WorldWideScience

Sample records for outcome rating system

  1. System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

    Science.gov (United States)

    Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

    1993-01-01

    A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

  2. Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

    Directory of Open Access Journals (Sweden)

    Sund Björn

    2013-02-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1 static changes such as trimming the emergency call handling time or (2 dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

  3. Calculating length of gestation from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database versus vital records may alter reported rates of prematurity.

    Science.gov (United States)

    Stern, Judy E; Kotelchuck, Milton; Luke, Barbara; Declercq, Eugene; Cabral, Howard; Diop, Hafsatou

    2014-05-01

    To compare length of gestation after assisted reproductive technology (ART) as calculated by three methods from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and vital records (birth and fetal death) in the Massachusetts Pregnancy to Early Life Longitudinal Data System (PELL). Historical cohort study. Database linkage analysis. Live or stillborn deliveries. None. ART deliveries were linked to live birth or fetal death certificates. Length of gestation in 7,171 deliveries from fresh autologous ART cycles (2004-2008) was calculated and compared with that of SART CORS with the use of methods: M1 = outcome date - cycle start date; M2 = outcome date - transfer date + 17 days; and M3 = outcome date - transfer date + 14 days + day of transfer. Generalized estimating equation models were used to compare methods. Singleton and multiple deliveries were included. Overall prematurity (delivery 45% of deliveries and by more than 1 week in >22% of deliveries. Each method differed from each other. Estimates of preterm birth in ART vary depending on source of data and method of calculation. Some estimates may overestimate preterm birth rates for ART conceptions. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Outcome assessment of lingual and labial appliances compared with cephalometric analysis, peer assessment rating, and objective grading system in Angle Class II extraction cases.

    Science.gov (United States)

    Deguchi, Toru; Terao, Fumie; Aonuma, Tomo; Kataoka, Tomoki; Sugawara, Yasuyo; Yamashiro, Takashi; Takano-Yamamoto, Teruko

    2015-05-01

    To validate our hypothesis that there would be significant differences in treatment outcomes, including cephalometric values, degree of root resorption, occlusal indices, and functional aspect, between cases treated with labial and lingual appliances. Twenty-four consecutively treated Class II cases with extractions and lingual appliance were compared with 25 matched cases treated with extraction and labial appliance. Orthodontic treatment outcomes were evaluated by cephalometric analysis, peer assessment rating, and an objective grading system (OGS). Additionally, functional analysis was also performed in both groups after orthodontic treatment. Statistical comparison was performed using the Wilcoxon signed rank test within the groups, and the Mann-Whitney U-test was used to compare between the labial and lingual groups. The only significant difference between the groups was that the interincisal angle was larger in the lingual group than in the labial group. OGS evaluation showed that control over root angulation was significantly worse in the lingual group than in the labial group. There was no significant difference between groups in the amount of root resorption or in functional evaluation. Generally, lingual appliances offer comparable treatment results to those obtained with labial appliances. However, care should be taken with lingual appliances because they are more prone to produce uprighted incisors and root angulation.

  5. Relationship between chest compression rates and outcomes from cardiac arrest.

    Science.gov (United States)

    Idris, Ahamed H; Guffey, Danielle; Aufderheide, Tom P; Brown, Siobhan; Morrison, Laurie J; Nichols, Patrick; Powell, Judy; Daya, Mohamud; Bigham, Blair L; Atkins, Dianne L; Berg, Robert; Davis, Dan; Stiell, Ian; Sopko, George; Nichol, Graham

    2012-06-19

    Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions per minute. Animal and human studies have reported that blood flow is greatest with chest compression rates near 120/min, but few have reported rates used during out-of-hospital (OOH) cardiopulmonary resuscitation or the relationship between rate and outcome. The purpose of this study was to describe chest compression rates used by emergency medical services providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between chest compression rate and outcome. Included were patients aged ≥ 20 years with OOH cardiac arrest treated by emergency medical services providers participating in the Resuscitation Outcomes Consortium. Data were abstracted from monitor-defibrillator recordings during cardiopulmonary resuscitation. Multiple logistic regression analysis assessed the association between chest compression rate and outcome. From December 2005 to May 2007, 3098 patients with OOH cardiac arrest were included in this study. Mean age was 67 ± 16 years, and 8.6% survived to hospital discharge. Mean compression rate was 112 ± 19/min. A curvilinear association between chest compression rate and return of spontaneous circulation was found in cubic spline models after multivariable adjustment (P=0.012). Return of spontaneous circulation rates peaked at a compression rate of ≈ 125/min and then declined. Chest compression rate was not significantly associated with survival to hospital discharge in multivariable categorical or cubic spline models. Chest compression rate was associated with return of spontaneous circulation but not with survival to hospital discharge in OOH cardiac arrest.

  6. Acute change in glomerular filtration rate with inhibition of the renin-angiotensin system does not predict subsequent renal and cardiovascular outcomes.

    Science.gov (United States)

    Clase, Catherine M; Barzilay, Joshua; Gao, Peggy; Smyth, Andrew; Schmieder, Roland E; Tobe, Sheldon; Teo, Koon K; Yusuf, Salim; Mann, Johannes F E

    2017-03-01

    Initiation of blockade of the renin-angiotensin system may cause an acute decrease in glomerular filtration rate (GFR): the prognostic significance of this is unknown. We did a post hoc analysis of patients with, or at risk for, vascular disease, in two randomized controlled trials: Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and the Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND), whose median follow-up was 56 months. In 9340 patients new to renin-angiotensin system blockade, who were then randomized to renin-angiotensin system blockade, a fall in GFR of 15% or more at 2 weeks after starting renin-angiotensin system blockade was seen in 1480 participants (16%), with persistence at 8 weeks in 700 (7%). Both acute increases and decreases in GFR after initiation of renin-angiotensin system blockade were associated with tendencies, mostly not statistically significant, to increased risk of cardiovascular outcomes, which occurred in 1280 participants, and of microalbuminuria, which occurred in 864. Analyses of creatinine-based outcomes were suggestive of regression to the mean. In more than 3000 patients randomized in TRANSCEND to telmisartan or placebo, there was no interaction between acute change in GFR and renal or cardiovascular benefit from telmisartan. Thus, both increases and decreases in GFR on initiation of renin-angiotensin system blockade are common, and may be weakly associated with increased risk of cardiovascular and renal outcomes. Changes do not predict increased benefit from therapy. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  7. Rate Adaptive OFDMA Communication Systems

    International Nuclear Information System (INIS)

    Abdelhakim, M.M.M.

    2009-01-01

    Due to the varying nature of the wireless channels, adapting the transmission parameters, such as code rate, modulation order and power, in response to the channel variations provides a significant improvement in the system performance. In the OFDM systems, Per-Frame adaptation (PFA) can be employed where the transmission variables are fixed over a given frame and may change from one frame to the other. Subband (tile) loading offers more degrees of adaptation such that each group of carriers (subband) uses the same transmission parameters and different subbands may use different parameters. Changing the code rate for each tile in the same frame, results in transmitting multiple codewords (MCWs) for a single frame. In this thesis a scheme is proposed for adaptively changing the code rate of coded OFDMA systems via changing the puncturing rate within a single codeword (SCW). In the proposed structure, the data is encoded with the lowest available code rate then it is divided among the different tiles where it is punctured adaptively based on some measure of the channel quality for each tile. The proposed scheme is compared against using multiple codewords (MCWs) where the different code rates for the tiles are obtained using separate encoding processes. For bit interleaved coded modulation architecture two novel interleaving methods are proposed, namely the puncturing dependant interleaver (PDI) and interleaved puncturing (IntP), which provide larger interleaving depth. In the PDI method the coded bits with the same rate over different tiles are grouped for interleaving. In IntP structure the interleaving is performed prior to puncturing. The performance of the adaptive puncturing technique is investigated under constant bit rate constraint and variable bit rate. Two different adaptive modulation and coding (AMC) selection methods are examined for variable bit rate adaptive system. The first is a recursive scheme that operates directly on the SNR whereas the second

  8. True mean rate measuring system

    International Nuclear Information System (INIS)

    Eichenlaub, D.P.

    1980-01-01

    A digital radiation-monitoring system for nuclear power plants uses digital and microprocessor circuitry to enable rapid processing of pulse information from remote radiation monitors. The pulse rates are analyzed to determine whether new pulse-rate information is statisticaly the same as that previously received and to determine the best possible averaging time, which can be changed so that the statistical error remains below a specified level while the system response time remains short. Several data modules each process the pulse-rate information from several remote radiation monitors. Each data module accepts pulse data from each radiation monitor and measures the true average or mean pulse rate of events occurring with a Poisson distribution to determine the radiation level. They then develop digital output signals which indciate the respective radiation levels and which can be transmitted via multiplexer circuits for additional processing and display. The data modules can accept signals from remote control stations or computer stations via the multiplexer circuit to change operating thresholds and alarm levels in their memories. A check module scans the various data modules to determine whether the output signals are valid. It also acts as a redundant data module and will automatically replace an inoperative unit. (DN)

  9. National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate.

    Science.gov (United States)

    Racowsky, Catherine; Stern, Judy E; Gibbons, William E; Behr, Barry; Pomeroy, Kimball O; Biggers, John D

    2011-05-01

    To evaluate the validity of collecting day 3 embryo morphology variables into the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Retrospective. National database-SART CORS. Fresh autologous assisted reproductive technology (ART) cycles from 2006-2007 in which embryos were transferred singly (n=1,020) or in pairs (n=6,508) and embryo morphology was collected. None. Relationship between live birth, maternal age, and morphology of transferred day 3 embryos as defined by cell number, fragmentation, and blastomere symmetry. Logistic multiple regressions and receiver operating characteristic curve analyses were applied to determine specificity and sensitivity for correctly classifying embryos as either failures or successes. Live birth rate was positively associated with increasing cell number up to eight cells (8 cells: 16.2%), but was negatively associated with maternal age, increasing fragmentation, and asymmetry scores. An area under the receiver operating curve of 0.753 (95% confidence interval 0.740-0.766) was derived, with a sensitivity of 45.0%, a specificity of 83.2%, and 76.4% of embryos being correctly classified with a cutoff probability of 0.3. This analysis provides support for the validity of collecting morphology fields for day 3 embryos into SART CORS. Standardization of morphology collections will assist in controlling for embryo quality in future database analyses. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. 76 FR 48159 - Integrated System Power Rates

    Science.gov (United States)

    2011-08-08

    ... DEPARTMENT OF ENERGY Southwestern Power Administration Integrated System Power Rates AGENCY... American Electric Reliability Corporation and to cover increased investments and replacements in..., prepared a Current Power Repayment Study using existing system rates. The Study indicates that Southwestern...

  11. [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.

  12. Laser Pyro System Standardization and Man Rating

    Science.gov (United States)

    Brown, Christopher W.

    2004-01-01

    This viewgraph presentation reviews an X-38 laser pyro system standardization system designed for a new manned rated program. The plans to approve this laser initiation system and preliminary ideas for this system are also provided.

  13. Outcome Rating Scale and Session Rating Scale in Psychological Practice: Clinical Utility of Ultra-Brief Measures

    Science.gov (United States)

    Campbell, Alistair; Hemsley, Samantha

    2009-01-01

    The validity and reliability of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) were evaluated against existing longer measures, including the Outcome Questionnaire-45, Working Alliance Inventory, Depression Anxiety Stress Scale-21, Quality of Life Scale, Rosenberg Self-Esteem Scale and General Self-efficacy Scale. The measures…

  14. Outcome mapping for health system integration

    Directory of Open Access Journals (Sweden)

    Tsasis P

    2013-03-01

    Full Text Available Peter Tsasis,1 Jenna M Evans,2 David Forrest,3 Richard Keith Jones4 1School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada; 2Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada; 3Global Vision Consulting Ltd, Victoria, Canada; 4R Keith Jones and Associates, Victoria, Canada Abstract: Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. Keywords: integrated care, integrated delivery systems, complex adaptive systems, social capital

  15. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... the outcome payments calculated under the outcome payment system? The amount of each monthly outcome...

  16. Investing in a Surgical Outcomes Auditing System

    Science.gov (United States)

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben

    2013-01-01

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763

  17. 77 FR 36536 - Examination Rating System

    Science.gov (United States)

    2012-06-19

    ... operations of the Bank System's Office of Finance, ratings were assigned only to the areas of Corporate... FEDERAL HOUSING FINANCE AGENCY [No. 2012-N-06] Examination Rating System AGENCY: Federal Housing Finance Agency. ACTION: Notice with request for comments. SUMMARY: The Federal Housing Finance Agency...

  18. The Optimal Interest Rates and the Current Interest Rate System

    Directory of Open Access Journals (Sweden)

    Ioannis N. Kallianiotis

    2014-12-01

    Full Text Available The paper discusses the current target interest rate, which is closed to zero with the new experiment of quantitative easing since 2009 and has reduced the rate of return and the income and has made the real savings rate negative. This target rate has not reduced unemployment and has not improved growth (it is not optimal, but has increased the debt of individuals and the low taxes on businesses have magnified the budget deficits and the national debt. People were borrowing the present value of their uncertain future wealth and their high debt and low income raise the risk and this high risk premium heighten the interest rate on loans, especially on credit cards. The current monetary system needs to be changed and an interest rate floor on deposits (savings and an interest rate ceiling on individuals‟ loans (borrowings is necessary to improve social welfare, fairness, and justice in our society and not to support only disintermediation (financial markets. The middle class cannot work only to pay taxes and interest on its debt (redistribution of their wealth to government and banks or worse to be in chronic unemployment. Many home owners defaulted on their loans payments and their homes are foreclosed. They will end up without property (real assets. The unconcern towards the middle class will affect negatively the entire socio-economic structure of the nation and after losing its productive power, it will start declining, as history has shown to us with so many empires that do not exist anymore. We hope the leaders (the democratic governments to improve public policies, to regulate the financial market and institutions, and to satisfy their policy ultimate objective, which is citizens‟ perfection and the nation‟s highest point of prosperity.

  19. Five-Star Quality Rating System

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about...

  20. System for increasing laser pulse rate

    International Nuclear Information System (INIS)

    1980-01-01

    A technique of static elements is disclosed for combining a plurality of laser beams having time sequenced, pulsed radiation to achieve an augmented pulse rate. The technique may also be applied in a system for combining both time sequenced pulses and frequency distinct pulses for use in a system for isotope enrichment. (author)

  1. Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study.

    Science.gov (United States)

    Amin, Pina; Zaher, Summia; Penketh, Richard; Cherian, Sobha; Collis, Rachel E; Sanders, Julia; Bhal, Kiron

    2018-02-19

    To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK. Cohort study of births from 2006 to 2015. A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom. Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA). Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more. During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen. Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

  2. Irrational reactions to negative outcomes: evidence for two conceptual systems.

    Science.gov (United States)

    Epstein, S; Lipson, A; Holstein, C; Huh, E

    1992-02-01

    According to cognitive-experiential self-theory (CEST), individuals have 2 systems for processing information, a rational system and an experiential system. Research conducted under norm theory (NT) has provided impressive evidence of an if only (IO) effect associated with postoutcome processing of aversive events that are highly consistent with formulations in CEST. Two studies involving vignettes adapted from NT were conducted that tested 4 hypotheses and corollaries derived from CEST. It was demonstrated, in support of hypotheses, that the IO effect can be obtained with ratings of one's own and of a protagonist's specific behaviors, as well as with ratings of a protagonist's diffuse emotions (the usual procedure); that a rational orientation decreases the IO effect; that increasing the intensity of outcomes increases it; and that priming the experiential system reduces people's ability to subsequently think rationally. The theoretical and research implications of these findings are discussed.

  3. Delta count-rate monitoring system

    International Nuclear Information System (INIS)

    Van Etten, D.; Olsen, W.A.

    1985-01-01

    A need for a more effective way to rapidly search for gamma-ray contamination over large areas led to the design and construction of a very sensitive gamma detection system. The delta count-rate monitoring system was installed in a four-wheel-drive van instrumented for environmental surveillance and accident response. The system consists of four main sections: (1) two scintillation detectors, (2) high-voltage power supply amplifier and single-channel analyzer, (3) delta count-rate monitor, and (4) count-rate meter and recorder. The van's 6.5-kW generator powers the standard nuclear instrument modular design system. The two detectors are mounted in the rear corners of the van and can be run singly or jointly. A solid-state bar-graph count-rate meter mounted on the dashboard can be read easily by both the driver and passenger. A solid-state strip chart recorder shows trends and provides a permanent record of the data. An audible alarm is sounded at the delta monitor and at the dashboard count-rate meter if a detected radiation level exceeds the set background level by a predetermined amount

  4. Changes in heart rate associated with contest outcome in agonistic encounters in lobsters.

    Science.gov (United States)

    Hernáindez-Falcón, Jesús; Basu, Alo C; Govindasamy, Siddhartan; Kravitz, Edward A

    2005-03-01

    Agonistic contests between lobsters housed together in a confined space progress through encounters of increasing intensity until a dominance relationship is established. Once this relationship is established, losing animals continually retreat from the advances of winners. These encounters are likely to consume much energy in both winning and losing animals. Therefore, one might expect involvement of many physiological systems before, during and after fights. Here, we report effects of agonistic encounters on cardiac frequency in winning and losing adult lobsters involved in dyadic interactions. The results show that: (i) small but significant increases in heart rate are observed upon chemical detection of a conspecific; (ii) during agonistic interactions, further increases in heart rate are seen; and (iii) ultimate winners exhibit greater increases in heart rate lasting longer periods of time compared to ultimate losers. Heart rate in winners remains elevated for at least 15 min after the contests have ended and animals have been returned to their home tanks. Reduced effects are seen in second and third pairings between familiar opponents. The sustained changes in heart rate that we observe in winning lobsters may result from hormonal modulation of cardiac function related to the change in social status brought about by contest outcome.

  5. 20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Will SSA periodically review the outcome payment system and the outcome-milestone payment system for possible modifications? 411.597 Section 411... Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

  6. Does Excision of Heterotopic Ossification of the Elbow Result in Satisfactory Patient-Rated Outcomes?

    Science.gov (United States)

    Sandeep, K N; Suresh, G; Gopisankar, B; Abhishek, N; Sujiv, A

    2017-03-01

    Treatment of heterotopic ossification (HO) of the elbow is challenging and fraught with complications. Patients who sustain direct trauma to the elbow joint, the central nervous system, and thermal burns are at increased risk for development of HO. There is a paucity of studies and reports on patient's self-evaluation after the excision of the heterotopic ossification. This retrospective study assessed outcomes after excision of heterotopic ossification around the elbow in a cohort of ten patients operated from 2012 to 2015. The outcome assessment was done by the Mayo Elbow Performance index (MEPI) and the American Shoulder and Elbow Surgeons-Elbow score (ASES-E scores). The mean follow-up was 18.11 months after the operation. The Mayo Elbow Performance Score was excellent in two elbows, good in six and fair in two. The mean gain in flexion-extension arc after excision of HO was 80 degrees. All of the patients had residual flexion deformity postoperatively. Eight of the nine patients were able to do activities requiring flexion at final follow-up. Excision of HO around the elbow is associated with satisfactory patient-rated outcomes in spite of failure to regain full range of motion.

  7. FPGA Implementation of Heart Rate Monitoring System.

    Science.gov (United States)

    Panigrahy, D; Rakshit, M; Sahu, P K

    2016-03-01

    This paper describes a field programmable gate array (FPGA) implementation of a system that calculates the heart rate from Electrocardiogram (ECG) signal. After heart rate calculation, tachycardia, bradycardia or normal heart rate can easily be detected. ECG is a diagnosis tool routinely used to access the electrical activities and muscular function of the heart. Heart rate is calculated by detecting the R peaks from the ECG signal. To provide a portable and the continuous heart rate monitoring system for patients using ECG, needs a dedicated hardware. FPGA provides easy testability, allows faster implementation and verification option for implementing a new design. We have proposed a five-stage based methodology by using basic VHDL blocks like addition, multiplication and data conversion (real to the fixed point and vice-versa). Our proposed heart rate calculation (R-peak detection) method has been validated, using 48 first channel ECG records of the MIT-BIH arrhythmia database. It shows an accuracy of 99.84%, the sensitivity of 99.94% and the positive predictive value of 99.89%. Our proposed method outperforms other well-known methods in case of pathological ECG signals and successfully implemented in FPGA.

  8. Optimising stocking rate and grazing management to enhance environmental and production outcomes for native temperate grasslands

    Science.gov (United States)

    Badgery, Warwick; Zhang, Yingjun; Huang, Ding; Broadfoot, Kim; Kemp, David; Mitchell, David

    2015-04-01

    lamb/ha), because individual animal performance was greater for continuous grazing than higher intensity grazing systems (4-Paddock and 20-Paddock). Differences in SOC, CO2 flux and erosion were determined by landscape position rather than grazing treatment. To remove the confounding influences of stocking rate and grazing management, the Ausfarm biophysical model, calibrated to the experimental treatments, examined the interaction between grazing management and stocking rates. Ground cover and profitability were similar between grazing systems at lower stocking rates (3 ewes per ha), but continuous grazing had higher profitability and lower ground cover above the optimum stocking rate of 4 ewes per ha. The findings of these two studies suggest that optimising stocking rate is more important than grazing management for a sustainable and profitable grazing system. Grazing management can further enhance environmental outcomes for an optimal stocking rate, but the findings from the Chinese study particularly highlight the need to look at multiple ecosystem services, when optimising systems. The Australian study also suggests the optimum stocking rate is dependent on the intensity of grazing management. Further work is required to understand the influence of landscape on grassland production and how stocking rates and grazing management can be sustainably optimised for different landscape areas to utilise this variation more effectively.

  9. 77 FR 67644 - Examination Rating System

    Science.gov (United States)

    2012-11-13

    ... condition, performance, and risk management. Under the new rating system, each Bank and Enterprise, as well... Home Loan Bank's or Enterprise's capital, asset quality, management, earnings, liquidity, sensitivity... performance from business fluctuations and adverse changes in the economic environment. Risk management...

  10. Apparent exchange rate imaging in anisotropic systems

    DEFF Research Database (Denmark)

    Sønderby, Casper Kaae; Lundell, Henrik M; Søgaard, Lise V

    2014-01-01

    Double-wave diffusion experiments offer the possibility of probing correlation between molecular diffusion at multiple time points. It has recently been shown that this technique is capable of measuring the exchange of water across cellular membranes. The aim of this study was to investigate...... the effect of macroscopic tissue anisotropy on the measurement of the apparent exchange rate (AXR) in multicompartment systems....

  11. Corrosion Rate Monitoring in District Heating Systems

    DEFF Research Database (Denmark)

    Hilbert, Lisbeth Rischel; Nielsen, Lars Vendelbo; Andersen, A.

    2005-01-01

    be applicable, and if on-line monitoring could improve the quality control. Water quality monitoring was applied as well as corrosion rate monitoring with linear polarization resistance (LPR), electrochemical impedance spectroscopy (EIS), electrical resistance (ER) technique, mass loss and a crevice corrosion......Quality control in district heating systems to keep uniform corrosion rates low and localized corrosion minimal is based on water quality control. Side-stream units equipped with carbon steel probes for online monitoring were mounted in district heating plants to investigate which techniques would...... cell for localized corrosion risk estimation. Important variations in corrosion rate due to changes in make-up water quality were detected with the continuous monitoring provided by ER and crevice cell, while LPR gave unreliable corrosion rates. The acquisition time of two-three days for EIS...

  12. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

    Directory of Open Access Journals (Sweden)

    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  13. Fertility and pregnancy outcome in women with systemic sclerosis.

