-term and social outcome, and the determinants of complications and clinical outcome. In this paper, we review the different facets of outcome, including surgical outcome (shunt failure, infection and independence, and complications of endoscopy, clinical outcome (neurological, sensory, cognitive sequels, epilepsy, schooling and social integration. We then provide a brief review of the English-language literature and highlighting selected studies that provide information on the outcome and sequelae of pediatric hydrocephalus, and the impact of predictive variables on outcome. Mortality caused by hydrocephalus and its treatments is between 0 and 3%, depending on the duration of follow-up. Shunt event-free survival (EFS is about 70% at one year and 40% at ten years. The EFS after endoscopic third ventriculostomy (ETV appears better but likely benefits from selection bias and long-term figures are not available. Shunt infection affects between 5 and 8% of surgeries, and 15 to 30% of patients according to the duration of follow-up. Shunt independence can be achieved in 3 to 9% of patients, but the definition of this varies. Broad variations in the prevalence of cognitive sequelae, affecting 12 to 50% of children, and difficulties at school, affecting between 20 and 60%, attest of disparities among studies in their clinical evaluation. Epilepsy, affecting 6 to 30% of patients, has a serious impact on outcome. In adulthood, social integration is poor in a substantial number of patients but data are sparse. Few controlled prospective studies exist regarding hydrocephalus outcomes; in their absence, largely retrospective studies must be used to evaluate the long-term consequences of hydrocephalus and its treatments. This review

Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya.

Science.gov (United States)

Graham, Susan M; Mugo, Peter; Gichuru, Evanson; Thiong'o, Alexander; Macharia, Michael; Okuku, Haile S; van der Elst, Elise; Price, Matthew A; Muraguri, Nicholas; Sanders, Eduard J

2013-05-01

African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference -3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART.

Histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging can predict histopathological findings including proliferation potential, cellularity, and nucleic areas in head and neck squamous cell carcinoma.

Science.gov (United States)

Surov, Alexey; Meyer, Hans Jonas; Leifels, Leonard; Höhn, Anne-Kathrin; Richter, Cindy; Winter, Karsten

2018-04-20

Our purpose was to analyze possible associations between histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging DCE MRI and histopathological findings like proliferation index, cell count and nucleic areas in head and neck squamous cell carcinoma (HNSCC). 30 patients (mean age 57.0 years) with primary HNSCC were included in the study. In every case, histogram analysis parameters of K trans , V e , and K ep were estimated using a mathlab based software. Tumor proliferation index, cell count, and nucleic areas were estimated on Ki 67 antigen stained specimens. Spearman's non-parametric rank sum correlation coefficients were calculated between DCE and different histopathological parameters. KI 67 correlated with K trans min ( p = -0.386, P = 0.043) and s K trans skewness ( p = 0.382, P = 0.045), V e min ( p = -0.473, P = 0.011), Ve entropy ( p = 0.424, P = 0.025), and K ep entropy ( p = 0.464, P = 0.013). Cell count correlated with K trans kurtosis ( p = 0.40, P = 0.034), V e entropy ( p = 0.475, P = 0.011). Total nucleic area correlated with V e max ( p = 0.386, P = 0.042) and V e entropy ( p = 0.411, P = 0.030). In G1/2 tumors, only K trans entropy correlated well with total ( P =0.78, P =0.013) and average nucleic areas ( p = 0.655, P = 0.006). In G3 tumors, KI 67 correlated with Ve min ( p = -0.552, P = 0.022) and V e entropy ( p = 0.524, P = 0.031). Ve max correlated with total nucleic area ( p = 0.483, P = 0.049). Kep max correlated with total area ( p = -0.51, P = 0.037), and K ep entropy with KI 67 ( p = 0.567, P = 0.018). We concluded that histogram-based parameters skewness, kurtosis and entropy of K trans , V e , and K ep can be used as markers for proliferation activity, cellularity and nucleic content in HNSCC. Tumor grading influences significantly associations between perfusion and histopathological parameters.

Functional Outcomes for Clinical Evaluation of Implant Restorations

NARCIS (Netherlands)

Bassi, Francesco; Carr, Alan B.; Chang, Ting-Ling; Estafanous, Emad W.; Garrett, Neal R.; Happonen, Risto-Pekka; Koka, Sreenivas; Laine, Juhani; Osswald, Martin; Reintsema, Harry; Rieger, Jana; Roumanas, Eleni; Salinas, Thomas J.; Stanford, Clark M.; Wolfaardt, Johan

2013-01-01

The functional outcomes related to treating patients afflicted with tooth loss are an important hallmark in substantiating prosthodontic intervention. The Oral Rehabilitation Outcomes Network (ORONet) conducted two international workshops to develop a core set of outcome measures, including a

SEEPAGE MODEL FOR PA INCLUDING DRIFT COLLAPSE

International Nuclear Information System (INIS)

C. Tsang

2004-01-01

The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes.

Science.gov (United States)

Kappen, Isabelle Francisca Petronella Maria; Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom Fjmc; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

2017-05-01

No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (Pspeech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Early outcome for the primary arterial switch operation beyond the age of 3 weeks.

Science.gov (United States)

Ismail, Sameh R; Kabbani, Mohamed S; Najm, Hani K; Abusuliman, Riyadh M; Elbarbary, Mahmoud

2010-07-01

The arterial switch operation (ASO) for neonates is the standard management for transposition of the great arteries (TGA) with an intact ventricular septum (IVS). Patients presenting for late ASO are at risk due to the possibility of left ventricle (LV) involution. This study aimed to assess the early postoperative course and outcome for children with TGA/IVS and still conditioned LV presenting for late primary ASO. A retrospective study of all TGA/IVS patients who underwent a primary ASO between March 2002 and March 2008 was conducted. The cases were divided into two groups. Group A included all the cases of early ASO repaired before the age of 3 weeks, whereas group B included all the preslected cases of late ASO repaired after the age of 3 weeks. The demographics, intensive care unit (ICU) parameters, complications, and short-term outcomes of the two groups were compared. The study enrolled of 91 patients: 64 patients (70%) in group A and 27 patients (30%) in group B. The mean age was 11 +/- 4 days in group A and 37 +/- 17 days in group B (P age should not be a limitation for ASO.

Deductive multiscale simulation using order parameters

Science.gov (United States)

Ortoleva, Peter J.

2017-05-16

Illustrative embodiments of systems and methods for the deductive multiscale simulation of macromolecules are disclosed. In one illustrative embodiment, a deductive multiscale simulation method may include (i) constructing a set of order parameters that model one or more structural characteristics of a macromolecule, (ii) simulating an ensemble of atomistic configurations for the macromolecule using instantaneous values of the set of order parameters, (iii) simulating thermal-average forces and diffusivities for the ensemble of atomistic configurations, and (iv) evolving the set of order parameters via Langevin dynamics using the thermal-average forces and diffusivities.

FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients

Energy Technology Data Exchange (ETDEWEB)

Brenner, Winfried; Eary, Janet F. [Division of Nuclear Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356113, WA 98195-6113, Seattle (United States); Conrad, Ernest U. [Department of Orthopaedics, University of Washington Medical Center, Seattle, WA (United States)

2004-02-01

The aims of this study were to assess the potential of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) for tumor grading in chondrosarcoma patients and to evaluate the role of standardized uptake value (SUV) as a parameter for prediction of patient outcome. FDG PET imaging was performed in 31 patients with chondrosarcoma prior to therapy. SUV was calculated for each tumor and correlated to tumor grade and size, and to patient outcome in terms of local relapse or metastatic disease with a mean follow-up period of 48 months. Chondrosarcomas were detectable in all patients. Tumor SUV was 3.38{+-}1.61 for grade I (n=15), 5.44{+-}3.06 for grade II (n=13), and 7.10{+-}2.61 for grade III (n=3). Significant differences were found between patients with and without disease progression: SUV was 6.42{+-}2.70 (n=10) in patients developing recurrent or metastatic disease compared with 3.74{+-}2.22 in patients without relapse (P=0.015). Using a cut-off of 4 for SUV, sensitivity, specificity, and positive and negative predictive values for a relapse were 90%, 76%, 64%, and 94%, respectively. Combining tumor grade and SUV, these parameters improved to 90%, 95%, 90%, and 95%, respectively. Pretherapeutic tumor SUV obtained by FDG PET imaging was a useful parameter for tumor grading and prediction of outcome in chondrosarcoma patients. The combination of SUV and histopathologic tumor grade further improved prediction of outcome substantially, allowing identification of patients at high risk for local relapse or metastatic disease. (orig.)

Prediction of oxidation parameters of purified Kilka fish oil including gallic acid and methyl gallate by adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network.

Science.gov (United States)

Asnaashari, Maryam; Farhoosh, Reza; Farahmandfar, Reza

2016-10-01

As a result of concerns regarding possible health hazards of synthetic antioxidants, gallic acid and methyl gallate may be introduced as natural antioxidants to improve oxidative stability of marine oil. Since conventional modelling could not predict the oxidative parameters precisely, artificial neural network (ANN) and neuro-fuzzy inference system (ANFIS) modelling with three inputs, including type of antioxidant (gallic acid and methyl gallate), temperature (35, 45 and 55 °C) and concentration (0, 200, 400, 800 and 1600 mg L(-1) ) and four outputs containing induction period (IP), slope of initial stage of oxidation curve (k1 ) and slope of propagation stage of oxidation curve (k2 ) and peroxide value at the IP (PVIP ) were performed to predict the oxidation parameters of Kilka oil triacylglycerols and were compared to multiple linear regression (MLR). The results showed ANFIS was the best model with high coefficient of determination (R(2)  = 0.99, 0.99, 0.92 and 0.77 for IP, k1 , k2 and PVIP , respectively). So, the RMSE and MAE values for IP were 7.49 and 4.92 in ANFIS model. However, they were to be 15.95 and 10.88 and 34.14 and 3.60 for the best MLP structure and MLR, respectively. So, MLR showed the minimum accuracy among the constructed models. Sensitivity analysis based on the ANFIS model suggested a high sensitivity of oxidation parameters, particularly the induction period on concentrations of gallic acid and methyl gallate due to their high antioxidant activity to retard oil oxidation and enhanced Kilka oil shelf life. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients.

Science.gov (United States)

Imura, Takeshi; Nagasawa, Yuki; Inagawa, Tetsuji; Imada, Naoki; Izumi, Hiroaki; Emoto, Katsuya; Tani, Itaru; Yamasaki, Hiroyuki; Ota, Yuichiro; Oki, Shuichi; Maeda, Tadanori; Araki, Osamu

2015-05-01

[Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes and activities of daily living function remains unclear. We evaluated the most appropriate diffusion tensor parameters and methodology to determine whether the region of interest- or tractography-based method was more useful for predicting motor outcomes and activities of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor imaging data within 10 days after stroke onset were collected and analyzed for 25 patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers, and apparent diffusion coefficient were used as diffusion tensor parameters. Motor outcomes and activities of daily living function were evaluated on the same day as diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy value of the affected corticospinal tract significantly correlated with the motor outcome and activities of daily living function within 10 days post-onset and at 1 month post-onset. Tthere were no significant correlations between other diffusion tensor parameters and motor outcomes or activities of daily living function. [Conclusion] The fractional anisotropy value of the affected corticospinal tract obtained using the tractography-based method was useful for predicting motor outcomes and activities of daily living function in stroke patients.

[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions].

Science.gov (United States)

Nübling, R; Kaluscha, R; Krischak, G; Kriz, D; Martin, H; Müller, G; Renzland, J; Reuss-Borst, M; Schmidt, J; Kaiser, U; Toepler, E

2017-02-01

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary. © Georg Thieme Verlag KG Stuttgart · New York.

The Human Bathtub: Safety and Risk Predictions Including the Dynamic Probability of Operator Errors

International Nuclear Information System (INIS)

Duffey, Romney B.; Saull, John W.

2006-01-01

Reactor safety and risk are dominated by the potential and major contribution for human error in the design, operation, control, management, regulation and maintenance of the plant, and hence to all accidents. Given the possibility of accidents and errors, now we need to determine the outcome (error) probability, or the chance of failure. Conventionally, reliability engineering is associated with the failure rate of components, or systems, or mechanisms, not of human beings in and interacting with a technological system. The probability of failure requires a prior knowledge of the total number of outcomes, which for any predictive purposes we do not know or have. Analysis of failure rates due to human error and the rate of learning allow a new determination of the dynamic human error rate in technological systems, consistent with and derived from the available world data. The basis for the analysis is the 'learning hypothesis' that humans learn from experience, and consequently the accumulated experience defines the failure rate. A new 'best' equation has been derived for the human error, outcome or failure rate, which allows for calculation and prediction of the probability of human error. We also provide comparisons to the empirical Weibull parameter fitting used in and by conventional reliability engineering and probabilistic safety analysis methods. These new analyses show that arbitrary Weibull fitting parameters and typical empirical hazard function techniques cannot be used to predict the dynamics of human errors and outcomes in the presence of learning. Comparisons of these new insights show agreement with human error data from the world's commercial airlines, the two shuttle failures, and from nuclear plant operator actions and transient control behavior observed in transients in both plants and simulators. The results demonstrate that the human error probability (HEP) is dynamic, and that it may be predicted using the learning hypothesis and the minimum

Provider volume and outcomes for oncological procedures.

LENUS (Irish Health Repository)

Killeen, S D

2012-02-03

BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

Motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment: a diffusion tensor imaging study

Directory of Open Access Journals (Sweden)

Jin Hyun Kim

2015-01-01

Full Text Available Previous diffusion tensor imaging (DTI studies regarding pediatric patients with motor dysfunction have confirmed the correlation between DTI parameters of the injured corticospinal tract and the severity of motor dysfunction. There is also evidence that DTI parameters can help predict the prognosis of motor function of patients with cerebral palsy. But few studies are reported on the DTI parameters that can reflect the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment. In the present study, 36 pediatric patients with hemiplegic cerebral palsy were included. Before and after rehabilitation treatment, DTI was used to measure the fiber number (FN, fractional anisotropy (FA and apparent diffusion coefficient (ADC of bilateral corticospinal tracts. Functional Level of Hemiplegia scale (FxL was used to assess the therapeutic effect of rehabilitative therapy on clinical hemiplegia. Correlation analysis was performed to assess the statistical interrelationship between the change amount of DTI parameters and FxL. DTI findings obtained at the initial and follow-up evaluations demonstrated that more affected corticospinal tract yielded significantly decreased FN and FA values and significantly increased ADC value compared to the less affected corticospinal tract. Correlation analysis results showed that the change amount of FxL was positively correlated to FN and FA values, and the correlation to FN was stronger than the correlation to FA. The results suggest that FN and FA values can be used to evaluate the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment and FN is of more significance for evaluation.

Prospective outcomes of injury study.

Science.gov (United States)

Derrett, S; Langley, J; Hokowhitu, B; Ameratunga, S; Hansen, P; Davie, G; Wyeth, E; Lilley, R

2009-10-01

In New Zealand (NZ), 20% of adults report a disability, of which one-third is caused by injury. No prospective epidemiological studies of predictors of disability following all-cause injury among New Zealanders have been undertaken. Internationally, studies have focused on a limited range of predictors or specific injuries. Although these studies provide useful insights, applicability to NZ is limited given the importance of NZ's unique macro-social factors, such as NZ's no-fault accident compensation and rehabilitation scheme, the Accident Compensation Corporation (ACC). (1) To quantitatively determine the injury, rehabilitation, personal, social and economic factors leading to disability outcomes following injury in NZ. (2) To qualitatively explore experiences and perceptions of injury-related outcomes in face-to-face interviews with 15 Māori and 15 other New Zealanders, 6 and 12 months after injury. Four geographical regions within NZ. Prospective cohort study with telephone interviews 1, 4 and 12 months after injury. 2500 people (including 460 Māori), aged 18-64 years, randomly selected from ACC's entitlement claims register (people likely to be off work for at least 1 week or equivalent). Telephone interviews, electronic hospital and ACC injury data. Exposures include demographic, social, economic, work-related, health status, participation and/or environmental factors. Primary: disability (including WHODAS II) and health-related quality of life (including EQ-5D). Secondary: participation (paid and unpaid activities), life satisfaction and costs. Separate regression models will be developed for each of the outcomes. Repeated measures outcomes will be modelled using general estimating equation models and generalised linear mixed models.

Serial analysis of 3D H-1 MRSI for patients with newly diagnosed GBM treated with combination therapy that includes bevacizumab.

Science.gov (United States)

Nelson, Sarah J; Li, Yan; Lupo, Janine M; Olson, Marram; Crane, Jason C; Molinaro, Annette; Roy, Ritu; Clarke, Jennifer; Butowski, Nicholas; Prados, Michael; Cha, Soonmee; Chang, Susan M

2016-10-01

Interpretation of changes in the T1- and T2-weighted MR images from patients with newly diagnosed glioblastoma (GBM) treated with standard of care in conjunction with anti-angiogenic agents is complicated by pseudoprogression and pseudoresponse. The hypothesis being tested in this study was that 3D H-1 magnetic resonance spectroscopic imaging (MRSI) provides estimates of levels of choline, creatine, N-acetylaspartate (NAA), lactate and lipid that change in response to treatment and that metrics describing these characteristics are associated with survival. Thirty-one patients with newly diagnosed GBM and being treated with radiation therapy (RT), temozolomide, erlotinib and bevacizumab were recruited to receive serial MR scans that included 3-D lactate edited MRSI at baseline, mid-RT, post-RT and at specific follow-up time points. The data were processed to provide estimates of metrics representing changes in metabolite levels relative to normal appearing brain. Cox proportional hazards analysis was applied to examine the relationship of these parameters with progression free survival (PFS) and overall survival (OS). There were significant reductions in parameters that describe relative levels of choline to NAA and creatine, indicating that the treatment caused a decrease in tumor cellularity. Changes in the levels of lactate and lipid relative to the NAA from contralateral brain were consistent with vascular normalization. Metabolic parameters from the first serial follow-up scan were associated with PFS and OS, when accounting for age and extent of resection. Integrating metabolic parameters into the assessment of patients with newly diagnosed GBM receiving therapies that include anti-angiogenic agents may be helpful for tracking changes in tumor burden, resolving ambiguities in anatomic images caused by non-specific treatment effects and for predicting outcome.

Isolators Including Main Spring Linear Guide Systems

Science.gov (United States)

Goold, Ryan (Inventor); Buchele, Paul (Inventor); Hindle, Timothy (Inventor); Ruebsamen, Dale Thomas (Inventor)

2017-01-01

Embodiments of isolators, such as three parameter isolators, including a main spring linear guide system are provided. In one embodiment, the isolator includes first and second opposing end portions, a main spring mechanically coupled between the first and second end portions, and a linear guide system extending from the first end portion, across the main spring, and toward the second end portion. The linear guide system expands and contracts in conjunction with deflection of the main spring along the working axis, while restricting displacement and rotation of the main spring along first and second axes orthogonal to the working axis.

Evaluation of Post-Operative Visual Outcomes of Cataract Surgery in ...

African Journals Online (AJOL)

Data was compiled on demographic characteristics, pre- and postoperative visual acuities and surgical complications. The preoperative and postoperative visual status was classified using the World Health Organization (WHO) category of Visual Impairment and Blindness. The standard parameters of assessing outcome of ...