    Science.gov (United States)

    Steen, V D; Medsger, T A

    1999-04-01

    To determine fertility and pregnancy outcome in women with systemic sclerosis (SSc; scleroderma) who had disease onset before age 45 years. All living women with scleroderma who had first been evaluated at the University of Pittsburgh Scleroderma Clinic after January 1, 1972 were sent a detailed self-administered questionnaire in 1986 specifically concerning pregnancy outcomes and infertility. This group was compared with 2 race- and age-matched control groups, one comprising women with rheumatoid arthritis (RA) and one comprising healthy neighborhood women identified by random-digit dialing. We determined the number, history, treatment, and outcome of women who either had never been pregnant or had attempted to become pregnant unsuccessfully for more than 1 year. We also obtained data regarding pregnancy outcomes, including the frequency of miscarriage, premature births, small full-term infants, perinatal deaths, and births of live healthy infants. The study group comprised 214 women with SSc, 167 with RA, and 105 neighborhood controls. There were no significant differences in the overall rates of miscarriage, premature births, small full-term births, or neonatal deaths between the 3 groups. Women with SSc were more likely than those without SSc to have adverse outcomes of pregnancy after the onset of their rheumatic disease, particularly premature births (also seen in RA women after disease onset) and small full-term infants. Although a significantly greater number of women with SSc had never been pregnant, there were no significant differences in the frequency of never having been pregnant or of infertility in the 3 groups after adjustment for contributing factors. This study indicates that women with SSc have acceptable pregnancy outcomes compared with those of women with other rheumatic disease and healthy neighborhood controls. Infertility was not a frequent problem. We believe that there are no excessive pregnancy risks to women with SSc or their infants

  14. Reactor core flow rate control system

    International Nuclear Information System (INIS)

    Sakuma, Hitoshi; Tanikawa, Naoshi; Takahashi, Toshiyuki; Miyakawa, Tetsuya.

    1996-01-01

    When an internal pump is started by a variable frequency power source device, if magnetic fields of an AC generator are introduced after the rated speed is reached, neutron flux high scram occurs by abrupt increase of a reactor core flow rate. Then, in the present invention, magnetic fields for the AC generator are introduced at a speed previously set at which the fluctuation range of the reactor core flow rate (neutron flux) by the start up of the internal pump is within an allowable value. Since increase of the speed of the internal pump upon its start up is suppressed to determine the change of the reactor core flow rate within an allowable range, increase of neutron fluxes is suppressed to enable stable start up. Then, since transition boiling of fuels caused by abrupt decrease of the reactor core flow rate upon occurrence of abnormality in an external electric power system is prevented, and the magnetic fields for the AC generator are introduced in such a manner to put the speed increase fluctuation range of the internal pump upon start up within an allowable value, neutron flux high scram is not caused to enable stable start-up. (N.H.)

  15. FFTF integrated leak rate computer system

    International Nuclear Information System (INIS)

    Hubbard, J.A.

    1987-01-01

    The Fast Flux Test Facility (FFTF) is a liquid-metal-cooled test reactor located on the Hanford site. The FFTF is the only reactor of this type designed and operated to meet the licensing requirements of the Nuclear Regulatory Commission. Unique characteristics of the FFTF that present special challenges related to leak rate testing include thin wall containment vessel construction, cover gas systems that penetrate containment, and a low-pressure design basis accident. The successful completion of the third FFTF integrated leak rate test 5 days ahead of schedule and 10% under budget was a major achievement for the Westinghouse Hanford Company. The success of this operational safety test was due in large part to a special network (LAN) of three IBM PC/XT computers, which monitored the sensor data, calculated the containment vessel leak rate, and displayed test results. The equipment configuration allowed continuous monitoring of the progress of the test independent of the data acquisition and analysis functions, and it also provided overall improved system reliability by permitting immediate switching to backup computers in the event of equipment failure

  16. Bretton Woods Fixed Exchange Rate System versus Floating Exchange Rate System

    OpenAIRE

    Geza, Paula; Giurca Vasilescu, Laura

    2011-01-01

    One of the most important issues of monetary policy is to find out whether the state should intervene among the exchange rates, taking into account the fact that changes in the exchange rates represent a significant transmission channel of the effects generated by the monetary policy. Taking into consideration the failure of fixed exchange rate regimes and the recent improvement of financial markets, the return in the near future to such a regime – as for example the Bretton Woods system –...

  17. Leak rate measurements and detection systems

    International Nuclear Information System (INIS)

    Kupperman, D.; Shack, W.J.; Claytor, T.

    1983-10-01

    A research program is under way to evaluate and develop improve leak detection systems. The primary focus of the work has been on acoustic emission detection of leaks. Leaks from artificial flaws, laboratory-generated IGSCCs and thermal fatigue cracks, and field-induced intergranular stress corrosion cracks (IGSCCs) from reactor piping have been examined. The effects of pressure, temperature, and leak rate and geometry on the acoustic signature are under study. The use of cross-correlation techniques for leak location and pattern recognition and autocorrelation for source discrimination is also being considered

  18. A method to assess obstetric outcomes using the 10-Group Classification System: a quantitative descriptive study.

    LENUS (Irish Health Repository)

    Rossen, Janne

    2017-01-01

    Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information.

  19. Exergy Rate Profile of Multicomponent Distillation System

    Directory of Open Access Journals (Sweden)

    Kehinde Adewale Adesina

    2016-07-01

    Full Text Available Exergy rate profiles, exergetic efficiency and irreversibility were used to examine the driving forces in multicomponent distillation system with the view to identifying feasible and efficient operating parameters. The mixture used comprised of 5% propane, 15% iso-butane, 25% nbutane, 20% iso-pentane and 35% n-pentane. Operating variables were feed temperature (-30 oC and -80 oC, pressure (800 kPa and 1200 kPa, and reflux-ratio (2 and 6. Stage-by-stage system exergy analysis was estimated. Column profiles of base case -30 oC, -80 oC, -30 oC-reflus ratio 6, -80 oC reflux ratio 6 and base case reflux ratio 6 did not crossed thus are thermodynamically feasible. Base case -30 oC-reflux ratio 2, -80 oC-reflux ratio 2, and base case-reflux ratio 2 were crossed and constricted and are infeasible. Base case results gave efficiency of 81.7% at depropanizer and 65.2% at debutanizer. Base cases sensitivity results with -30 oC, -80 oC and reflux ratio 6, efficiency range 57.40 – 70% and 65.20% - 54.90% for depropanizer and debutanizer respectively. Spitted cases gave 81.7% and 62.20% with more scatter profiles. Splitted feed base case -30 oC design gave the lowest overall system exergy loss rate of 1.12E+6 and efficiency of 95.70%. Design feasible parameters, system efficiency and irreversibility which form basis

  20. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes de Souza

    Full Text Available ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001, have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001 and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001 than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

  1. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

    OpenAIRE

    Souza, Maria de Lourdes de; Lynn, Fiona Ann; Johnston, Linda; Tavares, Eduardo Cardoso Teixeira; Brüggemann, Odaléa Maria; Botelho, Lúcio José

    2017-01-01

    ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 ye...

  2. Cold Climate Structural Fire Danger Rating System?

    Directory of Open Access Journals (Sweden)

    Maria-Monika Metallinou

    2018-03-01

    Full Text Available Worldwide, fires kill 300,000 people every year. The fire season is usually recognized to be in the warmer periods of the year. Recent research has, however, demonstrated that the colder season also has major challenges regarding severe fires, especially in inhabited (heated wood-based structures in cold-climate areas. Knowledge about the effect of dry cellulose-based materials on fire development, indoor and outdoor, is a motivation for monitoring possible changes in potential fire behavior and associated fire risk. The effect of wind in spreading fires to neighboring structures points towards using weather forecasts as information on potential fire spread behavior. As modern weather forecasts include temperature and relative humidity predictions, there may already be sufficient information available to develop a structural fire danger rating system. Such a system may include the following steps: (1 Record weather forecasts and actual temperature and relative humidity inside and outside selected structures; (2 Develop a meteorology-data-based model to predict indoor relative humidity levels; (3 Perform controlled drying chamber experiments involving typical hygroscopic fire fuel; (4 Compare the results to the recorded values in selected structures; and (5 Develop the risk model involving the results from drying chamber experiments, weather forecasts, and separation between structures. Knowledge about the structures at risk and their use is also important. The benefits of an automated fire danger rating system would be that the society can better plan for potentially severe cold-climate fires and thereby limit the negative impacts of such fires.

  3. Intrapartum intervention rates and perinatal outcomes following successful external cephalic version.

    Science.gov (United States)

    Basu, A; Flatley, C; Kumar, S

    2016-06-01

    To determine intrapartum and perinatal outcomes following successful external cephalic version for breech presentation at term. This was a retrospective cohort study of outcomes following successful external cephalic version in 411 women at an Australian tertiary maternity unit between November 2008 and March 2015. The study cohort was compared with a control group of 1236 women with cephalic presentation who underwent spontaneous labor. Intrapartum intervention rates and adverse neonatal outcomes were compared between both groups. The success rate of external cephalic version (ECV) was 66.4%. The spontaneous vaginal delivery rate in the study cohort was 59.4% (224/411) vs 72.8% (900/1236) in the control cohort (P<0.001). Intrapartum intervention rates (emergency cesarean section (CS) and instrumental delivery) were higher in the ECV group (38% vs 27.2%, P<0.001). Rates of emergency CS for non-reassuring fetal status (9.5%, 39/411 vs 4.4%, 54/1236, P⩽0.001) and failure to progress (13.4%, 55/411 vs 4.1%, 51/1236, P<0.001) were higher in the study cohort. Neonatal outcomes were worse in the study cohort-Apgar score <7 at 5 min (2.2%, 9/411 vs 0.6%, 8/1236, P<0.001) and abnormal cord gases (8.5%, 35/411 vs 0.2%, 3/1236, P<0.001). Rates for resuscitation at birth and admission to the neonatal intensive care unit were higher in the study cohort (6.1% vs 4.1% and 1.9% vs 1.1%, respectively) but these were not statistically significant. Labor following successful ECV is more likely to result in increased intrapartum intervention rates and poorer neonatal outcomes.

  4. Supplier Performance Evaluation and Rating System (SPEARS)

    International Nuclear Information System (INIS)

    Oged, M.; Warner, D.; Gurbuz, E.

    1993-03-01

    The SSCL Magnet Quality Assurance Department has implemented a Supplier Performance Evaluation and Rating System (SPEARS) to assess supplier performance throughout the development and production stages of the SSCL program. The main objectives of SPEARS are to promote teamwork and recognize performance. This paper examines the current implementation of SPEARS. MSD QA supports the development and production of SSCsuperconducting magnets while implementing the requirements of DOE Order 5700.6C. The MSD QA program is based on the concept of continuous improvement in quality and productivity. The QA program requires that procurement of items and services be controlled to assure conformance to specification. SPEARS has been implemented to meet DOE requirements and to enhance overall confidence in supplier performance. Key elements of SPEARS include supplier evaluation and selection as well as evaluation of furnished quality through source inspection, audit, and receipt inspection. These elements are described in this paper

  5. Supplier Performance Evaluation and Rating System (SPEARS)

    International Nuclear Information System (INIS)

    Oged, M.; Warner, D.G.; Gurbuz, E.

    1994-01-01

    The SSCL Magnet Quality Assurance Department has implemented a Supplier Performance Evaluation and Rating System (SPEARS) to assess supplier performance throughout the development and production stages of the SSCL program. The main objectives of SPEARS are to promote teamwork and recognize performance. This paper examines the current implementation of SPEARS. MSD QA supports the development and production of SSC superconducting magnets while implementing the requirements of DOE Order 5700.6C. The MSD QA program is based on the concept of continuous improvement in quality and productivity. The QA program requires that procurement of items and services be controlled to assure conformance to specification. SPEARS has been implemented to meet DOE requirements and to enhance overall confidence in supplier performance. Key elements of SPEARS include supplier evaluation and selection as well as evaluation of furnished quality through source inspection, audit, and receipt inspection. These elements are described in this paper

  6. Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes.

    Science.gov (United States)

    Llewellyn, Anthony; Karageorge, Aspasia; Nash, Louise; Li, Wenlong; Neuen, Dennis

    2018-02-16

    Objective The aim of this study was to describe rates of exposure to bullying and sexual harassment in junior doctors in first- or second-year prevocational medical training (PGY1 or PGY2 respectively) positions in New South Wales (NSW) and the Australian Capital Territory (ACT), and to explore the types of actions taken in response. Methods A cross-sectional survey of junior doctors in PGY1 or PGY2 positions was undertaken in 2015 and 2016 (n=374 and 440 respectively). Thematic analysis was undertaken on free-text responses to describe the reporting process and outcomes in more depth. Results The estimated response rate was 17-20%. Results from both surveys followed almost identical trends. Most respondents in 2015 and 2016 reported being bullied (n=203 (54.3%) and 253 (57.5%) respectively), 16-19% reported sexual harassment (n=58 and 82 respectively) and 29% of females reported sexual harassment. Qualitative analysis elucidated reasons for not taking action in response to bullying and harassment, including workplace normalisation of these behaviours, fear of reprisal and lack of knowledge or confidence in the reporting process. For respondents who did take action, most reported ineffective or personally harmful outcomes when reporting to senior colleagues, including being dismissed or blamed, and an intention not to trust the process in the future. Conclusions The findings suggest that interventions targeted at the level of junior doctors to improve the culture of bullying and harassment in medicine are unlikely to be helpful. Different approaches that address the problem in a more systemic way are needed, as is further research about the effectiveness of such interventions. What is known about the topic? Bullying and sexual harassment are common workplace experiences in the medical profession. What does this paper add? Over half the junior doctors in the present study experienced bullying and nearly one-fifth experienced sexual harassment. Junior doctors are

  7. Preservice Teachers' Belief Systems toward Curricular Outcomes for Physical Education

    Science.gov (United States)

    Kulinna, Pamela Hodges; Brusseau, Timothy; Ferry, Matthew; Cothran, Donetta

    2010-01-01

    This study was grounded in the belief systems and physical activity literature and investigated preservice teachers' belief systems toward curricular outcomes for physical education programs. Preservice teachers (N = 486; men = 62%, women = 38%) from 18 U.S. colleges/universities shared their beliefs about curricular outcomes. Preservice teachers…

  8. Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries

    Science.gov (United States)

    Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M.; Quagliarello, Vincent; Krumholz, Harlan M.

    2015-01-01

    Objectives To determine the hospitalization rates and outcomes of endocarditis among older adults. Background Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Methods Using Medicare inpatient Standard Analytic Files, we identified all Fee-For-Service beneficiaries aged ≥65 years with a principal or secondary diagnosis of endocarditis from 1999-2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised recommendations for endocarditis prophylaxis. Results Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999-2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006-2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with principal diagnosis of endocarditis. Conclusions Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. PMID:23994421

  9. Heart rate control with adrenergic blockade: Clinical outcomes in cardiovascular medicine

    Directory of Open Access Journals (Sweden)

    David Feldman

    2010-05-01

    Full Text Available David Feldman1, Terry S Elton2, Doron M Menachemi3, Randy K Wexler41Heart Failure/Transplant and VAD Programs, Minneapolis Heart Institute, Minneapolis, Minnesota, USA; 2Division of Pharmacology, College of Pharmacology, The Ohio State University, Columbus, Ohio, USA; 3Heart Failure Services, Edith Wolfson Medical Center, The Heart Institute, Sakler School of Medicine, Tel-Aviv University, Holon, Israel; 4Department of Clinical Family Medicine, The Ohio State University, Columbus, Ohio, USAAbstract: The sympathetic nervous system is involved in regulating various cardiovascular parameters including heart rate (HR and HR variability. Aberrant sympathetic nervous system expression may result in elevated HR or decreased HR variability, and both are independent risk factors for development of cardiovascular disease, including heart failure, myocardial infarction, and hypertension. Epidemiologic studies have established that impaired HR control is linked to increased cardiovascular morbidity and mortality. One successful way of decreasing HR and cardiovascular mortality has been by utilizing β-blockers, because their ability to alter cell signaling at the receptor level has been shown to mitigate the pathogenic effects of sympathetic nervous system hyperactivation. Numerous clinical studies have demonstrated that β-blocker-mediated HR control improvements are associated with decreased mortality in postinfarct and heart failure patients. Although improved HR control benefits have yet to be established in hypertension, both traditional and vasodilating β-blockers exert positive HR control effects in this patient population. However, differences exist between traditional and vasodilating β-blockers; the latter reduce peripheral vascular resistance and exert neutral or positive effects on important metabolic parameters. Clinical evidence suggests that attainment of HR control is an important treatment objective for patients with cardiovascular

  10. Liability aspects of home energy-rating systems

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, P.L.

    1983-10-01

    Liability aspects of home energy rating systems are discussed. An introduction to the rating system concept, including types of rating systems, implementation efforts to date, and possible groups to conduct ratings, is also included. The home energy rating system concept involves the periodic rating of the energy efficiency of residential buildings. The rating can provide a relative indication of a home's energy efficiency and also a quantitative estimate of consumption, fuel cost, or both. Primary attention is given to liability issues associated with developing and performing ratings. Secondary attention is given to possible liability associated with misuse of a rating once it has been performed.

  11. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients

    Science.gov (United States)

    Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

    2016-01-01

    Abstract Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients’ technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients. This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes. During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality. We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality. These results may help to identify and target patients who are at higher risk of HPR at the start

  12. Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes.

    Science.gov (United States)

    Rumalla, Kavelin; Smith, Kyle A; Arnold, Paul M; Schwartz, Theodore H

    2018-06-04

    Hospital readmissions can be detrimental to patients and may interfere with the potential benefits of the therapeutic procedure. Government agencies have begun to focus on reducing readmissions; however, the etiology of readmissions is lacking. To report the national rates, risk factors, and outcomes associated with 30- and 90-d readmissions following surgery for intractable epilepsy. We queried the Nationwide Readmissions Database from January to September 2013 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify all patients with intractable epilepsy, who underwent hemispherectomy (01.52), brain lobectomy (01.53), amydalohippocampectomy, or partial lobectomy (01.59). Predictor variables included epilepsy type, presurgical diagnostic testing, surgery type, medical complications, surgical complications, and discharge disposition. In 1587 patients, the 30- and 90-d readmission rates were 11.5% and 16.8%, respectively. The most common reasons for readmission were persistent epilepsy, video electroencephalography monitoring, postoperative infection, and postoperative central nervous system complication. In multivariable analysis, risk factors associated with both 30- and 90-d readmission were Medicare payer status, lowest quartile of median income, depression, hemispherectomy, and postoperative complications (P < .05). The only unique predictor of 30-d readmission was small bedsize hospital (P = .001). Readmissions within 30 d were associated with longer length of stay (6.8 vs 5.8 d), greater costs ($18 660 vs $15 515), and increased adverse discharges (26.4% vs 21.8%). Following epilepsy surgery, most readmissions that occurred within 30 d can be attributed to management of persistent epilepsy and predicted by Medicare payer status, depression, and complications. These data can assist the clinician in preventing readmissions and assist policy makers determine which admissions are potentially avoidable.

  13. Associations Between Participant Ratings of PREP for Strong Bonds and Marital Outcomes 1 Year Postintervention.

    Science.gov (United States)

    Allen, Elizabeth S; Post, Kristina M; Markman, Howard J; Rhoades, Galena K; Stanley, Scott M

    2017-07-01

    After completing a relationship education program, collecting participant evaluations of the program is common practice. These are generally used as an index of "consumer satisfaction" with the program, with implications for feasibility and quality. Rarely have these ratings been used as predictors of changes in marital quality, although such feedback may be the only data providers collect or have immediate access to when considering the success of their efforts. To better understand the utility of such ratings to predict outcomes, we evaluated links between participant ratings and changes in self-reported marital satisfaction and communication scores one year later for a sample of 191 Army couples who had participated in a relationship education program delivered by Army chaplains (PREP for Strong Bonds). Overall ratings of general satisfaction with the program and the leader did not predict changes in marital outcomes one year later, whereas higher ratings of how much was learned, program helpfulness, increased similarity in outlook regarding Army life, and helpfulness of communication skills training predicted greater change in communication skills one year later. Higher ratings of items reflecting intent to invest more time in the relationship, and increased confidence in constructive communication and working as a team with the spouse predicted greater increases in both marital satisfaction and communication skills one year later. The constructs of intention and confidence (akin to perceived behavioral control) suggest that the Theory of Planned Behavior may be particularly useful when considering which Army couples will show ongoing benefit after relationship education.

  14. 78 FR 18252 - Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System...

    Science.gov (United States)

    2013-03-26

    ...-AM78 Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System... applicable sections. The Federal Prevailing Rate Advisory Committee, the national labor- management committee... proposing to amend 5 CFR part 532 as follows: PART 532--PREVAILING RATE SYSTEMS 0 1. The authority citation...

  15. Sensitivity of adaptive enrichment trial designs to accrual rates, time to outcome measurement, and prognostic variables

    Directory of Open Access Journals (Sweden)

    Tianchen Qian

    2017-12-01

    Full Text Available Adaptive enrichment designs involve rules for restricting enrollment to a subset of the population during the course of an ongoing trial. This can be used to target those who benefit from the experimental treatment. Trial characteristics such as the accrual rate and the prognostic value of baseline variables are typically unknown when a trial is being planned; these values are typically assumed based on information available before the trial starts. Because of the added complexity in adaptive enrichment designs compared to standard designs, it may be of special concern how sensitive the trial performance is to deviations from assumptions. Through simulation studies, we evaluate the sensitivity of Type I error, power, expected sample size, and trial duration to different design characteristics. Our simulation distributions mimic features of data from the Alzheimer's Disease Neuroimaging Initiative cohort study, and involve two subpopulations based on a genetic marker. We investigate the impact of the following design characteristics: the accrual rate, the time from enrollment to measurement of a short-term outcome and the primary outcome, and the prognostic value of baseline variables and short-term outcomes. To leverage prognostic information in baseline variables and short-term outcomes, we use a semiparametric, locally efficient estimator, and investigate its strengths and limitations compared to standard estimators. We apply information-based monitoring, and evaluate how accurately information can be estimated in an ongoing trial.

  16. Organizational Climate, Services, and Outcomes in Child Welfare Systems

    Science.gov (United States)

    Glisson, Charles; Green, Philip

    2011-01-01

    Objective: This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and…

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  18. Importance ratings on patient-reported outcome items for survivorship care: comparison between pediatric cancer survivors, parents, and clinicians.

    Science.gov (United States)

    Jones, Conor M; Baker, Justin N; Keesey, Rachel M; Eliason, Ruth J; Lanctot, Jennifer Q; Clegg, Jennifer L; Mandrell, Belinda N; Ness, Kirsten K; Krull, Kevin R; Srivastava, Deokumar; Forrest, Christopher B; Hudson, Melissa M; Robison, Leslie L; Huang, I-Chan

    2018-04-18

    To compare importance ratings of patient-reported outcomes (PROs) items from the viewpoints of childhood cancer survivors, parents, and clinicians for further developing short-forms to use in survivorship care. 101 cancer survivors, 101 their parents, and 36 clinicians were recruited from St. Jude Children's Research Hospital. Participants were asked to select eight items that they deemed useful for clinical decision making from each of the four Patient-Reported Outcomes Measurement Information System Pediatric item banks. These item banks were pain interference (20 items), fatigue (23 items), psychological stress (19 items), and positive affect (37 items). Compared to survivors, clinicians rated more items across four domains that were statistically different than did parents (23 vs. 13 items). Clinicians rated five items in pain interference domain (ORs 2.33-6.01; p's important but rated three items in psychological stress domain (ORs 0.14-0.42; p's important than did survivors. In contrast, parents rated seven items in positive affect domain (ORs 0.25-0.47; p's important than did survivors. Survivors, parents, and clinicians viewed importance of PRO items for survivorship care differently. These perspectives should be used to assist the development of PROs tools.

  19. The Politics of Hope and Despair: The Effect of Presidential Election Outcomes on Suicide Rates*

    Science.gov (United States)

    Classen, Timothy J.; Dunn, Richard A.

    2010-01-01

    Objectives This article examines the effect of election outcomes on suicide rates by combining the theory of social integration developed by Durkheim with the models of rational choice used in economics. Methods Theory predicts that states with a greater percentage of residents who supported the losing candidate would tend to exhibit a relative increase in suicide rates. However, being around others who also supported the losing candidate may indicate a greater degree of social integration at the local level, thereby lowering relative suicide rates. We therefore use fixed-effects regression of state suicide rates from 1981 to 2005 on state election outcomes during presidential elections to determine which effect is stronger. Results We find that the local effect of social integration is dominant. The suicide rate when a state supports the losing candidate will tend to be lower than if the state had supported the winning candidate—4.6 percent lower for males and 5.3 percent lower for females. Conclusion Social integration works at many levels; it not only affects suicide risk directly, but can mediate other shocks that influence suicide risk. PMID:20645463

  20. The effect of learning models and emotional intelligence toward students learning outcomes on reaction rate

    Science.gov (United States)

    Sutiani, Ani; Silitonga, Mei Y.