Complex investigation of thermo-technical parameters of Ruskov andesite

Directory of Open Access Journals (Sweden)

František Krepelka

2006-12-01

Full Text Available The research of thermo-technical parameters of Ruskov andesite was made as a part of the complex research of its properties as well as of rock disintegration by the action of chemical flame on the rock surface, i.e. thermal spalling in particular. Thermal spalling is a process in which thermal stresses are induced in the surface layer of rock whose surface is thereby disintegrated into small parts, the so called spalls, by the brittle manner. The evaluation of thermo-technical properties of the studied rocks is necessary for the qualification and quantification of the thermal spalling process. The measured and evaluated parameters were the coefficient of linear thermal expansion, the coefficient of thermal conductivity, the specific heat capacity and the coefficient of thermal diffusivity. Andesite from the Ruskov locality was chosen as a basic experimental material for the investigation of thermal spalling upon preliminary experiments. The estimated thermo-technical parameters were analyzed regarding the application of thermal spalling for the disintegration of the Ruskov andesite. The outcome as that the values of determine thermo-technical parameters established an expectation for its successful application.

Neither Single nor a Combination of Routine Laboratory Parameters can Discriminate between Gram-positive and Gram-negative Bacteremia

Science.gov (United States)

Ratzinger, Franz; Dedeyan, Michel; Rammerstorfer, Matthias; Perkmann, Thomas; Burgmann, Heinz; Makristathis, Athanasios; Dorffner, Georg; Loetsch, Felix; Blacky, Alexander; Ramharter, Michael

2015-01-01

Adequate early empiric antibiotic therapy is pivotal for the outcome of patients with bloodstream infections. In clinical practice the use of surrogate laboratory parameters is frequently proposed to predict underlying bacterial pathogens; however there is no clear evidence for this assumption. In this study, we investigated the discriminatory capacity of predictive models consisting of routinely available laboratory parameters to predict the presence of Gram-positive or Gram-negative bacteremia. Major machine learning algorithms were screened for their capacity to maximize the area under the receiver operating characteristic curve (ROC-AUC) for discriminating between Gram-positive and Gram-negative cases. Data from 23,765 patients with clinically suspected bacteremia were screened and 1,180 bacteremic patients were included in the study. A relative predominance of Gram-negative bacteremia (54.0%), which was more pronounced in females (59.1%), was observed. The final model achieved 0.675 ROC-AUC resulting in 44.57% sensitivity and 79.75% specificity. Various parameters presented a significant difference between both genders. In gender-specific models, the discriminatory potency was slightly improved. The results of this study do not support the use of surrogate laboratory parameters for predicting classes of causative pathogens. In this patient cohort, gender-specific differences in various laboratory parameters were observed, indicating differences in the host response between genders. PMID:26522966

Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers

Energy Technology Data Exchange (ETDEWEB)

Lin, Peter [Liverpool Hospital, Department of Nuclear Medicine and PET, Liverpool BC, NSW (Australia); University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Min, Myo; Forstner, Dion [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lee, Mark [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Holloway, Lois [University of New South Wales, South Western Sydney Clinical School, Sydney, NSW (Australia); Western Sydney University, Sydney, NSW (Australia); Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Bray, Victoria; Fowler, Allan [Liverpool Hospital, Cancer Therapy Centre, Liverpool, NSW (Australia)

2017-05-15

To evaluate the prognostic utility of nodal metabolic parameters derived from FDG PET/CT performed before radiotherapy (prePET) and during the third week of radiotherapy (iPET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC). This analysis included 75 patients with newly diagnosed locally advanced node-positive MPHNSCC treated with radical radiotherapy and concurrent systemic therapy who underwent prePET and iPET: N1 11 patients, N2a 38, N2b 12, N2c 9, N3 5. The median follow-up was 28 months (9 - 70 months). The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of the index lymph node (node with the highest TLG) and the combined total lymph nodes, and their percentage reductions on iPET were determined, and the results were correlated with 3-year Kaplan-Meier locoregional, regional and distant metastatic failure-free survival (FFS), disease-free survival (DFS) and overall survival (OS). Optimal cut-off values were derived from receiver operating characteristic curves. Cox regression univariate and multivariate analyses with clinical covariates were performed. Based on assessment of residual nodal metabolic burden during treatment, the iPET index node SUVmean (optimal cut-off value 2.95 g/ml) and the total node SUVmean (optimal cut-off value 3.25) were the best independent predictors of outcome in the multivariate analysis: index node SUVmean for DFS and OS p = 0.033 and 0.003, respectively, and the total node SUVmean for locoregional FFS, DFS and OS p = 0.028, 0.025 and 0.014, respectively. Based on the assessment of response rates during treatment, a reduction of more than 50 % in the total node TLG was the best biomarker for locoregional and regional FFS, DFS and OS in the multivariate analysis (p = 0.001, 0.016, 0.001 and 0.004, respectively), and reduction in the total node MTV for locoregional FFS, DFS and OS (p = 0.026, 0.003 and 0

Automated parameter estimation for biological models using Bayesian statistical model checking.

Science.gov (United States)

Hussain, Faraz; Langmead, Christopher J; Mi, Qi; Dutta-Moscato, Joyeeta; Vodovotz, Yoram; Jha, Sumit K

2015-01-01

Probabilistic models have gained widespread acceptance in the systems biology community as a useful way to represent complex biological systems. Such models are developed using existing knowledge of the structure and dynamics of the system, experimental observations, and inferences drawn from statistical analysis of empirical data. A key bottleneck in building such models is that some system variables cannot be measured experimentally. These variables are incorporated into the model as numerical parameters. Determining values of these parameters that justify existing experiments and provide reliable predictions when model simulations are performed is a key research problem. Using an agent-based model of the dynamics of acute inflammation, we demonstrate a novel parameter estimation algorithm by discovering the amount and schedule of doses of bacterial lipopolysaccharide that guarantee a set of observed clinical outcomes with high probability. We synthesized values of twenty-eight unknown parameters such that the parameterized model instantiated with these parameter values satisfies four specifications describing the dynamic behavior of the model. We have developed a new algorithmic technique for discovering parameters in complex stochastic models of biological systems given behavioral specifications written in a formal mathematical logic. Our algorithm uses Bayesian model checking, sequential hypothesis testing, and stochastic optimization to automatically synthesize parameters of probabilistic biological models.

Changes in inflammatory mediators in gingival crevicular fluid following periodontal disease treatment in pregnancy: relationship to adverse pregnancy outcome.

Science.gov (United States)

Penova-Veselinovic, Blagica; Keelan, Jeffrey A; Wang, Carol A; Newnham, John P; Pennell, Craig E

2015-11-01

Periodontal disease (PD) in pregnancy is associated with an increased risk of adverse pregnancy outcomes including miscarriage and preterm birth. Evidence exists that periodontal disease treatment may reduce inflammatory mediators in gingival crevicular fluid (GCF) and the risk of inflammation-associated pregnancy complications. The aim was to determine if periodontal disease treatment during mid-pregnancy alters local inflammation in GCF and has beneficial effects on clinical dental parameters. Eighty pregnant women with clinically diagnosed PD were recruited from a randomised controlled trial on the treatment of periodontal disease in pregnancy conducted in Perth, Australia. The treatment group underwent intensive PD treatment (20-28 weeks' GA), while the control group underwent the same treatment postnatally. GCF was collected at 20 and 28 weeks' gestation and concentrations of cytokines determined by multiplex assay: IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, TNF-α and MCP-1. Periodontal treatment significantly reduced the GCF levels of IL-1β, IL-10, IL-12p70 and IL-6 at 28 weeks' GA compared with controls, while levels of MCP-1, IL-8 and TNF-α exhibited a significant gestational age-dependent increase, but no treatment response. Post-treatment clinical parameters improved with significant reductions in bleeding on probing, clinical attachment loss, and probing depth. No changes in pregnancy-related outcomes were observed, although the severity of periodontal disease was significantly associated with an increased risk of infants born small for gestational age. PD treatment in pregnancy reduces the levels of some inflammatory mediators in the GCF and improves dental parameters, with no overt effects on pregnancy outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Factors contributing to outcome following traumatic brain injury.

Science.gov (United States)

Ponsford, Jennie

2013-01-01

Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. This paper reviews the factors associated with each of these aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process.

Outcomes analysis in 100 liver transplantation patients.

Science.gov (United States)

Geevarghese, S K; Bradley, A E; Wright, J K; Chapman, W C; Feurer, I; Payne, J L; Hunter, E B; Pinson, C W

1998-05-01

There is an increasing demand for outcomes analysis, including quality of life and financial analysis, following medical interventions and surgical procedures. We analyzed outcomes for 100 consecutive patients undergoing liver transplantation during a period of case management revision. Patient survival was calculated by Kaplan-Meier actuarial methods. The Karnofsky performance status was objectively assessed for surviving patients up to 6 years after transplantation and was evaluated by repeated measures analysis of variance and covariance. Subjective evaluation of quality of life over time was obtained using the Psychosocial Adjustment to Illness Scale. The correlations between time and scale were calculated. Financial data were accumulated from billing records. Six-month, 1-year, 2-year, and 3- through 5-year survival was 86%, 84%, 83%, and 78%, respectively. Karnofsky performance status confirmed poor functional status preoperatively with a mean of 53 +/- 2, but significantly improving to 72 +/- 2 at 3 months, 80 +/- 2 at 6 months, 90 +/- 1 at 1 year, 92 +/- 1 at 2 years, 94 +/- 1 at 3 years, 96 +/- 1 at 4 years, and 97 +/- 1 at 5 years (P <0.001). Psychosocial Adjustment to Illness Scale scores demonstrated significant improvement following transplantation overall (r = -0.33), improving most in sexual relationships (r = -0.41), and domestic environment (r = -0.35; P <0.001). Median length of stay for the first half of the patients was 19 days declining to 11 days for the second half. Median hospital charges declined from $105,000 to $90,000. Quality of life parameters assessed both by care givers (Karnofsky) and by patients (Psychosocial Adjustment to Illness Scale) improved dramatically following transplantation and over time, demonstrating that liver transplantation effectively restores a good quality of life. Outcomes can be improved while reducing length of stay and charges through modifications in case management.

The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis.

Science.gov (United States)

Wandro, Stephen; Osborne, Stephanie; Enriquez, Claudia; Bixby, Christine; Arrieta, Antonio; Whiteson, Katrine

2018-06-27

The assembly and development of the gut microbiome in infants have important consequences for immediate and long-term health. Preterm infants represent an abnormal case for bacterial colonization because of early exposure to bacteria and frequent use of antibiotics. To better understand the assembly of the gut microbiota in preterm infants, fecal samples were collected from 32 very low birth weight preterm infants over the first 6 weeks of life. Infant health outcomes included health, late-onset sepsis, and necrotizing enterocolitis (NEC). We characterized bacterial compositions by 16S rRNA gene sequencing and metabolomes by untargeted gas chromatography-mass spectrometry. Preterm infant fecal samples lacked beneficial Bifidobacterium spp. and were dominated by Enterobacteriaceae , Enterococcus , and Staphylococcus organisms due to nearly uniform antibiotic administration. Most of the variance between the microbial community compositions could be attributed to the baby from which the sample derived (permutational multivariate analysis of variance [PERMANOVA] R 2 = 0.48, P PERMANOVA R 2 = 0.43, P < 0.001) and weakly associated with bacterial composition (Mantel statistic r = 0.23 ± 0.05, P < 0.05). No measured metabolites were found to be associated with necrotizing enterocolitis, late-onset sepsis, or a healthy outcome. Overall, preterm infant gut microbial communities were personalized and reflected antibiotic usage. IMPORTANCE Preterm infants face health problems likely related to microbial exposures, including sepsis and necrotizing enterocolitis. However, the role of the gut microbiome in preterm infant health is poorly understood. Microbial colonization differs from that of healthy term babies because it occurs in the NICU and is often perturbed by antibiotics. We measured bacterial compositions and metabolomic profiles of 77 fecal samples from 32 preterm infants to investigate the differences between microbiomes in health and disease. Rather than finding

Epidemiologic research using probabilistic outcome definitions.

Science.gov (United States)

Cai, Bing; Hennessy, Sean; Lo Re, Vincent; Small, Dylan S

2015-01-01

Epidemiologic studies using electronic healthcare data often define the presence or absence of binary clinical outcomes by using algorithms with imperfect specificity, sensitivity, and positive predictive value. This results in misclassification and bias in study results. We describe and evaluate a new method called probabilistic outcome definition (POD) that uses logistic regression to estimate the probability of a clinical outcome using multiple potential algorithms and then uses multiple imputation to make valid inferences about the risk ratio or other epidemiologic parameters of interest. We conducted a simulation to evaluate the performance of the POD method with two variables that can predict the true outcome and compared the POD method with the conventional method. The simulation results showed that when the true risk ratio is equal to 1.0 (null), the conventional method based on a binary outcome provides unbiased estimates. However, when the risk ratio is not equal to 1.0, the traditional method, either using one predictive variable or both predictive variables to define the outcome, is biased when the positive predictive value is value is poor (less than 0.75 in our simulation). In contrast, the POD method provides unbiased estimates of the risk ratio both when this measure of effect is equal to 1.0 and not equal to 1.0. Even when the sensitivity and positive predictive value are low, the POD method continues to provide unbiased estimates of the risk ratio. The POD method provides an improved way to define outcomes in database research. This method has a major advantage over the conventional method in that it provided unbiased estimates of risk ratios and it is easy to use. Copyright © 2014 John Wiley & Sons, Ltd.

Predicting outcome after appendicectomy.

LENUS (Irish Health Repository)

Kell, M R

2012-02-03

AIM: To validate an intraoperative appendicitis severity score (IASS) and examine outcome following emergency appendectomy. METHODS: A prospective study was undertaken, enrolling consecutive patients undergoing emergency appendicectomy. Data were obtained independently on preoperative Alvarado scores, IASS (0-3: 0 no inflammation, 1 engorged appendix\\/no peritonitis, 2 peritoneal reaction\\/exudate or 3 evidence of perforation\\/abscess) and postoperative outcome parameters. RESULTS: There were 149 patients identified with a mean age of 20.7 years. There was no association between Alvarado score and length of hospital stay, septic complication, patient sex or duration of symptoms (p>0.05). IASS was found to be an independent risk factor for septic complication, wound infection (p<0.05) and length of hospital stay (p<0.001). There was no correlation between preoperative duration of symptoms or time until surgery and intraoperative score. CONCLUSIONS: This simple scoring system can identify patients more likely to suffer morbidity following emergency appendicectomy. Specifically, this system identifies patients who have a high risk of sepsis and therefore could be of use when comparing healthcare performance.

Reliable prediction of clinical outcome in patients with chronic HCV infection and compensated advanced hepatic fibrosis: a validated model using objective and readily available clinical parameters.

Science.gov (United States)

van der Meer, Adriaan J; Hansen, Bettina E; Fattovich, Giovanna; Feld, Jordan J; Wedemeyer, Heiner; Dufour, Jean-François; Lammert, Frank; Duarte-Rojo, Andres; Manns, Michael P; Ieluzzi, Donatella; Zeuzem, Stefan; Hofmann, W Peter; de Knegt, Robert J; Veldt, Bart J; Janssen, Harry L A

2015-02-01

Reliable tools to predict long-term outcome among patients with well compensated advanced liver disease due to chronic HCV infection are lacking. Risk scores for mortality and for cirrhosis-related complications were constructed with Cox regression analysis in a derivation cohort and evaluated in a validation cohort, both including patients with chronic HCV infection and advanced fibrosis. In the derivation cohort, 100/405 patients died during a median 8.1 (IQR 5.7-11.1) years of follow-up. Multivariate Cox analyses showed age (HR=1.06, 95% CI 1.04 to 1.09, pstatistic=0.78, 95% CI 0.72 to 0.83). In the validation cohort, 58/296 patients with cirrhosis died during a median of 6.6 (IQR 4.4-9.0) years. Among patients with estimated 5-year mortality risks 10%, the observed 5-year mortality rates in the derivation cohort and validation cohort were 0.9% (95% CI 0.0 to 2.7) and 2.6% (95% CI 0.0 to 6.1), 8.1% (95% CI 1.8 to 14.4) and 8.0% (95% CI 1.3 to 14.7), 21.8% (95% CI 13.2 to 30.4) and 20.9% (95% CI 13.6 to 28.1), respectively (C statistic in validation cohort = 0.76, 95% CI 0.69 to 0.83). The risk score for cirrhosis-related complications also incorporated HCV genotype (C statistic = 0.80, 95% CI 0.76 to 0.83 in the derivation cohort; and 0.74, 95% CI 0.68 to 0.79 in the validation cohort). Prognosis of patients with chronic HCV infection and compensated advanced liver disease can be accurately assessed with risk scores including readily available objective clinical parameters. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Low-protein diet does not alter reproductive, biochemical, and hematological parameters in pregnant Wistar rats

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M.A.V. Barros

2018-05-01

Full Text Available The aim of this study was to investigate the reproductive, biochemical, and hematological outcomes of pregnant rats exposed to protein restriction. Wistar rat dams were fed a control normal-protein (NP, 17% protein, n=8 or a low-protein (LP, 8% protein, n=14 diet from the 1st to the 20th day of pregnancy. On the 20th day, the clinical signs of toxicity were evaluated. The pregnant rats were then anesthetized and blood samples were collected for biochemical-hematological analyses, and laparotomy was performed to evaluate reproductive parameters. No sign of toxicity, or differences (P>0.05 in body weight gain and biochemical parameters (urea, creatinine, albumin, globulin, and total protein between NP and LP pregnant dams were observed. Similarly, hematological data, including red blood cell count, white blood cell count, hemoglobin, hematocrit, red blood cell distribution width (coefficient of variation, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, % lymphocytes, absolute lymphocyte count, platelet count, and mean platelet volume were similar (P>0.05 at the end of pregnancy. Reproductive parameters (the dam-offspring relationship, ovary mass, placenta mass, number of corpora lutea, implantation index, resorption index, and the pre- and post-implantation loss rates were also not different (P>0.05 between NP and LP pregnant dams. The present data showed that a protein-restricted diet during pregnancy did not alter reproductive, biochemical, and hematological parameters and seems not to have any toxic effect on pregnant Wistar rats.

Fetal growth and perinatal outcome of pregnancies continuing after threatened abortion.

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Das, A G; Gopalan, S; Dhaliwal, L K

1996-05-01

The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6-12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying with 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth-weight and overall perinatal outcome.

Outcome Indicators on Interprofessional Collaboration Interventions for Elderly

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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

Cosmetic micromanipulation of vitrified-warmed cleavage stage embryos does not improve ART outcomes: An ultrastructural study of fragments.

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Safari, Somayyeh; Khalili, Mohammad Ali; Barekati, Zeinab; Halvaei, Iman; Anvari, Morteza; Nottola, Stefania A

2017-09-01

The aim was to study the ultrastructure of cytoplasmic fragments along with the effect of cosmetic micromanipulation (CM) on the morphology and development of vitrified-warmed embryos as well as assisted reproductive technology (ART) outcomes. A total of 96 frozen embryo transfer (FET) cycles were included in this prospective randomized study. They were divided into three groups of CM (n=32), sham (n=32) and control (n=32). In the CM group, the vitrified- warmed embryos were subjected to fragments and coarse granules removal (cosmetic micromanipulation) after laser assisted zona hatching (LAH); sham group subjected only to LAH and no intervention was taken for the control group. Fragmented embryo was evaluated by transmission electron microscopy (TEM). Significant improvement was observed in the morphological parameters, such as fragmentation degrees, evenness of the blastomeres and embryo grade during the subsequent development, after applying cosmetic micromanipulation, when compared to sham or control groups (P=0.00001). However, there were no differences in the clinical outcomes amongst the three studied groups e.g. the rates of clinical, ongoing and multiple pregnancies, implantation, delivery and live birth. In fine structure view, fragments exhibited uniform cytoplasmic texture containing majority of organelles that were observed in normal blastomeres including mitochondria. In conclusion, application of cosmetic micromanipulation in low-grade vitrified-warmed embryos showed significant improvement on embryo morphology parameters; however, did not result in noticeable improvements in clinical outcomes of the patients undergoing ART program. In addition, embryo vitrification had no adverse effects on fine structure of the fragments. Copyright © 2017 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Cosmological parameters from CMB and other data: A Monte Carlo approach

International Nuclear Information System (INIS)

Lewis, Antony; Bridle, Sarah

2002-01-01

We present a fast Markov chain Monte Carlo exploration of cosmological parameter space. We perform a joint analysis of results from recent cosmic microwave background (CMB) experiments and provide parameter constraints, including σ 8 , from the CMB independent of other data. We next combine data from the CMB, HST Key Project, 2dF galaxy redshift survey, supernovae type Ia and big-bang nucleosynthesis. The Monte Carlo method allows the rapid investigation of a large number of parameters, and we present results from 6 and 9 parameter analyses of flat models, and an 11 parameter analysis of non-flat models. Our results include constraints on the neutrino mass (m ν < or approx. 3 eV), equation of state of the dark energy, and the tensor amplitude, as well as demonstrating the effect of additional parameters on the base parameter constraints. In a series of appendixes we describe the many uses of importance sampling, including computing results from new data and accuracy correction of results generated from an approximate method. We also discuss the different ways of converting parameter samples to parameter constraints, the effect of the prior, assess the goodness of fit and consistency, and describe the use of analytic marginalization over normalization parameters

International and Interdisciplinary Identification of Health Care Transition Outcomes.

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Fair, Cynthia; Cuttance, Jessica; Sharma, Niraj; Maslow, Gary; Wiener, Lori; Betz, Cecily; Porter, Jerlym; McLaughlin, Suzanne; Gilleland-Marchak, Jordan; Renwick, Amy; Naranjo, Diana; Jan, Sophia; Javalkar, Karina; Ferris, Maria

2016-03-01

There is a lack of agreement on what constitutes successful outcomes for the process of health care transition (HCT) among adolescent and young adults with special health care needs. To present HCT outcomes identified by a Delphi process with an interdisciplinary group of participants. A Delphi method involving 3 stages was deployed to refine a list of HCT outcomes. This 18-month study (from January 5, 2013, of stage 1 to July 3, 2014, of stage 3) included an initial literature search, expert interviews, and then 2 waves of a web-based survey. On this survey, 93 participants from outpatient, community-based, and primary care clinics rated the importance of the top HCT outcomes identified by the Delphi process. Analyses were performed from July 5, 2014, to December 5, 2014. Health care transition outcomes of adolescents and young adults with special health care needs. Importance ratings of identified HCT outcomes rated on a Likert scale from 1 (not important) to 9 (very important). The 2 waves of surveys included 117 and 93 participants as the list of outcomes was refined. Transition outcomes were refined by the 3 waves of the Delphi process, with quality of life being the highest-rated outcome with broad agreement. The 10 final outcomes identified included individual outcomes (quality of life, understanding the characteristics of conditions and complications, knowledge of medication, self-management, adherence to medication, and understanding health insurance), health services outcomes (attending medical appointments, having a medical home, and avoidance of unnecessary hospitalization), and a social outcome (having a social network). Participants indicated that different outcomes were likely needed for individuals with cognitive disabilities. Quality of life is an important construct relevant to HCT. Future research should identify valid measures associated with each outcome and further explore the role that quality of life plays in the HCT process. Achieving

Cerebral perfusion pressure, microdialysis biochemistry and clinical outcome in patients with traumatic brain injury

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Paraforou Theoniki

2011-12-01

Full Text Available Abstract Background Traumatic Brain Injury (TBI is a major cause of death and disability. It has been postulated that brain metabolic status, intracranial pressure (ICP and cerebral perfusion pressure (CPP are related to patients' outcome. The aim of this study was to investigate the relationship between CPP, ICP and microdialysis parameters and clinical outcome in TBIs. Results Thirty four individuals with severe brain injury hospitalized in an intensive care unit participated in this study. Microdialysis data were collected, along with ICP and CPP values. Glasgow Outcome Scale (GOS was used to evaluate patient outcome at 6 months after injury. Fifteen patients with a CPP greater than 75 mmHg, L/P ratio lower than 37 and Glycerol concentration lower than 72 mmol/l had an excellent outcome (GOS 4 or 5, as opposed to the remaining 19 patients. No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively. Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared. In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury. Conclusions Patients with favorable outcome had certain common features in terms of microdialysis parameters and CPP values. An individualized approach regarding CPP levels and cut -off points for Glycerol concentration and L/P ratio are proposed.

Patient-reported outcomes in borderline personality disorder

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Hasler, Gregor; Hopwood, Christopher J.; Jacob, Gitta A.; Brändle, Laura S.; Schulte-Vels, Thomas

2014-01-01

Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes. PMID:25152662

Outcome of Minnesota's gambling treatment programs.

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Stinchfield, R; Winters, K C

2001-01-01

This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

The design, rationale, and baseline characteristics of a nationwide cohort registry in China: blood pressure and clinical outcome in TIA or ischemic stroke.

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Xu, Jie; Liu, Yi; Tao, Yongli; Xie, Xuewei; Gu, Hongqiu; Pan, Yuesong; Zhao, Xingquan; Wang, Yongjun; Yan, Aoshuang; Wang, Yilong

2016-01-01

The relationship between poststroke blood pressure (BP) and clinical outcomes in ischemic stroke (IS) is still controversial. However, there is no large BP database for IS or transient ischemic attack (TIA) in China. This study aims to describe the rationale, study design, and baseline characteristics of a nationwide BP database in IS or TIA patients in China. The BOSS (blood pressure and clinical outcome in TIA or ischemic stroke) study was a hospital-based, prospective cohort study aiming to assess BP parameters and clinical outcome in IS/TIA patients. BP parameters were based on office BP, ambulatory BP, and home BP. Clinical outcomes included stroke recurrence, combined vascular events, and disability. Electronic case-report forms were used to record baseline and follow-up data. The patients were followed up for clinical outcomes at 3 months through face-to-face interview and at 12 months by telephone. Between October 2012 and February 2014, the BOSS registry recruited 2,608 patients from 61 hospitals, with a mean age of 62.5 years, 32.4% of whom were female, 88.9% with an entry diagnosis of IS, and 86% diagnosed with hypertension. The rates of patients lost-to-follow-up were 3.1% at 3 months and 5.1% at 1 year; 93% of patients completed ambulatory BP monitoring during hospitalization and 94.7% finished a 3-month BP diary. The BOSS registry will provide important evidence about BP management in the acute phase and secondary prevention for IS/TIA patients.

Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept

International Nuclear Information System (INIS)

Rieken, Stefan; Gaiser, Timo; Mohr, Angela; Welzel, Thomas; Witt, Olaf; Kulozik, Andreas E; Wick, Wolfgang; Debus, Jürgen; Combs, Stephanie E

2010-01-01

Desmoplasia in medulloblastoma is often diagnosed in adult patients and was repeatedly associated with improved results. Today, all medulloblastoma patients receive intensive multimodal treatment including surgery, radiotherapy and chemotherapy. This study was set up to investigate treatment outcome and prognostic factors after radiation therapy in patients with desmoplastic medulloblastomas. Twenty patients treated for desmoplastic medulloblastoma in the Department of Radiation Oncology at the University of Heidelberg between 1984 and 2007 were included. Data were collected retrospectively. Tumor resection was performed in all patients. All patients underwent postsurgical radiotherapy (RT). Two patients underwent whole brain radiotherapy (WBRT), and 18 patients received craniospinal irradiation (CSI). In all patients, an additional boost was delivered to the posterior fossa. The median dose to the whole brain and the craniospinal axis was 35.2 Gray (Gy), and 54.4 Gy to the posterior fossa. Fourteen patients received chemotherapy, including seven who were treated with combined radiochemotherapy and twelve who received adjuvant chemotherapy. Statistical analysis was performed using the log-rank test and the Kaplan-Meier method. Median follow-up was 59 months. Overall (OS), local (LPFS) and distant progression-free survival (DPFS) was 80%, 71.2%, and 83.3% at 60 months. Patients who suffered from local or distant relapses had significantly worse outcome. Five patients died from recurrent medulloblastoma. Treatment-associated toxicity was acceptable. Multimodal approaches with surgical resection followed by chemoirradiation achieved high response rates with long OS in desmoplastic medulloblastoma patients. Staging parameters expected to predict for poor prognosis did not significantly influence outcome. However, success of any first line regimen had strong impact on disease control, and remission was achieved in no patient with relapsing disease. Multimodal concepts

Using the International Classification of Functioning, Disability, and Health to identify outcome domains for a core outcome set for aphasia: a comparison of stakeholder perspectives.

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Wallace, Sarah J; Worrall, Linda; Rose, Tanya; Le Dorze, Guylaine

2017-11-12

This study synthesised the findings of three separate consensus processes exploring the perspectives of key stakeholder groups about important aphasia treatment outcomes. This process was conducted to generate recommendations for outcome domains to be included in a core outcome set for aphasia treatment trials. International Classification of Functioning, Disability, and Health codes were examined to identify where the groups of: (1) people with aphasia, (2) family members, (3) aphasia researchers, and (4) aphasia clinicians/managers, demonstrated congruence in their perspectives regarding important treatment outcomes. Codes were contextualized using qualitative data. Congruence across three or more stakeholder groups was evident for ICF chapters: Mental functions; Communication; and Services, systems, and policies. Quality of life was explicitly identified by clinicians/managers and researchers, while people with aphasia and their families identified outcomes known to be determinants of quality of life. Core aphasia outcomes include: language, emotional wellbeing, communication, patient-reported satisfaction with treatment and impact of treatment, and quality of life. International Classification of Functioning, Disability, and Health coding can be used to compare stakeholder perspectives and identify domains for core outcome sets. Pairing coding with qualitative data may ensure important nuances of meaning are retained. Implications for rehabilitation The outcomes measured in treatment research should be relevant to stakeholders and support health care decision making. Core outcome sets (agreed, minimum set of outcomes, and outcome measures) are increasingly being used to ensure the relevancy and consistency of the outcomes measured in treatment studies. Important aphasia treatment outcomes span all components of the International Classification of Functioning, Disability, and Health. Stakeholders demonstrated congruence in the identification of important

Clinical Characteristics and Predictors of Outcome for Onconeural Antibody-Associated Disorders: A Retrospective Analysis

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Shaohua Liao

2017-11-01

Full Text Available ObjectiveTo describe and analyze the clinical characteristics, laboratory data, management, and outcome of patients with onconeural antibody-associated disorders (OAAD and identify predictors for poor outcome.MethodsThis was a retrospective review of all patients with potential OAAD, who were hospitalized in Jinan General Hospital between September 2009 and July 2017. We clarified the diagnosis, collected comprehensive information and categorized patients into three groups: paraneoplastic neurological disorders (PNDs, autoimmune encephalitis (AE, and possible OAAD. Within the three groups, we analyzed a range of clinical and laboratory parameters and used univariate and multivariate regression analysis to identify predictors for poor outcome [modified Rankin Scale (mRS = 3–6].ResultsFrom 158 patients, we identified 70 who fulfilled the criteria for OAAD, including 44 men (62.9% and 26 women (37.1%. There were 38 patients (54.3% in the PNDs group, 14 patients (20% in the AE group, and 18 patients (25.7% in the possible OAAD group. After the last follow-up, 14 (36.8%, 9 (64.2%, and 12 (66.7% had a good outcome (mRS = 0–2. However, 6 (15.8%, 2 (14.3%, and 3 (16.7% died, respectively. Univariate analysis showed that duration prior to the hospital (p = 0.0224 and urinary incontinence/retention (p = 0.0043 were associated with poor outcome (mRS = 3–6. After multivariate regression analysis, urinary incontinence/retention (p = 0.0388 and an immunocompromised state (p = 0.0247 remained as significant factors for poor outcome.ConclusionUrinary incontinence/retention and an immunocompromised state represent significant predictors of a worse prognosis for patients with OAAD. By contrast, cerebrospinal fluid analysis showed that serum autoantibodies and tumor markers, the function of crucial organs, electrophysiology, and radiological findings were not associated with a poor outcome.

Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes.

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Pattyn, Nele; Beulque, Randy; Cornelissen, Véronique

2018-05-01

In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training. The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes. We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life. Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p aerobic interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected. This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.

A Novel adaptative Discrete Cuckoo Search Algorithm for parameter optimization in computer vision

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loubna benchikhi

2017-10-01

Full Text Available Computer vision applications require choosing operators and their parameters, in order to provide the best outcomes. Often, the users quarry on expert knowledge and must experiment many combinations to find manually the best one. As performance, time and accuracy are important, it is necessary to automate parameter optimization at least for crucial operators. In this paper, a novel approach based on an adaptive discrete cuckoo search algorithm (ADCS is proposed. It automates the process of algorithms’ setting and provides optimal parameters for vision applications. This work reconsiders a discretization problem to adapt the cuckoo search algorithm and presents the procedure of parameter optimization. Some experiments on real examples and comparisons to other metaheuristic-based approaches: particle swarm optimization (PSO, reinforcement learning (RL and ant colony optimization (ACO show the efficiency of this novel method.

Correlation between pre-treatment quasispecies complexity and treatment outcome in chronic HCV genotype 3a.

LENUS (Irish Health Repository)

Moreau, Isabelle

2012-02-03

Pre-treatment HCV quasispecies complexity and diversity may predict response to interferon based anti-viral therapy. The objective of this study was to retrospectively (1) examine temporal changes in quasispecies prior to the start of therapy and (2) investigate extensively quasispecies evolution in a group of 10 chronically infected patients with genotype 3a, treated with pegylated alpha2a-Interferon and ribavirin. The degree of sequence heterogeneity within the hypervariable region 1 was assessed by analyzing 20-30 individual clones in serial serum samples. Genetic parameters, including amino acid Shannon entropy, Hamming distance and genetic distance were calculated for each sample. Treatment outcome was divided into (1) sustained virological responders (SVR) and (2) treatment failure (TF). Our results indicate, (1) quasispecies complexity and diversity are lower in the SVR group, (2) quasispecies vary temporally and (3) genetic heterogeneity at baseline can be use to predict treatment outcome. We discuss the results from the perspective of replicative homeostasis.

Prognostic significance of perioperative nutritional parameters in patients with gastric cancer.

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Oh, Sung Eun; Choi, Min-Gew; Seo, Jeong-Meen; An, Ji Yeong; Lee, Jun Ho; Sohn, Tae Sung; Bae, Jae Moon; Kim, Sung

2018-02-20

It has been suggested that nutritional status is related to the survival outcomes of cancer patients. The purpose of the current research is to evaluate the importance of the prognosis of various nutritional parameters during the perioperative period in patients with gastric cancer. This study enrolled patients with gastric cancer who underwent D2 gastrectomy at the Department of Surgery, Samsung Medical Center, in 2008. The prognostic significance of nutritional parameters was analyzed, along with other clinical and pathological variables, preoperatively and postoperatively at 3, 6, and 12 months. The total number of patients was 1415. The mean values of nutritional parameters, weight, body mass index (BMI), hemoglobin, total cholesterol, and total lymphocyte count (TLC) decreased significantly over time after surgery. On the contrary, albumin and prognostic nutritional index (PNI) score increased significantly during the postoperative follow-up period. Preoperatively, low BMI (nutritional prognostic indicators. Various perioperative nutritional parameters were confirmed as independent prognostic factors in patients with gastric cancer. Our results imply prognostic benefit from careful nutritional support for patients with poor nutritional parameters. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Impact of an intensive dynamic exercise program on oxidative stress and on the outcome in patients with fibromyalgia

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Amal F Soliman

2016-01-01

Conclusion Twelve weeks of intensive dynamic exercise program should be recommended to patients with FM as it was effective in decreasing the oxidative stress parameters, increasing the antioxidant parameters, and improving the clinical outcome of this disease.

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

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

2013-04-01

Evaluation of participation programmes, projects and activities is essential to identify whether stakeholder involvement has been successful in achieving its aims. Aims may include an improvement in water resource management such as enhanced ecological functioning, an improvement in human wellbeing and economic conditions, or overcoming a conflict between interest groups. Evaluating against "interest-based" resource management criteria requires that a desirable outcome can be identified, agreed upon and be measured at the time of evaluation. In many water management situations where collaborative approaches are applied, multiple interests and objectives are present, or stakeholders have not yet identified their own positions and priorities. Even if a resource management objective has been identified and strategy agreed upon, resource management changes tend to emerge over longer timescales and evaluation frequently takes place before they can be recognised. Evaluating against resource management criteria may lead evaluators to conclude that a programme has failed because it has not achieved a resource management objective at the time of evaluation. This presents a critical challenge to researchers assessing the effectiveness of stakeholder participation programmes. One strategy to overcome this is to conduct "goal-free" evaluation to identify what the programme is actually achieving. An evaluation framework that includes intermediary outcomes that are both tangible achievements such as innovation, creation of new organisations, and shared information and knowledge, as well as intangible achievements such as trust and network development can be applied to more broadly assess a programme's success. Analysis of case-studies in the published literature for which a resource management outcome has been achieved shows that intermediary outcomes frequently precede resource management outcomes. They seem to emerge over shorter timescales than resource management outcomes

Computer controlled automated assay for comprehensive studies of enzyme kinetic parameters.

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Felix Bonowski

Full Text Available Stability and biological activity of proteins is highly dependent on their physicochemical environment. The development of realistic models of biological systems necessitates quantitative information on the response to changes of external conditions like pH, salinity and concentrations of substrates and allosteric modulators. Changes in just a few variable parameters rapidly lead to large numbers of experimental conditions, which go beyond the experimental capacity of most research groups. We implemented a computer-aided experimenting framework ("robot lab assistant" that allows us to parameterize abstract, human-readable descriptions of micro-plate based experiments with variable parameters and execute them on a conventional 8 channel liquid handling robot fitted with a sensitive plate reader. A set of newly developed R-packages translates the instructions into machine commands, executes them, collects the data and processes it without user-interaction. By combining script-driven experimental planning, execution and data-analysis, our system can react to experimental outcomes autonomously, allowing outcome-based iterative experimental strategies. The framework was applied in a response-surface model based iterative optimization of buffer conditions and investigation of substrate, allosteric effector, pH and salt dependent activity profiles of pyruvate kinase (PYK. A diprotic model of enzyme kinetics was used to model the combined effects of changing pH and substrate concentrations. The 8 parameters of the model could be estimated from a single two-hour experiment using nonlinear least-squares regression. The model with the estimated parameters successfully predicted pH and PEP dependence of initial reaction rates, while the PEP concentration dependent shift of optimal pH could only be reproduced with a set of manually tweaked parameters. Differences between model-predictions and experimental observations at low pH suggest additional protonation

Prognostic value of (18)F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer.