    2017-08-01

    This research focused on the effect of learning models and emotional intelligence in students' chemistry learning outcomes on reaction rate teaching topic. In order to achieve the objectives of the research, with 2x2 factorial research design was used. There were two factors tested, namely: the learning models (factor A), and emotional intelligence (factor B) factors. Then, two learning models were used; problem-based learning/PBL (A1), and project-based learning/PjBL (A2). While, the emotional intelligence was divided into higher and lower types. The number of population was six classes containing 243 grade X students of SMAN 10 Medan, Indonesia. There were 15 students of each class were chosen as the sample of the research by applying purposive sampling technique. The data were analyzed by applying two-ways analysis of variance (2X2) at the level of significant α = 0.05. Based on hypothesis testing, there was the interaction between learning models and emotional intelligence in students' chemistry learning outcomes. Then, the finding of the research showed that students' learning outcomes in reaction rate taught by using PBL with higher emotional intelligence is higher than those who were taught by using PjBL. There was no significant effect between students with lower emotional intelligence taught by using both PBL and PjBL in reaction rate topic. Based on the finding, the students with lower emotional intelligence were quite hard to get in touch with other students in group discussion.

  1. Video Ratings of Surgical Skill and Late Outcomes of Bariatric Surgery

    Science.gov (United States)

    Scally, Christopher P.; Varban, Oliver A.; Carlin, Arthur M.; Birkmeyer, John D.; Dimick, Justin B.

    2018-01-01

    Importance Measures of surgeons’ skill have been associated with variations in short-term outcomes after laparoscopic gastric bypass. However, the impact of surgical skill on long-term outcomes after bariatric surgery is unknown. Objective To study the association between surgical skill and long-term outcomes of bariatric surgery Design Surgeons were ranked on their skill level through blinded peer video review, and sorted into quartiles of skill. Outcomes of bariatric surgery were then examined at the patient level across skill levels. Setting The Michigan Bariatric Surgical Collaborative, a prospective clinical registry of 40 hospitals performing bariatric surgery in the state of Michigan Participants 20 surgeons performing bariatric surgery who submitted videos for anonymous peer ratings; patients undergoing surgery with these surgeons for whom one year follow-up data postoperatively was available. Exposure Surgeon skill level. Main Outcome Measures Excess body weight loss at one year; resolution of medical comorbidities (hypertension, sleep apnea, diabetes, hyperlipidemia), functional status, patient satisfaction. Results Peer ratings of surgical skill varied from 2.6 to 4.8 on a 5-point scale. There was no difference between the best (top 25%) and worst (bottom 25%) performance quartiles when comparing excess body weight loss (67.2% excess body weight loss vs 68.5%, p=.89) at one year. There were no differences in resolution of sleep apnea (62.6% vs 62.0%, p=.77), hypertension (47.1% vs 45.4%, p=.73), or hyperlipidemia (52.3% vs 63.4%, p=.45). Surgeons with the lowest skill rating had patients with higher rates of diabetes resolution (78.8%) when compared to the high-skill group (72.8%, p=0.01). Conclusions and Relevance In contrast to its impact on early complications, surgical skill did not impact postoperative weight loss or resolution of medical comorbidities at one year after laparoscopic gastric bypass. These findings suggest that long-term outcomes

  2. Mutation Rates of STR Systems in Danes

    DEFF Research Database (Denmark)

    Andersen, Kim Emil; Bøttcher, Susanne Gammelgaard; Christensen, Susanne

    Danish paternity cases in the period 1999 to 2005 were investigated regarding mutation rates in STR loci. STR-typing was performed by the Applied Biosystems AmplfStr Profiler Plus kit in the period 1999 to early 2005, hereafter named the PP9, and by Applied Biosystems AmplfStr Identifier kit for ...... and kits. Sex and STR locus specific mutation rates were estimated with 95% confidence limits by the method of Clopper and Pearson (1934)....

  3. 20 CFR 411.545 - How are the outcome payments calculated under the outcome-milestone payment system?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome-milestone payment system? 411.545 Section 411.545 Employees' Benefits SOCIAL SECURITY... are the outcome payments calculated under the outcome-milestone payment system? The amount of each...

  4. 13 CFR 120.1015 - Risk Rating System.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Risk Rating System. 120.1015 Section 120.1015 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Risk-Based Lender Oversight Supervision § 120.1015 Risk Rating System. (a) Risk Rating. SBA may assign a Risk Rating...

  5. Prostate Cancer Diagnosed After Repeat Biopsies Have a Favorable Pathological Outcome but Similar Recurrence Rate

    Science.gov (United States)

    Lopez-Corona, Ernesto; Ohori, Makoto; Wheeler, Thomas M.; Reuter, Victor E.; Scardino, Peter T.; Kattan, Michael W.; Eastham, James A.

    2007-01-01

    Purpose We investigated whether repeat prostate biopsies are associated with more favorable prognoses, less extensive disease or higher rates of IC in patients who are ultimately diagnosed with prostate cancer and treated with RRP. Materials and Methods We examined standard clinical and pathological data on 1,357 patients treated with RRP from 1983 to 2001. In addition, we noted the rate of IC in a subgroup of 847 patients in whom tumor volume was measured. Results Cancer was found in 1,042 patients (77%) at the first biopsy, in 227 (17%) at the second biopsy, in 59 (4%) at the third biopsy and in 29 (2%) at the fourth or later biopsy. Patients with 2 or greater biopsies had a higher rate of clinical T1c stage cancer and larger prostates than patients with only 1 biopsy (each p <0.0001). After RRP patients with 1 biopsy had a lower rate of organ confined tumors (61% vs 75%, p <0.0001), and a higher rate of extracapsular extension, seminal vesicle invasion, lymph node metastases and Gleason sum 7 or greater than other patients. IC was found in 10% of patients with 1 biopsy and 18% of those with 2 or greater biopsies (p = 0.018). Despite these more favorable pathological outcomes there was no difference in biochemical recurrence rate. Conclusions Although we found that a greater number of biopsies was related to a better pathological outcome after RRP, the number of biopsies did not predict disease recurrence. The increasing number of biopsies currently being performed, especially in patients with larger prostates, likely results in higher rates of IC. PMID:16469581

  6. 78 FR 62616 - Integrated System Power Rates

    Science.gov (United States)

    2013-10-22

    .... James K. McDonald, Vice President for Corporate Operations/Chief Operating Office, Southwestern Power...) 595-6690, jim.mcdonald@swpa.gov . SUPPLEMENTARY INFORMATION: Rate Order No. SWPA-66, which has been... final approval by the Federal Energy Regulatory Commission. Available: In the marketing area of...

  7. 75 FR 1363 - Integrated System Power Rates

    Science.gov (United States)

    2010-01-11

    ... increased. Those customers taking transformation service will be affected by an increase in that rate... Regulation Purchased. With factors defined as follows: RPA = The Customer's specific monthly dollar amount of... formulas provided in Customers' contracts indicate an overrun on Hydro Peaking Power, and investigation...

  8. Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes.

    Science.gov (United States)

    Khader, Yousef S; Batieha, Anwar; Al Fursan, Rana Kareem; Al-Hader, Rami; Hijazi, Sa'ad S

    2017-07-26

    Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.

  9. [Design of Oxygen Saturation, Heart Rate, Respiration Rate Detection System Based on Smartphone of Android Operating System].

    Science.gov (United States)

    Zhu, Mingshan; Zeng, Bixin

    2015-03-01

    In this paper, we designed an oxygen saturation, heart rate, respiration rate monitoring system based on smartphone of android operating system, physiological signal acquired by MSP430 microcontroller and transmitted by Bluetooth module.

  10. Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.

    Science.gov (United States)

    Floridia, M; Tamburrini, E; Masuelli, G; Martinelli, P; Spinillo, A; Liuzzi, G; Vimercati, A; Alberico, S; Maccabruni, A; Pinnetti, C; Frisina, V; Dalzero, S; Ravizza, M

    2017-07-01

    The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple

  11. A fire danger rating system for Hawaii

    Science.gov (United States)

    Robert E. Burgan; Francis M. Fujioka; George H. Hirata

    1974-01-01

    Extremes in rainfall on the Hawaiian Islands make it difficult to judge forest fire danger conditions. The use of an automatic data collection and computer processing system helps to monitor the problem.

  12. AIR TICKETS RATES MONITORING: INFORMATION SYSTEM DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Oleg Smirnov

    2015-05-01

    Full Text Available In the article conduct analysis of preconditions of air tickets fares dynamics. Monitoring informational system formation in aim of public regulation of air transport on base of an assessment of the current state and development prospects of Russian civil aviation, and formed the conceptual basis for information system architecture at the levels of the presentation layer, business-logic and data access layer.

  13. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Adriana Campos Passanezi Sant'Ana

    2011-04-01

    Full Text Available OBJECTIVES: The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. MATERIAL AND METHODS: Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG - "no intervention" (n=17 or IG- "intervention" (n=16. IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP, professional prophylaxis (PROPH and oral hygiene instruction (OHI. NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD, clinical attachment level (CAL, plaque index (PI and sulcular bleeding index (SBI at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (0.05 at IG and worsening of all periodontal parameters at NIG (p<0.0001, except for PI. Signifcant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001. The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. CONCLUSIONS: Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

  14. High Repetition Rate Thermometry System And Method

    KAUST Repository

    Chrystie, Robin

    2015-05-14

    A system and method for rapid thermometry using intrapulse spectroscopy can include a laser for propagating pulses of electromagnetic radiation to a region. Each of the pulses can be chirped. The pulses from the region can be detected. An intrapulse absorbance spectrum can be determined from the pulses. An instantaneous temperature of the region based on the intrapulse absorbance spectrum can be determined.

  15. High Repetition Rate Thermometry System And Method

    KAUST Repository

    Chrystie, Robin; Farooq, Aamir

    2015-01-01

    A system and method for rapid thermometry using intrapulse spectroscopy can include a laser for propagating pulses of electromagnetic radiation to a region. Each of the pulses can be chirped. The pulses from the region can be detected. An intrapulse absorbance spectrum can be determined from the pulses. An instantaneous temperature of the region based on the intrapulse absorbance spectrum can be determined.

  16. Constraints on relaxation rates for N-level quantum systems

    International Nuclear Information System (INIS)

    Schirmer, S.G.; Solomon, A.I.

    2004-01-01

    We study the constraints imposed on the population and phase relaxation rates by the physical requirement of completely positive evolution for open N-level systems. The Lindblad operators that govern the evolution of the system are expressed in terms of observable relaxation rates, explicit formulas for the decoherence rates due to population relaxation are derived, and it is shown that there are additional, nontrivial constraints on the pure dephasing rates for N>2. Explicit, experimentally testable inequality constraints for the decoherence rates are derived for three- and four-level systems, and the implications of the results are discussed for generic ladder, Λ, and V systems and transitions between degenerate energy levels

  17. Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes.

    Science.gov (United States)

    Rosenbaum, Clemens M; Schmid, Marianne; Ludwig, Tim A; Kluth, Luis A; Dahlem, Roland; Fisch, Margit; Ahyai, Sascha

    2016-11-01

    To determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU. We included 50 patients who underwent redo BMGU between February 2009 and September 2014. Patients' charts and non-validated questionnaires were reviewed. The primary endpoint was success rate, defined as stricture-free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty, or a maximum urinary flow rate <15 mL/s, and a stricture was consecutively verified in a combined cysto-urethrogram or cystoscopy at annual follow-up visit. The secondary endpoint was oral morbidity. Additional endpoints were erectile function, urinary continence and patients' satisfaction. Redo BMGU was performed for bulbar (71.4%) or penile (28.6%) recurrent strictures. The mean (median; range) follow-up was 25.6 (15.5; 3-70) months. Stricture recurrence occurred in 18.0% of patients within a mean (median; range) of 13.8 (9.0; 3-36) months. Stricture-free survival at 12, 24 and 36 months was 91.2, 86.2 and 80.8%, respectively. The majority of the patients (97.0%) reported no or only mildly changed salivation or problems in opening of the mouth. Severe or very severe oral numbness occurred in 13.5% of patients. Oral problems in daily life were a moderate or severe burden to 13.6 and 2.7% of the patients, respectively, while 75.0% of the patients reported improved quality of life compared with preoperative status. The success rate and oral morbidity of redo BMGU are almost the same as outcomes of primary BMGU. Oral numbness was the most frequently reported oral disorder. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  18. Rate My Information Systems Professor: Exploring the Factors That Influence Student Ratings

    Science.gov (United States)

    Sena, Mark; Crable, Elaine

    2017-01-01

    Based on 820 entries on Ratemyprofessors.com, we explore whether information systems course ratings differ from those in marketing or management courses, whether lower level course ratings differ from those in senior or graduate level courses, whether course ratings differ between genders, and whether perceived course difficulty impacts course…

  19. Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study.

    Science.gov (United States)

    Souza, Maria de Lourdes de; Lynn, Fiona Ann; Johnston, Linda; Tavares, Eduardo Cardoso Teixeira; Brüggemann, Odaléa Maria; Botelho, Lúcio José

    2017-04-06

    analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; ppobreza social y económica. Madres adolescentes y sus bebés tienen mayor probabilidad de efectos perinatales adversos. Enfermeros, trabajadores de salud pública, profesionales de salud y asistencia social y educadores deben colaborar para mejor dirigir estrategias a adolescentes con riesgo superior; para fines de ayudar a reducir las tasas de fertilidad y mejorar los resultados.

  20. Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients.

    Science.gov (United States)

    Mueller, Claire Mackenzie; Boden, Stephanie Ann; Boden, Allison Lee; Maidman, Samuel David; Cutler, Anya; Mignemi, Danielle; Bariteau, Jason

    2018-02-01

    Hammertoe deformities are the most common lesser toe deformity. To date, no studies have looked at outcomes of operative management in the geriatric population, which may be at greater risk for complications or functional compromise because of comorbidities. Data on 58 patients undergoing operative correction of hammertoe deformities were prospectively collected. Clinical outcomes were assessed using preoperative and postoperative visual analogue scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of 6-month follow-up. Patients were divided into 2 groups on the basis of age at the time of surgery: younger than 65 and 65 and older. Complication rates and mean VAS and SF-36 improvement were compared. Forty-seven patients met inclusion criteria (7 men, 40 women), with 26 patients (37 toes) in the younger cohort and 21 patients (39 toes) in the older cohort. Overall, patients demonstrated significant improvement from baseline to 6 and 12 months postoperatively in VAS ( P < .001 and P < .001) and SF-36 ( P < .001 and P < .001) scores. Mean improvement in VAS and SF-36 scores was not significantly different between the groups at 6 and 12 months postoperatively. Complications occurred in 13.5% and 10.3% of patients in the younger and older cohorts, respectively. Outcomes of operative correction of hammertoe deformities in older patients were similar to outcomes in younger patients after greater than 6 months of follow-up. Overall improvement in VAS and SF-36 was statistically significant for both cohorts. There was no associated increase in complications for older patients. Level, III comparative series.

  1. Degradation Rate of 5-Fluorouracil in Metastatic Colorectal Cancer: A New Predictive Outcome Biomarker?

    Directory of Open Access Journals (Sweden)

    Andrea Botticelli

    Full Text Available 5-FU based chemotherapy is the most common first line regimen used for metastatic colorectal cancer (mCRC. Identification of predictive markers of response to chemotherapy is a challenging approach for drug selection. The present study analyzes the predictive role of 5-FU degradation rate (5-FUDR and genetic polymorphisms (MTHFR, TSER, DPYD on survival.Genetic polymorphisms of MTHFR, TSER and DPYD, and the 5-FUDR of homogenous patients with mCRC were retrospectively studied. Genetic markers and the 5-FUDR were correlated with clinical outcome.133 patients affected by mCRC, treated with fluoropyrimidine-based chemotherapy from 2009 to 2014, were evaluated. Patients were classified into three metabolic classes, according to normal distribution of 5-FUDR in more than 1000 patients, as previously published: poor-metabolizer (PM with 5-FU-DR ≤ 0,85 ng/ml/106 cells/min (8 pts; normal metabolizer with 0,85 < 5-FU-DR < 2,2 ng/ml/106 cells/min (119 pts; ultra-rapid metabolizer (UM with 5-FU-DR ≥ 2,2 ng/ml/106 cells/min (6 pts. PM and UM groups showed a longer PFS respect to normal metabolizer group (14.5 and 11 months respectively vs 8 months; p = 0.029. A higher G3-4 toxicity rate was observed in PM and UM, respect to normal metabolizer (50% in both PM and UM vs 18%; p = 0.019. No significant associations between genes polymorphisms and outcomes or toxicities were observed.5-FUDR seems to be significantly involved in predicting survival of patients who underwent 5-FU based CHT for mCRC. Although our findings require confirmation in large prospective studies, they reinforce the concept that individual genetic variation may allow personalized selection of chemotherapy to optimize clinical outcomes.

  2. Evaluation of mortality rate and predictors of outcome in dogs receiving outpatient treatment for parvoviral enteritis.

    Science.gov (United States)

    Sarpong, Kathryn J; Lukowski, Jennifer M; Knapp, Cassandra G

    2017-11-01

    OBJECTIVE To determine mortality rates and prognostic factors for dogs with parvoviral enteritis receiving outpatient treatment. DESIGN Retrospective case series and case-control study. ANIMALS 130 client-owned dogs with a diagnosis of parvoviral enteritis between August 1, 2012, and January 31, 2015, that were treated with outpatient care. PROCEDURES Medical records were reviewed and data extracted regarding dog age, body weight, breed, and vaccination history; treatments administered; and short-term (≥ 3 day) outcome (determined via telephone call with owner). Treatments were administered according to clinician preference. Mortality rates were calculated overall and for various signalment and treatment groupings and compared. RESULTS 97 (75%) dogs survived and 33 (25%) dogs failed to survive for ≥ 3 days after initial diagnosis of parvoviral enteritis. Compared with distributions in the general hospital population, Chihuahuas, German Shepherd Dogs, pit bull-type dogs, and males were overrepresented. No significant difference was identified between survivors and nonsurvivors regarding age, body weight, or sex. Dogs prescribed a caloric supplement fed every 2 to 4 hours had a mortality rate of 19% (16/85). Most of these dogs had also received fluids administered SC, an antiemetic, and antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE Clinicians should note the 25% mortality rate of the dogs with parvoviral enteritis that received outpatient care in this study setting when discussing treatment options with owners of affected dogs who are financially unable to pursue hospitalization.

  3. Conservative interacting particles system with anomalous rate of ergodicity

    OpenAIRE

    Brzeźniak, Zdzislaw; Flandoli, Franco; Neklyudov, Misha; Zegarliński, Boguslaw

    2010-01-01

    We analyze certain conservative interacting particle system and establish ergodicity of the system for a family of invariant measures. Furthermore, we show that convergence rate to equilibrium is exponential. This result is of interest because it presents counterexample to the standard assumption of physicists that conservative system implies polynomial rate of convergence.

  4. Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe.

    Directory of Open Access Journals (Sweden)

    Anna Heino

    Full Text Available Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level.We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA, stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births. We also used European Society of Human Reproduction and Embryology (ESHRE data on assisted conception and single embryo transfer (SET. The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR for these groups.In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania to 26.5 (Cyprus. Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8 of preterm birth (<37 weeks GA, an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0-12.4 of very preterm birth (<32 weeks GA. Pooled RR were 2.4 (95% Cl 1.5-3.6 for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1-8.0 for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8-20.2 versus 9.8% (95% Cl 9.6-11.0 for neonatal death and 29.6% (96% CI 28.5-30.6 versus 17.5% (95% CI 15.7-18.3 for very preterm births, respectively.Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health.

  5. Two-Stage Variable Sample-Rate Conversion System

    Science.gov (United States)

    Tkacenko, Andre

    2009-01-01

    A two-stage variable sample-rate conversion (SRC) system has been pro posed as part of a digital signal-processing system in a digital com munication radio receiver that utilizes a variety of data rates. The proposed system would be used as an interface between (1) an analog- todigital converter used in the front end of the receiver to sample an intermediatefrequency signal at a fixed input rate and (2) digita lly implemented tracking loops in subsequent stages that operate at v arious sample rates that are generally lower than the input sample r ate. This Two-Stage System would be capable of converting from an input sample rate to a desired lower output sample rate that could be var iable and not necessarily a rational fraction of the input rate.

  6. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use.

    Science.gov (United States)

    Evans, Jonathan P; Smith, Chris D; Fine, Nicola F; Porter, Ian; Gangannagaripalli, Jaheeda; Goodwin, Victoria A; Valderas, Jose M

    2018-04-01

    Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lauren A V Orenstein

    Full Text Available Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa.We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM, low birth weight (LBW, prematurity, and major congenital malformations (MCM in Sub-Saharan African countries were also performed.Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3 per 1,000 total births, and the most common causes were hemorrhage (34%, dystocia (22%, and severe hypertensive disorders of pregnancy (22%. Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4 or premature (median 15.4%, IQR: 10.6-19.1 were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6, with the musculoskeletal system comprising 30%.Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of

  8. Introduction to State Estimation of High-Rate System Dynamics.

    Science.gov (United States)

    Hong, Jonathan; Laflamme, Simon; Dodson, Jacob; Joyce, Bryan

    2018-01-13

    Engineering systems experiencing high-rate dynamic events, including airbags, debris detection, and active blast protection systems, could benefit from real-time observability for enhanced performance. However, the task of high-rate state estimation is challenging, in particular for real-time applications where the rate of the observer's convergence needs to be in the microsecond range. This paper identifies the challenges of state estimation of high-rate systems and discusses the fundamental characteristics of high-rate systems. A survey of applications and methods for estimators that have the potential to produce accurate estimations for a complex system experiencing highly dynamic events is presented. It is argued that adaptive observers are important to this research. In particular, adaptive data-driven observers are advantageous due to their adaptability and lack of dependence on the system model.

  9. Initial heart rate and cardiovascular outcomes in patients presenting with acute coronary syndrome.

    Science.gov (United States)

    Asaad, Nidal; El-Menyar, Ayman; AlHabib, Khalid F; Shabana, Adel; Alsheikh-Ali, Alawi A; Almahmeed, Wael; Al Faleh, Hussam; Hersi, Ahmad; Al Saif, Shukri; Al-Motarreb, Ahmed; Sulaiman, Kadhim; Al Nemer, Khalid; Amin, Haitham; Al Suwaidi, Jassim

    2014-06-01

    To assess the impact of on-admission heart rate (HR) in patients presenting with acute coronary syndrome (ACS). Data were collected retrospectively from the second Gulf Registry of Acute Coronary Events. Patients were divided according to their initial HR into: (I: < 60, II: 60-69, III: 70-79, IV: 80-89 and V: ≥ 90 bpm). Patients' characteristics and hospital and one- and 12-month outcomes were analyzed and compared. Among 7939 consecutive ACS patients, groups I to V represented 7%, 13%, 20%, 23.5%, and 37%, respectively. Mean age was higher in groups I and V. Group V were more likely males, diabetic and hypertensive. ST-elevation myocardial infarction was the main presentation in groups I and V. Reperfusion therapies were less likely given to group V. Beta blockers were more frequently prescribed to group III in comparison to groups with higher HR. Groups I and V were associated with worse hospital outcomes. Multivariate analysis showed initial tachycardia as an independent predictor for heart failure (OR 2.2; 95%CI: 1.39-3.32), while bradycardia was independently associated with higher one-month mortality (OR 2.0; 95%CI: 1.04-3.85) CONCLUSION: The majority of ACS patients present with tachycardia. However, low or high HR is a marker of high risk that needs more attention and management.

  10. Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes.

    Science.gov (United States)

    Cruz-Hervert, Luis Pablo; García-García, Lourdes; Ferreyra-Reyes, Leticia; Bobadilla-del-Valle, Miriam; Cano-Arellano, Bulmaro; Canizales-Quintero, Sergio; Ferreira-Guerrero, Elizabeth; Báez-Saldaña, Renata; Téllez-Vázquez, Norma; Nava-Mercado, Ariadna; Juárez-Sandino, Luis; Delgado-Sánchez, Guadalupe; Fuentes-Leyra, César Alejandro; Montero-Campos, Rogelio; Martínez-Gamboa, Rosa Areli; Small, Peter M; Sifuentes-Osornio, José; Ponce-de-León, Alfredo

    2012-07-01

    worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults. to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people. we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status. eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; Ptuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.