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Mayoral, M; Fernandez-Martinez, A; Vidal, L; Fuster, D; Aya, F; Pavia, J; Pons, F; Lomeña, F; Paredes, P

2016-01-01

Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in various solid neoplasms. These volumetric parameters and the SUVmax have shown to be useful criteria for disease prognostication in preoperative and post-treatment epithelial ovarian cancer (EOC) patients. The purpose of this study was to evaluate the utility of (18)F-FDG PET/CT measurements to predict survival in patients with recurrent EOC. Twenty-six patients with EOC who underwent a total of 31 (18)F-FDG PET/CT studies for suspected recurrence were retrospectively included. SUVmax and volumetric parameters whole-body MTV (wbMTV) and whole-body TLG (wbTLG) with a threshold of 40% and 50% of the SUVmax were obtained. Correlation between PET parameters and progression-free survival (PFS) and the survival analysis of prognostic factors were calculated. Serous cancer was the most common histological subtype (76.9%). The median PFS was 12.5 months (range 10.7-20.6 months). Volumetric parameters showed moderate inverse correlation with PFS but there was no significant correlation in the case of SUVmax. The correlation was stronger for first recurrences. By Kaplan-Meier analysis and log-rank test, wbMTV 40%, wbMTV 50% and wbTLG 50% correlated with PFS. However, SUVmax and wbTLG 40% were not statistically significant predictors for PFS. Volumetric parameters wbMTV and wbTLG 50% measured by (18)F-FDG PET/CT appear to be useful prognostic predictors of outcome and may provide valuable information to individualize treatment strategies in patients with recurrent EOC. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease

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Kempny, Aleksander; Diller, Gerhard-Paul; Alonso-Gonzalez, Rafael; Uebing, Anselm; Rafiq, Isma; Li, Wei; Swan, Lorna; Hooper, James; Donovan, Jackie; Wort, Stephen J; Gatzoulis, Michael A; Dimopoulos, Konstantinos

2015-01-01

Background In patients with acquired heart failure, hypoalbuminaemia is associated with increased risk of death. The prevalence of hypoproteinaemia and hypoalbuminaemia and their relation to outcome in adult patients with congenital heart disease (ACHD) remains, however, unknown. Methods Data on patients with ACHD who underwent blood testing in our centre within the last 14 years were collected. The relation between laboratory, clinical or demographic parameters at baseline and mortality was assessed using Cox proportional hazards regression analysis. Results A total of 2886 patients with ACHD were included. Mean age was 33.3 years (23.6–44.7) and 50.1% patients were men. Median plasma albumin concentration was 41.0 g/L (38.0–44.0), whereas hypoalbuminaemia (disease complexity, hypoalbuminaemia remained a significant predictor of death. Conclusions Hypoalbuminaemia is common in patients with ACHD and is associated with a threefold increased risk of risk of death. Hypoalbuminaemia, therefore, should be included in risk-stratification algorithms as it may assist management decisions and timing of interventions in the growing ACHD population. PMID:25736048

Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

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Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

2014-10-01

Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

The use of ketamine in ECT anaesthesia: A systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes.

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Gálvez, Verònica; McGuirk, Lucy; Loo, Colleen K

2017-09-01

This review will discuss ECT efficacy and cognitive outcomes when using ketamine as an ECT anaesthetic compared to other anaesthetics, taking into account important moderator variables that have often not been considered to date. It will also include information on safety and other ECT outcomes (seizure threshold and quality). A systematic search through MEDLINE, PubMed, PsychINFO, Cochrane Databases and reference lists from retrieved articles was performed. Search terms were: "ketamine" and "Electroconvulsive Therapy", from 1995 to September 2016. Meta-analyses, randomised controlled trials, open-label and retrospective studies published in English of depressed samples receiving ECT with ketamine anaesthesia were included (n = 24). Studies were heterogeneous in the clinical populations included and ECT treatment and anaesthetic methods. Frequently, studies did not report on ECT factors (i.e., pulse-width, treatment schedule). Findings regarding efficacy were mixed. Tolerance from repeated use may explain why several studies found that ketamine enhanced efficacy early in the ECT course but not at the end. The majority of studies did not comprehensively examine cognition and adverse effects were not systematically studied. Only a minority of the studies reported on seizure threshold and expression. The routine use of ketamine anaesthesia for ECT in clinical settings cannot yet be recommended based on published data. Larger randomised controlled trials, taking into account moderator variables, specifically reporting on ECT parameters and systematically assessing outcomes are encouraged.

Patient-Reported Outcome and Observer-Reported Outcome Assessment in Rare Disease Clinical Trials: An ISPOR COA Emerging Good Practices Task Force Report.

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Benjamin, Katy; Vernon, Margaret K; Patrick, Donald L; Perfetto, Eleanor; Nestler-Parr, Sandra; Burke, Laurie

Rare diseases (RDs) affect a small number of people within a population. About 5000 to 8000 distinct RDs have been identified, with an estimated 6% to 8% of people worldwide suffering from an RD. Approximately 75% of RDs affect children. Frequently, these conditions are heterogeneous; many are progressive. Regulatory incentives have increased orphan drug designations and approvals. To develop emerging good practices for RD outcomes research addressing the challenges inherent in identifying, selecting, developing, adapting, and implementing patient-reported outcome (PRO) and observer-reported outcome (ObsRO) assessments for use in RD clinical trials. This report outlines the challenges and potential solutions in determining clinical outcomes for RD trials. It follows the US Food and Drug Administration Roadmap to Patient-Focused Outcome Measurement in Clinical Trials. The Roadmap consists of three columns: 1) Understanding the Disease or Condition, 2) Conceptualizing Treatment Benefit, and 3) Selecting/Developing the Outcome Measure. Challenges in column 1 include factors such as incomplete natural history data and heterogeneity of disease presentation and patient experience. Solutions include using several information sources, for example, clinical experts and patient advocacy groups, to construct the condition's natural history and understand treatment patterns. Challenges in column 2 include understanding and measuring treatment benefit from the patient's perspective, especially given challenges in defining the context of use such as variations in age or disease severity/progression. Solutions include focusing on common symptoms across patient subgroups, identifying short-term outcomes, and using multiple types of COA instruments to measure the same constructs. Challenges in column 3 center around the small patient population and heterogeneity of the condition or study sample. Few disease-specific instruments for RDs exist. Strategies include adapting existing

Teleophthalmology: improving patient outcomes?

Directory of Open Access Journals (Sweden)

Sreelatha OK

2016-02-01

Full Text Available Omana Kesary Sreelatha,1 Sathyamangalam VenkataSubbu Ramesh2 1Ophthalmology Department, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, India Abstract: Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP. Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR, glaucoma, age-related macular degeneration (ARMD, and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

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Isabelle Francisca Petronella Maria Kappen

2017-05-01

Full Text Available BackgroundNo consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP.MethodsThis was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation.ResultsForty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years. Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001. In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry.ConclusionsThe present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

Science.gov (United States)

Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom FJMC; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

2017-01-01

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence. PMID:28573094

Improved Differential Evolution Algorithm for Parameter Estimation to Improve the Production of Biochemical Pathway

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Chuii Khim Chong

2012-06-01

Full Text Available This paper introduces an improved Differential Evolution algorithm (IDE which aims at improving its performance in estimating the relevant parameters for metabolic pathway data to simulate glycolysis pathway for yeast. Metabolic pathway data are expected to be of significant help in the development of efficient tools in kinetic modeling and parameter estimation platforms. Many computation algorithms face obstacles due to the noisy data and difficulty of the system in estimating myriad of parameters, and require longer computational time to estimate the relevant parameters. The proposed algorithm (IDE in this paper is a hybrid of a Differential Evolution algorithm (DE and a Kalman Filter (KF. The outcome of IDE is proven to be superior than Genetic Algorithm (GA and DE. The results of IDE from experiments show estimated optimal kinetic parameters values, shorter computation time and increased accuracy for simulated results compared with other estimation algorithms

Parameter Optimization Analysis of Prolonged Analgesia Effect of tDCS on Neuropathic Pain Rats

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Wen, Hui-Zhong; Gao, Shi-Hao; Zhao, Yan-Dong; He, Wen-Juan; Tian, Xue-Long; Ruan, Huai-Zhen

2017-01-01

Background: Transcranial direct current stimulation (tDCS) is widely used to treat human nerve disorders and neuropathic pain by modulating the excitability of cortex. The effectiveness of tDCS is influenced by its stimulation parameters, but there have been no systematic studies to help guide the selection of different parameters. Objective: This study aims to assess the effects of tDCS of primary motor cortex (M1) on chronic neuropathic pain in rats and to test for the optimal parameter combinations for analgesia. Methods: Using the chronic neuropathic pain models of chronic constriction injury (CCI), we measured pain thresholds before and after anodal-tDCS (A-tDCS) using different parameter conditions, including stimulation intensity, stimulation time, intervention time and electrode located (ipsilateral or contralateral M1 of the ligated paw on male/female CCI models). Results: Following the application of A-tDCS over M1, we observed that the antinociceptive effects were depended on different parameters. First, we found that repetitive A-tDCS had a longer analgesic effect than single stimulus, and both ipsilateral-tDCS (ip-tDCS) and contralateral-tDCS (con-tDCS) produce a long-lasting analgesic effect on neuropathic pain. Second, the antinociceptive effects were intensity-dependent and time-dependent, high intensities worked better than low intensities and long stimulus durations worked better than short stimulus durations. Third, timing of the intervention after injury affected the stimulation outcome, early use of tDCS was an effective method to prevent the development of pain, and more frequent intervention induced more analgesia in CCI rats, finally, similar antinociceptive effects of con- and ip-tDCS were observed in both sexes of CCI rats. Conclusion: Optimized protocols of tDCS for treating antinociceptive effects were developed. These findings should be taken into consideration when using tDCS to produce analgesic effects in clinical applications. PMID

Effect of varicocelectomy on testis volume and semen parameters in adolescents: a meta-analysis

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Tie Zhou

2015-01-01

Full Text Available Varicocele repair in adolescent remains controversial. Our aim is to identify and combine clinical trials results published thus far to ascertain the efficacy of varicocelectomy in improving testis volume and semen parameters compared with nontreatment control. A literature search was performed using Medline, Embase and Web of Science, which included results obtained from meta-analysis, randomized and nonrandomized controlled studies. The study population was adolescents with clinically palpable varicocele with or without the testicular asymmetry or abnormal semen parameters. Cases were allocated to treatment and observation groups, and testis volume or semen parameters were adopted as outcome measures. As a result, seven randomized controlled trials (RCTs and nonrandomized controlled trials studying bilateral testis volume or semen parameters in both treatment and observation groups were identified. Using a random effect model, mean difference of testis volume between the treatment group and the observation group was 2.9 ml (95% confidence interval [CI]: 0.6, 5.2; P< 0.05 for the varicocele side and 1.5 ml (95% CI: 0.3, 2.7; P< 0.05 for the healthy side. The random effect model analysis demonstrated that the mean difference of semen concentration, total semen motility, and normal morphology between the two groups was 13.7 × 10 6 ml−1 (95% CI: −1.4, 28.8; P = 0.075, 2.5% (95% CI: −3.6, 8.6; P= 0.424, and 2.9% (95% CI: −3.0, 8.7; P= 0.336 respectively. In conclusion, although varicocelectomy significantly improved bilateral testis volume in adolescents with varicocele compared with observation cases, semen parameters did not have any statistically significant difference between two groups. Well-planned, properly conducted RCTs are needed in order to confirm the above-mentioned conclusion further and to explore whether varicocele repair in adolescents could improve subsequently spontaneous pregnancy rates.

LMFBR plant parameters

International Nuclear Information System (INIS)

1979-03-01

This document contains up-to-date data on existing or firmly decided prototype or demonstration LMFBR reactors (Table I), on planned commercial size LMFBR according to the present status of design (Table II) and on experimental fast reactors such as BOR-60, DFR, EBR-II, FERMI, FFTF, JOYO, KNK-II, PEC, RAPSODIE-FORTISSIMO (Table III). Only corrected and revised parameters submitted by the countries participating in the IWGFR are included in this document

Predictors of outcome for severe IgA Nephropathy in a multi-ethnic U.S. cohort.

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Arroyo, Ana Huerta; Bomback, Andrew S; Butler, Blake; Radhakrishnan, Jai; Herlitz, Leal; Stokes, M Barry; D'Agati, Vivette; Markowitz, Glen S; Appel, Gerald B; Canetta, Pietro A

2015-09-01

Although IgA nephropathy (IgAN) is the leading cause of glomerulonephritis worldwide, there are few large cohorts representative of U.S. Prognosis remains challenging, particularly as more patients are treated with RAAS blockade and immunosuppression. We analyzed a retrospective cohort of IgAN patients followed at Columbia University Medical Center from 1980 to 2010. We evaluated two outcomes - halving of eGFR and ESRD - using three proportional hazards models: 1) a model with only clinical parameters, 2) a model with only histopathologic parameters, and 3) a model combining clinical and histopathologic parameters. Of 154 patients with biopsy-proven IgAN, 126 had follow-up data available and 93 had biopsy slides re-read. Median follow-up was 47 months. The cohort was 64% male, 60% white, and the average age was 34 years at diagnosis. Median (IQR) eGFR and proteinuria at diagnosis were 64.1 (38.0 - 88.7) mL/min/1.73 m2 and 2.7 (1.3 - 4.5) g/day. Over 90% of subjects were treated with RAAS blockade, and over 66% received immunosuppression. In the clinical parameters-only model, baseline eGFR and African-American race predicted both halving of eGFR and ESRD. In the histopathologic parameters-only model, no parameter significantly predicted outcome. In the combined model, baseline eGFR remained the strongest predictor of both halving of eGFR (p = 0.03) and ESRD (p = 0.001), while the presence of IgG by immunofluorescence microscopy also predicted progression to ESRD. In this diverse U.S. IgAN cohort in which the majority of patients received RAAS blockade and immunosuppression, baseline eGFR, African-American race, and co-staining of IgG predicted poor outcome.

Unfavourable outcomes in orthognathic surgery

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Bonanthaya, Krishnamurthy; Anantanarayanan, P.

2013-01-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution. PMID:24501454

Unfavourable outcomes in orthognathic surgery

Directory of Open Access Journals (Sweden)

Krishnamurthy Bonanthaya

2013-01-01

Full Text Available Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A Pre- Treatment B During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Unfavourable outcomes in orthognathic surgery.

Science.gov (United States)

Bonanthaya, Krishnamurthy; Anantanarayanan, P

2013-05-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Treatment outcome and prognostic factor analysis in transplant-eligible Chinese myeloma patients receiving bortezomib-based induction regimens including the staged approach, PAD or VTD

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Chim Chor

2012-06-01

Full Text Available Abstract Background We have reported promising outcomes using a staged approach, in which bortezomib/thalidomide/dexamethasone was used only in 14 patients with suboptimal response to VAD (vincristine/adriamycin/dexamethasone before autologous stem cell transplantation (ASCT. Here we compared the outcomes of the staged approach with frontline PAD (bortezomib/doxorubicin/dexamethasone or VTD (bortezomib/thalidomide/dexamethasone induction, and analysed prognostic factors for outcome. Patients and methods Ninety-one transplant-eligible Chinese patients received three induction regimens prior to ASCT [staged approach (N = 25, PAD (N = 31, VTD (N = 35]. and received thalidomide maintenance for 2 years post-ASCT. Results 43 (47.3% patients had International Staging System (ISS III disease. By an intention-to-treat analysis, the overall CR/nCR rate were 37.4% post-induction, and 62.6% post-ASCT. Five-year overall (OS and event-free (EFS survivals were 66% and 45.1%. There was no difference of the post-induction CR/nCR rate, EFS or OS between patients induced by these three regimens. Moreover, ISS III disease did not affect CR/nCR rates. Multivariate analysis showed that ISS and post-ASCT CR/nCR impacted OS while ISS and post-induction CR/nCR impacted EFS. Conclusions These three induction regimens produced comparable and favorable outcomes in myeloma. The unfavorable outcome of ISS stage III persisted despite upfront/early use of bortezomib. CR/nCR predicted favorable survivals.

[Chorionicity and adverse perinatal outcome].

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Ferreira, Isabel; Laureano, Carla; Branco, Miguel; Nordeste, Ana; Fonseca, Margarida; Pinheiro, Adelaide; Silva, Maria Isabel; Almeida, Maria Céu

2005-01-01

Considering the highest rate of morbidity and mortality in diamniotic monochorionic twins, the authors evaluated and compared the adverse obstetric and perinatal outcome in twin pregnancies according to chorionicity. A retrospective study was conducted in all twin deliveries that occurred in the Obstetric Unit of Maternidade Bissaya-Barreto, for a period of tree years (from the 1st of January 1999 until the 31st of December 2001). From de 140 diamniotic twin pregnancies studied, we considered two groups according to the chorionicity: monochorionic and dichorionic. We compared multiple parameters as, epidemiologic data, adverse obstetric outcome, gestacional delivery age, type of delivery and the morbidity, the mortality and the follow-up of the newborn. The statistic tests used were the X2 and the t student. From the 140 twin pregnancies included in the study, 66% (92 cases) presented dichorionic placentation and 34% (48 cases) were monochorionic. In the group of monochorionic pregnancies, we observed highly difference related to pathology of amniotic fluid (14.5% vs 2.2%), discordant fetal growth (41.6% vs 22.8%) and rate of preterm delivery (66.6% vs 32.6%). Related to the newborn we verified that they had a lower average birth weight (1988g vs 2295g), a highly rate of weight discordancy (23% vs 15.3%), intraventricular haemorrhage (2.2% vs 0%) and IUGR (6.6% vs 1.6%), statistically significant in the monochorionic group. Also the perinatal mortality rate was significantly higher in the monochorionic pregnancies (93.7 per thousand vs 21.7 per thousand). The high rate of morbidity and mortality related to the monochorionic twin pregnancies, implies the need of a correct identification of the type of chorionicity and also a high standard of prenatal surveillance in prenatal specialised health centers.

Outcome in chronic inflammatory demyelinating polyneuropathy from a Malaysian centre over sixteen years.

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Hiew, Fu Liong; Ong, Jun-Jean; Viswanathan, Shanthi; Puvanarajah, Santhi

2018-04-01

Long-term outcome in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is very limited, especially from Asian countries. We aimed to determine the outcome of our cohort of CIDP patients and to define the relevant clinical, electrophysiological and laboratory determinants of disease activity, progression and treatment response. We retrospectively reviewed records of 23 CIDP patients attending our Neurology service at Kuala Lumpur Hospital, Malaysia between January 2000 and December 2016. We analysed data on neurological deficits, electrophysiological and laboratory parameters to determine diagnostic characteristics, correlation with disease activity and clinical outcomes following treatment. Included were 15 (65%) males and 8 (35%) females with a mean age of 42.7 years (SD 14.4). Mean duration of follow-up visit was 66 months (range 6-134 months). The cohort consists of 19 classical (sensory-motor) CIDP and 4 MADSAM. Large majority of patients (66%) had either stable active disease (CDAS 3, 44%) or were in remission (CDAS class 2, 22%) following treatment with standard immunotherapies (Intravenous Immunoglobulins, steroids or immunosuppressants). The proportion of CIDP patients in each CDAS class was comparable to published cohorts from North America and Europe. Medical Research Council (MRC) sum score was the only clinical score that differed across CDAS classes (p = .010) with significant inverse correlation (Spearman's rho -0.664, p = .001). In conclusion, treatment outcomes of our CIDP cohort was comparable to those of published series. Further studies with larger cohort of patients from other parts of Asia are important to determine the long-term outcome of this heterogenous disease in this region. Copyright © 2018 Elsevier Ltd. All rights reserved.

Scope and design of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements (FREEDOM) Study.

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Jaber, Bertrand L; Finkelstein, Fredric O; Glickman, Joel D; Hull, Alan R; Kraus, Michael A; Leypoldt, John K; Liu, Jiannong; Gilbertson, David; McCarthy, James; Miller, Brent W; Moran, John; Collins, Allan J

2009-02-01

Conventional thrice-weekly hemodialysis (HD) has limited the ability to generate further improvements in patient quality of life, morbidity, and mortality. Daily HD (DHD) offers the promise of providing clinical and economic benefits. The objectives of the Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements Study are to evaluate outcomes of DHD (6 times/wk) with the NxStage System One (NxStage Medical Inc, Lawrence, MA) device. Cohort study with matched control group. The DHD group will include up to 500 participants at 70 clinical sites, enrolling for 3 years with a minimum of 1-year follow-up. Study candidates include adult patients (age >or= 18 years) with end-stage renal disease who are considered suitable candidates for DHD with the NxStage System One device by the treating physician and who have Medicare as their primary insurance payer. The control group will consist of a matched thrice-weekly in-center HD cohort derived from the US Renal Data System database using a 10:1 ratio, totaling 5,000 patients. Treatment with DHD and "standard of care" thrice-weekly HD. The primary intent-to-treat analysis compares hospitalization days/patient-year between the DHD and thrice-weekly HD groups. Other outcomes recorded in both groups include non-treatment-related medical expenditures. In addition, in the DHD cohort, changes in quality-of-life measures (baseline, 4 and 12 months, and every 6 months thereafter); urea kinetics; parameters related to anemia, bone and mineral metabolism, and nutrition; vascular access interventions; and use of medications will be examined. This study has the potential to elucidate the health and economic benefits of DHD and complement results of current clinical trials.