  11. Hazard rate for a two-channel protective system subject to a high demand rate

    International Nuclear Information System (INIS)

    Oliveira, L.F.; Youngblood, R.; Melo, P.F.F.

    1989-01-01

    A basic figure of merit associated with a protective system for an industrial plant is the number of accidents expected to occur in the plant within a given period of time, with the system installed. By definition, in a plant equipped with a protective system, an accident can only happen if an initiating event (a demand) occurs while the protective system is unavailable, that is, while it is in one of its possible failed states. This means that the hazard rate or accident frequency depends on the demand rate and on the unavailability of the protective systems. It has long been recognized that the demand rate influences the unavailability of the protective system, and practical expressions incorporating that effect have been developed for single-channel (Lees, 1982) and multi-channel (Kumamoto and Henley 1978) protective systems. The effect has also been incorporated into a Markovian treatment of a plant protection system (Papazoglou and Cho, 1985). In a previous paper (Oliveira and Netto, 1987) a Markovian approach was used to derive analytical expressions for the evaluation of the plant hazard rate for a single-channel protective system, properly accounting for the effects of the demand and the repair rates. In this paper the authors present an extension of that model to the case of a plant equipped with a two-channel protective system

  12. Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

    Science.gov (United States)

    Aminoshariae, Anita; Kulild, James C; Mickel, Andre; Fouad, Ashraf F

    2017-04-01

    To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  13. Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder.

    Science.gov (United States)

    Suh, Joyce; Orinstein, Alyssa; Barton, Marianne; Chen, Chi-Ming; Eigsti, Inge-Marie; Ramirez-Esparza, Nairan; Fein, Deborah

    2016-11-01

    The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high functioning individuals with ASD (HFA), and 23 typically developing (TD) peers. HFA children displayed higher ratings than their peers on all BAP traits. OO were indistinguishable from TD, with the exception of greater extraversion (e.g., increased talkativeness), a potential tendency to be less emotionally stable, and pragmatic language deficits such as getting sidetracked in conversation. Overall, OO individuals are not showing BAP characteristics, but may be subject to other mild ADHD-like characteristics.

  14. Comparing 2 Whiplash Grading Systems to Predict Clinical Outcomes.

    Science.gov (United States)

    Croft, Arthur C; Bagherian, Alireza; Mickelsen, Patrick K; Wagner, Stephen

    2016-06-01

    Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum. This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics. Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure. The Croft grading system for whiplash injury severity showed a better predictive measure for recovery status from whiplash injuries as compared with the QTF-WAD grading system.

  15. The order and volume fill rates in inventory control systems

    DEFF Research Database (Denmark)

    Thorstenson, Anders; Larsen, Christian

    2011-01-01

    This paper differentiates between an order (line) fill rate and a volume fill rate and specifies their performance for different inventory control systems. When the focus is on filling complete customer orders rather than total quantities the order fill rate would be the preferred service level m...

  16. Rate-distortion in Closed-Loop LTI Systems

    DEFF Research Database (Denmark)

    Silva, Eduardo; Derpich, Milan; Østergaard, Jan

    2013-01-01

    We consider a networked LTI system subject to an average data-rate constraint in the feedback path.We provide upper bounds to the minimal source coding rate required to achieve mean square stability and a desired level of performance. In the quadratic Gaussian case, an almost complete rate...

  17. Treatment outcome with low-dose-rate interstitial brachytherapy in early-stage oral tongue cancers

    Directory of Open Access Journals (Sweden)

    Bhalavat Rajendra

    2009-01-01

    Full Text Available Purpose : Although radical radiotherapy is known to be equally effective for early-stage oral tongue cancers (T1-2 N0 with the added advantage of organ and function preservation, surgery remains the preferred treatment. We present outcome of patients treated with brachytherapy (BT either radical or boost. Materials and Methods : Fifty-seven patients (T1/T2 31/26 were studied. Seventeen patients (30% were treated with radical BT (50-67 Gy while 40 (70% with external beam radiation therapy (EBRT + BT (36-56 Gy + 15-38 Gy]. Low-dose-rate (LDR BT was delivered with 192 Ir wires, using plastic bead technique with varied dose rates (< 60 cGy/h in 29 patients, 60-90 cGy/h in 17, and> 90 cGy/h in 11. Results : The overall local control (LCR was achieved in 59.7% (34/57 patients. LCR for T1 and T2 was 67.8% and 50%, respectively. A total of 23 patients had failures [local: 20 (T1: 8; T2: 12 patients, node: 5 (T1:2; T2: 3, and local + nodal: 3]. Overall 5-year disease-free survival and overall survival (OAS were 51% and 67%, respectively and those for T1 and T2 was 64.5/77.4% and 38.5/54% respectively (P = 0.002. All 16 patients were salvaged. Median survival after salvage treatment was 13.5 months (6-100 months. Soft tissue necrosis was observed in 12.3% (7/57 and osteoradionecrosis in two patients. Conclusion : BT, as an integral part of radical radiation therapy in early-stage tongue cancers, appears to be an effective alternative treatment modality with preservation of the organ and function without jeopardizing the outcome.

  18. The utilization rate of the regional health information exchange: how it impacts on health care delivery outcomes.

    Science.gov (United States)

    Mäenpää, Tiina; Asikainen, Paula; Gissler, Mika; Siponen, Kimmo; Maass, Marianne; Saranto, Kaija; Suominen, Tarja

    2012-01-01

    Interest in improving quality and effectiveness is the primary driver for health information exchange efforts across a health care system to improve the provision of public health care services. The aim here was to describe and identify the impact of a regional health information exchange (HIE) using quantitative statistics for 2004-2008 in one hospital district in Finland. We conducted a comparative, longitudinal 5-year follow-up study to evaluate the utilization rates of HIE, and the impact on health care delivery outcomes. The selected outcomes were total laboratory tests, radiology examinations, appointments, emergency visits, and referrals. The HIE utilization rates increased annually in all 10 federations of municipalities, and the viewing of reference information increased steadily in each professional group over the 5-year study period. In these federations, a significant connection was found to the number of laboratory tests and radiology examinations, with a statistically significant increase in the number of viewed references and use of HIE. The higher the numbers of emergency visits and appointments, the higher the numbers of emergency referrals to specialized care, viewed references, and HIE usage among the groups of different health care professionals. There is increasing interest in HIE usage through regional health information system among health professionals to improve health care delivery regionally and bring information on the patient directly to care delivery. It will be important to study which changes in working methods in the service system are explained by RHIS. Also, the experiences of the change that has taken place should be studied among the different stakeholders, administrative representatives, and patients.

  19. Position paper -- Tank ventilation system design air flow rates

    International Nuclear Information System (INIS)

    Goolsby, G.K.

    1995-01-01

    The purpose of this paper is to document a project position on required ventilation system design air flow rates for the waste storage tanks currently being designed by project W-236A, the Multi-Function Waste Tank Facility (MWTF). The Title 1 design primary tank heat removal system consists of two systems: a primary tank vapor space ventilation system; and an annulus ventilation system. At the conclusion of Title 1 design, air flow rates for the primary and annulus ventilation systems were 960 scfm and 4,400 scfm, respectively, per tank. These design flow rates were capable of removing 1,250,000 Btu/hr from each tank. However, recently completed and ongoing studies have resulted in a design change to reduce the extreme case heat load to 700,000 Btu/hr. This revision of the extreme case heat load, coupled with results of scale model evaporative testing performed by WHC Thermal Hydraulics, allow for a reduction of the design air flow rates for both primary and annulus ventilation systems. Based on the preceding discussion, ICF Kaiser Hanford Co. concludes that the design should incorporate the following design air flow rates: Primary ventilation system--500 scfm maximum and Annulus ventilation system--1,100 scfm maximum. In addition, the minimum air flow rates in the primary and annulus ventilation systems will be investigated during Title 2 design. The results of the Title 2 investigation will determine the range of available temperature control using variable air flows to both ventilation systems

  20. Clinical outcome of high-dose-rate interstitial brachytherapy in patients with oral cavity cancer

    International Nuclear Information System (INIS)

    Lee, Sung Uk; Cho, Kwan Ho; Moon, Sung Ho; Choi, Sung Weon; Park, Joo Yong; Yun, Tak; Lee, Sang Hyun; Lim, Young Kyung; Jeong, Chi Young

    2014-01-01

    To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.

  1. Rates of initial acceptance of PAP masks and outcomes of mask switching.

    Science.gov (United States)

    Bachour, Adel; Vitikainen, Pirjo; Maasilta, Paula

    2016-05-01

    Recently, we noticed a considerable development in alleviating problems related to positive airway pressure (PAP) masks. In this study, we report on the initial PAP mask acceptance rates and the effects of mask switching on mask-related symptoms. We prospectively collected all cases of mask switching in our sleep unit for a period of 14 months. At the time of the study, we used ResMed™ CPAP devices and masks. Mask switching was defined as replacing a mask used for at least 1 day with another type of mask. Changing to a different size but keeping the same type of mask did not count as mask switching. Switching outcomes were considered failed if the initial problem persisted or reappeared during the year that followed switching. Our patient pool was 2768. We recorded 343 cases of mask switching among 267 patients. Of the 566 patients who began new PAP therapy, 108 (39 women) had switched masks, yielding an initial mask acceptance rate of 81 %. The reason for switching was poor-fit/uncomfortable mask in 39 %, leak-related in 30 %, outdated model in 25 %, and nasal stuffiness in 6 % of cases; mask switching resolved these problems in 61 %. Mask switching occurred significantly (p = 0.037) more often in women and in new PAP users. The odds ratio for abandoning PAP therapy within 1 year after mask switching was 7.2 times higher (interval 4.7-11.1) than not switching masks. The initial PAP mask acceptance rate was high. Patients who switched their masks are at greater risk for abandoning PAP therapy.

  2. The order and volume fill rates in inventory control systems

    DEFF Research Database (Denmark)

    Thorstenson, Anders; Larsen, Christian

    2011-01-01

    This paper differentiates between an order (line) fill rate and a volume fill rate and specifies their performance for different inventory control systems. When the focus is on filling complete customer orders rather than total quantities the order fill rate would be the preferred service level...... measure. The main result shows how the order and volume fill rates are related in magnitude. Earlier results derived for a single-item, single-stage, continuous review inventory system with backordering and constant lead times controlled by a base-stock policy are extended in different directions...

  3. [Impact of sperm DNA and acrosome integrity and acrosome reaction rate on outcomes of rescue intracytoplasmic sperm injection].

    Science.gov (United States)

    He, Yongzhi; Li, Dawen; Cheng, Junping; Huo, Zhongchao; Huang, Hongyi; Xiao, Xin

    2016-01-01

    Objective To explore the effects of sperm DNA integrity rate, acrosome integrity rate and acrosome reaction rate on the outcomes of rescue intracytoplasmic sperm injection (ICSI). This retrospective analysis was conducted among 97 infertile couples receiving rescue ICSI due to failure of in vitro fertilization procedures in our Reproductive Medicine Center. Of these 97 women, 41 had clinical pregnancy and 56 did not, and the effects of sperm DNA integrity rate (estimated by DNA fragmentation index, DFI), acrosome integrity rate and acrosome reaction rate on rescue ICSI outcomes were analyzed. No significant difference was found in paternal age, testosterone value, testicular volume, FSH, female patient' age or the number of eggs retrieved between the two groups (P>0.05), but the infertility years was significantly shorter in the pregnancy group than in the non-pregnancy group (Prate and cleavage rate were similar between the two groups (P>0.05), but the good embryo rate was significantly higher in the pregnancy group (Preaction rate did not differ significantly between the two groups (P>0.05), but the acrosome integrity rate was significantly higher in the pregnancy group (Prate, acrosome integrity or acrosome reaction rate were not correlated with the fertilization rate, cleavage rate or good embryo rate (P>0.05). The pregnancy rate, twin and single fetus rates were 42.3%, 10.3% and 32.0% in this cohort after recue ICSI, respectively. Rescue ICSI is an effective treatment after failed in vitro fertilization procedure, and sperm acrosome integrity rate is associated with the outcome of rescue ICSI.

  4. Measured glomerular filtration rate at dialysis initiation and clinical outcomes of Indian peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    N Prasad

    2017-01-01

    Full Text Available The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD. Measured glomerular filtration rate (mGFR not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5–10, and> 10 ml/min/1.73 m2. Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m2 (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85–6.30, P = 0.000 and> 5–10 ml/min/1.73 m2 (HR - 2.16, 95% CI - 1.26–3.71, P = 0.005 had higher risk of mortality as compared to those with GFR of> 10 ml/min/1.73 m2. Each increment of 1 ml/min/1.73 m2 in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85–0.96, P = 0.002. Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m2 as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.

  5. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer.

    Science.gov (United States)

    Martinez, Alvaro A; Gustafson, Gary; Gonzalez, José; Armour, Elwood; Mitchell, Chris; Edmundson, Gregory; Spencer, William; Stromberg, Jannifer; Huang, Raywin; Vicini, Frank

    2002-06-01

    To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose-escalating conformal high-dose-rate (HDR) prostate brachytherapy was performed. Between November 1991 and August 2000, 207 patients were treated with 46 Gy pelvic EBRT and increasing HDR brachytherapy boost doses (5.50-11.5 Gy/fraction) during 5 weeks. The eligibility criteria were pretreatment prostate-specific antigen level >or=10.0 ng/mL, Gleason score >or=7, or clinical Stage T2b or higher. Patients were divided into 2 dose levels, low-dose biologically effective dose 93 Gy (149 patients). No patient received hormones. We used the American Society for Therapeutic Radiology and Oncology definition for biochemical failure. The median age was 69 years. The mean follow-up for the group was 4.4 years, and for the low and high-dose levels, it was 7.0 and 3.4 years, respectively. The actuarial 5-year biochemical control rate was 74%, and the overall, cause-specific, and disease-free survival rate was 92%, 98%, and 68%, respectively. The 5-year biochemical control rate for the low-dose group was 52%; the rate for the high-dose group was 87% (p failure. The Radiation Therapy Oncology Group Grade 3 gastrointestinal/genitourinary complications ranged from 0.5% to 9%. The actuarial 5-year impotency rate was 51%. Pelvic EBRT interdigitated with transrectal ultrasound-guided real-time conformal HDR prostate brachytherapy boost is both a precise dose delivery system and a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on biochemical control and cause-specific survival with higher doses. These results, coupled with the low risk of complications, the advantage of not being radioactive after implantation, and the real-time interactive planning, define a new standard for treatment.

  6. Trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

    Science.gov (United States)

    Ventura, S J; Mosher, W D; Curtin, S C; Abma, J C; Henshaw, S

    2000-01-01

    This report presents national estimates of pregnancies and pregnancy rates according to women's age, race, and Hispanic origin, and by marital status, race, and Hispanic origin. Data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity, contraceptive practices, and infertility, as well as women's reports of pregnancy intentions. Tables of pregnancy rates and the factors affecting pregnancy rates are presented and interpreted. Birth data are from the birth-registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 years to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.

  7. Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States.

    Science.gov (United States)

    Kim, Sun Moon; Long, Jin; Montez-Rath, Maria E; Leonard, Mary B; Norton, Jeffrey A; Chertow, Glenn M

    2016-07-07

    Secondary hyperparathyroidism is common among patients with ESRD. Although medical therapy for secondary hyperparathyroidism has changed dramatically over the last decade, rates of parathyroidectomy for secondary hyperparathyroidism across the United States population are unknown. We examined temporal trends in rates of parathyroidectomy, in-hospital mortality, length of hospital stay, and costs of hospitalization. Using the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, a representative national database on hospital stay regardless of age and payer in the United States, we identified parathyroidectomies for secondary hyperparathyroidism from 2002 to 2011. Data from the US Renal Data System reports were used to calculate the rate of parathyroidectomy. We identified 32,971 parathyroidectomies for secondary hyperparathyroidism between 2002 and 2011. The overall rate of parathyroidectomy was approximately 5.4/1000 patients (95% confidence interval [95% CI], 5.0/1000 to 6.0/1000). The rate decreased from 2003 (7.9/1000 patients; 95% CI, 6.2/1000 to 9.6/1000), reached a nadir in 2005 (3.3/1000 patients; 95% CI, 2.6/1000 to 4.0/1000), increased again through 2006 (5.4/1000 patients; 95% CI, 4.4/1000 to 6.4/1000), and remained stable since that time. Rates of in-hospital mortality decreased from 1.7% (95% CI, 0.8% to 2.6%) in 2002 to 0.8% (95% CI, 0.1% to 1.6%) in 2011 (P for trend secondary hyperparathyroidism have not declined in recent years. Copyright © 2016 by the American Society of Nephrology.

  8. Fill Rates of Single-Stage and Multistage Supply Systems

    OpenAIRE

    Matthew J. Sobel

    2004-01-01

    A supply system's fill rate is the fraction of demand that is met from on-hand inventory. This paper presents formulas for the fill rate of periodic review supply systems that use base-stock-level policies. The first part of the paper contains fill-rate formulas for a single-stage system and general distributions of demand. When demand is normally distributed, an exact expression uses only the standard normal distribution and density functions, and a good approximation uses only the standard ...

  9. Reduction of Large Dynamical Systems by Minimization of Evolution Rate

    Science.gov (United States)

    Girimaji, Sharath S.

    1999-01-01

    Reduction of a large system of equations to a lower-dimensional system of similar dynamics is investigated. For dynamical systems with disparate timescales, a criterion for determining redundant dimensions and a general reduction method based on the minimization of evolution rate are proposed.

  10. State estimation for networked control systems using fixed data rates

    Science.gov (United States)

    Liu, Qing-Quan; Jin, Fang

    2017-07-01

    This paper investigates state estimation for linear time-invariant systems where sensors and controllers are geographically separated and connected via a bandwidth-limited and errorless communication channel with the fixed data rate. All plant states are quantised, coded and converted together into a codeword in our quantisation and coding scheme. We present necessary and sufficient conditions on the fixed data rate for observability of such systems, and further develop the data-rate theorem. It is shown in our results that there exists a quantisation and coding scheme to ensure observability of the system if the fixed data rate is larger than the lower bound given, which is less conservative than the one in the literature. Furthermore, we also examine the role that the disturbances have on the state estimation problem in the case with data-rate limitations. Illustrative examples are given to demonstrate the effectiveness of the proposed method.

  11. 76 FR 50726 - Integrated System Power Rates: Correction

    Science.gov (United States)

    2011-08-16

    ... DEPARTMENT OF ENERGY Southwestern Power Administration Integrated System Power Rates: Correction AGENCY: Southwestern Power Administration, DOE. ACTION: Notice of public review and comment; Correction... date listed for the combined Public Information and Comment Forum (Forum) was erroneously listed in the...

  12. Temporal framing and the hidden-zero effect: rate-dependent outcomes on delay discounting.

    Science.gov (United States)

    Naudé, Gideon P; Kaplan, Brent A; Reed, Derek D; Henley, Amy J; DiGennaro Reed, Florence D

    2018-05-01

    Recent research suggests that presenting time intervals as units (e.g., days) or as specific dates, can modulate the degree to which humans discount delayed outcomes. Another framing effect involves explicitly stating that choosing a smaller-sooner reward is mutually exclusive to receiving a larger-later reward, thus presenting choices as an extended sequence. In Experiment 1, participants (N = 201) recruited from Amazon Mechanical Turk completed the Monetary Choice Questionnaire in a 2 (delay framing) by 2 (zero framing) design. Regression suggested a main effect of delay, but not zero, framing after accounting for other demographic variables and manipulations. We observed a rate-dependent effect for the date-framing group, such that those with initially steep discounting exhibited greater sensitivity to the manipulation than those with initially shallow discounting. Subsequent analyses suggest these effects cannot be explained by regression to the mean. Experiment 2 addressed the possibility that the null effect of zero framing was due to within-subject exposure to the hidden- and explicit-zero conditions. A new Amazon Mechanical Turk sample completed the Monetary Choice Questionnaire in either hidden- or explicit-zero formats. Analyses revealed a main effect of reward magnitude, but not zero framing, suggesting potential limitations to the generality of the hidden-zero effect. © 2018 Society for the Experimental Analysis of Behavior.

  13. Quality Rating and Improvement System State Evaluations and Research

    Science.gov (United States)

    Ferguson, Daniel

    2016-01-01

    A quality rating and improvement system (QRIS) is a method used by states and local jurisdictions to assess the level of quality of child care and early education programs, improve quality, and convey quality ratings to parents and other consumers. A typical QRIS incorporates the following components: quality standards for participating providers;…

  14. Performance evaluation of a center pivot variable rate irrigation system

    Science.gov (United States)

    Variable Rate Irrigation (VRI) for center pivots offers potential to match specific application rates to non-uniform soil conditions along the length of the lateral. The benefit of such systems is influenced by the areal extent of these variations and the smallest scale to which the irrigation syste...

  15. Labeling and Rating Systems: Greater Access or Censorship?

    Science.gov (United States)

    Martin, Ann M.

    2015-01-01

    This article asks the question: How well versed are school librarians on issues related to labeling and rating systems? As school librarians continue to design and implement resource location schemes to assist patrons, they must recognize the difference between using labels to create interest in books or implementing labeling and rating systems…

  16. Renin-angiotensin system antagonists, glomerular filtration rate and blood pressure

    Directory of Open Access Journals (Sweden)

    D.D. Ivanov

    2018-02-01

    Full Text Available The article deals with the mModern data on the influence of renin-angiotensin system blockers on the glomerular filtration rate, the level of arterial pressure and the outcome of chronic kidney disease. The strategy of  rennin-angiotensine blockade is offered to be changed depending on the criteria va­lues of glomerular filtration rate: a combination of inhibitors of angiotensin-converting enzyme + angiotensin receptors blo­ckers, monotherapy and drug withdrawal in glomerular filtration rate under 15–30 ml/min/m2. The formula BRIMONEL for treatment of chronic kidney disease is given.

  17. Determination of cost effective waste management system receipt rates

    International Nuclear Information System (INIS)

    McKee, R.W.; Huber, H.D.

    1991-01-01

    A comprehensive logistics and cost analysis has been carried out to determine if there are potential benefits to the high-level waste management system for receipt rates other than the current 3,000 MTU/yr design-basis receipt rate. The scope of the analysis includes both a Repository-Only System and a Storage-Only or Basic MRS System. To allow for current uncertainties in facility startup scheduling, cases considering repository startup dates of 2010 and 2015 and MRS startup dates of 1998 and three years prior to the repository have been evaluated. Receipt rates ranging from 1,500 to 6,000 MTU/yr have been considered for both the MRS and the repository. Higher receipt rates appear to be economically justified for both the repository and an MRS. For a repository-only system, minimum costs are found at a repository receipt rate of 6,000 MTU/yr. When a storage-only MRS is included in the system, minimum system costs are also achieved at a repository receipt rate of 6,000 MTU/yr. However, the MRS receipt rate for minimum system costs depends on the MRS startup date and ranges from 3,500 to 6,000 MTU/yr. With a 1998 MRS and a 2010 repository, the added cost of providing the MRS is offset by at-reactor storage cost reductions and the total system cost of $10.0 billion is virtually the same as for the repository-only system

  18. Outcome of limb reconstruction system in open tibial diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Anand Ajmera

    2015-01-01

    Full Text Available Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm. The mean duration of bone transport was 13 weeks (range 8-30 weeks with a mean time for LRS in place was 44 weeks (range 24-51 weeks. The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25, good in 12% (3/25 and fair in 4% (1/25 with union in all except 2 patients, which showed poor results (8% with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25, good in 8% (2/25, fair in 8% (2/25. Pin

  19. Outcome of limb reconstruction system in open tibial diaphyseal fractures.

    Science.gov (United States)

    Ajmera, Anand; Verma, Ankit; Agrawal, Mukul; Jain, Saurabh; Mukherjee, Arunangshu

    2015-01-01

    Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm). The mean duration of bone transport was 13 weeks (range 8-30 weeks) with a mean time for LRS in place was 44 weeks (range 24-51 weeks). The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks) with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25), good in 12% (3/25) and fair in 4% (1/25) with union in all except 2 patients, which showed poor results (8%) with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25), good in 8% (2/25), fair in 8% (2/25). Pin tract infection was seen in 5 cases, out of which 4

  20. Outcomes in Diabetic Patients Undergoing Orbital Atherectomy System.

    Science.gov (United States)

    Lee, Michael S; Shlofmitz, Evan; Nguyen, Heajung; Shlofmitz, Richard A

    2016-10-01

    We evaluated the angiographic and clinical outcomes of orbital atherectomy to treat severely calcified coronary lesions in diabetic and non-diabetic patients. Diabetics have increased risk for death, myocardial infarction, and target vessel revascularization after percutaneous coronary intervention. Severely calcified coronary lesions are associated with increased cardiac events. Orbital atherectomy facilitates stent delivery and optimizes stent expansion by modifying severely calcified plaque. Outcomes in diabetic patients who undergo orbital atherectomy have not been reported. Our retrospective multicenter registry included 458 consecutive real-world patients with severely calcified coronary arteries who underwent orbital atherectomy. The primary safety endpoint was the rate of major adverse cardiac and cerebrovascular events at 30 days. Diabetics represented 42.1% (193/458) of the entire cohort. The primary endpoint was similar in diabetics and non-diabetics (1.0% vs. 3.0%%, P = 0.20), as were 30-day rates of death (0.5% vs. 1.9%, P = 0.41), myocardial infarction (0.5% vs. 1.5%, P = 0.40), target vessel revascularization (0% vs. 0%, P = 1), and stroke (0% vs. 0.4%, P > 0.9). Angiographic complications and stent thrombosis rate were low and did not differ between the 2 groups. Diabetics represented a sizeable portion of patients who underwent orbital atherectomy. Diabetics who had severely calcified coronary arteries and underwent orbital atherectomy had low event rates that were similar to non-diabetics. Orbital atherectomy appears to be a viable treatment strategy for diabetic patients. Randomized trials with longer-term follow-up are needed to determine the ideal treatment strategy for diabetics. © 2016, Wiley Periodicals, Inc.

  1. Determination of cost effective waste management system receipt rates

    International Nuclear Information System (INIS)

    McKee, R.W.; Huber, H.D.

    1991-01-01

    A comprehensive logistics and cost analysis has been carried out to determine if there are potential benefits to the high-level waste management system for receipt rates other than the current 3000 MTU/yr design-basis. The analysis includes both a Repository-Only System and a Storage-Only System. Repository startup dates of 2010 and 2015 and MRS startup dates of 1988 and three years prior to the repository have been evaluated. Receipt rates ranging from 1,500 to 6, 000 MTU/yr have been considered. Higher receipt rates appear to be economically justified, for either system, minimum costs are found at a repository receipt rate of 6000 MTU/yr. However, the MRS receipt rate for minimum system costs depends on the MRS startup date. With a 1988 MRS and a 2010 repository, the added cost of providing the MRS is offset by at-reactor storage cost reductions and the total system cost of $10.0 billion is virtually the same as for the repository- only system. 9 refs., 8 figs., 3 tabs

  2. A zero-sum monetary system, interest rates, and implications

    OpenAIRE

    Hanley, Brian P.

    2015-01-01

    To the knowledge of the author, this is the first time it has been shown that interest rates that are extremely high by modern standards (100% and higher) are necessary within a zero-sum monetary system, and not just driven by greed. Extreme interest rates that appeared in various places and times reinforce the idea that hard money may have contributed to high rates of interest. Here a model is presented that examines the interest rate required to succeed as an investor in a zero-sum fixed qu...

  3. Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Hollingsworth, John M; Funk, Russell J; Garrison, Spencer A; Owen-Smith, Jason; Kaufman, Samuel A; Pagani, Francis D; Nallamothu, Brahmajee K

    2016-11-01

    Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. © 2016 American Heart Association, Inc.

  4. The order and volume fill rates in inventory control systems

    DEFF Research Database (Denmark)

    Thorstenson, Anders; Larsen, Christian

    2014-01-01

    This paper differentiates between an order (line) fill rate and a volume fill rate and specifies their performance for different inventory control systems. When the focus is on filling complete customer orders rather than total demanded quantity the order fill rate would be the preferred service...... level measure. The main result shows how the order and volume fill rates are related in magnitude. Earlier results derived for a single-item, single-stage, continuous review inventory system with backordering and constant lead times controlled by a base-stock policy are extended in different directions...... extensions consider more general inventory control review policies with backordering, as well as some relations between service measures. A particularly important result in the paper concerns an alternative service measure, the customer order fill rate, and shows how this measure always exceeds the other two...

  5. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer

    International Nuclear Information System (INIS)

    Martinez, Alvaro A.; Gustafson, Gary; Gonzalez, Jose; Armour, Elwood; Mitchell, Chris; Edmundson, Gregory; Spencer, William; Stromberg, Jannifer; Huang, Raywin; Vicini, Frank

    2002-01-01

    Purpose: To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose-escalating conformal high-dose-rate (HDR) prostate brachytherapy was performed. Methods and Materials: Between November 1991 and August 2000, 207 patients were treated with 46 Gy pelvic EBRT and increasing HDR brachytherapy boost doses (5.50-11.5 Gy/fraction) during 5 weeks. The eligibility criteria were pretreatment prostate-specific antigen level ≥10.0 ng/mL, Gleason score ≥7, or clinical Stage T2b or higher. Patients were divided into 2 dose levels, low-dose biologically effective dose 93 Gy (149 patients). No patient received hormones. We used the American Society for Therapeutic Radiology and Oncology definition for biochemical failure. Results: The median age was 69 years. The mean follow-up for the group was 4.4 years, and for the low and high-dose levels, it was 7.0 and 3.4 years, respectively. The actuarial 5-year biochemical control rate was 74%, and the overall, cause-specific, and disease-free survival rate was 92%, 98%, and 68%, respectively. The 5-year biochemical control rate for the low-dose group was 52%; the rate for the high-dose group was 87% (p<0.001). Improvement occurred in the cause-specific survival in favor of the brachytherapy high-dose level (p=0.014). On multivariate analysis, a low-dose level, higher Gleason score, and higher nadir value were associated with increased biochemical failure. The Radiation Therapy Oncology Group Grade 3 gastrointestinal/genitourinary complications ranged from 0.5% to 9%. The actuarial 5-year impotency rate was 51%. Conclusion: Pelvic EBRT interdigitated with transrectal ultrasound-guided real-time conformal HDR prostate brachytherapy boost is both a precise dose delivery system and a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on biochemical control and cause

  6. A system approach to high quality picture-rate conversion

    NARCIS (Netherlands)

    Bartels, C.L.L.; Cordes, C.N.; Riemens, B.; Haan, de G.

    2010-01-01

    Various techniques have been implemented to improve the motion portrayal of flat-panel displays, of which the widespread introduction of motion-compensated picture-rate conversion systems is an essential part. However, a careful design of such systems is critical as they have the potential to

  7. Positron imaging system with improved count rate and tomographic capability

    International Nuclear Information System (INIS)

    1979-01-01

    A system with improved count rate capability for detecting the radioactive distribution of positron events within an organ of interest in a living subject is described. Objects of the invention include improving the scintillation crystal and pulse processing electronics, avoiding the limitations of collimators and provide an Arger camera positron imaging system that avoids the use of collimators. (U.K.)

  8. Sustainable systems rating program: Marketing ``Green`` Building in Austin, Texas

    Energy Technology Data Exchange (ETDEWEB)

    1991-12-01

    Four major resource issues for home construction were identified: water, energy, materials, and waste. A systems flow model was then developed that tracked the resource issues through interactive matrices in the areas of sourcing, processing, using, and disposing or recycling. This model served as the basis for a rating system used in an educational and marketing tool called the Eco-Home Guide.

  9. Asymptotic failure rate of a continuously monitored system

    International Nuclear Information System (INIS)

    Grall, A.; Dieulle, L.; Berenguer, C.; Roussignol, M.

    2006-01-01

    This paper deals with a perfectly continuously monitored system which gradually and stochastically deteriorates. The system is renewed by a delayed maintenance operation, which is triggered when the measured deterioration level exceeds an alarm threshold. A mathematical model is developed to study the asymptotic behavior of the reliability function. A procedure is proposed which allows us to identify the asymptotic failure rate of the maintained system. Numerical experiments illustrate the efficiency of the proposed procedure and emphasize the relevance of the asymptotic failure rate as an interesting indicator for the evaluation of the control-limit preventive replacement policy

  10. Asymptotic failure rate of a continuously monitored system

    Energy Technology Data Exchange (ETDEWEB)

    Grall, A. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: antoine.grall@utt.fr; Dieulle, L. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: laurence.dieulle@utt.fr; Berenguer, C. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: christophe.berenguer@utt.fr; Roussignol, M. [Laboratoire d' Analyse et de Mathematiques Appliquees, Universite de Marne la Vallee, 5 bd Descartes, Champs sur Marne, 77454 Marne la Vallee, Cedex 2 (France)]. E-mail: michel.roussignol@univ-mlv.fr

    2006-02-01

    This paper deals with a perfectly continuously monitored system which gradually and stochastically deteriorates. The system is renewed by a delayed maintenance operation, which is triggered when the measured deterioration level exceeds an alarm threshold. A mathematical model is developed to study the asymptotic behavior of the reliability function. A procedure is proposed which allows us to identify the asymptotic failure rate of the maintained system. Numerical experiments illustrate the efficiency of the proposed procedure and emphasize the relevance of the asymptotic failure rate as an interesting indicator for the evaluation of the control-limit preventive replacement policy.

  11. Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system.

    Science.gov (United States)

    Moore, Lynne; Lavoie, André; Bourgeois, Gilles; Lapointe, Jean

    2015-06-01

    According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes

  12. Installation and commissioning of instantaneous dose rate monitoring system

    CERN Document Server

    Iaydjiev, Plamen

    2018-01-01

    INRNE-Sofia was working on the installation and commissioning of new instantaneous dose rate monitoring system for the GIF++ facility at CERN. The final device, containing an 8-channels readout board was designed and tested at the CERN facility during November 2017, in an irradiation campaign supported by the AIDA-2020 TA program. The system is designed to be fully integrated in the GIF++ control system and the data measured are available to the users.

  13. Online System Adoption and K-12 Academic Outcomes

    Science.gov (United States)

    Kimmons, R.

    2015-01-01

    This study seeks to understand the relationship between K-12 online system adoption (e.g., Blackboard, Edmodo, WordPress) and school-level academic achievement ratings. Utilizing a novel approach to data collection via website data extraction and indexing of all school websites in a target state in the United States (n?=?732) and merging these…

  14. Treatment staff turnover in organizations implementing evidence-based practices: Turnover rates and their association with client outcomes

    Science.gov (United States)

    Garner, Bryan R.; Hunter, Brooke D.; Modisette, Kathryn C.; Ihnes, Pamela C.; Godley, Susan H.

    2011-01-01

    High staff turnover has been described as a problem for the substance use disorder treatment field. This assertion is based primarily on the assumption that staff turnover adversely impacts treatment delivery and effectiveness. This assumption, however, has not been empirically tested. In this study, we computed annualized rates of turnover for treatment staff (n=249) participating in an evidence-based practice implementation initiative and examined the association between organizational-level rates of staff turnover and client-level outcomes. Annualized rates of staff turnover were 31% for clinicians and 19% for clinical supervisors. Additionally, multilevel analyses did not reveal the expected relationship between staff turnover and poorer client-level outcomes. Rather, organizational-level rates of staff turnover were found to have a significant positive association with two measures of treatment effectiveness: less involvement in illegal activity and lower social risk. Possible explanations for these findings are discussed. PMID:22154040

  15. Evaluation of safety ratings of roads based on frontal crashes with known crash pulse and injury outcome.

    Science.gov (United States)

    Stigson, H

    2009-06-01

    The objective in this study, using data from crashed cars fitted with on-board crash pulse recorders, was to present differences in average crash severity, distribution of crash severity, and injury outcomes, based on an independent safety rating of roads, also taking road type and speed limit into consideration. Furthermore, the objective was to evaluate differences in injury risk, based on the distribution of crash severity. The investigation included both frontal two-vehicle crashes and single-vehicle crashes with known injury outcome. In total, 209 real-world crashes involving cars fitted with crash pulse recorders were included. For all crashes, average mean acceleration and change of velocity of the vehicle acceleration pulse were measured and calculated. All crash spots were classified according to an independent road safety rating program (European Road Assessment Programme Road Protection Score), where the safety quality of roads is rated in relation to posted speed limits. The crash severity and injury outcome in crashes that occurred on roads with good safety ratings were compared with crashes on roads with poor safety ratings. The data were also divided into subcategories according to posted speed limit and road type, to evaluate whether there was a difference in crash severity and injury outcome within the categories. In total, crash severity was statistically significantly lower in crashes occurring on roads with good safety ratings than in crashes occurring on roads with poor safety ratings. It was found that crash severity and injury risk were lower on roads with good safety ratings with a speed limit of above 90 km/h compared with roads with poor safety ratings, irrespective of speed limit. On the other hand, crash severity was higher on roads with good safety ratings with speed limit of 70 km/h than on roads with poor safety ratings with the same speed limit. Though it was found that a higher speed limit resulted in higher crash severity on roads

  16. MANAGED FLOAT EXCHANGE RATE SYSTEM: THE SINGAPORE EXPERIENCE

    OpenAIRE

    HOE EE KHOR; JASON LEE; EDWARD ROBINSON; SAKTIANDI SUPAAT

    2007-01-01

    This paper examines the key characteristics of Singapore's exchange rate-centered monetary policy; in particular, its managed float regime which incorporates key features of the basket, band and crawl system popularized by Williamson (1998, 1999). We assess how the flexibility accorded by this framework has been advantageous in facilitating adjustment to various shocks to the economy. A characterization of the countercyclical nature of Singapore's exchange rate policy is also offered, with re...

  17. Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy.

    Science.gov (United States)

    Zhang, Ruiyun; Wu, Guangyu; Huang, Jiwei; Shi, Oumin; Kong, Wen; Chen, Yonghui; Xu, Jianrong; Xue, Wei; Zhang, Jin; Huang, Yiran

    2017-06-06

    The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p renal function outcome after laparoscopic partial nephrectomy.

  18. Predicting Positive Education Outcomes for Emerging Adults in Mental Health Systems of Care.

    Science.gov (United States)

    Brennan, Eileen M; Nygren, Peggy; Stephens, Robert L; Croskey, Adrienne

    2016-10-01

    Emerging adults who receive services based on positive youth development models have shown an ability to shape their own life course to achieve positive goals. This paper reports secondary data analysis from the Longitudinal Child and Family Outcome Study including 248 culturally diverse youth ages 17 through 22 receiving mental health services in systems of care. After 12 months of services, school performance was positively related to youth ratings of school functioning and service participation and satisfaction. Regression analysis revealed ratings of young peoples' perceptions of school functioning, and their experience in services added to the significant prediction of satisfactory school performance, even controlling for sex and attendance. Finally, in addition to expected predictors, participation in planning their own services significantly predicted enrollment in higher education for those who finished high school. Findings suggest that programs and practices based on positive youth development approaches can improve educational outcomes for emerging adults.

  19. Development of Wireless System for Containment Integrated Leakage Rate Test

    International Nuclear Information System (INIS)

    Lee, Kwang-Dae; Oh, Eung-Se; Yang, Seung-Ok

    2006-01-01

    The containment system leakage rate should be estimated periodically with reliable test equipment. In light-water reactor nuclear power plants, ANSI/ANS- 56.8 is a basis for determining leakage rates. Two types of data acquisition system, centralized type and networked type, has been used. In centralized type, all sensors are connected directly from sensors in the containment to the measuring equipment outside the building. The other hand, the networked type has several branch chains which connect one group of the network-sensors together. To test leakage rate, more than 20 temperature sensors and 6 humidity sensors, which are different for each plant, should be installed on a specific level in the containment. A wireless technology gives the benefits such as reducing installation efforts, making pretest easy, so it is widely used more and more in the plant monitoring. As the containment system has many kinds of complex barriers to the radio frequency, the radio power and frequency band for better transmission rate as well as the interference by the radio frequency should be considered. The overview of the wireless sensor system for the containment leakage rate test is described here and the test results on Yonggwang unit 4 PWR plant is presented

  20. Oncologic outcomes and complication rates after laparoscopic-assisted cryoablation: a EuRECA multi-institutional study

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjaergaard; Lagerveld, Brunolf W; Keeley, Francis

    2017-01-01

    OBJECTIVE: To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs). PATIENTS AND METHODS: A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European inst...... invasive procedure, risk of complications should be considered when counselling patients....

  1. Stenting for symptomatic vertebral artery stenosis associated with bilateral carotid rate mirabile: The long-term clinical and angiographic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jang Hyun; Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rate mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

  2. Stenting for symptomatic vertebral artery stenosis associated with bilateral carotid rate mirabile: The long-term clinical and angiographic outcome

    International Nuclear Information System (INIS)

    Baek, Jang Hyun; Kim, Byung Moon

    2015-01-01

    Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rate mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

  3. Creatinine excretion rate, a marker of muscle mass, is related to clinical outcome in patients with chronic systolic heart failure

    NARCIS (Netherlands)

    ter Maaten, Jozine M.; Damman, Kevin; Hillege, Hans L.; Bakker, Stephan J.; Anker, Stefan D.; Navis, Gerjan; Voors, Adriaan A.

    2014-01-01

    Aims In chronic heart failure (CHF), low body mass as a reflection of low muscle mass has been associated with poor outcome. Urinary creatinine excretion rate (CER) is an established marker of muscle mass, but has not been investigated in CHF. This study aims to evaluate urinary CER as a marker of

  4. Attendance Rates in a Workplace Predict Subsequent Outcome of Employment-Based Reinforcement of Cocaine Abstinence in Methadone Patients

    Science.gov (United States)

    Donlin, Wendy D.; Knealing, Todd W.; Needham, Mick; Wong, Conrad J.; Silverman, Kenneth

    2008-01-01

    This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N = 111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction…

  5. Training and Maintaining System-Wide Reliability in Outcome Management.

    Science.gov (United States)

    Barwick, Melanie A; Urajnik, Diana J; Moore, Julia E

    2014-01-01

    The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909-.995, .915-.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.

  6. A new high rate positron lifetime measurement system

    International Nuclear Information System (INIS)

    Bedwell, M.O.; Paulus, T.J.

    1979-01-01

    Positron lifetime measuring system, a technique to perform non-destructive studies on the internal structure of materials, has many components common to those used for nuclear time spectroscopy systems. In each case, a timing coincidence curve is measured for the energy range of interest, and this is accomplished in a typical timing coincidence system. The paper first describes the conventional timing coincidence system, then a new fast timing system is introduced. Comparing to the conventional fast/slow timing system, the fast timing technique offers reduced complexity, lower system cost, and improved high data rate capability. Experimental results show that the FWHM timing resolution ranges from 190 ps for a 1.1 : 1 dynamic range to 337 ps for a 100 : 1 dynamic range of signals with 60 Co. As for the timing resolution as a function of energy, the FWHM resolution for each channel ranges from 124 ps at 1 MeV to 400 ps at 100 keV. Since the excellent timing performance is maintained even at very high input rate, the experimenters can use much more active sources to increase the true coincidence rate and reduce data accumulation time. This method has the added advantage of minimizing long term drift effects since the experiments can be conducted in less time. (Wakatsuki, Y.)

  7. Flexible proportional-rate scheduling for OFDMA system

    KAUST Repository

    Leith, Alex

    2013-10-01

    In this paper, we study the sum-rate maximization algorithms for downlink and uplink orthogonal frequency division multiple access (OFDMA) systems under proportional-rate constraint (PRC) and minimum-rate constraint. We develop a low-complexity weighted channel signal-to-noise ratio (w-SNR)-based ranking scheme for user selection on each subchannel in OFDMA combined with waterfilling (WF) power allocation. Both offline and online optimization algorithms are developed to optimize the SNR weight vector to maximize the sum rate while satisfying several constraints, such as PRC. The offline weight optimization technique relies on the analytical throughput results developed in this paper, and the online weight adaptation method tracks the user rates and meets the PRC using a subgradient search. Furthermore, we introduce a novel SNR operating region test to enhance the multiuser diversity gain and the sum rate. The proposed schemes have a low complexity, which is linear to the numbers of users and subchannels. Simulation results verify the accuracy of the developed analytical rates and fairness formulas, and show that the proposed w-SNR schemes can achieve higher sum rates than several benchmark schemes that provide the PRC with either short-term or long-term fairness. © 2013 IEEE. © 2013 ESO.

  8. Flexible proportional-rate scheduling for OFDMA system

    KAUST Repository

    Leith, Alex; Alouini, Mohamed-Slim; Kim, Dongin; (Sherman) Shen X., Xuemin; Wu, Zhiqiang

    2013-01-01

    In this paper, we study the sum-rate maximization algorithms for downlink and uplink orthogonal frequency division multiple access (OFDMA) systems under proportional-rate constraint (PRC) and minimum-rate constraint. We develop a low-complexity weighted channel signal-to-noise ratio (w-SNR)-based ranking scheme for user selection on each subchannel in OFDMA combined with waterfilling (WF) power allocation. Both offline and online optimization algorithms are developed to optimize the SNR weight vector to maximize the sum rate while satisfying several constraints, such as PRC. The offline weight optimization technique relies on the analytical throughput results developed in this paper, and the online weight adaptation method tracks the user rates and meets the PRC using a subgradient search. Furthermore, we introduce a novel SNR operating region test to enhance the multiuser diversity gain and the sum rate. The proposed schemes have a low complexity, which is linear to the numbers of users and subchannels. Simulation results verify the accuracy of the developed analytical rates and fairness formulas, and show that the proposed w-SNR schemes can achieve higher sum rates than several benchmark schemes that provide the PRC with either short-term or long-term fairness. © 2013 IEEE. © 2013 ESO.

  9. Eliminating the Effect of Rating Bias on Reputation Systems

    Directory of Open Access Journals (Sweden)

    Leilei Wu

    2018-01-01

    Full Text Available The ongoing rapid development of the e-commercial and interest-base websites makes it more pressing to evaluate objects’ accurate quality before recommendation. The objects’ quality is often calculated based on their historical information, such as selected records or rating scores. Usually high quality products obtain higher average ratings than low quality products regardless of rating biases or errors. However, many empirical cases demonstrate that consumers may be misled by rating scores added by unreliable users or deliberate tampering. In this case, users’ reputation, that is, the ability to rate trustily and precisely, makes a big difference during the evaluation process. Thus, one of the main challenges in designing reputation systems is eliminating the effects of users’ rating bias. To give an objective evaluation of each user’s reputation and uncover an object’s intrinsic quality, we propose an iterative balance (IB method to correct users’ rating biases. Experiments on two datasets show that the IB method is a highly self-consistent and robust algorithm and it can accurately quantify movies’ actual quality and users’ stability of rating. Compared with existing methods, the IB method has higher ability to find the “dark horses,” that is, not so popular yet good movies, in the Academy Awards.