Cost-effectiveness analysis in severe mental illness : Outcome measures selection

NARCIS (Netherlands)

Stant, A. Dennis; Buskens, Erik; Jenner, Jack A.; Wiersma, Durk; TenVergert, Elisabeth M.

Background: Most economic evaluations conducted in mental healthcare did not include widely recommended preference-based health outcomes like the QALY (Quality-Adjusted Life Years). Instead, studies have mainly been designed as cost-effectiveness analyses that include single outcome measures aimed

A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

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Kovač Mirjana

2011-01-01

Full Text Available Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency.

ST-Segment resolution and clinical outcome with ischemic postconditioning and comparison to magnetic resonance

DEFF Research Database (Denmark)

Lønborg, Jacob; Holmvang, Lene; Kelbæk, Henning

2010-01-01

Ischemic postconditioning (IPost) during primary percutaneous coronary intervention (PPCI) is suggested to reduce myocardial damage. However, the association with ST-segment resolution (STR) and clinical outcome is not determined. The primary aim of this study was to evaluate the association of I...... of IPost with STR and clinical outcome. Secondly, we sought to determine the relationship between STR and cardiac magnetic resonance (CMR) parameters in these patients....

Understanding reproducibility of human IVF traits to predict next IVF cycle outcome.

Science.gov (United States)

Wu, Bin; Shi, Juanzi; Zhao, Wanqiu; Lu, Suzhen; Silva, Marta; Gelety, Timothy J

2014-10-01

Evaluating the failed IVF cycle often provides useful prognostic information. Before undergoing another attempt, patients experiencing an unsuccessful IVF cycle frequently request information about the probability of future success. Here, we introduced the concept of reproducibility and formulae to predict the next IVF cycle outcome. The experimental design was based on the retrospective review of IVF cycle data from 2006 to 2013 in two different IVF centers and statistical analysis. The reproducibility coefficients (r) of IVF traits including number of oocytes retrieved, oocyte maturity, fertilization, embryo quality and pregnancy were estimated using the interclass correlation coefficient between the repeated IVF cycle measurements for the same patient by variance component analysis. The formulae were designed to predict next IVF cycle outcome. The number of oocytes retrieved from patients and their fertilization rate had the highest reproducibility coefficients (r = 0.81 ~ 0.84), which indicated a very close correlation between the first retrieval cycle and subsequent IVF cycles. Oocyte maturity and number of top quality embryos had middle level reproducibility (r = 0.38 ~ 0.76) and pregnancy rate had a relative lower reproducibility (r = 0.23 ~ 0.27). Based on these parameters, the next outcome for these IVF traits might be accurately predicted by the designed formulae. The introduction of the concept of reproducibility to our human IVF program allows us to predict future IVF cycle outcomes. The traits of oocyte numbers retrieved, oocyte maturity, fertilization, and top quality embryos had higher or middle reproducibility, which provides a basis for accurate prediction of future IVF outcomes. Based on this prediction, physicians may counsel their patients or change patient's stimulation plans, and laboratory embryologists may improve their IVF techniques accordingly.

Consequences of Parenting on Adolescent Outcomes

Directory of Open Access Journals (Sweden)

Donna Hancock Hoskins

2014-09-01

Full Text Available In recent years, substantial gains have been made in our understanding of the influence of parenting behaviors and styles on adolescent emotional and behavioral outcomes. Empirical work focusing on the associations between parenting and adolescent outcomes is important because the influence of parenting during adolescence continues to affect behaviors into adulthood. Additionally, there has been considerable attention paid to the mechanisms that shape parenting that then influence adolescent outcomes. For instance, researchers have found that neighborhood conditions moderated the association between parenting and adolescent development. In this paper, several covariates and contextual effects associated with parenting and adolescent outcomes will be discussed. Also, parental behaviors, parental styles and adolescent outcomes are discussed in this literature review. This review provides an assessment of the literature on parenting and adolescent outcomes from the past decade and includes advancements in parenting research. The review concludes with a summary of major research findings, as well as a consideration of future directions and implications for practice and policy.

Psychosocial predictors of treatment outcome for trauma-affected refugees

DEFF Research Database (Denmark)

Sonne, Charlotte; Carlsson, Jessica; Bech, Per

2016-01-01

at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients' past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social...... situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms...

DRAGON score predicts functional outcomes in acute ischemic stroke patients receiving both intravenous tissue plasminogen activator and endovascular therapy.

Science.gov (United States)

Wang, Arthur; Pednekar, Noorie; Lehrer, Rachel; Todo, Akira; Sahni, Ramandeep; Marks, Stephen; Stiefel, Michael F

2017-01-01

The DRAGON score, which includes clinical and computed tomographic (CT) scan parameters, predicts functional outcomes in ischemic stroke patients treated with intravenous tissue plasminogen activator (IV tPA). We assessed the utility of the DRAGON score in predicting functional outcome in stroke patients receiving both IV tPA and endovascular therapy. A retrospective chart review of patients treated at our institution from February 2009 to October 2015 was conducted. All patients with computed tomography angiography (CTA) proven large vessel occlusions (LVO) who underwent intravenous thrombolysis and endovascular therapy were included. Baseline DRAGON scores and modified Rankin Score (mRS) at the time of hospital discharge was calculated. Good outcome was defined as mRS ≤3. Fifty-eight patients with LVO of the anterior circulation were studied. The mean DRAGON score of patients on admission was 5.3 (range, 3-8). All patients received IV tPA and endovascular therapy. Multivariate analysis demonstrated that DRAGON scores ≥7 was associated with higher mRS ( P DRAGON scores ≤6. Patients with DRAGON scores of 7 and 8 on admission had a mortality rate of 3.8% and 40%, respectively. The DRAGON score can help predict better functional outcomes in ischemic stroke patients receiving both IV tPA and endovascular therapy. This data supports the use of the DRAGON score in selecting patients who could potentially benefit from more invasive therapies such as endovascular treatment. Larger prospective studies are warranted to further validate these results.

[Knowledge produced from the outcomes of the "Nursing Outcomes Classification--NOC": integrative review].

Science.gov (United States)

da Silva, Natália Chantal Magalhães; de Souza Oliveira, Ana Railka; de Carvalho, Emília Campos

2015-12-01

To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC). A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Scopus Info Site (SCOPUS), during the months of August and September 2014. The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%); Applicability in clinical practice (33.33%); and, Validation (63.90%). Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

Optimizing outcomes with multifocal intraocular lenses

Directory of Open Access Journals (Sweden)

Gitansha Shreyas Sachdev

2017-01-01

Full Text Available Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

Psychosocial determinants of outcomes in knee replacement.

Science.gov (United States)

Lopez-Olivo, Maria A; Landon, Glenn C; Siff, Sherwin J; Edelstein, David; Pak, Chong; Kallen, Michael A; Stanley, Melinda; Zhang, Hong; Robinson, Kausha C; Suarez-Almazor, Maria E

2011-10-01

To identify potential psychosocial and educational barriers to clinical success following knee replacement. The authors evaluated 241 patients undergoing total knee replacement, preoperatively and 6 months after surgery. Outcomes included the Western Ontario McMaster (WOMAC) scale and the Knee Society rating system (KSRS). Independent variables included: the medical outcome study-social support scale; depression, anxiety and stress scale; brief COPE inventory; health locus of control; arthritis self-efficacy scale and the life orientation test-revised. Multiple regression models evaluated associations of baseline demographic and psychosocial variables with outcomes at 6 months, controlling for body mass index, comorbidities and baseline outcome scores. Patients' mean age was 65 ± 9 years; 65% were women. Most patients improved outcomes after surgery. Several psychosocial variables were associated with outcomes. Regression analyses indicated lower education, less tangible support, depression, less problem-solving coping, more dysfunctional coping, lower internal locus of control were associated with worse WOMAC scores (R(2) contribution of psychosocial variables for pain 0.07; for function, 0.14). Older age, lower education, depression and less problem-solving coping were associated with poorer total KSRS scores (R(2) contribution of psychosocial variables to total KSRS model 0.09). Psychosocial variables as a set contributed from 25% to 74% of total explained variance across the models tested. Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.

A new nomogram to predict pathologic outcome following radical prostatectomy

Directory of Open Access Journals (Sweden)

Alexandre Crippa

2006-04-01

Full Text Available OBJECTIVE: To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. MATERIALS AND METHODS: Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. RESULTS: In univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001, serum PSA (p = 0.001 and biopsy Gleason score (p < 0.001 with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10 and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10 to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. CONCLUSION: Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Benefits of applying a proxy eligibility period when using electronic health records for outcomes research: a simulation study.

Science.gov (United States)

Yu, Tzy-Chyi; Zhou, Huanxue

2015-06-09

Electronic health records (EHRs) can provide valuable data for outcomes research. However, unlike administrative claims databases, EHRs lack eligibility tables or a standard way to define the benefit coverage period, which could lead to underreporting of healthcare utilization or outcomes, and could result in surveillance bias. We tested the effect of using a proxy eligibility period (eligibility proxy) when estimating a range of health resource utilization and outcomes parameters under varying degrees of missing encounter data. We applied an eligibility proxy to create a benchmark cohort of chronic obstructive pulmonary disease (COPD) patients with 12 months of follow-up, with the assumption of no missing encounter data. The benchmark cohort provided parameter estimates for comparison with 9,000 simulated datasets representing 10-90% of COPD patients (by 10th percentiles) with between 1 and 11 months of continuous missing data. Two analyses, one for datasets using an eligibility proxy and one for those without an eligibility proxy, were performed on the 9,000 datasets to assess estimator performance under increasing levels of missing data. Estimates for each study variable were compared with those from the benchmark dataset, and performance was evaluated using bias, percentage change, and root-mean-square error. The benchmark dataset contained 6,717 COPD patients, whereas the simulated datasets where the eligibility proxy was applied had between 671 and 6,045 patients depending on the percentage of missing data. Parameter estimates had better performance when an eligibility proxy based on the first and last month of observed activity was applied. This finding was consistent across a range of variables representing patient comorbidities, symptoms, outcomes, health resource utilization, and medications, regardless of the measures of performance used. Without the eligibility proxy, all evaluated parameters were consistently underestimated. In a large COPD patient

Culturally Sensitive and Environment-Friendly Outcome Measures in

African Journals Online (AJOL)

Dr Olaleye

A systematic review of evidence on culturally sensitive and environment-friendly outcome measures in ..... which included manual grass cutting/hoeing, assuming the Islamic ... who opined that the starting point for any outcome measure is to ...

Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study.

Science.gov (United States)

Solomonow-Avnon, Deborah; Herman, Amir; Levin, Daniel; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2017-10-01

Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

A NTCP approach for estimating the outcome in radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Strigari, L.; Sciuto, R.; Benassi, M.; Bergomi, S.; Nocentini, S.; Maini, C. L.

2008-01-01

Radioiodine has been in use for over 60 years as a treatment for hyperthyroidism. Major changes in clinical practice have led to accurate dosimetry capable of avoiding the risks of adverse effects and the optimization of the treatment. The aim of this study was to test the capability of a radiobiological model, based on normal tissue complication probability (NTCP), to predict the outcome after oral therapeutic 131 I administration. Following dosimetric study, 79 patients underwent treatment for hyperthyroidism using radioiodine and then 67 had at least a one-year follow up. The delivered dose was calculated using the MIRD formula, taking into account the measured maximum uptake of administered iodine transferred to the thyroid, U0, and the effective clearance rate, T eff and target mass. The dose was converted to normalized total dose delivered at 2 Gy per fraction (NTD 2 ). Furthermore, the method to take into account the reduction of the mass of the gland during radioiodine therapy was also applied. The clinical outcome and dosimetric parameters were analyzed in order to study the dose-response relationship for hypothyroidism. The TD 50 and m parameters of the NTCP model approach were then estimated using the likelihood method. The TD 50 , expressed as NTD 2 , resulted in 60 Gy (95% C.I.: 45-75 Gy) and 96 Gy (95% C.I.: 86-109 Gy) for patients affected by Graves or autonomous/multinodular disease, respectively. This supports the clinical evidence that Graves' disease should be characterized by more radiosensitive cells compared to autonomous nodules. The m parameter for all patients was 0.27 (95% C.I.: 0.22-0.36). These parameters were compared with those reported in the literature for hypothyroidism induced after external beam radiotherapy. The NTCP model correctly predicted the clinical outcome after the therapeutic administration of radioiodine in our series

Evaluation of the feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income country setting

Science.gov (United States)

Beane, Abi; De Silva, Ambepitiyawaduge Pubudu; De Silva, Nirodha; Sujeewa, Jayasingha A; Rathnayake, R M Dhanapala; Sigera, P Chathurani; Athapattu, Priyantha Lakmini; Mahipala, Palitha G; Rashan, Aasiyah; Munasinghe, Sithum Bandara; Jayasinghe, Kosala Saroj Amarasiri; Dondorp, Arjen M; Haniffa, Rashan

2018-01-01

Objective This study describes the availability of core parameters for Early Warning Scores (EWS), evaluates the ability of selected EWS to identify patients at risk of death or other adverse outcome and describes the burden of triggering that front-line staff would experience if implemented. Design Longitudinal observational cohort study. Setting District General Hospital Monaragala. Participants All adult (age >17 years) admitted patients. Main outcome measures Existing physiological parameters, adverse outcomes and survival status at hospital discharge were extracted daily from existing paper records for all patients over an 8-month period. Statistical analysis Discrimination for selected aggregate weighted track and trigger systems (AWTTS) was assessed by the area under the receiver operating characteristic (AUROC) curve. Performance of EWS are further evaluated at time points during admission and across diagnostic groups. The burden of trigger to correctly identify patients who died was evaluated using positive predictive value (PPV). Results Of the 16 386 patients included, 502 (3.06%) had one or more adverse outcomes (cardiac arrests, unplanned intensive care unit admissions and transfers). Availability of physiological parameters on admission ranged from 90.97% (95% CI 90.52% to 91.40%) for heart rate to 23.94% (95% CI 23.29% to 24.60%) for oxygen saturation. Ability to discriminate death on admission was less than 0.81 (AUROC) for all selected EWS. Performance of the best performing of the EWS varied depending on admission diagnosis, and was diminished at 24 hours prior to event. PPV was low (10.44%). Conclusion There is limited observation reporting in this setting. Indiscriminate application of EWS to all patients admitted to wards in this setting may result in an unnecessary burden of monitoring and may detract from clinician care of sicker patients. Physiological parameters in combination with diagnosis may have a place when applied on admission to

Assessment of an Isolation Condenser of an Integral Reactor in View of Uncertainties in Engineering Parameters

Directory of Open Access Journals (Sweden)

G. Lorenzo

2011-01-01

As main outcomes, a ranking of parameters' importance and an estimate of the failure probability, from a design target point of view, were achieved by sensitivity analysis and Monte Carlo simulations based on a response surface model.

An efficient method to generate a perturbed parameter ensemble of a fully coupled AOGCM without flux-adjustment

Directory of Open Access Journals (Sweden)

P. J. Irvine

2013-09-01

Full Text Available We present a simple method to generate a perturbed parameter ensemble (PPE of a fully-coupled atmosphere-ocean general circulation model (AOGCM, HadCM3, without requiring flux-adjustment. The aim was to produce an ensemble that samples parametric uncertainty in some key variables and gives a plausible representation of the climate. Six atmospheric parameters, a sea-ice parameter and an ocean parameter were jointly perturbed within a reasonable range to generate an initial group of 200 members. To screen out implausible ensemble members, 20 yr pre-industrial control simulations were run and members whose temperature responses to the parameter perturbations were projected to be outside the range of 13.6 ± 2 °C, i.e. near to the observed pre-industrial global mean, were discarded. Twenty-one members, including the standard unperturbed model, were accepted, covering almost the entire span of the eight parameters, challenging the argument that without flux-adjustment parameter ranges would be unduly restricted. This ensemble was used in 2 experiments; an 800 yr pre-industrial and a 150 yr quadrupled CO2 simulation. The behaviour of the PPE for the pre-industrial control compared well to ERA-40 reanalysis data and the CMIP3 ensemble for a number of surface and atmospheric column variables with the exception of a few members in the Tropics. However, we find that members of the PPE with low values of the entrainment rate coefficient show very large increases in upper tropospheric and stratospheric water vapour concentrations in response to elevated CO2 and one member showed an implausible nonlinear climate response, and as such will be excluded from future experiments with this ensemble. The outcome of this study is a PPE of a fully-coupled AOGCM which samples parametric uncertainty and a simple methodology which would be applicable to other GCMs.

Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial

NARCIS (Netherlands)

Schrijver, H.M.; Gerritsen, A.A.M.; Strijers, R.L.; Uitdehaag, B.M.J.; Scholten, R.J.P.M.; Vet, de H.C.W.; Bouter, L.M.

2005-01-01

0.4) were found between the neurophysiologic and clinical outcome measures after 12 months, and between the changes in these different categories of outcome measures. This study confirms that the parameters of NCS improve significantly after treatment for CTS, but the modest correlations between

Targeted estimation of nuisance parameters to obtain valid statistical inference.

Science.gov (United States)

van der Laan, Mark J

2014-01-01

In order to obtain concrete results, we focus on estimation of the treatment specific mean, controlling for all measured baseline covariates, based on observing independent and identically distributed copies of a random variable consisting of baseline covariates, a subsequently assigned binary treatment, and a final outcome. The statistical model only assumes possible restrictions on the conditional distribution of treatment, given the covariates, the so-called propensity score. Estimators of the treatment specific mean involve estimation of the propensity score and/or estimation of the conditional mean of the outcome, given the treatment and covariates. In order to make these estimators asymptotically unbiased at any data distribution in the statistical model, it is essential to use data-adaptive estimators of these nuisance parameters such as ensemble learning, and specifically super-learning. Because such estimators involve optimal trade-off of bias and variance w.r.t. the infinite dimensional nuisance parameter itself, they result in a sub-optimal bias/variance trade-off for the resulting real-valued estimator of the estimand. We demonstrate that additional targeting of the estimators of these nuisance parameters guarantees that this bias for the estimand is second order and thereby allows us to prove theorems that establish asymptotic linearity of the estimator of the treatment specific mean under regularity conditions. These insights result in novel targeted minimum loss-based estimators (TMLEs) that use ensemble learning with additional targeted bias reduction to construct estimators of the nuisance parameters. In particular, we construct collaborative TMLEs (C-TMLEs) with known influence curve allowing for statistical inference, even though these C-TMLEs involve variable selection for the propensity score based on a criterion that measures how effective the resulting fit of the propensity score is in removing bias for the estimand. As a particular special

Temperature dependence of the fundamental band gap parameters ...

Indian Academy of Sciences (India)

the energy and broadening of the fundamental band gap have been evaluated using various models including the ... other crucial parameters including the operating temperatures of these devices. ... refrigeration system (Air Product Displex).

Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up.