  10. Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy. Efficacy and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Mohnike, K. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); DTZ am Frankfurter Tor, Berlin (Germany); Neumann, K.; Seidensticker, M.; Seidensticker, R.; Pech, M.; Streitparth, T.; Ricke, J. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); Hass, P.; Gademann, G. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Strahlentherapie, Magdeburg (Germany); Klose, S. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie, Magdeburg (Germany); Garlipp, B.; Benckert, C. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Allgemein-, Viszeral- und Gefaesschirurgie, Magdeburg (Germany); Wendler, J.J.; Liehr, U.B.; Schostak, M. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Urologie und Kinderurologie, Magdeburg (Germany); Goeppner, D. [Universitaetsklinikum Magdeburg A.oe.R., Otto-von-Guericke-Universitaet, Klinik fuer Dermatologie, Magdeburg (Germany)

    2017-08-15

    To assess the efficacy, safety, and outcome of image-guided high-dose-rate (HDR) brachytherapy in patients with adrenal gland metastases (AGM). From January 2007 to April 2014, 37 patients (7 female, 30 male; mean age 66.8 years, range 41.5-82.5 years) with AGM from different primary tumors were treated with CT-guided HDR interstitial brachytherapy (iBT). Primary endpoint was local tumor control (LTC). Secondary endpoints were time to untreatable progression (TTUP), time to progression (TTP), overall survival (OS), and safety. In a secondary analysis, risk factors with an influence on survival were identified. The median biological equivalent dose (BED) was 37.4 Gy. Mean LTC after 12 months was 88%; after 24 months this was 74%. According to CTCAE criteria, one grade 3 adverse event occurred. Median OS after first diagnosis of AGM was 18.3 months. Median OS, TTUP, and TTP after iBT treatment were 11.4, 6.6, and 3.5 months, respectively. Uni- and multivariate Cox regression analyses revealed significant influences of synchronous disease, tumor diameter, and the total number of lesions on OS or TTUP or both. Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment. (orig.) [German] Beurteilung der Effektivitaet, Sicherheit und Ergebnisse nach bildgefuehrter High-dose-rate-(HDR-)Brachytherapie bei Patienten mit Nebennierenmetastasen. Von Januar 2007 bis April 2014 wurden 37 Patienten (7 weiblich, 30 maennlich; mittleres Alter 66,8 Jahre, Spanne 41,5-82,5 Jahre) mit Nebennierenmetastasen verschiedener Primarien mit CT-gesteuerter interstitieller HDR-Brachytherapie (iBT) behandelt. Der primaere Endpunkt war die lokale Tumorkontrolle (LTC). Sekundaere Endpunkte umfassten die Zeit bis zum nicht mehr behandelbaren Progress (TTUP), die Zeit bis zum Progress (TTP), das Gesamtueberleben (OS) und die Sicherheit der Methode. In einer sekundaeren Analyse wurden Risikofaktoren

  11. Development of dose rate estimation system for FBR maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Iizawa, Katsuyuki [Japan Nuclear Cycle Development Inst., Tsuruga Head Office, International Cooperation and Technology Development Center, Tsuruga, Fukui (Japan); Takeuchi, Jun; Yoshikawa, Satoru [Hitachi Engineering Company, Ltd., Hitachi, Ibaraki (Japan); Urushihara, Hiroshi [Ibaraki Hitachi Information Service Co., Ltd., Omika, Ibaraki (Japan)

    2001-09-01

    During maintenance activities on the primary sodium cooling system by an FBR Personnel radiation exposure arises mainly from the presence of radioactive corrosion products (CP). A CP behavior analysis code, PSYCHE, and a radiation shielding calculation code, QAD-CG, have been developed and applied to investigate the possible reduction of radiation exposure of workers. In order to make these evaluation methods more accessible to plant engineers, the user interface of the codes has been improved and an integrated system, including visualization of the calculated gamma-ray radiation dose-rate map, has been developed. The system has been verified by evaluating the distribution of the radiation dose-rate within the Monju primary heat transport system cells from the estimated saturated CP deposition and distribution which would be present following about 20 cycles of full power operation. (author)

  12. Development of dose rate estimation system for FBR maintenance

    International Nuclear Information System (INIS)

    Iizawa, Katsuyuki; Takeuchi, Jun; Yoshikawa, Satoru; Urushihara, Hiroshi

    2001-01-01

    During maintenance activities on the primary sodium cooling system by an FBR Personnel radiation exposure arises mainly from the presence of radioactive corrosion products (CP). A CP behavior analysis code, PSYCHE, and a radiation shielding calculation code, QAD-CG, have been developed and applied to investigate the possible reduction of radiation exposure of workers. In order to make these evaluation methods more accessible to plant engineers, the user interface of the codes has been improved and an integrated system, including visualization of the calculated gamma-ray radiation dose-rate map, has been developed. The system has been verified by evaluating the distribution of the radiation dose-rate within the Monju primary heat transport system cells from the estimated saturated CP deposition and distribution which would be present following about 20 cycles of full power operation. (author)

  13. Implementing a Childhood Cancer Outcomes Surveillance System Within a Population-Based Cancer Registry

    Directory of Open Access Journals (Sweden)

    Oscar Ramirez

    2018-03-01

    Full Text Available Purpose: Approximately 80% of cases of childhood cancer occur in low- and middle-income countries and are associated with high mortality rates. Assessing outcomes is essential for designing effective strategies to improve outcomes equally worldwide. We implemented a real-time surveillance system, VIGICANCER, embedded in a population-based cancer registry (PBCR to assess childhood cancer outcomes. Methods: VIGICANCER was established in 2009 as an integral part of Cali’s PBCR to collect real-time data on outcomes of patients (age < 19 years with a new diagnosis of cancer treated in pediatric oncology units in Cali, Colombia. Baseline and follow-up data (death, relapse, treatment abandonment, second neoplasms were collected from medical records, hospital discharge logs, pathology reports, death certificates, and the National Public Health Insurance database. A quality assurance process was implemented for the system. Results: From 2009 to 2013, data from 1,242 patients were included in VIGICANCER: 32% of patients were younger than 5 years, 55% were male, and 15% were Afro-descendants. International Classification of Childhood Cancer group I diagnoses predominated in all age groups except children younger than 1 year old, in whom CNS tumors predominated. Five-year overall survival for all cancers was 51.7% (95% CI, 47.9% to 55.4% for children (< 15 years, and 39.4% (95% CI, 29.8% to 50.5% for adolescents (15 to 18.9 years. Five-year overall survival for acute lymphoblastic leukemia was 55.6% (95% CI, 48.5% to 62.2%. Conclusion: Our study demonstrates the feasibility of implementing a real-time childhood cancer outcomes surveillance system embedded in a PBCR that can guide interventions to improve clinical outcomes in low- and middle-income countries.

  14. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial.

    Science.gov (United States)

    Sant'Ana, Adriana Campos Passanezi; Campos, Marinele R de; Passanezi, Selma Campos; Rezende, Maria Lúcia Rubo de; Greghi, Sebastião Luiz Aguiar; Passanezi, Euloir

    2011-04-01

    The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG--"no intervention" (n=17) or IG--"intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (pperiodontal conditions of IG and NIG were observed at 2nd examination (ppregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

  15. Reconciliation of international administrative coding systems for comparison of colorectal surgery outcome.

    Science.gov (United States)

    Munasinghe, A; Chang, D; Mamidanna, R; Middleton, S; Joy, M; Penninckx, F; Darzi, A; Livingston, E; Faiz, O

    2014-07-01

    Significant variation in colorectal surgery outcomes exists between different countries. Better understanding of the sources of variable outcomes using administrative data requires alignment of differing clinical coding systems. We aimed to map similar diagnoses and procedures across administrative coding systems used in different countries. Administrative data were collected in a central database as part of the Global Comparators (GC) Project. In order to unify these data, a systematic translation of diagnostic and procedural codes was undertaken. Codes for colorectal diagnoses, resections, operative complications and reoperative interventions were mapped across the respective national healthcare administrative coding systems. Discharge data from January 2006 to June 2011 for patients who had undergone colorectal surgical resections were analysed to generate risk-adjusted models for mortality, length of stay, readmissions and reoperations. In all, 52 544 case records were collated from 31 institutions in five countries. Mapping of all the coding systems was achieved so that diagnosis and procedures from the participant countries could be compared. Using the aligned coding systems to develop risk-adjusted models, the 30-day mortality rate for colorectal surgery was 3.95% (95% CI 0.86-7.54), the 30-day readmission rate was 11.05% (5.67-17.61), the 28-day reoperation rate was 6.13% (3.68-9.66) and the mean length of stay was 14 (7.65-46.76) days. The linkage of international hospital administrative data that we developed enabled comparison of documented surgical outcomes between countries. This methodology may facilitate international benchmarking. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  16. On the Achievable Rate of Hardware-Impaired Transceiver Systems

    KAUST Repository

    Javed, Sidrah; Amin, Osama; Ikki, Salama S.; Alouini, Mohamed-Slim

    2018-01-01

    In this paper, we accurately model the transceiver hardware impairments (HWIs) of multiple-input multiple-output (MIMO) systems considering different HWI stages at transmitter and receiver. The proposed novel statistical model shows that transceiver HWIs transform the transmitted symmetric signal to asymmetric one. Moreover, it shows that the aggregate self-interference has asymmetric characteristics. Therefore, we propose improper Gaussian signaling (IGS) for transmission in order to improve the achievable rate performance. IGS is considered as a general signaling scheme which includes the proper Gaussian signaling (PGS) as a special case. Thus, IGS has additional design parameters which enable it to mitigate the HWI self-interference. As a case study, we analyze the achievable rate performance of single-input multiple-output systems with linear and selection combiner. Furthermore, we optimize the IGS statistical characteristics for interference alignment. This improves the achievable rate performance as compared to the PGS, which is validated through numerical results.

  17. On the Achievable Rate of Hardware-Impaired Transceiver Systems

    KAUST Repository

    Javed, Sidrah

    2018-01-15

    In this paper, we accurately model the transceiver hardware impairments (HWIs) of multiple-input multiple-output (MIMO) systems considering different HWI stages at transmitter and receiver. The proposed novel statistical model shows that transceiver HWIs transform the transmitted symmetric signal to asymmetric one. Moreover, it shows that the aggregate self-interference has asymmetric characteristics. Therefore, we propose improper Gaussian signaling (IGS) for transmission in order to improve the achievable rate performance. IGS is considered as a general signaling scheme which includes the proper Gaussian signaling (PGS) as a special case. Thus, IGS has additional design parameters which enable it to mitigate the HWI self-interference. As a case study, we analyze the achievable rate performance of single-input multiple-output systems with linear and selection combiner. Furthermore, we optimize the IGS statistical characteristics for interference alignment. This improves the achievable rate performance as compared to the PGS, which is validated through numerical results.

  18. The European debate on rate systems in the interwar period

    International Nuclear Information System (INIS)

    Madureira, Nuno Luis

    2010-01-01

    This article describes a particular branch that evolved in the diffusion of electrical rate systems in twentieth-century Europe and the debate that ensued between the competitive, promotional and cost based approaches. Three major questions are addressed: What factors and historical circumstances favoured the emergence of more or less efficient pricing schemes? Why did some enterprises opt for promotional rates while others defended the cost based alternative? What is the historical origin of marginal cost pricing? It is shown how the volatility of the costs that characterize hydro-electric production made this particular technology very sensitive to a cost approach towards pricing and to a seasonal and time-of-day perspective on rate systems. (author)

  19. Schedule for Rating Disabilities; the Endocrine System. Final rule.

    Science.gov (United States)

    2017-11-02

    This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD) by revising the portion of the Schedule that addresses endocrine conditions and disorders of the endocrine system. The effect of this action is to ensure that the VASRD uses current medical terminology and to provide detailed and updated criteria for evaluation of endocrine disorders.

  20. 75 FR 13145 - SBA Lender Risk Rating System

    Science.gov (United States)

    2010-03-18

    ... SMALL BUSINESS ADMINISTRATION [Docket No. SBA-2010-0004] SBA Lender Risk Rating System AGENCY: Small Business Administration. ACTION: Notice; extension of comment period and correction. SUMMARY: On... of Credit Risk Management, U.S. Small Business Administration, 409 Third Street, SW., 8th Floor...

  1. The 1978 National Fire-Danger Rating System: technical documentation

    Science.gov (United States)

    Larry S. Bradshaw; John E. Deeming; Robert E. Burgan; Jack D. Cohen

    1984-01-01

    The National Fire-Danger Rating System (NFDRS), implemented in 1972, has been revised and reissued as the 1978 NFDRS. This report describes the full developmental history of the NFDRS, including purpose, technical foundation, and structure. Includes an extensive bibliography and appendixes.

  2. Rating PV Power and Energy: Cell, Module, and System Measurements

    Energy Technology Data Exchange (ETDEWEB)

    Emery, Keith

    2016-06-02

    A summary of key points related to research-level measurements of current vs. voltage measurement theory including basic PV operation, equivalent circuit, and concept of spectral error; PV power performance including PV irradiance sensors, simulators and commercial and generic I-V systems; PV measurement artifacts, intercomparisons, and alternative rating methods.

  3. Quality Rating and Improvement Systems and Children's Cognitive Development

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  4. Failure rate of piping in hydrogen sulphide systems

    International Nuclear Information System (INIS)

    Hare, M.G.

    1993-08-01

    The objective of this study is to provide information about piping failures in hydrogen sulphide service that could be used to establish failures rates for piping in 'sour service'. Information obtained from the open literature, various petrochemical industries and the Bruce Heavy Water Plant (BHWP) was used to quantify the failure analysis data. On the basis of this background information, conclusions from the study and recommendations for measures that could reduce the frequency of failures for piping systems at heavy water plants are presented. In general, BHWP staff should continue carrying out their present integrity and leak detection programmes. The failure rate used in the safety studies for the BHWP appears to be based on the rupture statistics for pipelines carrying sweet natural gas. The failure rate should be based on the rupture rate for sour gas lines, adjusted for the unique conditions at Bruce

  5. Clinical outcomes of hydronephrosis in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Hong, Seokchan; Kim, Yong-Gil; Ahn, Soo Min; Bae, Seung-Hyeon; Lim, Doo-Ho; Kim, Jeong Kon; Lee, Chang-Keun; Yoo, Bin

    2016-12-01

    Hydronephrosis is a rare complication of systemic lupus erythematosus (SLE). Bladder and/or gastrointestinal involvement in SLE are associated with development of hydronephrosis, but the management and treatment outcomes of hydronephrosis are largely unknown. Therefore, we investigated the clinical manifestations and factors associated with the treatment response in patients with SLE complicated by hydronephrosis. A retrospective analysis was performed of all 634 SLE patients who underwent computed tomography and/or ultrasonography between January 1998 and December 2013. We reviewed the clinical characteristics and treatment outcomes of patients with SLE-associated hydronephrosis. Hydronephrosis was identified in 15 patients with SLE complicated by cystitis and/or enteritis. All patients were treated initially with moderate to high doses of corticosteroids. A follow-up imaging study showed that 11 (73.3%) of 15 patients experienced improvements in hydronephrosis, and urinary obstruction was resolved without urological intervention in the majority of these patients (8/11, 72.7%). The four patients who experienced no improvement in hydronephrosis were older than those who responded to treatment (median age [interquartile range]; 43.0 [37.5-53.0] years vs. 28.0 [21.0-38.5] years; P = 0.026). In addition, delayed treatment (≥ 1 month after onset of symptoms) with corticosteroids was more frequently observed in the non-responding patients than in the responding patients (P = 0.011). Our findings suggest that treatment with corticosteroids alone leads to favorable outcomes in patients with SLE-associated hydronephrosis, except when treatment is delayed, particularly in elderly patients. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  6. Radiation dosemeters and ambient dose rate measuring systems

    International Nuclear Information System (INIS)

    Maushart, R.

    1985-01-01

    The manufacturers have got the feeling that the PTB only reluctantly accepts complex dosimetric systems or systems with modern digital and microprocessor technology. Especially the fact that the PTB demands a restriction to a defined system configuration which must not be changed after design approval is felt to be a severe handicap. The rigid frame of design qualification forces manufacturers to adopt a two-tier development line, at least for ambient dose rate measuring systems, and frequently it is not necessarily the 'nature' system, i.e. equipment with modern technology, that is sent in to the PTB for testing. The way of solving the problem could be that PTB more readily accepts less familiar technologies, for instance by more frequently approving equipment at least preliminarily or for a restricted period of time, in order to collect experience. Another way could be to grant licence for system components, especially detectors. (orig./HP) [de

  7. Health systems performance in sub-Saharan Africa: governance, outcome and equity.

    Science.gov (United States)

    Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale

    2011-04-16

    The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health

  8. Health systems performance in sub-Saharan Africa: governance, outcome and equity

    Directory of Open Access Journals (Sweden)

    Pokhrel Subhash

    2011-04-01

    Full Text Available Abstract Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the

  9. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

    Science.gov (United States)

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

    2014-02-01

    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  10. 35% Good Outcome Rate in IV-tPA treated Patients with CTA Confirmed Severe Anterior Circulation Occlusive Stroke

    Science.gov (United States)

    González, R. Gilberto; Furie, Karen L.; Goldmacher, Gregory V.; Smith, Wade S.; Kamalian, Shervin; Payabvash, Seyedmehdi; Harris, Gordon J.; Halpern, Elkan F.; Koroshetz, Walter J.; Camargo, Erica C. S.; Dillon, William P.; Lev, Michael H.

    2015-01-01

    BACKGROUND AND PURPOSE To determine the effect of IV-tPA on outcomes in patients with severe major anterior circulation ischemic stroke. METHODS Prospectively, 649 acute stroke patients had admission NIH stroke scale scores (NIHSS), non-contrast CT, CT angiography (CTA), and 6-month outcome assessed using modified Rankin scale (mRS). IV-tPA treatment decisions were made prior to CTA, at the time of non-contrast CT scanning, as per routine clinical protocol. Severe symptoms were defined as NIHSS>10. Poor outcome was defined as mRS>2. Major occlusions were identified on CTA. Univariate and multivariate stepwise-forward logistic regression analyses of the full cohort were performed. RESULTS Of 649 patients, 188 (29%) presented with NIHSS>10, and 64/188 (34%) of these received IV-tPA. Admission NIHSS, large artery occlusion, and IV-tPA all independently predicted good outcomes, however a significant interaction existed between IV-tPA and occlusion (p10 patients with anterior circulation occlusion, twice the percentage had good outcomes if they received IV-tPA (17/49, 35%), than if they did not (13/77, 17%; p=0.031). The “number needed to treat” was 7 (95% CI = 3–60). CONCLUSIONS IV-tPA treatment resulted in significantly more good outcomes in severely symptomatic stroke patients with major anterior circulation occlusions. The 35% good outcome rate was similar to rates found in endovascular therapy trials. Vascular imaging may help in patient selection and stratification for trials of IV-thrombolytic and endovascular therapies. PMID:24003051

  11. Comparing replacement rates under private and federal retirement systems.

    Science.gov (United States)

    Martin, Patricia P

    One measure of the adequacy of retirement income is replacement rate - the percentage of pre-retirement salary that is available to a worker in retirement. This article compares salary replacement rates for private-sector employees of medium and large private establishments with those for federal employees under the Civil Service Retirement System and the Federal Employees Retirement System. Because there is no standard benefit formula to represent the variety of formulas available in the private sector, a composite defined benefit formula was developed using the characteristics of plans summarized in the Bureau of Labor Statistics Medium and Large Employer Plan Survey. The resulting "typical" private-sector defined benefit plan, with an accompanying defined contribution plan, was then compared with the two federal systems. The Civil Service Retirement System (CSRS) is a stand-alone defined benefit plan whose participants are not covered by Social Security. Until passage of the 1983 Amendments to Social Security Act, it was the only retirement plan for most federal civilian employees. Provisions of the 1983 Amendments were designed to restore long-term financial stability to the Social Security trust funds. One provision created the Federal Employees Retirement System (FERS), which covers federal employees hired after 1983. It was one of the provisions designed to restore long-term financial stability to the Social Security trust funds. FERS employees contribute to and are covered by Social Security. FERS, which is a defined benefit plan, also includes a basic benefit and a 401(k)-type plan known as the Thrift Savings Plan (TSP). To compare how retirees would fare under the three different retirement systems, benefits of employees retiring at age 65 with 35 years of service were calculated using hypothetical workers with steady earnings. Workers were classified according to a percentage of the average wage in the economy: low earners (45 percent), average earners

  12. Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder

    Science.gov (United States)

    Suh, Joyce; Orinstein, Alyssa; Barton, Marianne; Chen, Chi-Ming; Eigsti, Inge-Marie; Ramirez-Esparza, Nairan; Fein, Deborah

    2016-01-01

    The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high…

  13. Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale.

    Science.gov (United States)

    Bellut, David; Burkhardt, Jan-Karl; Mannion, Anne F; Porchet, François

    2015-08-01

    OBJECT The aim of this study was to evaluate outcome in patients undergoing surgical treatment for intradural spinal tumor using a patient-oriented, self-rated, outcome instrument and a physician-based disease-specific instrument. METHODS Prospectively collected data from 63 patients with intradural spinal tumor were analyzed in relation to scores on the multidimensional patient-rated Core Outcome Measures Index (COMI) and the physician-rated modified McCormick Scale, before and at 3 and 12 months after surgery. RESULTS There was no statistically significant difference between the scores on the modified McCormick Scale preoperatively and at the 3-month follow-up, though there was a trend for improvement (p = 0.073); however, comparisons between the scores determined preoperatively and at the 12-month follow-up, as well as 3- versus 12-month follow-ups, showed a statistically significant improvement in each case (p 0.05) up to 12 months postoperatively. In contrast, the overall COMI score, "worst pain," quality of life, and social disability not only showed a significant reduction from before surgery to 3 months after surgery (p 0.05), but did show a significant improvement (p = 0.011) from 3 months to 12 months after surgery. At the 3- and 12-month follow-ups, 85.2% and 83.9% of patients, respectively, declared that the surgical procedure had helped/helped a lot; 95.1% and 95.2%, respectively, declared that they were satisfied/very satisfied with their care. CONCLUSIONS COMI is a feasible tool to use in the evaluation of baseline symptoms and outcome in patients undergoing surgery for intradural spinal tumor. COMI was able to detect changes in outcome at 3 months after surgery (before changes were apparent on the modified McCormick Scale) and on later postoperative follow-up. The COMI subdomains are valuable for monitoring the patient's reintegration into society and the work environment. The addition of an item that specifically covers neurological deficits may

  14. Impact of collateral circulation on early outcome and risk of hemorrhagic complications after systemic thrombolysis.

    Science.gov (United States)

    Brunner, Freimuth; Tomandl, Bernd; Hanken, Katrin; Hildebrandt, Helmut; Kastrup, Andreas

    2014-12-01

    In stroke patients, collateral flow can rapidly be assessed on computed tomography angiography (CTA). In this study, the impact of baseline collaterals on early outcome and risk of symptomatic intracerebral hemorrhages after systemic thrombolysis in patients with proximal arterial occlusions within the anterior circulation were analyzed. Collateralization scores were determined on the CT angiography source images (0 = absent; 1 ≤ 50%, 2 > 50% but collateral filling) of patients with distal intracranial carotid artery and/or M1 segment occlusions treated from 2008 to December 2011. A collateral score of 0 to 1 was designated as poor and 2 to 3 as good collateral vessel status. Outcome variables included in hospital mortality, favorable outcome at discharge (modified Rankin score ≤ 2), and rates of symptomatic intracerebral hemorrhage based on the European-Australasian Acute Stroke Study II definition. Among 246 subjects (mean age of 74 years; median National Institutes of Health Stroke Scale N at admission 14), 205 patients (83%) had good collaterals, whereas 41 patients (17%) had poor collaterals, respectively. Patients with poor collaterals had significantly higher rates of in-hospital mortality (41% vs. 12%, P collaterals. The grade of collateralization was independently associated with in-hospital mortality (P collaterals have a poor early functional outcome and high rates of symptomatic intracerebral hemorrhage after systemic thrombolysis. Since similar findings have also been reported after endovascular therapy, strategies to improve collateral blood flow should be assessed in this patient population. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  15. Outcomes of chronic dialysis in Korean children with respect to survival rates and causes of death

    OpenAIRE

    Chang, Hye Jin; Han, Kyoung Hee; Cho, Min Hyun; Park, Young Seo; Kang, Hee Gyung; Cheong, Hae Il; Ha, Il Soo

    2014-01-01

    Purpose Adult Korean patients on chronic dialysis have a 9-year survival rate of 50%, with cardiovascular problems being the most significant cause of death. The 2011 annual report of the North American Pediatric Renal Trials and Collaborative Studies group reported 3-year survival rates of 93.4% and relatively poorer survival in younger patients. Methods In this study, we have reviewed data from Korean Pediatric Chronic Kidney Disease Registry from 2002 to 2010 to assess survival rates and c...

  16. High rate tests of the LHCb RICH Upgrade system

    CERN Multimedia

    Blago, Michele Piero

    2016-01-01

    One of the biggest challenges for the upgrade of the LHCb RICH detectors from 2020 is to readout the photon detectors at the full 40 MHz rate of the LHC proton-proton collisions. A test facility has been setup at CERN with the purpose to investigate the behaviour of the Multi Anode PMTs, which have been proposed for the upgrade, and their readout electronics at high trigger rates. The MaPMTs are illuminated with a monochromatic laser that can be triggered independently of the readout electronics. A first series of tests, including threshold scans, is performed at low trigger rates (20 kHz) for both the readout and the laser with the purpose to characterise the behaviour of the system under test. Then the trigger rate is increased in two separate steps. First the MaPMTs are exposed to high illumination by triggering the pulsed laser at a high (20 MHz) repetition rate while the DAQ is readout at the same low rate as before. In this way the performance of the MaPMTs and the attached electronics can be evaluated ...