Science.gov (United States)

Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

2017-10-01

To evaluate the clinical and radiological outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess whether patellofemoral osteoarthritis (OA) progression and alignment changes after OWHTO affect clinical outcomes. Inclusion criteria were consecutive patients who underwent OWHTO from March 2005 to September 2013. Exclusion criteria were loss to follow-up within 2 years and absence of second-look arthroscopy findings at the time of plate removal. The clinical parameters, including anterior knee pain while climbing stairs, Japanese Orthopedic Association score, and Oxford Knee Score, were evaluated. Radiological outcomes, including weight-bearing line ratio, modified Blackburne-Peel ratio, posterior tibial slope, tilting angle, lateral shift ratio, and patellofemoral OA (Kellgren-Lawrence grade), were evaluated preoperatively and at the final follow-up. Cartilage status (International Cartilage Repair Society grade) was evaluated at the initial HTO and at plate removal. Fifty-three patients (60 knees) were included in this study. The mean follow-up was 58.2 ± 22.4 months. Two knees (3%) presented with mild anterior knee pain after OWHTO. The mean Japanese Orthopedic Association score (66.9 ± 11.2 to 91.2 ± 9.7) significantly improved (P patellofemoral OA had progressed in 15 knees (27%), and arthroscopically patellofemoral cartilage degeneration had progressed in 27 knees (45%). However, there was no significant correlation between changes in patellofemoral alignment and clinical outcomes. Changes in patellofemoral alignment and patellofemoral OA progression did not affect the clinical outcomes of OWHTO at mid-term follow-up. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

An exploratory study to evaluate Clostridium difficile polymerase chain reaction ribotypes and infection outcomes

Directory of Open Access Journals (Sweden)

Thabit AK

2016-06-01

Full Text Available Abrar K Thabit,1,2 David P Nicolau1,3 1Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA; 2Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 3Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA Background: Clostridium difficile infection ranges from mild to severe prolonged diarrhea with systemic symptoms. Previous studies have assessed the correlation of some disease severity parameters to C. difficile ribotypes. However, certain clinical parameters of interest have not yet been evaluated.Aim: We conducted an exploratory study to evaluate the correlation of C. difficile ribotypes to parameters not assessed previously, notably days to diarrhea resolution (in terms of days to formed stools and days to less than three stools per day, length of hospital stay, 30-day recurrence rates, and 30-day readmission rates. Additional severity parameters evaluated include leukocytosis, serum creatinine, fever, and nausea/vomiting.Methods: Polymerase chain reaction ribotyping was performed on C. difficile isolates from baseline stool samples of 29 patients. A retrospective chart review was conducted to assess the parameters of interest.Results: The most common ribotypes were 027 (38%, 014/020 (21%, and 106/174 (21%. Numerically, 027 ribotype patients required more days to less than three stools per day versus 014/020 and 106/174 ribotype patients (P=0.2. The three ribotypes were similar regarding time to formed stools, duration of hospitalization, and 30-day readmission rate (P=0.2, 0.6, and 0.8, respectively. Recurrence within 30 days occurred in two patients with 027 and two patients with 014/020 (P=0.6. Leukocytosis and fever were more prominent with 027 than with 014/020 and 106/174 (P=0.04 for both parameters, although the degree of nausea/vomiting did not differ between the three groups (P=0.3. A serum creatinine level ≥1.5 times the premorbid level was seen in only three

Predictors for outcome after surgery for traumatic acute subdural hematoma

Directory of Open Access Journals (Sweden)

Atanasov Vladimir A.

2016-09-01

Full Text Available Introduction: Acute traumatic subdural hematoma (ASDH is one of the most frequent conditions in neurosurgery demanding emergency surgery. The aim of the study was to identify factors influencing outcome in patients who had surgery for evacuation of ASDH. Methods: From 2005 to 2012 eighty-five patients at age above 18 years had surgery for evacuation of ASDH. Outcome was measured according GOS at discharge and was dichotomized as “favorable outcome” (GOS 4 to 5 and “unfavorable outcome” (GOS 1 to 3. These factors were evaluated with univariate and logistic regression analysis for significance with outcome. Results: The mean age of the 85 patients was 62.7 years (SD±18.5. 45.9% patients were with favorable outcome and 54.1% had unfavorable outcome. Patients with GCS score 3-8 (54.1% had 80.4% unfavorable outcome whereas 78.6% of patients with GCS score 13-15 (32.9% had favorable outcome. All patients with nonreactive pupils (bilaterally or unilaterally - 31.8% had unfavorable outcome whereas patients (36.5% with both reactive pupils (36.5% had in 80.6% favorable outcome. All patients (40% with Rotterdam CT scores 5 and 6 had unfavorable outcome. The factors determining outcome were admission GSC score, Rotterdam CT scores, and prothrombin time. Conclusion: Patients who have GSC score of 3, unresponsive pupil(s or have Rotterdam CT scores 5 and 6 have little chance of survival. Patients with coagulopathy have two times more unfavorable outcome. The patients with ASDH should have surgery as soon as possible after correction of vital parameters in order to avoid deterioration which can be very rapid and irreversible.

Health outcome after major trauma: what are we measuring?

Science.gov (United States)

Hoffman, Karen; Cole, Elaine; Playford, E Diane; Grill, Eva; Soberg, Helene L; Brohi, Karim

2014-01-01

Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. MEDLINE, EMBASE, and CINAHL (from 2006-2012) were searched for studies evaluating health outcome after traumatic injuries. Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

Determining "small parameters" for quasi-steady state

Science.gov (United States)

Goeke, Alexandra; Walcher, Sebastian; Zerz, Eva

2015-08-01

For a parameter-dependent system of ordinary differential equations we present a systematic approach to the determination of parameter values near which singular perturbation scenarios (in the sense of Tikhonov and Fenichel) arise. We call these special values Tikhonov-Fenichel parameter values. The principal application we intend is to equations that describe chemical reactions, in the context of quasi-steady state (or partial equilibrium) settings. Such equations have rational (or even polynomial) right-hand side. We determine the structure of the set of Tikhonov-Fenichel parameter values as a semi-algebraic set, and present an algorithmic approach to their explicit determination, using Groebner bases. Examples and applications (which include the irreversible and reversible Michaelis-Menten systems) illustrate that the approach is rather easy to implement.

The effects of palatal lengthening on the functional and speech outcomes after submucous cleft palate repair.

Science.gov (United States)

Ezzat, Abdelrahman E M; El-Begermy, Marwa M; Eid, Mustafa I; Akel, Mabrouk M

2016-02-29

This study was designed to compare intravelar veloplasty with and without V-Y pushback palatoplasty regarding postoperative functional and speech outcomes. is to find out the importance and influence of palatal lengthening on the functional and speech outcomes after SMCP repair. This is a prospective randomized comparative study of 20 patients divided into 2 equal groups. The study was conducted between February 2008 and January 2015. Radical Intravelar Veloplasty (RIVVP group): included 10 patients with a mean age of 5.539±1.335 years and V-Y Pushback Pharyngoplasty and Radical Intravelar Veloplasty (VYP+RIVVP group): included 10 patients with a mean age of 5.688±1.341 years for non-syndromic SMCP. Academic tertiary care medical centres. In both groups there was a significant change in Eustachian tube function, nasal emission and nasal tone of voice postoperatively than preoperatively, while there was no significant difference between both groups in the postoperative outcomes as regards the same parameters (ET function, nasal emission and resonance) (p=0.558, 0.563 and 0.164 respectively). However, there was a significant difference between both groups as regards palatal lengthening, no statistically significant difference was present between both groups as regards the postoperative mean pharyngeal gap, using videoendoscopic analysis. In conclusion, RIVVP and VYP+RIVVP are both effective methods to repair non-syndromic SMCP. Moreover, the lengthening of the palate in non-syndromic SMCP is an unnecessary process.

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

NARCIS (Netherlands)

Jahagirdar, D.; Kroll, T.; Ritchie, K.; Wyke, S.

2012-01-01

ABSTRACT: BACKGROUND: Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated

A Review of Educational Outcomes in the Children's Mental Health Treatment Literature

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Becker, Kimberly D.; Brandt, Nicole Evangelista; Stephan, Sharon H.; Chorpita, Bruce F.

2014-01-01

We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational…

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice.

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Orimo, Tatsuya; Kamiyama, Toshiya; Yokoo, Hideki; Wakayama, Kenji; Shimada, Shingo; Tsuruga, Yosuke; Kamachi, Hirofumi; Taketomi, Akinobu

2016-08-01

This study aimed to evaluate the short- and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice. The study reviewed 42 HCC patients with BDTT, including six patients who needed preoperative biliary drainage due to obstructive jaundice, and 732 HCC patients without BDTT. The authors analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice. The HCC patients with BDTT, almost all with stage 3 or 4 disease, had increased alpha-fetoprotein expression, larger tumors, and more portal vein invasion status. The survival of the HCC patients with BDTT was significantly inferior to that of the patients without BDTT (p = 0.0003). Survival did not differ significantly between the HCC patients with BDTT and those without BDTT when the two groups were matched by stage (p = 0.3366). The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p = 0.5469). The perioperative outcomes for the HCC patients with BDTT did not depend on the presence or absence of preoperative jaundice. No patients in either BDTT group demonstrated 90-day mortality in this study. Hepatectomy should be considered for HCC patients with BDTT, even for patients with obstructive jaundice, because the surgical outcomes equivalent to those for HCC without BDTT can be achieved.

Relationship Between Preoperative Sarcopenia Status and Immuno-nutritional Parameters in Patients with Early-stage Non-small Cell Lung Cancer.

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Shoji, Fumihiro; Matsubara, Taichi; Kozuma, Yuka; Haratake, Naoki; Akamine, Takaki; Takamori, Shinkichi; Katsura, Masakazu; Toyokawa, Gouji; Okamoto, Tatsuro; Maehara, Yoshihiko

2017-12-01

Although the skeletal muscle in the region of the third lumbar vertebra (L3) is generally assessed in order to judge sarcopenia, not every patient with non-small cell lung cancer (NSCLC) undergoes computed tomography including the L3 region. We hypothesized that immuno-nutritional parameters could predict the existence of sarcopenia in patients with NSCLC. The aim of this study was to retrospectively investigate the correlation between preoperative sarcopenia and immuno-nutritional parameters in patients with early-stage NSCLC. We selected 147 of patients with pathological stage I NSCLC who underwent preoperative measurement of immuno-nutritional parameters and CT including the L3 region. Preoperative sarcopenia was significantly associated with female gender (p=0.0003) and poor prognosis (p=0.0322). In Kaplan-Meier analysis of overall survival (OS) by preoperative sarcopenia status, the sarcopenic group had significantly shorter OS than the non-sarcopenic group (5-year OS: 87.27% vs. 77.37%, p=0.0131, log-rank test). In multivariate analysis, the preoperative sarcopenia status (hazard ratio=5.138; 95% confidence interval=2.305-11.676; psarcopenia status was significantly related to controlling nutritional status score (p=0.0071) and Geriatric Nutritional Risk Index (GNRI) (psarcopenia status and GNRI (r=0.348, psarcopenia which was associated with poor outcome in patients with early-stage NSCLC. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Implant rehabilitation of the atrophic edentulous maxilla including immediate fixed provisional restoration without the use of bone grafting: a review of 1-year outcome data from a long-term prospective clinical trial.

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Toljanic, Joseph A; Baer, Russell A; Ekstrand, Karl; Thor, Andreas

2009-01-01

The literature suggests that predictable integration can be achieved when dental implant placement is combined with immediate fixed provisional restoration in a variety of clinical situations. Fewer data are available, however, regarding outcomes for immediate provisional restoration of implants in the edentulous maxilla. This report presents 1-year data acquired from a long-term prospective clinical trial designed to assess outcomes following the immediate provisional fixed restoration of implants in the atrophic edentulous maxilla without the use of bone augmentation. Fifty-one subjects diagnosed with an atrophic edentulous maxilla received a total of 306 implants (six implants per subject) followed by fixed provisional restoration within 24 hours of implant placement. No subjects underwent grafting to enhance bone volume in preparation for implant treatment. Data acquired included bone quantity and quality, implant dimensions, implant locations, and implant placement stability. Subjects returned for 1-year follow-up examinations to assess implant integration and restoration function. Periapical radiographs were obtained and compared to baseline images to assess marginal bone height maintenance. At the 3-month follow-up examination, 294 of 306 implants placed in 51 subjects were found to be integrated. This represents a cumulative implant survival rate of 96%. At the 1-year follow-up examination, mean marginal bone loss of 0.5 mm was noted, with no further loss of implants. These results support the contention that predictable long-term outcomes may be obtained for the atrophic edentulous maxilla when treated with an implant rehabilitation protocol that includes immediate fixed provisional restoration without the use of bone grafting. This strategy offers a promising treatment alternative for the patient with an atrophic edentulous maxilla.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis

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Pia Leon

2016-06-01

Full Text Available AIM: To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. METHODS: Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST and cumulative dissipated energy (CDE. The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA and the endothelial cell loss (ECL were taken in consideration. RESULTS: The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001. CONCLUSION: The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE and postoperative ECL outcomes.

An evaluation of intraoperative and postoperative outcomes of torsional mode versus longitudinal ultrasound mode phacoemulsification: a Meta-analysis.

Science.gov (United States)

Leon, Pia; Umari, Ingrid; Mangogna, Alessandro; Zanei, Andrea; Tognetto, Daniele

2016-01-01

To evaluate and compare the intraoperative parameters and postoperative outcomes of torsional mode and longitudinal mode of phacoemulsification. Pertinent studies were identified by a computerized MEDLINE search from January 2002 to September 2013. The Meta-analysis is composed of two parts. In the first part the intraoperative parameters were considered: ultrasound time (UST) and cumulative dissipated energy (CDE). The intraoperative values were also distinctly considered for two categories (moderate and hard cataract group) depending on the nuclear opacity grade. In the second part of the study the postoperative outcomes as the best corrected visual acuity (BCVA) and the endothelial cell loss (ECL) were taken in consideration. The UST and CDE values proved statistically significant in support of torsional mode for both moderate and hard cataract group. The analysis of BCVA did not present statistically significant difference between the two surgical modalities. The ECL count was statistically significant in support of torsional mode (P<0.001). The Meta-analysis shows the superiority of the torsional mode for intraoperative parameters (UST, CDE) and postoperative ECL outcomes.

EFFECT OF POSTURAL DRAINAGE POSITIONS ON VITAL PARAMETERS IN ASYMPTOMATIC HEALTHY INDIVIDUALS

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Animesh Hazari

2017-09-01

Full Text Available Background: Postural drainage is used exclusively or in combination with other airway clearance techniques in the management of chronic pulmonary diseases. Postural drainage therapy helps to prevent accumulation of secretions in patients who are at high risk for pulmonary complications. It also helps to remove accumulated secretions from the lungs.The role of body positioning on lung function and the clinical implications of postural drainage has been identified in a variety of settings including intensive care units. There is dearth in literature on effects on postural drainage on vital parameters. Thus the objective of the study was to measure the vital parameters at different postural drainage positions in healthy asymptomatic adults. Methods: Twenty healthy subjects participated in the study. The instruments used in the current study included a Pulse oximeter, Sphygmomanometer, Stethoscope, Postural drainage table.The outcome measures of interest were heart rate, respiratoryrate, oxygen saturation, blood pressure and Borg’s scale of rate of perceived exertion. The changes in the vital signs were recorded at different head down titling position of 0°, 15° & 30° in both supine and prone lying positions Results: Statistical significant difference was found for Systolic Blood Pressure in prone lying at different degrees of tilt (p=0.001 and Diastolic Blood Pressure in prone lying (p=0.000. Conclusion: Postural drainage positioning should be given with caution and under proper monitoring as there is a risk of change in the blood pressure even in asymptomatic elderly population. The monitoring of vital signs should be done during the therapy to decrease the risk of complications.

Knowledge produced from the outcomes of the "Nursing Outcomes Classification - NOC": integrative review

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Natália Chantal Magalhães da Silva

Full Text Available Objective: To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC. Method: A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS, US National Library of Medicine (PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL and Scopus Info Site (SCOPUS, during the months of August and September 2014. Results: The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%; Applicability in clinical practice (33.33%; and, Validation (63.90%. Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Conclusion: Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

Outcomes of endovascular aortic repair in the modern era

DEFF Research Database (Denmark)

Budtz-Lilly, Jacob; Wanhainen, Anders; Mani, Kevin

2018-01-01

Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored...... the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm...... pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview...

The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol.

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Spencer, Lisa; Rollo, Megan; Hauck, Yvonne; MacDonald-Wicks, Lesley; Wood, Lisa; Hutchesson, Melinda; Giglia, Roslyn; Smith, Roger; Collins, Clare

2015-01-01

What are the effects of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women?The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aimed at limiting gestational weight gain and postpartum weight retention in women.The second objective of this systematic review is to investigate included intervention components with respect to effect on weight-related outcomes. This may include, but is not limited to: length of intervention, use of face-to-face counselling, group or individual consultations, use of other interventions components including exercise, use of goals and use of support tools like food diaries, coaching, including email or text message support. Around half of all women of reproductive age are either overweight or obese, with women aged 25-34 years having a greater risk of substantial weight gain compared with men of all ages. Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may play a significant role in long term obesity. Having one child doubles the five- and 10-year obesity incidence for women, with many women who gain excessive weight during pregnancy remaining obese permanently. Excessive GWG and/or PPWR can also significantly contribute to short- and long-term adverse health outcomes for mother, baby and future pregnancies.Maternal obesity increases the risk of pregnancy related complications such as pre-eclampsia, gestational diabetes mellitus, stillbirth and the rate of caesarean section. Childhood obesity is a further long term complication of maternal obesity for offspring, which may persist in to adulthood. Excess GWG is also a risk factor for PPWR both in the short and long-term. Nehring et al. conducted a meta-analysis with over 65,000 women showing that, compared to women who gained weight within recommendations during pregnancy, women with GWG

The psychopathological and psychosocial outcome of early-onset schizophrenia: Preliminary data of a 13-year follow-up

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Mehler-Wex Claudia

2008-02-01

Full Text Available Abstract Background Relatively little is known about the long-term psychopathological and psychosocial outcome of early-onset schizophrenia. The existing literature describes more severe courses of illness in these patients compared with adult-onset schizophrenia. This article reports preliminary data of a study exploring the outcome of early-onset schizophrenia 13.4 years (mean after first admission. Predictors for interindividual outcomes were investigated. Methods We retrospectively assessed 27 former patients (mean age at first admission 15.5 years, SD = 2.0 that were consecutively admitted to the Department of Child and Adolescent Psychiatry at the University of Wuerzburg between 1990 and 2000. A multidimensional approach was chosen to assess the outcome consisting of a mail survey including different questions about psychopathological symptoms, psychosocial parameters, and standardized self-reports (ESI and ADS. Results Concerning the psychopathological outcome, 22.2% reported having acute schizophrenic symptoms. Almost one third (30.8% described symptoms of depression and 37.0% reported having tried to commit suicide or seriously thought about it. 77.8% of the former patients were still in outpatient treatment. Compared to the general population, the number of patients without a school graduation was relatively high (18.5%. Almost half of participants still live with their parents (48.1% or in assisted or semi-assisted living conditions (33.3%. Only 18.5% were working in the open market. Conclusion Schizophrenia with an early onset has an unfavourable prognosis. Our retrospective study of the psychopathological and psychosocial outcome concludes with a generally poor rating.

Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation.

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Lv, You; Chen, Jingyang; Chen, Jinchuan; Wu, Yuling; Chen, Xiangyang; Liu, Yi; Chu, Zhaoming; Sheng, Luxin; Qin, Rujie; Chen, Ming

2017-06-01

The aim of this study is to assess the long-term clinical and radiological outcomes between minimally invasive (MIS) and conventional transforaminal lumbar interbody fusion (TLIF) in treating one-segment lumbar disc herniation (LDH). One-hundred and six patients treated by MIS-TLIF (50 cases) or conventional TLIF (56 cases) were included. Perioperative results were evaluated. Clinical outcomes were compared preoperatively and postoperatively. Radiologic parameters were based on a comparison of preoperative and three-year postoperative lumbar lordosis, segmental lordosis, sacral slope, the cross-sectional area of the paraspinal muscle and fusion rates. MIS TILF had significantly less blood, shorter operation time, mean return to work time and lower intramuscular pressure compared with the conventional group during the operation. VAS scores for lower back pain and ODI in MIS-TLIF were significantly decreased. The mean cross-sectional area of the paraspinal muscle was significantly decreased after surgery in the conventional TLIF group and no significant intragroup differences were established in the MIS-TLIF group. No significant differences were found in fusion rate, lumbar lordosis, segmental lordosis and sacral slope. Both MIS and conventional TLIF were beneficial for patients with LDH. However, MIS-TLIF manifests a great improvement in perioperative outcomes, low back pain, disability and preventing paraspinal muscle atrophy during the follow-up period observation.