  17. Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

    Science.gov (United States)

    Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

    2017-04-01

    To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

  18. Patient Care Outcomes: Implications for the Military Health Services Systems

    Science.gov (United States)

    1991-05-05

    regionalization as a data driven decision. There is a growing body of information that supports the use of regionalization.7- 13 Overall, higher volume is...outcomes. American Journal of Hospital Pharmacy, 45, 1376-1378. 59. Epstein, A. M. (1990). The outcomes movement --will it get us where we want to go...Outcome assessment. (1987). New England Journal of Medicine, 317(4), 251-252. 177. Partridge, C. J. (1982). The outcome of physiotherapy and its

  19. Artificial Neural Network System to Predict the Postoperative Outcome of Percutaneous Nephrolithotomy.

    Science.gov (United States)

    Aminsharifi, Alireza; Irani, Dariush; Pooyesh, Shima; Parvin, Hamid; Dehghani, Sakineh; Yousofi, Khalilolah; Fazel, Ebrahim; Zibaie, Fatemeh

    2017-05-01

    To construct, train, and apply an artificial neural network (ANN) system for prediction of different outcome variables of percutaneous nephrolithotomy (PCNL). We calculated predictive accuracy, sensitivity, and precision for each outcome variable. During the study period, all adult patients who underwent PCNL at our institute were enrolled in the study. Preoperative and postoperative variables were recorded, and stone-free status was assessed perioperatively with computed tomography scans. MATLAB software was used to design and train the network in a feed forward back-propagation error adjustment scheme. Preoperative and postoperative data from 200 patients (training set) were used to analyze the effect and relative relevance of preoperative values on postoperative parameters. The validated adequately trained ANN was used to predict postoperative outcomes in the subsequent 254 adult patients (test set) whose preoperative values were serially fed into the system. To evaluate system accuracy in predicting each postoperative variable, predicted values were compared with actual outcomes. Two hundred fifty-four patients (155 [61%] males) were considered the test set. Mean stone burden was 6702.86 ± 381.6 mm 3 . Overall stone-free rate was 76.4%. Fifty-four out of 254 patients (21.3%) required ancillary procedures (shockwave lithotripsy 5.9%, transureteral lithotripsy 10.6%, and repeat PCNL 4.7%). The accuracy and sensitivity of the system in predicting different postoperative variables ranged from 81.0% to 98.2%. As a complex nonlinear mathematical model, our ANN system is an interconnected data mining tool, which prospectively analyzes and "learns" the relationships between variables. The accuracy and sensitivity of the system for predicting the stone-free rate, the need for blood transfusion, and post-PCNL ancillary procedures ranged from 81.0% to 98.2%.The stone burden and the stone morphometry were among the most significant preoperative characteristics that

  20. Performance of slow rate systems for treatment of domestic wastewater.

    Science.gov (United States)

    Tzanakakis, V E; Paranychianakis, N V; Angelakis, A N

    2007-01-01

    The performance of slow rate (SR) systems in terms of treatment efficiency, environmental and health risks, and land sustainability was investigated over a three-year period in a rural community close to Iraklio, Greece. Four plant species (Acacia cyanophylla, Eucalyptus camandulensis, Populus nigra and Arundo donax) were used in order to investigate the role of vegetation in the treatment of wastewater and in biomass production. Wastewater effluent was pre-treated in a septic tank before its application to land. Applied hydraulic loading rates were based on crop water requirements which were determined separately for each plant species. The evaluation of treatment performance was accomplished by measuring COD, TKN, NH3-N, NO3-N, total and reactive P, TC and FC in soil solution samples taken at different depths (15, 30 and 60 cm). SR systems showed great potential for COD, TKN and NH4-N removal which reached 89, 90 and 94%, respectively at a depth of 15 cm. An outstanding removal was also observed for TC and FC which reached 99.99%. The concentration of both P and NO3-N in soil solution increased with the passage of time, but it was lower in winter. Despite the differences in the application rates among the SR systems planted with different plant species, the treatment efficiency was not affected. Moreover, increasing the soil depth from 15 to 60 cm had no effect on the treatment efficiency of the SR systems.

  1. Rated power factor and excitation system of large turbine generator

    International Nuclear Information System (INIS)

    Tokumitsu, Iwao; Watanabe, Takashi; Banjou, Minoru.

    1979-01-01

    As for the rated power factor of turbine generators for thermal power stations, 90% has been adopted since around 1960. On the other hand, power transmission system has entered 500 kV age, and 1,000 kV transmission is expected in the near future. As for the supply of reactive power from thermal and nuclear turbine generators, the necessity of supplying leading reactive power has rather increased. Now, the operating power factor of thermal and nuclear generators becomes 96 to 100% actually. As for the excess stability of turbine generators owing to the strengthening of transmission system and the adoption of super-high voltage, the demand of strict conditions can be dealt with by the adoption of super-fast response excitation system of thyristor shunt winding self exciting type. The adoption of the turbine generators with 90 to 95% power factor and the adoption of the thyristor shunt winding self exciting system were examined and evaluated. The rated power factor of generators, excitation system and economy of adopting these systems are explained. When the power factor of generators is increased from 0.9 to 0.95, about 6% of saving can be obtained in the installation cost. When the thyristor shunt winding self excitation is adopted, it is about 10% more economical than AC excitation. (Kako, I.)

  2. Variations in multiple birth rates and impact on perinatal outcomes in Europe

    NARCIS (Netherlands)

    Heino, A.; Gissler, M.; Hindori-Mohangoo, A.D.; Blondel, B.; Klungsøyr, K.; Verdenik, I.; Mierzejewska, E.; Velebil, P.; Sól Ólafsdóttir, H.; Macfarlane, A.; Zeitlin, J.; et al.

    2016-01-01

    Objective. Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse

  3. Psychiatric Outcomes at Age Seven for Very Preterm Children: Rates and Predictors

    Science.gov (United States)

    Treyvaud, Karli; Ure, Alexandra; Doyle, Lex W.; Lee, Katherine J.; Rogers, Cynthia E.; Kidokoro, Hiroyuki; Inder, Terrie E.; Anderson, Peter J.

    2013-01-01

    Background: Uncertainty remains about the rate of specific psychiatric disorders and associated predictive factors for very preterm (VPT) children. The aims of this study were to document rates of psychiatric disorders in VPT children aged 7 years compared with term born children, and to examine potential predictive factors for psychiatric…

  4. High rate 4π β-γ coincidence counting system

    International Nuclear Information System (INIS)

    Johnson, L.O.; Gehrke, R.J.

    1978-01-01

    A high count rate 4π β-γ coincidence counting system for the determination of absolute disintegration rates of short half-life radionuclides is described. With this system the dead time per pulse is minimized by not stretching any pulses beyond the width necessary to satisfy overlap coincidence requirements. The equations used to correct for the β, γ, and coincidence channel dead times and for accidental coincidences are presented but not rigorously developed. Experimental results are presented for a decaying source of 56 Mn initially at 2 x 10 6 d/s and a set of 60 Co sources of accurately known source strengths varying from 10 3 to 2 x 10 6 d/s. A check of the accidental coincidence equation for the case of two independent sources with varying source strengths is presented

  5. Comodulation masking release in bit-rate reduction systems

    DEFF Research Database (Denmark)

    Vestergaard, Martin David; Rasmussen, Karsten Bo; Poulsen, Torben

    1999-01-01

    It has been suggested that the level dependence of the upper masking slope be utilized in perceptual models in bit-rate reduction systems. However, comodulation masking release (CMR) phenomena lead to a reduction of the masking effect when a masker and a probe signal are amplitude modulated...... with the same frequency. In bit-rate reduction systems the masker would be the audio signal and the probe signal would represent the quantization noise. Masking curves have been determined for sinusoids and 1-Bark-wide noise maskers in order to investigate the risk of CMR, when quantizing depths are fixed...... in accordance with psycho-acoustical principles. Masker frequencies of 500 Hz, 1 kHz, and 2 kHz have been investigated, and the masking of pure tone probes has been determined in the first four 1/3 octaves above the masker. Modulation frequencies between 6 and 20 Hz were used with a modulation depth of 0...

  6. Secondary standard dosimetry system with automatic dose/rate calculation

    International Nuclear Information System (INIS)

    Duftschmid, K.E.; Bernhart, J.; Stehno, G.; Klosch, W.

    1980-01-01

    A versatile and automated secondary standard instrument has been designed for quick and accurate dose/rate measurement in a wide range of radiation intensity and quality (between 1 μR and 100 kR; 0.2 nC/kg - 20C/kg) for protection and therapy level dosimetry. The system is based on a series of secondary standard ionization chambers connected to a precision digital current integrator with microprocessor circuitry for data evaluation and control. Input of measurement parameters and calibration factors stored in an exchangeable memory chip provide computation of dose/rate values in the desired units. The ionization chambers provide excellent long-term stability and energy response and can be used with internal check sources to test validity of calibration. The system is a useful tool particularly for daily measurements in a secondary standard dosimetry laboratory or radiation therapy center. (H.K.)

  7. Estimating marginal CO2 emissions rates for national electricity systems

    International Nuclear Information System (INIS)

    Hawkes, A.D.

    2010-01-01

    The carbon dioxide (CO 2 ) emissions reduction afforded by a demand-side intervention in the electricity system is typically assessed by means of an assumed grid emissions rate, which measures the CO 2 intensity of electricity not used as a result of the intervention. This emissions rate is called the 'marginal emissions factor' (MEF). Accurate estimation of MEFs is crucial for performance assessment because their application leads to decisions regarding the relative merits of CO 2 reduction strategies. This article contributes to formulating the principles by which MEFs are estimated, highlighting the strengths and weaknesses in existing approaches, and presenting an alternative based on the observed behaviour of power stations. The case of Great Britain is considered, demonstrating an MEF of 0.69 kgCO 2 /kW h for 2002-2009, with error bars at +/-10%. This value could reduce to 0.6 kgCO 2 /kW h over the next decade under planned changes to the underlying generation mix, and could further reduce to approximately 0.51 kgCO 2 /kW h before 2025 if all power stations commissioned pre-1970 are replaced by their modern counterparts. Given that these rates are higher than commonly applied system-average or assumed 'long term marginal' emissions rates, it is concluded that maintenance of an improved understanding of MEFs is valuable to better inform policy decisions.

  8. Positron imaging system with improved count rate and tomographic capability

    International Nuclear Information System (INIS)

    Muehllehner, G.; Buchin, M.P.

    1980-01-01

    Improvements to a positron camera imaging system are described. A pair of Angear-type scintillation cameras serve as the detectors, each camera being positioned on opposite sides of the organ of interest. Pulse shaping circuits reduce the pulse duration below 900 nanoseconds and the integration time below 500 noneseconds, improving the count rate capability and the counting statistics of the system and thus the image quality and processing speed. The invention also provides means for rotating the opposed camera heads about an axis which passes through the organ of interest. The cameras do not use collimators, and are capable of accepting radiation travelling in planes not perpendicular to the scintillation crystals. (LL)

  9. Drift chamber system for use in a high rate environment

    International Nuclear Information System (INIS)

    Etkin, A.

    1978-01-01

    A system of short drift distance (0.125'') drift chambers is described. This system is being built for use in the Brookhaven National Laboratory Multiparticle Spectrometer. These chambers will be able to handle beam rates of several million/pulse and give a spatial resolution of the order of 150 μm. Cathode readout will provide unique 3-dimensional points for each crack. The readout will utilize three custom built integrated circuits, a four channel amplifier-shaper, a four channel discriminator and a four channel shift register delay and time digitizer. A summary of test results on a prototype is also given

  10. Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury.

    Science.gov (United States)

    Deepika, Akhil; Devi, B Indira; Shukla, Dhaval

    2017-01-01

    Most patients with severe traumatic brain injury (TBI) are discharged when they have still not recovered completely. Many such patients are not available for follow up. We conducted this study to determine whether the condition at discharge from acute care setting, as assessed with disability rating scale (DRS), correlates with functional outcome at follow up. This study was conducted at a Neurosurgical intensive care unit (ICU) of a tertiary care referral center. This was a prospective observational study. Patients admitted to ICU with a diagnosis of severe TBI were enrolled for the study. On the day of discharge, all patients underwent DRS assessment. A final assessment was performed using Glasgow outcome scale extended (GOSE) at 6 months after discharge from the hospital. The correlation between the DRS scores at the time of discharge with DRS scores and GOSE categories at 6 months after discharge was determined using Spearman's rho correlation coefficient. A total of 88 patients were recruited for the study. The correlation coefficient of DRS at discharge for DRS at 6 months was 0.536 and for GOSE was -0.553. The area under the curve of DRS score at discharge for predicting unfavorable outcome and mortality at 6 months was 0.770 and 0.820, respectively. The predictive validity of DRS is fair to good in determining GOSE at follow-up. Pending availability of a more accurate outcome assessment tool, DRS at discharge can be used as a surrogate outcome for GOSE at follow up.

  11. Asymmetric Effects on Escape Rates of Bistable System

    International Nuclear Information System (INIS)

    Wang Canjun; Mei Dongcheng; Dai Zucheng

    2011-01-01

    The asymmetric effects on the escape rates from the stable states x ± in the bistable system are analyzed. The results indicate that the multiplicative noise and the additive noise always enhance the particle escape from stable states x ± of bistable. However, the asymmetric parameter r enhances the particle escape from stable state x + , and holds back the particle escape from stable state x - . (general)

  12. Integrating patient reported outcomes with clinical cancer registry data: a feasibility study of the electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) system.

    Science.gov (United States)

    Ashley, Laura; Jones, Helen; Thomas, James; Newsham, Alex; Downing, Amy; Morris, Eva; Brown, Julia; Velikova, Galina; Forman, David; Wright, Penny

    2013-10-25

    Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both Pplanning and for targeting service provision.

  13. Attendance Rates in A Workplace Predict Subsequent Outcome of Employment-Based Reinforcement of Cocaine Abstinence in Methadone Patients

    OpenAIRE

    Donlin, Wendy D; Knealing, Todd W; Needham, Mick; Wong, Conrad J; Silverman, Kenneth

    2008-01-01

    This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N  =  111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction period, participants provided urine samples but could work independent of their urinalysis results. After the induction period, participants had to prov...

  14. Fabrication and evaluation of variable rate fertilizer system

    Directory of Open Access Journals (Sweden)

    A Damirchi

    2015-09-01

    Full Text Available Introduction: In conventional farming, the soil and crop are considered uniform in different locations of the farm and the fertilizers are applied according to the average of soil needs with an additional percentage for safety (Loghavi, 2003. Non-essential chemical fertilizers in the field have harmful effects and social, economic and environmental concerns will increase. Many fertilizers go into the surface waters and ground waters and cause poisoning and environmental pollution without being absorbed by the plants. In variable rate technology, the soil fertilizer needs a map of all parts of the farm which is prepared with the GIS system. This map is uploaded on the computer before variable rate fertilizer machine starts. The computer continually controls the fertilizing rate for each part of the farm using a fertilizing map and global positioning system. The purpose of this study is to construct and evaluate a map-based variable rate fertilizer system that can be installed on a common fertilizer in Iran to be used as a variable rate system. Materials and methods: In common variable rate fertilizers, the rotational speed change of the distributor shaft is used to apply fertilizers. In this way, a DC motor is assembled on the main shaft of all distributors, which reduces the fertilizing accuracy. The reason for this is that there is no separation for units along the width of the fertilizer. Therefore, we used one DC motor for each distributor and another motor to rotate the agitator in the tank. System Set up: To design and select a suitable engine, the required torque for the rotation distributor shaft was measured by a torque meter and the amount of 2.1 Nm was acquired for that. With regard to the maximum rate of nitrogen fertilizer for land and tractor speed at the time of fertilizing, the order of 350 kg per hectare and 8 km per hour, the maximum distributor shaft speed and power required to rotate distributor shaft were calculated to be 55

  15. Low rate of membrane lithium transport during treatment correlates with outcome of maintenance pharmacotherapy in bipolar disorder.

    Science.gov (United States)

    Mallinger, A G; Frank, E; Thase, M E; Dippold, C S; Kupfer, D J

    1997-05-01

    Lithium is transported across cell membranes by an exchange diffusion process (Na(+)-Li+ countertransport) that is inhibited during lithium treatment. We hypothesized that low rates of lithium efflux (a potential manifestation of strong transport inhibition) would be associated with better clinical outcome of maintenance pharmacotherapy. We measured the erythrocyte (RBC) apparent rate constant for lithium efflux (kexch) in 22 patients with bipolar disorder who had been euthymic on lithium for 1 month. Subsequently, clinical mood ratings and in vivo RBC: plasma lithium ratios (LiR) were determined monthly. Outcome was categorized according to whether subjects completed 1 year of successful maintenance treatment (n = 10), experienced a recurrent affective episode (n = 8), or dropped out (n = 4). The kexch at the outset of the study was significantly lower (potentially because of greater transport inhibition) in 1-year completers than in patients with recurrences or those who dropped out (median kexch = 0.09, 0.24, and 0.27 h-1, respectively; P lower were successfully maintained on lithium for 1 year, whereas only 23% of those with a kexch greater than or equal to 0.12 h-1 had a successful treatment outcome. LiR measured during the course of maintenance treatment was significantly higher (suggesting greater transport inhibition) in 1-year completers than in noncompleters (recurrences and dropouts). Measurement of kexch at an early point in treatment may provide a means for prospectively identifying those bipolar patients at greater risk for failure of maintenance lithium therapy.

  16. Optimizing Discount Rates: Expressing Preferences for Sustainable Outcomes in Present Value Calculations

    OpenAIRE

    Axelrod, David

    2017-01-01

    This paper describes how the discount rate used in present value calculations expresses the preference for sustainability in decision making, and its implication for sustainable economic growth. In essence, the lower the discount rate, the greater the regard for the future, and the more likely we choose behaviors that lead to long-term sustainability. The theoretical framework combines behavioral economics and holonomics, which involve limitations of regard for the future due to constraints o...

  17. Association Between Physician Teamwork and Health System Outcomes Following Coronary Artery Bypass Grafting

    Science.gov (United States)

    Hollingsworth, John M.; Funk, Russell J.; Garrison, Spencer A.; Owen-Smith, Jason; Kaufman, Samuel A.; Pagani, Francis D.; Nallamothu, Brahmajee K.

    2017-01-01

    Background Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether “teamwork” (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system’s teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (standard deviation for the bipartite clustering coefficient was 0.09). While health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (e.g., physician staff size, surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions Health systems with physicians who tend to work together in tightly knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. PMID:28263939

  18. Short and long term mortality rates associated with first pregnancy outcome: population register based study for Denmark 1980-2004.

    Science.gov (United States)

    Reardon, David C; Coleman, Priscilla K

    2012-09-01

    There is a growing interest in examining death rates associated with different pregnancy outcomes for time periods beyond one year. Previous population studies, however, have failed to control for complete reproductive histories. In this study we seek to eliminate the potential confounding effect of unknown prior pregnancy history by examining mortality rates associated specifically with first pregnancy outcome alone. We also examine differences in mortality rates associated with early abortion and late abortions (after 12 weeks). Medical records for the entire population of women born in Denmark between 1962 and 1991 and were alive in 1980, were linked to death certificates. Mortality rates associated with first pregnancy outcomes (delivery, miscarriage, abortion, and late abortion) were calculated. Odds ratios examining death rates based on reproductive outcomes, adjusted for age at first pregnancy and year of women's births, were also calculated. A total of 463,473 women had their first pregnancy between 1980 and 2004, of whom 2,238 died. In nearly all time periods examined, mortality rates associated with miscarriage or abortion of a first pregnancy were higher than those associated with birth. Compared to women who delivered, the age and birth year adjusted cumulative risk of death for women who had a first trimester abortion was significantly higher in all periods examined, from 180 days (OR=1.84; 1.11 <95% CI <3.71) through 10 years (1.39; 1.22 <95% CI <1.61), as was the risk for women who had abortions after 12 weeks from one year (OR=4.31; 2.18 <95% CI <8.54) through 10 years (OR=2.41; 1.56 <95% CI <2.41). For women who miscarried, the risk was significantly higher for cumulative deaths through 4 years (OR=1.75; 1.34 <95% CI <2.27) and at 10 years (OR=1.48; 1.18 <95% CI <1.85). Compared to women who delivered, women who had an early or late abortion had significantly higher mortality rates within 1 through 10 years. A lesser effect may also be present

  19. Genetic Variation in the Dopamine System Influences Intervention Outcome in Children with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Rochellys Diaz Heijtz

    2018-02-01

    Interpretation: Naturally occurring genetic variation in the dopamine system can influence treatment outcomes in children with cerebral palsy. A polygenic dopamine score might be valid for treatment outcome prediction and for designing individually tailored interventions for children with cerebral palsy.

  20. Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital

    Directory of Open Access Journals (Sweden)

    Chirag Mathukia

    2015-04-01

    Full Text Available Background and objective: Severe adverse events such as cardiac arrest and death are often heralded by abnormal vital signs hours before the event. This necessitates an organized track and trigger approach of early recognition and response to subtle changes in a patient's condition. The Modified Early Warning System (MEWS is one of such systems that use temperature, blood pressure, pulse, respiratory rate, and level of consciousness with each progressive higher score triggering an action. Root cause analysis for mortalities in our institute has led to the implementation of MEWS in an effort to improve patient outcomes. Here we discuss our experience and the impact of MEWS implementation on patient care at our community academic hospital. Methods: MEWS was implemented in a protocolized manner in June 2013. The following data were collected from non-ICU wards on a monthly basis from January 2010 to June 2014: 1 number of rapid response teams (RRTs per 100 patient-days (100PD; 2 number of cardiopulmonary arrests ‘Code Blue’ per 100PD; and 3 result of each RRT and Code Blue (RRT progressed to Code Blue, higher level of care, ICU transfer, etc.. Overall inpatient mortality data were also analyzed. Results: Since the implementation of MEWS, the number of RRT has increased from 0.24 per 100PD in 2011 to 0.38 per 100PD in 2013, and 0.48 per 100PD in 2014. The percentage of RRTs that progressed to Code Blue, an indicator of poor outcome of RRT, has been decreasing. In contrast, the numbers of Code Blue in non-ICU floors has been progressively decreasing from 0.05 per 100PD in 2011 to 0.02 per 100PD in 2013 and 2014. These improved clinical outcomes are associated with a decline of overall inpatient mortality rate from 2.3% in 2011 to 1.5% in 2013 and 1.2% in 2014. Conclusions: Implementation of MEWS in our institute has led to higher rapid response system utilization but lower cardiopulmonary arrest events; this is associated with a lower mortality

  1. Effect of a provincial system of stroke care delivery on stroke care and outcomes

    Science.gov (United States)

    Kapral, Moira K.; Fang, Jiming; Silver, Frank L.; Hall, Ruth; Stamplecoski, Melissa; O’Callaghan, Christina; Tu, Jack V.

    2013-01-01

    Background: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. Methods: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. Results: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system’s implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. Interpretation: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke. PMID:23713072

  2. Physics Education: Desired outcomes, minds, and learning systems

    Science.gov (United States)

    van Heuvelen, Alan

    2000-11-01

    Recent studies and surveys indicate that the workplace is looking for different outcomes than are emphasized in traditional physics instruction. Cognitive science has learned much about the operation of our minds. Physicists have now systematically studied student learning in physics for about 30 years. What has been learned from these different studies that can help us achieve the desired outcomes in our large (and small) introductory physics courses? The talk will focus on these three ideas: the desired outcomes, student minds (very brief), and pedagogical strategies and activities that help achieve these outcomes.

  3. 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.

  4. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2009-09-01

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  5. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2012-01-31

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  6. Comparability of the Social Skills Improvement System to the Social Skills Rating System: A Norwegian Study

    Science.gov (United States)

    Gamst-Klaussen, Thor; Rasmussen, Lene-Mari P.; Svartdal, Frode; Strømgren, Børge

    2016-01-01

    The Social Skills Improvement System-Rating Scales (SSIS-RS) is a multi-informant instrument assessing social skills and problem behavior in children and adolescents. It is a revised version of the Social Skills Rating System (SSRS). A Norwegian translation of the SSRS has been validated, but this has not yet been done for the Norwegian…

  7. Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation

    DEFF Research Database (Denmark)

    Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa

    2018-01-01

    BACKGROUND: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. DESIGN: We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling el...