Adolescent antisocial behavior explained by combining stress-related parameters

NARCIS (Netherlands)

Platje, Evelien; Jansen, Lucres M. C.; Vermeiren, Robert R. J. M.; Doreleijers, Theo A. H.; van Lier, Pol A. C.; Koot, Hans M.; Meeus, W.H.J.; Branje, Suzan J. T.; Popma, Arne

Many stress-related parameters have been associated with antisocial behavior, including low cortisol awakening responses (CAR), as well as low cortisol and alpha-amylase reactivity to stress. These parameters reflect different, yet interrelated components of the stress system, yet it remains to be

Participation process and outcome interactions: Exploring participation in water resource management

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Carr, G.; Loucks, D. P.; Blöschl, G.

2012-04-01

Evaluating participation programmes, projects and activities aids understanding of effective mechanisms and enables the identification of improvements to current strategies. Characteristics of participation processes, such whether the process is cost effective, adequately facilitated, accessible, includes a representative section of society or interest groups and allocates power equivalently between participants, are commonly described and evaluated in the literature. A key question concerns whether effective processes lead to desirable outcomes. Two types of outcomes can be identified from participation programmes - tangible and non-tangible. Tangible outcomes include resource management changes or resource quality changes. Non tangible outcomes include developing and strengthening communication and action networks, building trust between individuals and/or organisations, developing innovative solutions, or developing shared knowledge and understandings of issues. To better understand how participation impacts upon resource management it is necessary to identify i) how non-tangible outcomes lead to resource management outcomes and ii) which characteristics of the participation process are connected to achieving non-tangible outcomes. This has been attempted with a literature based meta-analysis. Literature has been analysed to identify outcomes from participations programmes, and the process characteristics present that are associated with promoting or inhibiting their achievement. Preliminary analysis shows that process characteristics such as representation, facilitation and accessibility are important for achieving non-tangible outcomes. The relationship between non-tangible outcomes and resource management outcomes is less clear in the literature. This may be due to the different timescales over which the different types of outcomes emerge (resource management outcomes emerge over longer time periods) and the different contexts or settings in which

Health outcome after major trauma: what are we measuring?

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Karen Hoffman

Full Text Available Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients.To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma.MEDLINE, EMBASE, and CINAHL (from 2006-2012 were searched for studies evaluating health outcome after traumatic injuries.Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF were used to evaluate to what extent outcome measures captured health impacts.34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%, functional activities (11% and environmental factors (2%.Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

Exclusive queueing model including the choice of service windows

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Tanaka, Masahiro; Yanagisawa, Daichi; Nishinari, Katsuhiro

2018-01-01

In a queueing system involving multiple service windows, choice behavior is a significant concern. This paper incorporates the choice of service windows into a queueing model with a floor represented by discrete cells. We contrived a logit-based choice algorithm for agents considering the numbers of agents and the distances to all service windows. Simulations were conducted with various parameters of agent choice preference for these two elements and for different floor configurations, including the floor length and the number of service windows. We investigated the model from the viewpoint of transit times and entrance block rates. The influences of the parameters on these factors were surveyed in detail and we determined that there are optimum floor lengths that minimize the transit times. In addition, we observed that the transit times were determined almost entirely by the entrance block rates. The results of the presented model are relevant to understanding queueing systems including the choice of service windows and can be employed to optimize facility design and floor management.

Evaluation of voice acoustic parameters related to the vocal-loading test in professionally active teachers with dysphonia.

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Niebudek-Bogusz, Ewa; Kotyło, Piotr; Sliwińska-Kowalska, Mariola

2007-01-01

Teachers are at risk of developing voice disorders. A clinical battery of vocal function tests should include non-invasive and accurate measurements. The quantitative methods (e.g., voice acoustic analysis) make it possible to objectively evaluate voice efficiency and outcomes of dysphonia treatment. To identify possible signs of vocal fatigue, acoustic waveform perturbations during sustained phonation were measured before and after the vocal-loading test in 51 professionally active female teachers with functional voice disorders, using IRIS software. All the participants were also subjected to laryngological/phoniatric examination involving videostroboscopy combined with self-estimation by voice handicap index (VHI)-based scale. The phoniatric examination revealed glottal insufficiency with bowed vocal folds in 35.2%, soft vocal nodules in 31.4%, and hyperfunctional dysphonia with a tendency towards vestibular phonation in 19.6% of the patients. In the VHI scale, 66% of the female teachers estimated their own voice problems as moderate disability. An acoustic analysis performed after the vocal-loading test showed an increased rate of abnormal frequency perturbation parameters (pitch perturbation quotient (Jitter), relative average perturbation (RAP), and pitch period perturbation quotient (PPQ)) compared to the pre-test outcomes. The same was true of pitch-intensity contour of vowel /a:/, an indication of voice instability during sustained phonation. The recorded impairments of voice acoustic parameters related to vocal loading provide further evidence of dysphonia. The voice acoustic analysis performed before and after the vocal-loading test can significantly contribute to objective voice examinations useful in diagnosis of dysphonia among teachers.

Self-responsibility predicts the successful outcome of coronary artery bypass surgery

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C. J. Eales

2004-01-01

and their spouses/care-givers had a greater knowledge about the disease and the risk factor modification (p=0.01; p<0.01, and twelve months after the operation the patients are satisfied with the outcome of the operation (p<0.01. Conclusions: A stepwise logistic regression established that the acceptance of self-responsibility was the strongest  factor predicting an improved quality of life after CABG surgery. Patients who did not accept responsibility did not have an improved quality of life irrespective of the impact of all other parameters. Patients' satisfaction with the outcome of the operative procedure is an important predictor of the acceptance of self-responsibility. Realistic expectations of the outcome of CABG surgery will improve patients' satisfaction with the outcome. The knowledge of the spouse is a significant factor in the patients' acceptance of self-responsibility. Knowledge of the chronic nature of their disease as well as risk factor modification and realistic expectations of the outcome of CABG surgery influences patientsacceptance of self-responsibility.

The influence of model parameters on catchment-response

International Nuclear Information System (INIS)

Shah, S.M.S.; Gabriel, H.F.; Khan, A.A.

2002-01-01

This paper deals with the study of influence of influence of conceptual rainfall-runoff model parameters on catchment response (runoff). A conceptual modified watershed yield model is employed to study the effects of model-parameters on catchment-response, i.e. runoff. The model is calibrated, using manual parameter-fitting approach, also known as trial and error parameter-fitting. In all, there are twenty one (21) parameters that control the functioning of the model. A lumped parametric approach is used. The detailed analysis was performed on Ling River near Kahuta, having catchment area of 56 sq. miles. The model includes physical parameters like GWSM, PETS, PGWRO, etc. fitting coefficients like CINF, CGWS, etc. and initial estimates of the surface-water and groundwater storages i.e. srosp and gwsp. Sensitivity analysis offers a good way, without repetititious computations, the proper weight and consideration that must be taken when each of the influencing factor is evaluated. Sensitivity-analysis was performed to evaluate the influence of model-parameters on runoff. The sensitivity and relative contributions of model parameters influencing catchment-response are studied. (author)

Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions.

Science.gov (United States)

Chen, Po-Yi; Jan, Ya-Wen; Yang, Chien-Ming

2017-07-01

The purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I. A clinical data set including scores on the Chinese versions of the ISI and the PSQI obtained from 114 insomnia patients prior to and after a 6-week CBT-I program in Taiwan was analyzed. A series of measurement invariance (MI) tests were conducted to compare the factorial parameters of the ISI and the PSQI before and after the CBT-I treatment program. Most factorial parameters of the ISI remained invariant after CBT-I. However, the factorial model of the PSQI changed after CBT-I treatment. An extra loading with three residual correlations was added into the factorial model after treatment. The partial strong invariance of the ISI supports that it is a valid outcome measure for CBT-I. In contrast, various changes in the factor model of the PSQI indicate that it may not be an appropriate outcome measure for CBT-I. Some possible causes for the changes of the constructs of the PSQI following CBT-I are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Achieving High Accuracy in Calculations of NMR Parameters

DEFF Research Database (Denmark)

Faber, Rasmus

quantum chemical methods have been developed, the calculation of NMR parameters with quantitative accuracy is far from trivial. In this thesis I address some of the issues that makes accurate calculation of NMR parameters so challenging, with the main focus on SSCCs. High accuracy quantum chemical......, but no programs were available to perform such calculations. As part of this thesis the CFOUR program has therefore been extended to allow the calculation of SSCCs using the CC3 method. CC3 calculations of SSCCs have then been performed for several molecules, including some difficult cases. These results show...... vibrations must be included. The calculation of vibrational corrections to NMR parameters has been reviewed as part of this thesis. A study of the basis set convergence of vibrational corrections to nuclear shielding constants has also been performed. The basis set error in vibrational correction...

CCFpams: Atmospheric stellar parameters from cross-correlation functions

Science.gov (United States)

Malavolta, Luca; Lovis, Christophe; Pepe, Francesco; Sneden, Christopher; Udry, Stephane

2017-07-01

CCFpams allows the measurement of stellar temperature, metallicity and gravity within a few seconds and in a completely automated fashion. Rather than performing comparisons with spectral libraries, the technique is based on the determination of several cross-correlation functions (CCFs) obtained by including spectral features with different sensitivity to the photospheric parameters. Literature stellar parameters of high signal-to-noise (SNR) and high-resolution HARPS spectra of FGK Main Sequence stars are used to calibrate the stellar parameters as a function of CCF areas.

Core Health Outcomes In Childhood Epilepsy (CHOICE): protocol for the selection of a core outcome set.

Science.gov (United States)

Morris, Christopher; Dunkley, Colin; Gibbon, Frances M; Currier, Janet; Roberts, Deborah; Rogers, Morwenna; Crudgington, Holly; Bray, Lucy; Carter, Bernie; Hughes, Dyfrig; Tudur Smith, Catrin; Williamson, Paula R; Gringras, Paul; Pal, Deb K

2017-11-28

There is increasing recognition that establishing a core set of outcomes to be evaluated and reported in trials of interventions for particular conditions will improve the usefulness of health research. There is no established core outcome set for childhood epilepsy. The aim of this work is to select a core outcome set to be used in evaluative research of interventions for children with rolandic epilepsy, as an exemplar of common childhood epilepsy syndromes. First we will identify what outcomes should be measured; then we will decide how to measure those outcomes. We will engage relevant UK charities and health professional societies as partners, and convene advisory panels for young people with epilepsy and parents of children with epilepsy. We will identify candidate outcomes from a search for trials of interventions for childhood epilepsy, statutory guidance and consultation with our advisory panels. Families, charities and health, education and neuropsychology professionals will be invited to participate in a Delphi survey following recommended practices in the development of core outcome sets. Participants will be able to recommend additional outcome domains. Over three rounds of Delphi survey participants will rate the importance of candidate outcome domains and state the rationale for their decisions. Over the three rounds we will seek consensus across and between families and health professionals on the more important outcomes. A face-to-face meeting will be convened to ratify the core outcome set. We will then review and recommend ways to measure the shortlisted outcomes using clinical assessment and/or patient-reported outcome measures. Our methodology is a proportionate and pragmatic approach to expediently produce a core outcome set for evaluative research of interventions aiming to improve the health of children with epilepsy. A number of decisions have to be made when designing a study to develop a core outcome set including defining the scope

Life cycle assessment and residue leaching: The importance of parameter, scenario and leaching data selection

Energy Technology Data Exchange (ETDEWEB)

Allegrini, E., E-mail: elia@env.dtu.dk [Technical University of Denmark, Department of Environmental Engineering, Building 115, 2800 Lyngby (Denmark); Butera, S. [Technical University of Denmark, Department of Environmental Engineering, Building 115, 2800 Lyngby (Denmark); Kosson, D.S. [Vanderbilt University, Department of Civil and Environmental Engineering, Box 1831 Station B, Nashville, TN 37235 (United States); Van Zomeren, A. [Energy Research Centre of the Netherlands (ECN), Department of Environmental Risk Assessment, P.O. Box 1, 1755 ZG Petten (Netherlands); Van der Sloot, H.A. [Hans van der Sloot Consultancy, Dorpsstraat 216, 1721 BV Langedijk (Netherlands); Astrup, T.F. [Technical University of Denmark, Department of Environmental Engineering, Building 115, 2800 Lyngby (Denmark)

2015-04-15

Highlights: • Relevance of metal leaching in waste management system LCAs was assessed. • Toxic impacts from leaching could not be disregarded. • Uncertainty of toxicity, due to background activities, determines LCA outcomes. • Parameters such as pH and L/S affect LCA results. • Data modelling consistency and coverage within an LCA are crucial. - Abstract: Residues from industrial processes and waste management systems (WMSs) have been increasingly reutilised, leading to landfilling rate reductions and the optimisation of mineral resource utilisation in society. Life cycle assessment (LCA) is a holistic methodology allowing for the analysis of systems and products and can be applied to waste management systems to identify environmental benefits and critical aspects thereof. From an LCA perspective, residue utilisation provides benefits such as avoiding the production and depletion of primary materials, but it can lead to environmental burdens, due to the potential leaching of toxic substances. In waste LCA studies where residue utilisation is included, leaching has generally been neglected. In this study, municipal solid waste incineration bottom ash (MSWI BA) was used as a case study into three LCA scenarios having different system boundaries. The importance of data quality and parameter selection in the overall LCA results was evaluated, and an innovative method to assess metal transport into the environment was applied, in order to determine emissions to the soil and water compartments for use in an LCA. It was found that toxic impacts as a result of leaching were dominant in systems including only MSWI BA utilisation, while leaching appeared negligible in larger scenarios including the entire waste system. However, leaching could not be disregarded a priori, due to large uncertainties characterising other activities in the scenario (e.g. electricity production). Based on the analysis of relevant parameters relative to leaching, and on general results

Laparoscopic partial nephrectomy for hilar tumors: oncologic and renal functional outcomes.

Science.gov (United States)

George, Arvin K; Herati, Amin S; Rais-Bahrami, Soroush; Waingankar, Nikhil; Kavoussi, Louis R

2014-01-01

To present our experience with laparoscopic partial nephrectomy (LPN) for hilar tumors and evaluate intermediate oncologic and renal functional outcomes. A retrospective review of LPN cases performed in 488 patients was performed. Hilar lesions were defined as renal cortical tumors in direct physical contact with the renal artery, vein, or both, as identified on preoperative imaging and confirmed intraoperatively. The clinicopathologic parameters, perioperative course, complications, and oncologic and 6-month renal functional outcomes were analyzed. A total of 488 patients underwent LPN, of which 43 were hilar. The mean tumor size for hilar and nonhilar tumors was 3.6 cm and 3.1 cm, respectively. The mean operative time was shorter for hilar as compared with nonhilar tumors (129.1 minutes vs 141.8 minutes). Mean estimated blood loss was greater in LPN for hilar tumors (311.65 mL vs 298.4 mL). There were no statistically significant differences noted in any of the perioperative parameters investigated despite a higher nephrometry complexity score in the hilar group. Change in estimated glomerular filtration rate at 6 months showed a decrease of 10.9 mL/min and 8.8 mL/min for hilar and nonhilar tumors, respectively (P = NS). There was 1 recurrence detected in the hilar group, with a median follow-up of 41.6 months. In the hands of an experienced laparoscopist, LPN can safely be performed for hilar tumors, with preservation of perioperative outcomes and durable renal functional and oncologic outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

The use of bootstrap methods for analysing health-related quality of life outcomes (particularly the SF-36

Directory of Open Access Journals (Sweden)

Campbell Michael J

2004-12-01

Full Text Available Abstract Health-Related Quality of Life (HRQoL measures are becoming increasingly used in clinical trials as primary outcome measures. Investigators are now asking statisticians for advice on how to analyse studies that have used HRQoL outcomes. HRQoL outcomes, like the SF-36, are usually measured on an ordinal scale. However, most investigators assume that there exists an underlying continuous latent variable that measures HRQoL, and that the actual measured outcomes (the ordered categories, reflect contiguous intervals along this continuum. The ordinal scaling of HRQoL measures means they tend to generate data that have discrete, bounded and skewed distributions. Thus, standard methods of analysis such as the t-test and linear regression that assume Normality and constant variance may not be appropriate. For this reason, conventional statistical advice would suggest that non-parametric methods be used to analyse HRQoL data. The bootstrap is one such computer intensive non-parametric method for analysing data. We used the bootstrap for hypothesis testing and the estimation of standard errors and confidence intervals for parameters, in four datasets (which illustrate the different aspects of study design. We then compared and contrasted the bootstrap with standard methods of analysing HRQoL outcomes. The standard methods included t-tests, linear regression, summary measures and General Linear Models. Overall, in the datasets we studied, using the SF-36 outcome, bootstrap methods produce results similar to conventional statistical methods. This is likely because the t-test and linear regression are robust to the violations of assumptions that HRQoL data are likely to cause (i.e. non-Normality. While particular to our datasets, these findings are likely to generalise to other HRQoL outcomes, which have discrete, bounded and skewed distributions. Future research with other HRQoL outcome measures, interventions and populations, is required to

The ASDEX Upgrade Parameter Server

Energy Technology Data Exchange (ETDEWEB)

Neu, Gregor, E-mail: gregor.neu@ipp.mpg.de [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); Cole, Richard [Unlimited Computer Systems, Seeshaupter Str. 15, 82393 Iffeldorf (Germany); Gräter, Alex [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); Lüddecke, Klaus [Unlimited Computer Systems, Seeshaupter Str. 15, 82393 Iffeldorf (Germany); Rapson, Christopher J.; Raupp, Gerhard; Treutterer, Wolfgang; Zasche, Dietrich; Zehetbauer, Thomas [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany)

2015-10-15

Highlights: • We describe our main tool in the plasma control configuration process. • Parameter access and computation are configurable with XML files. • Simple implementation of in situ tests by rerouting requests to test data. • Pulse specific overriding of parameters. - Abstract: Concepts for the configuration of plant systems and plasma control of modern devices such as ITER and W7-X are based on global data structures, or “pulse schedules” or “experiment programs”, which specify all physics characteristics (waveforms for controlled actuators and plasma quantities) and all technical characteristics of the plant systems (diagnostics and actuators operation settings) for a planned pulse. At ASDEX Upgrade we use different approach. We observed that the physics characteristics driving the discharge control system (DCS) are frequently modified on a pulse-to-pulse basis. Plant system operation, however, relies on technical standard settings, or “basic configurations” to provide guaranteed resources or services, which evolve according to longer term session or campaign operation schedules. This is why AUG manages technical configuration items separately from physics items. Consistent computation of the DCS configuration requires access to all this physics and technical data, which include the discharge programme (DP), settings of actuator systems and real-time diagnostics, the current system state and a database of static parameters. A Parameter Server provides a unified view on all these parameter sets and acts as the central point of access. We describe the functionality and architecture of the Parameter Server and its embedding into the control environment.

Maternal nutrition and birth outcomes.

Science.gov (United States)

Abu-Saad, Kathleen; Fraser, Drora

2010-01-01

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Assessment of anthropometric parameters including area of the psoas, area of the back muscle, and psoas-vertebra distance as indices for prediction of vertebral fracture

International Nuclear Information System (INIS)

Suzuki, Tamotsu; Morita, Masahumi; Mabuchi, Kiyoshi

2005-01-01

We assessed some anthropometric parameters as indices for the prediction of vertebral compression fracture. We measured the area of the total cross section, area of the back muscle, area of the psoas, area of subcutaneous fat tissue, ratio of the right and left area of the psoas, psoas-vertebra distance, the mediolateral length of the back muscle, anteroposterior length of the back muscle, the mediolateral length of the psoas, and anteroposterior length of the psoas, on computed tomography images. Logistic regression analysis was performed in order to test the correlation between each anthropometric parameter and the incidence of fracture. The odds ratio corresponding to one standard deviation of each parameter was calculated. The ratio of center and anterior vertebral heights and the ratio of center and posterior vertebral heights were measured from the positioning image. The smaller value of these was defined as the vertebral height ratio value. Vertebral height ratio was used as the parameter directly related to vertebral fracture. The subjects for research were 25 women with vertebral compression fracture and 36 women without fracture. Vertebral height ratio had a significant correlation with area of the psoas (correlation coefficient, r=0.609 p<0.001), area of the back muscle (r=0.547 p<0.001), and the psoas-vertebra distance (r=-0.523 p<0.001) in the anthropometric parameters. The odds ratios of the area of the psoas (odds ratio, OR:0.18, 95% confidence interval, CI:0.43 to 0.08), area of the back muscle (OR:0.13, 95% CI:0.37 to 0.05), and the psoas-vertebra distance (OR:3.01, 95% CI:6.22 to 1.46) were high. The odds ratio of the mediolateral length of the psoas (OR:0.34, 95% CI:0.67 to 0.18), and the left-to-right area ratio of the psoas (OR:0.41, 95% CI:0.76 to 0.22) were rather high. However, the vertebral height ratio had no significant correlation with the left-to-right area ratio of the psoas. It was considered that area of the psoas, area of the back

Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Raquel Pei Chen Chan

2009-01-01

Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

Planck 2013 results. XVI. Cosmological parameters

DEFF Research Database (Denmark)

Planck Collaboration,; Ade, P. A. R.; Aghanim, N.

2013-01-01

parameters to high precision. We find a low value of the Hubble constant, H0=67.3+/-1.2 km/s/Mpc and a high value of the matter density parameter, Omega_m=0.315+/-0.017 (+/-1 sigma errors) in excellent agreement with constraints from baryon acoustic oscillation (BAO) surveys. Including curvature, we find...... over standard LCDM. The deviation of the scalar spectral index from unity is insensitive to the addition of tensor modes and to changes in the matter content of the Universe. We find a 95% upper limit of r...

Redefining Outcome Measurement: A Model for Brief Psychotherapy.

Science.gov (United States)

McGuinty, Everett; Nelson, John; Carlson, Alain; Crowther, Eric; Bednar, Dina; Foroughe, Mirisse

2016-05-01

The zeitgeist for short-term psychotherapy efficacy has fundamentally shifted away from evidence-based practices to include evidence-informed practices, resulting in an equally important paradigm shift in outcome measurement designed to reflect change in this short-term modality. The present article delineates a short-term psychotherapy structure which defines four fundamental stages that all brief therapies may have in common, and are represented through Cognitive Behavioral Therapy, Solution-Focused Brief Therapy, Narrative Therapy, and Emotion-Focused Therapy. These four theoretical approaches were analyzed via a selected literature review through comparing and contrasting specific and common tasks as they relate to the process of psychotherapy and change. Once commonalities were identified within session, they were categorized or grouped into themes or general stages of change within the parameters of a four to six session model of short-term therapy. Commonalities in therapeutic stages of change may more accurately and uniformly measure outcome in short-term work, unlike the symptom-specific psychometric instruments of longer-term psychotherapy. A systematic framework for evaluating the client and clinician adherence to 20 specific tasks for these four short-term therapies is presented through the newly proposed, Brief Task Acquisition Scale (BTAS). It is further proposed that the client-clinicians' adherence to these tasks will track and ultimately increase treatment integrity. Thus, when the client-clinician relationship tracks and evaluates the three pillars of (1) stage/process change, (2) task acquisition, and (3) treatment integrity, the culmination of these efforts presents a new way of more sensitively measuring outcome in short-term psychotherapy. Data collection is suggested as a first step to empirically evaluate the testable hypotheses suggested within this current model. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The

Parameter estimation and inverse problems

CERN Document Server

Aster, Richard C; Thurber, Clifford H

2005-01-01

Parameter Estimation and Inverse Problems primarily serves as a textbook for advanced undergraduate and introductory graduate courses. Class notes have been developed and reside on the World Wide Web for faciliting use and feedback by teaching colleagues. The authors'' treatment promotes an understanding of fundamental and practical issus associated with parameter fitting and inverse problems including basic theory of inverse problems, statistical issues, computational issues, and an understanding of how to analyze the success and limitations of solutions to these probles. The text is also a practical resource for general students and professional researchers, where techniques and concepts can be readily picked up on a chapter-by-chapter basis.Parameter Estimation and Inverse Problems is structured around a course at New Mexico Tech and is designed to be accessible to typical graduate students in the physical sciences who may not have an extensive mathematical background. It is accompanied by a Web site that...

Culturally Sensitive and Environment-Friendly Outcome Measures in

African Journals Online (AJOL)

Dr Olaleye

to review research studies on outcome measures that were developed for ... A systematic review of evidence on culturally sensitive and environment- ... Various databases including Google Scholar, PEDro and PubMed were accessed to search for relevant empirical ... utilization of disease-specific, patient-centered outcome.

Environmental Outcomes in the South African Learnership System ...

African Journals Online (AJOL)

Since 1994, the published environmental goals and objectives of the South African Government include environmental education outcomes in all education and ... of manifest and latent environmental outcomes distributed across learnerships and SETAs; a strong influence of occupational health and safety legislation; and a ...

Hyperspectral signature analysis of skin parameters

Science.gov (United States)

Vyas, Saurabh; Banerjee, Amit; Garza, Luis; Kang, Sewon; Burlina, Philippe

2013-02-01

The temporal analysis of changes in biological skin parameters, including melanosome concentration, collagen concentration and blood oxygenation, may serve as a valuable tool in diagnosing the progression of malignant skin cancers and in understanding the pathophysiology of cancerous tumors. Quantitative knowledge of these parameters can also be useful in applications such as wound assessment, and point-of-care diagnostics, amongst others. We propose an approach to estimate in vivo skin parameters using a forward computational model based on Kubelka-Munk theory and the Fresnel Equations. We use this model to map the skin parameters to their corresponding hyperspectral signature. We then use machine learning based regression to develop an inverse map from hyperspectral signatures to skin parameters. In particular, we employ support vector machine based regression to estimate the in vivo skin parameters given their corresponding hyperspectral signature. We build on our work from SPIE 2012, and validate our methodology on an in vivo dataset. This dataset consists of 241 signatures collected from in vivo hyperspectral imaging of patients of both genders and Caucasian, Asian and African American ethnicities. In addition, we also extend our methodology past the visible region and through the short-wave infrared region of the electromagnetic spectrum. We find promising results when comparing the estimated skin parameters to the ground truth, demonstrating good agreement with well-established physiological precepts. This methodology can have potential use in non-invasive skin anomaly detection and for developing minimally invasive pre-screening tools.

Using clinical parameters to guide fluid therapy in high-risk thoracic surgery. A retrospective, observational study

DEFF Research Database (Denmark)

Bjerregaard, Lars Stryhn; Møller-Sørensen, Hasse; Hansen, Kristoffer Lindskov

2015-01-01

the use of central venous oxygen saturation and intended low urine output to guide therapy in the early postoperative period. Here we evaluate the consequences of our changes. METHODS: Retrospective, observational study of 30 consecutive patients undergoing EPP; 18 who had surgery before and 12 who had...... surgery after the changes. Data were collected from patient files and from institutional databases. Outcome measures included: Volumes of administered fluids, fluid balances, length of stays and postoperative complications. Dichotomous variables were compared with Fisher's exact test, whereas continuous...... increasing the incidence of postoperative complications. Mean length of stay in the intensive care unit (LOSI) was reduced from three to one day (p = 0.04) after the changes. CONCLUSION: The use of clinical parameters to balance fluid restriction and a sufficient circulation in patients undergoing EPP...

Re-Examination of the BEST Trial Using Composite Outcomes, Including Emergency Department Visits

DEFF Research Database (Denmark)

Shen, Li; Jhund, Pardeep S.; Mogensen, Ulrik M.

2017-01-01

that included emergency department (ED) visits. We also undertook an analysis of recurrent events primarily using the Lin, Wei, Ying, and Yang model. Results Overall, 448 (33%) patients on placebo and 411 (30%) patients on bucindolol died (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78 to 1.02; p...... = 0.11). A total of 730 (54%) patients experienced CVD/HFH on placebo and 624 (46%) on bucindolol (HR: 0.80; 95% CI: 0.72 to 0.89; p 0.90; p

Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

Science.gov (United States)

Hodges, Kay; Wotring, James R

2012-04-01

An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

School-based diabetes interventions and their outcomes: a systematic literature review

Directory of Open Access Journals (Sweden)

Bénédicte Pansier

2015-04-01

Full Text Available Type 1 diabetes is one of the most common chronic childhood diseases, while type 2 diabetes in children is increasing at alarming rates globally. Against this backdrop, the school is a critical environment for children with diabetes. They continue to face barriers to education that may lead to depression, poor academic performance, and poor quality of life. To address these challenges, diabetes interventions have been implemented in school and the goal was to systematically review these interventions and their outcomes between 2000 and 2013. Fifteen studies were included in the narrative synthesis. Education of school personnel was the main focus before 2006. Studies reported gains in knowledge and perceived confidence of school staff. Since 2006, more comprehensive interventions have been developed to promote better care coordination and create a safe school environment. These studies reported improved diabetes management and quality of life of students. Assessment tools varied and study design included randomized controlled trials, quantitative and qualitative methods. Although many of the studies reported a significant difference in the parameters measured, it was not possible to determine optimal ways to improve the health, quality of life and academic performance of children with diabetes, given the disparity in scope, assessment tools and measured outcomes. Experimental designs, longer follow-up studies, larger sample sizes, and a higher number of participating schools are critical issues to consider in future studies. Most of the research was conducted in North America and further research is needed in other parts of the world.

Impact of Site Selection and Study Conduct on Outcomes in Global Clinical Trials.

Science.gov (United States)

Sarwar, Chaudhry M S; Vaduganathan, Muthiah; Butler, Javed

2017-08-01

There are over 25 million patients living with heart failure globally. Overall, and especially post-discharge, clinical outcomes have remained poor in heart failure despite multiple trials, with both successes and failures over the last two decades. Matching therapies to the right patient population, identifying high-quality sites, and ensuring optimal trial design and execution represent important considerations in the development of novel therapeutics in this space. While clinical trials have undergone rapid globalization, this has come with regional variation in comorbidities, clinical parameters, and even clinical outcomes and treatment effects across international sites. These issues have now highlighted knowledge gaps about the conduct of trials, selection of study sites, and an unmet need to develop and identify "ideal" sites. There is a need for all stakeholders, including academia, investigators, healthcare organizations, patient advocacy groups, industry sponsors, research organizations, and regulatory authorities, to work as a multidisciplinary group to address these problems and develop practical solutions to improve trial conduct, efficiency, and execution. We review these trial-level issues using examples from contemporary studies to inform and optimize the design of future global clinical trials in heart failure.

Spatio-temporal modeling of nonlinear distributed parameter systems

CERN Document Server

Li, Han-Xiong

2011-01-01

The purpose of this volume is to provide a brief review of the previous work on model reduction and identifi cation of distributed parameter systems (DPS), and develop new spatio-temporal models and their relevant identifi cation approaches. In this book, a systematic overview and classifi cation on the modeling of DPS is presented fi rst, which includes model reduction, parameter estimation and system identifi cation. Next, a class of block-oriented nonlinear systems in traditional lumped parameter systems (LPS) is extended to DPS, which results in the spatio-temporal Wiener and Hammerstein s

A new concept of safety parameter display system

International Nuclear Information System (INIS)

Martinez, A.S.; Oliveira, L.F.S. de; Schirru, R.; Thome Filho, Z.D.; Silva, R.A. da.

1986-07-01

A general description of Angra-1 Parameter Display System (SSPA), a real time and on-line computerized monitoring system for the parameters related to the power plant safety is presented. This system has the main purpose of diminish the load on the Angra-1 power plant operators at an emergency event by supplying them with the additional tools serving as the basis for a prompt identification of the accident. The SSPA is a kind of safety parameter display system whose concept was introduced after Three Mile Island accident in USA. The SSPA comprises two nuclear applications independently considered. They are included into the Parameters Monitoring Integrated System (SIMP) and the safety critical function system (SFCS). (Author) [pt

Correlation between quantitative and semiquantitative parameters in DCE-MRI with a blood pool agent in rectal cancer: can semiquantitative parameters be used as a surrogate for quantitative parameters?

Science.gov (United States)

Dijkhoff, Rebecca A P; Maas, Monique; Martens, Milou H; Papanikolaou, Nikolaos; Lambregts, Doenja M J; Beets, Geerard L; Beets-Tan, Regina G H

2017-05-01

The aim of this study was to assess correlation between quantitative and semiquantitative parameters in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in rectal cancer patients, both in a primary staging and restaging setting. Nineteen patients were included with DCE-MRI before and/or after neoadjuvant therapy. DCE-MRI was performed with gadofosveset trisodium (Ablavar ® , Lantheus Medical Imaging, North Billerica, Massachusetts, USA). Regions of interest were placed in the tumor and quantitative parameters were extracted with Olea Sphere 2.2 software permeability module using the extended Tofts model. Semiquantitative parameters were calculated on a pixel-by-pixel basis. Spearman rank correlation tests were used for assessment of correlation between parameters. A p value ≤0.05 was considered statistically significant. Strong positive correlations were found between mean peak enhancement and mean K trans : 0.79 (all patients, prectal cancer. Peak enhancement correlates strongly with K trans and wash-in showed strong correlation with V p and K ep . These parameters have been reported to predict tumor aggressiveness and response in rectal cancer. Therefore, semiquantitative analyses might be a surrogate for quantitative analyses.

Systematic Review of Treatment Outcome Measures for Vulvodynia.

Science.gov (United States)

Sadownik, Leslie A; Yong, Paul J; Smith, Kelly B

2018-07-01

To systematically evaluate the literature regarding vulvodynia treatment outcome measures. A systematic literature search on OVID, PubMed, and PsycINFO databases was conducted from inception until May 2016. Studies were included/excluded based on prespecified criteria. Reported outcome measures were organized into 6 core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT): pain; physical functioning, emotional functioning, participant ratings of global improvement and satisfaction with treatment, symptoms and adverse events, and participant disposition. Of the 206 articles identified for full-text screening, 33 met our criteria. One study adhered to all IMMPACT recommendations. The number of outcomes measured per study ranged from 1 to greater than 20. Patient-reported pain outcomes were found in the majority (27/33; 82%) of studies. Pain severity with intercourse was reported by 24 (73%) of 33 studies-9 different scales were used to measure this outcome. Clinician-reported outcomes were present in 14 (42%) of 33 studies. Methods of measuring vestibular sensitivity by "cotton swab" test were different in 8 of 10 studies. Other domains reported included; physical function (8/33 studies; 24%), sexual function (23/33 studies; 70%), and emotional function (13/33 studies; 39%). Symptoms and adverse events were reported by 15 (45%) of 33 studies. One study formally reported participant disposition using all the information recommended by CONSORT. Comparison of clinical trial results in vulvodynia is not possible because of a lack of standard treatment outcome measures. Vulvodynia researchers should apply the IMMPACT criteria to guide the development of a minimum core set of standard outcome measures that measure holistic health.

Optimal Design and Real Time Implementation of Autonomous Microgrid Including Active Load

OpenAIRE

Mohamed A. Hassan; Muhammed Y. Worku; Mohamed A. Abido

2018-01-01

Controller gains and power-sharing parameters are the main parameters affect the dynamic performance of the microgrid. Considering an active load to the autonomous microgrid, the stability problem will be more involved. In this paper, the active load effect on microgrid dynamic stability is explored. An autonomous microgrid including three inverter-based distributed generations (DGs) with an active load is modeled and the associated controllers are designed. Controller gains of the inverters ...

Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients.

Science.gov (United States)

Mlakar, Miha; Puddu, Paolo Emilio; Somrak, Maja; Bonfiglio, Silvio; Luštrek, Mitja

2018-01-01

This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

Parameter selection for peak alignment in chromatographic sample profiling: Objective quality indicators and use of control samples

NARCIS (Netherlands)

Peters, S.; van Velzen, E.; Janssen, H.-G.

2009-01-01

In chromatographic profiling applications, peak alignment is often essential as most chromatographic systems exhibit small peak shifts over time. When using currently available alignment algorithms, there are several parameters that determine the outcome of the alignment process. Selecting the

Patient-Reported Outcome questionnaires for hip arthroscopy: a systematic review of the psychometric evidence

Science.gov (United States)

2011-01-01

Background Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy. Methods A search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list. Results Five articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles. Conclusions This systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy. PMID:21619610

CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy

Energy Technology Data Exchange (ETDEWEB)

Dullerud, R. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Radiology; Amundsen, T. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. Neurology; Lie, H. [Chrismed, Oslo (Norway); Juel, N.G. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Physical Medicine; Magnaes, B. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Neurosurgery

1995-11-01

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system. Sixity-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior buldges. The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain. (orig./UG).

CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy

International Nuclear Information System (INIS)

Dullerud, R.; Juel, N.G.; Magnaes, B.

1995-01-01

This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system. Sixity-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior buldges. The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain. (orig./UG)

Multicentre clinical trial experience with the HeartMate 3 left ventricular assist device: 30-day outcomes.

Science.gov (United States)

Zimpfer, Daniel; Netuka, Ivan; Schmitto, Jan D; Pya, Yuriy; Garbade, Jens; Morshuis, Michiel; Beyersdorf, Friedhelm; Marasco, Silvana; Rao, Vivek; Damme, Laura; Sood, Poornima; Krabatsch, Thomas

2016-09-01

The objective of this study was to describe the operative experience and 30-day outcomes of patients implanted with the HeartMate 3 Left Ventricular Assist System (LVAS) during the Conformité Européenne (CE) Mark clinical trial. Adult patients met inclusion and exclusion criteria defining advanced-stage heart failure and included the indications of bridge to transplant and destination therapy. Operative parameters, outcomes, adverse events, physical status and quality-of-life parameters were assessed in the first 30 days after LVAS implant. Fifty patients were implanted with the HeartMate 3 at 10 centres in 6 countries. The 30-day survival rate was 98%. The median operative and cardiopulmonary bypass times were 200 (range: 95-585) min and 84 (range: 47-250) min, respectively. Patients required transfusion with packed red blood cells (3.6 ± 2.3 units), fresh frozen plasma (6.5 ± 5 units) and platelets (2 ± 1 units). Six patients (12%) required reoperation for postoperative bleeding and 10 patients (20%) did not require blood transfusion. The median intensive care time was 6 days (range: 1-112 days) and the total hospital stay was 28 days (range: 14-116 days). The most common adverse events were bleeding (15, 30%), arrhythmia (14, 28%) and infection (10, 20%). There were 2 (4%) strokes. The 30-day outcomes following implantation of the HeartMate 3 demonstrates excellent survival with low adverse event rates. The LVAD performed as intended with no haemolysis or device failure. NCT02170363. HeartMate 3™ CE Mark Clinical Investigation Plan (HM3 CE Mark). © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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