  8. Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders M; Bang, Casper N; Berg, Ronan M G

    2015-01-01

    BACKGROUND: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown. METHODS: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS)...

  9. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study.

    Science.gov (United States)

    Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

    2016-12-01

    Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to

  10. Disagreements in meta-analyses using outcomes measured on continuous or rating scales: observer agreement study

    DEFF Research Database (Denmark)

    Tendal, Britta; Higgins, Julian P T; Jüni, Peter

    2009-01-01

    difference (SMD), the protocols for the reviews and the trial reports (n=45) were retrieved. DATA EXTRACTION: Five experienced methodologists and five PhD students independently extracted data from the trial reports for calculation of the first SMD result in each review. The observers did not have access...... to the reviews but to the protocols, where the relevant outcome was highlighted. The agreement was analysed at both trial and meta-analysis level, pairing the observers in all possible ways (45 pairs, yielding 2025 pairs of trials and 450 pairs of meta-analyses). Agreement was defined as SMDs that differed less...... than 0.1 in their point estimates or confidence intervals. RESULTS: The agreement was 53% at trial level and 31% at meta-analysis level. Including all pairs, the median disagreement was SMD=0.22 (interquartile range 0.07-0.61). The experts agreed somewhat more than the PhD students at trial level (61...

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

    Directory of Open Access Journals (Sweden)

    Gayatri Desai

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

  12. Green roofs and the LEED green building rating system

    Energy Technology Data Exchange (ETDEWEB)

    Kula, R. [Sustainable Solutions Inc., Wagoner, OK (United States)

    2005-07-01

    The sustainable building industry is becoming increasingly aware of the host of public and private benefits that green roofs can provide in built environments. In dense urban environments, green roofs function to reduce stormwater runoff, urban heat island effects, and particulate matter (PM) pollution. The emerging green roof industry is now poised to support the efforts of green building networks in North America. This paper discussed the general benefits of green roofs, and their recognition within the Leadership in Energy and Environmental Design (LEED) Green Building Rating System. A case study of Mountain Equipment Co-op's Winnipeg site was presented. The building's green roof was directly responsible for earning 5 credits and contributing to the achievement of an additional 2 credits under the LEEDS certification process. Credits were earned for reduced site disturbance; landscape design to reduce heat islands; and water efficiency. The green roof at the site provided the vast majority of the building's cooling needs through an evaporative cooling trough. A photovoltaic pump was used to feed the building's irrigation system, as well as to pump ground water through cooling valances. It was concluded that the rise of sustainable building practices and the LEED Green Building Rating System will revolutionize the way new buildings are constructed.

  13. Fluctuations of Estimated Glomerular Filtration Rate Outside Kidney Disease Improving Global Outcomes Diagnostic Criteria for Acute Kidney Injury in End-Stage Liver Disease Outpatients and Outcome Postliver Transplantation

    Directory of Open Access Journals (Sweden)

    Federica Fiacco, MD

    2018-01-01

    Full Text Available Background. Renal dysfunction in end-stage liver disease (ESLD results from systemic conditions that affect both liver and kidney with activation of vasoconstrictor systems. In this setting, estimated glomerular filtration rate (eGFR may undergo variations often outside Kidney Disease Improving Global Outcomes criteria for acute kidney injury (AKI diagnosis, whose meaning is not clear. The aim of this study was to evaluate eGFR variations in ESLD outpatients listed for liver transplant (liver Tx and the association with post-Tx outcome. Methods. Fifty-one patients with ESLD were retrospectively evaluated from listing to transplant (L-Tx time, intraoperatively (Tx time, and up to 5 years post-Tx time. Variations between the highest and the lowest eGFR occurring in more than 48 hours, not satisfying Kidney Disease Improving Global Outcomes guideline, were considered as fluctuations (eGFR-F. Fluctuations of eGFR greater than 50% were defined as eGFR drops (DeGFR. Early graft dysfunction, AKI within 7 days, chronic kidney disease, and short- and long-term patient survivals were considered as outcomes. Results. All patients presented eGFR-F, whereas DeGFR were observed in 18 (35.3% of 51 (DeGFR+ group. These patients presented higher levels of Model for End-stage Liver Disease score, pre-Tx bilirubin and significantly greater incidence of post-Tx AKI stages 2 to 3 compared with patients without drops (DeGFR−. DeGFR was the only independent predictive factor of the occurrence of post-Tx AKI. The occurrence of AKI post-Tx was associated with the development of chronic kidney disease at 3 months and 5 years post-Tx. Conclusions. Drops of eGFR are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome.

  14. 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 ...

  15. Self-rated health as a predictor of outcomes of type 2 diabetes patient education programmes in Denmark

    DEFF Research Database (Denmark)

    Laursen, D. H.; Christensen, K. B.; Christensen, U.

    2016-01-01

    OBJECTIVE: To explore if self-rated health (SRH) can predict differences in outcomes of patient education programmes among patients with type 2 diabetes over time. STUDY DESIGN: This is an observational cohort study conducted among 83 patients with type 2 diabetes participating in patient educati...... education, as measured by the HeiQ, at 12 months. Only participants with optimal SRH appeared to benefit from patient education. Other patient characteristics may be responsible to explain the observed difference between patients with optimal and poor SRH.......OBJECTIVE: To explore if self-rated health (SRH) can predict differences in outcomes of patient education programmes among patients with type 2 diabetes over time. STUDY DESIGN: This is an observational cohort study conducted among 83 patients with type 2 diabetes participating in patient education...... programmes in the Capital Region of Denmark. METHODS: Questionnaire data were collected by telephone interview at baseline and 2 weeks (77 participants, 93%) and 12 months (66, 80%) after the patient education ended. The seven-scale Health Education Impact Questionnaire (HeiQ) was the primary outcome...

  16. Early quality of life outcomes in patients with prostate cancer managed by high-dose-rate brachytherapy as monotherapy

    International Nuclear Information System (INIS)

    Komiya, Akira; Fujiuchi, Yasuyoshi; Ito, Takatoshi

    2013-01-01

    The purpose of this study was to evaluate the early quality of life outcomes in prostate cancer patients managed by high-dose-rate brachytherapy as monotherapy. A total of 51 patients with cT1c-T3aN0M0 prostate cancer treated between July 2007 and January 2010 were included in this study. The average age was 69?years, and the average initial serum prostate-specific antigen was 10.98?ng/mL. A total of 25, 18 and eight patients were considered to be low, intermediate and high risk, respectively. All patients received one implant of Ir-192 and seven fractions of 6.5?Gy within 3.5?days for a total prescribed dose of 45.5?Gy. For high-risk prostate cancer, neoadjuvant androgen deprivation therapy was carried out for at least 6?months, and continued after high-dose-rate brachytherapy. Quality of life outcomes were measured by using the International Prostate Symptom Score, the Functional Assessment of Cancer Therapy-Prostate and the International Index of Erectile Function Questionnaire. The oncological outcome was assessed by serum prostate-specific antigen and diagnostic imaging. Adverse events were also recorded. The Functional Assessment of Cancer Therapy-Prostate scores decreased for a few months after high-dose-rate brachytherapy, and recovered to pretreatment condition thereafter. The International Prostate Symptom Score significantly increased 2?weeks after treatment for each of its items and their sum, and it returned to baseline after 12?weeks. Sexual function decreased at 2 and 4?weeks, and recovered after 12?weeks. Severe complications were rare. Within a median follow up of 17.2?months, two patients showed a prostate-specific antigen recurrence. High-dose-rate brachytherapy for prostate cancer is a feasible treatment modality with acceptable toxicity and only a limited impact on the quality of life. (author)

  17. Osteo-odonto keratoprosthesis: systematic review of surgical outcomes and complication rates.

    Science.gov (United States)

    Tan, Anna; Tan, Donald T; Tan, Xiao-Wei; Mehta, Jodhbir S

    2012-01-01

    Case series on osteo-odonto keratoprosthesis (OOKP) published in English from 1950-June 2010 were identified in Medline/PubMed. Indications for surgery, visual acuity, anatomical survival, complication and repeat surgery rates were compared among the different studies. Our own case series is a retrospective review of all OOKP surgeries performed in our center from February 2004-July 2011. Eight case series including our own were systematically reviewed. Sample sizes ranged from 4-181 eyes. The most common indications for surgery were severe cases of Stevens-Johnson syndrome and thermal and chemical burns that were unamenable to other forms of surgery or had had previous surgical failure. Anatomical survival rate in all the studies was 87.8% (range 67-100%) at 5 years, and three studies showed survival rates of 81.0% (range 65-98%) at 20 years. Visual acuity was more than 6/18 in 52% (range 46-72%) of the eyes with OOKP surgery. The most common intraoperative complication was vitreous hemorrhage (0-52%) and the most common long-term blinding complication was glaucoma (7-47%). Endophthalmitis rates ranged from 2-8%. The most common repeat surgical procedure was mucosal trimming due to mucosal overgrowth at the optical cylinder and mucosal grafting for extrusion of the OOKP or mucosal ulceration. Of the available biological and synthetic keratoprosthesis, OOKP appears to be an excellent option for the treatment of end-stage corneal diseases. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Outcome of Membrane Sweeping in Reducing Induction Rates in Post-Date Pregnancies

    International Nuclear Information System (INIS)

    Saleem, U.; Mustafa, N.; Akhtar, S.

    2013-01-01

    Objectives: To determine the effectiveness of membrane sweeping in reducing need for induction of labour in post-date pregnancies and to enlist types and frequencies of complications experienced with membrane sweeping. Study Design: Randomized Control trial. Setting and Duration of Study: The study was carried out at Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore from February 2007 to April 2008. Patients and Methods: One hundred primi or second gravidas with uncomplicated singleton pregnancies having cephalic presentation at 40+1-5 weeks of gestation were enrolled after informed consent, and divided randomly into two groups of fifty each. Biophysical profile of 8/8 for each case was ensured. Group A underwent membrane sweeping while group B did not. All patients not having spontaneous labour were induced at 40+5 weeks. Data regarding number of patients having spontaneous labour or induction of labour was recorded. Mode of delivery either vaginal or cesarean birth was also recorded. In group A occurence of complications i.e vaginal bleeding or leaking, discomfort, irregular pains, fever and neonatal sepsis was recorded. Results: The difference in rate of spontaneous labor, induction rate and mode of delivery was insignificant between both the groups (p>0.05). In group A, 44% felt discomfort, 4% had bleeding per vaginum, 2% had leaking per vaginum and 28% had more than one complication. There were no cases of maternal or neonatal sepsis. Twenty percent did not have any side effects. Conclusion: Sweeping of membranes is not effective in reducing induction rates in post dates pregnancies. It does not improve the spontaneous labour rate and there is no effect on the mode of delivery. Therefore, any potential benefits of this intervention must be balanced against risk of maternal discomfort and other adverse effects. (author)

  19. OPERABILITY RATE OF DISTAL GASTRIC CANCER AND THE EFFECT OF GASTRIC OUTLET OBSTRUCTION IN THE OPERABILITY RATE AND POSTOPERATIVE OUTCOME- A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Rajesh T. R

    2017-10-01

    Full Text Available BACKGROUND Stomach cancer is the fourth most common malignancy in the world. 1 Except in countries where screening for stomach cancer is prevalent, most of the distal stomach tumours are diagnosed at advanced stage. Gastric outlet obstruction is usually believed to be a sign of locally-advanced disease. Complete surgical removal of the disease (R0 is the only potentially curative treatment for resectable gastric cancer. The aim of the study is to finda The operability rate of gastric cancer in our institution and the incidence of Gastric Outlet Obstruction (GOO in patients undergoing gastrectomy for distal gastric cancer. b To compare the postoperative outcome in patients with gastric outlet obstruction and those without gastric outlet obstruction. c To see if the histology of the tumour has any role in the development of GOO. MATERIALS AND METHODS This is a retrospective study. The study includes patients who were admitted with carcinoma stomach and underwent operative or nonoperative treatment in our institution during 2013 to 2015. RESULTS Overall operability rate was 45.8%. Operable patients in the GOO group were 47%. Operability in the no outlet obstruction group were 45%. Data shows a slightly increased predilection for GOO in diffuse and mixed type of tumours (statistically not significant. Intestinal tumours had significant rate of anaemia compared to diffuse tumours (p <0.005. Overall mortality was 6.7%. Mortality is higher in the GOO group (8.8%. CONCLUSION (a. Operability rate of distal gastric cancer in our institution is 45.8%. (b. Incidence of gastric outlet obstruction in patients undergoing gastrectomy is 38.2%. (c. Presence of gastric outlet obstruction does not influence operability rate (47% vs. 45%. (d. Morbidity and mortality after distal radical gastrectomy is comparable in both groups. (e. Both intestinal and diffuse histology have equal incidence of GOO. (f. Chronic blood loss and incidence of anaemia is more in

  20. Safety handling manual for high dose rate remote afterloading system

    International Nuclear Information System (INIS)

    1999-01-01

    This manual is mainly for safety handling of 192 Ir-RALS (remote afterloading system) of high dose rate and followings were presented: Procedure and document format for the RALS therapy and for handling of its radiation source with the purpose of prevention of human errors and unexpected accidents, Procedure for preventing errors occurring in the treatment schedule and operation, and Procedure and format necessary for newly introducing the system into a facility. Consistency was intended in the description with the quality assurance guideline for therapy with small sealed radiation sources made by JASTRO (Japan Society for Therapeutic Radiology and Oncology). Use of the old type 60 Co-RALS was pointed out to be a serious problem remained and its safety handling procedure was also presented. (K.H.)

  1. Sum-Rate Maximization of Coordinated Direct and Relay Systems

    DEFF Research Database (Denmark)

    Sun, Fan; Popovski, Petar; Thai, Chan

    2012-01-01

    Joint processing of multiple communication flows in wireless systems has given rise to a number of novel transmission techniques, notably the two-way relaying based on wireless network coding. Recently, a related set of techniques has emerged, termed coordinated direct and relay (CDR) transmissions......, where the constellation of traffic flows is more general than the two-way. Regardless of the actual traffic flows, in a CDR scheme the relay has a central role in managing the interference and boosting the overall system performance. In this paper we investigate the novel transmission modes, based...... on amplify-and-forward, that arise when the relay is equipped with multiple antennas and can use beamforming. We focus on one representative traffic type, with one uplink and one downlink users and consider the achievable sum-rate maximization relay beamforming. The beamforming criterion leads to a non...

  2. 75 FR 9257 - SBA Lender Risk Rating System

    Science.gov (United States)

    2010-03-01

    ... Liquidation Rate; 3. Gross Delinquency Rate; 4. Gross Past-Due Rate; 5. Six (6) Month Net Flow Indicator; 6.... The statistical analysis performed showed that incorporating the Portfolio Size/Age component improved...) Month Delinquency Rate; 3. Gross Delinquency Rate; 4. Gross Past-Due Rate; 5. Average Small Business...

  3. Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates.

    Science.gov (United States)

    Schuster, Bernd

    2015-06-01

    Injection rhinoplasty offers an attractive, reversible alternative to surgery. Here we assessed outcome, longevity of benefits, adverse effects, and patient assessment of injection rhinoplasty, using degradable synthetic fillers. Forty-six patients who underwent injection rhinoplasty using degradable fillers over the past 3 years were assessed (calcium hydroxyapatite: 26 patients, hyaluronic acid: 20 patients). Comparison of pre- and postoperative images indicated realistically achievable treatment results. Patient satisfaction was assessed using a 5-point questionnaire at 3 weeks and 9 months posttreatment. Forty-six patients (88 areas) were treated. At 3 weeks posttreatment, 85% of patients were satisfied with treatment results. At 9 months or later posttreatment, 87% of patients were very/completely satisfied with treatment results, regardless of filler used. Treatment longevity varied between 6 and 30 months (mean: 13.5 months). Positive evaluation was mainly due to accurate prediction of achievable results to meet patient expectations. There were one moderate and two severe complications, all following calcium hydroxyapatite treatment. Two resolved completely following treatment and one patient was lost to follow-up. This resulted in subsequent exclusive use of hyaluronic acid filler. Injectable biodegradable fillers are effective for correction of minor nasal deformities or irregularities. Attention must be given to injection technique and adverse effect management. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. A review on leakage rate tests for containment isolation systems

    International Nuclear Information System (INIS)

    Kim, In Goo; Kim, Hho Jung

    1992-01-01

    Wide experiences in operating containment isolation systems have been accumulated in Korea since 1978. Hence, it becomes necessary to review the operating data in order to confirm the integrity of containments with about 50 reactor-years of experience and to establish the future direction to the containment test program. The objectives of present work are to collect, consolidate and assess the leakage rate data, and then to find out dominant leakage paths and factors affecting integrated leakage rate test. General trends of overall leakage show that more careful surveillance during pre-operational test can reduce the containment leakage. Dominant leakage paths are found to be through air locks and large-sized valves, such as butterfly valves of purge lines, so that weighted surveillance and inspection on these dominant leakage paths can considerably reduce the containment leakage. The atmosphere stabilization are found to be the most important to obtain the reliable result. In order to get well stabilized atmosphere, temperature and flow rate of compressed air should be kept constant and it is preferable not to operate fan cooler during pressurizing the containment for test

  5. HydroCoils, occlusion rates, and outcomes: a large single-center study.

    LENUS (Irish Health Repository)

    O'Hare, A M

    2010-11-01

    The HydroCoil is an expansile hydrogel coil designed to produce a greater degree of volumetric packing within cerebral aneurysms when compared with bare platinum coils. This increased packing is, in turn, believed to decrease the risk of recurrence within aneurysms and hence the risk of their rupture in the long term. The aim of this work was to assess whether the use of HydroCoils and the proportion of HydroCoil used have any influence on the subsequent occlusion and recurrence rates of treated aneurysms.

  6. Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies

    NARCIS (Netherlands)

    Van Gelder, Isabelle C.; Wyse, D. George; Chandler, Mary L.; Cooper, Howard A.; Olshansky, Brian; Hagens, Vincent E.; Crijns, Harry J. G. M.

    2006-01-01

    Aims The AFFIRM and RACE studies showed that rate control is an acceptable treatment strategy for atrial, fibrillation (AF). We examined whether strict rate control offers benefit over more lenient rate control. Methods and Results We compared the outcome of patients enrolled in the rate-control

  7. A rating system for post pulse data validation

    International Nuclear Information System (INIS)

    Buceti, G.; Centioli, Cristina; Iannone, F.; Panella, M.; Rizzo, A.; Vitale, V.

    2003-01-01

    The aim of an automatic data validation system in a fusion experiment is to account--after every shot--for any occurrence of faulty sensors and unreliable measurements, thus preventing the proliferation of poor pulse data. In the past years a prototype has been successfully developed at Frascati Tokamak Upgrade (FTU) on a small set of density measurements. The results have shown that the model can be further extended to plant and diagnostic data, and that the same system can be used to assign to raw data a quality factor, to be stored in the archive and to be used in the post-shot elaboration phase as a selection criterion. In this way, a data validation system can also provide data analysts with an useful tool to be used as a key--together with other significant parameters, like plasma current, or magnetic field--to search the archive for quality data. This paper will describe how, using soft computing techniques, both these functions have been implemented on FTU, providing the users with a simple interface for fault detection developed in an open source environment (PHP-MySQL), to be finalised into the realisation of an overall rating system for FTU data

  8. A rating system for post pulse data validation

    Energy Technology Data Exchange (ETDEWEB)

    Buceti, G.; Centioli, Cristina E-mail: centioli@frascati.enea.it; Iannone, F.; Panella, M.; Rizzo, A.; Vitale, V

    2003-09-01

    The aim of an automatic data validation system in a fusion experiment is to account--after every shot--for any occurrence of faulty sensors and unreliable measurements, thus preventing the proliferation of poor pulse data. In the past years a prototype has been successfully developed at Frascati Tokamak Upgrade (FTU) on a small set of density measurements. The results have shown that the model can be further extended to plant and diagnostic data, and that the same system can be used to assign to raw data a quality factor, to be stored in the archive and to be used in the post-shot elaboration phase as a selection criterion. In this way, a data validation system can also provide data analysts with an useful tool to be used as a key--together with other significant parameters, like plasma current, or magnetic field--to search the archive for quality data. This paper will describe how, using soft computing techniques, both these functions have been implemented on FTU, providing the users with a simple interface for fault detection developed in an open source environment (PHP-MySQL), to be finalised into the realisation of an overall rating system for FTU data.

  9. A high rate clarifier for load levelling in sewerage systems.

    Science.gov (United States)

    Jago, R A; Davey, A; Li, H

    2003-01-01

    The combining of chemically assisted clarification with a proprietary physical separation technology has led to a high rate process for clarifying flocculated sewage and other waste streams. This hybrid physico-chemical system, known as the CDS Fine Solids Separation (FSS) System, was developed over a two year period within a sewage treatment plant environment. This paper summarises the results of a recent field trial of the system with a Victorian water authority which experiences heavy loading of sewers in a coastal town during holiday periods. The trial sought to evaluate the FSS as a tool for smoothing the load on the 11 km long sewer to the sewage treatment plant (STP). The FSS system could possibly enable the costly augmentation of the sewer to be deferred, particularly as the capacity of the existing sewer pipe is satisfactory for most of the year. Water quality parameters were determined for a range of flowrates and operational conditions over a two month period. Large reductions were achieved in TSS, TP, FC, turbidity and BOD5, with only minimal reductions in NH3 and TON. These results showed that the FSS could meet the authority's objectives for load levelling and would provide a 20-25% increase in effective sewer capacity. The data are also discussed in terms of possible use of the effluent from the FSS for water reuse applications.

  10. New classification system-based visual outcome in Eales′ disease

    Directory of Open Access Journals (Sweden)

    Saxena Sandeep

    2007-01-01

    Full Text Available Purpose: A retrospective tertiary care center-based study was undertaken to evaluate the visual outcome in Eales′ disease, based on a new classification system, for the first time. Materials and Methods: One hundred and fifty-nine consecutive cases of Eales′ disease were included. All the eyes were staged according to the new classification: Stage 1: periphlebitis of small (1a and large (1b caliber vessels with superficial retinal hemorrhages; Stage 2a: capillary non-perfusion, 2b: neovascularization elsewhere/of the disc; Stage 3a: fibrovascular proliferation, 3b: vitreous hemorrhage; Stage 4a: traction/combined rhegmatogenous retinal detachment and 4b: rubeosis iridis, neovascular glaucoma, complicated cataract and optic atrophy. Visual acuity was graded as: Grade I 20/20 or better; Grade II 20/30 to 20/40; Grade III 20/60 to 20/120 and Grade IV 20/200 or worse. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. Results: Vitreous hemorrhage was the commonest presenting feature (49.32%. Cases with Stages 1 to 3 and 4a and 4b achieved final visual acuity ranging from 20/15 to 20/40; 20/80 to 20/400 and 20/200 to 20/400, respectively. Statistically significant improvement in visual acuities was observed in all the stages of the disease except Stages 1a and 4b. Conclusion: Significant improvement in visual acuities was observed in the majority of stages of Eales′ disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales′ disease.

  11. The mechanics of granitoid systems and maximum entropy production rates.

    Science.gov (United States)

    Hobbs, Bruce E; Ord, Alison

    2010-01-13

    A model for the formation of granitoid systems is developed involving melt production spatially below a rising isotherm that defines melt initiation. Production of the melt volumes necessary to form granitoid complexes within 10(4)-10(7) years demands control of the isotherm velocity by melt advection. This velocity is one control on the melt flux generated spatially just above the melt isotherm, which is the control valve for the behaviour of the complete granitoid system. Melt transport occurs in conduits initiated as sheets or tubes comprising melt inclusions arising from Gurson-Tvergaard constitutive behaviour. Such conduits appear as leucosomes parallel to lineations and foliations, and ductile and brittle dykes. The melt flux generated at the melt isotherm controls the position of the melt solidus isotherm and hence the physical height of the Transport/Emplacement Zone. A conduit width-selection process, driven by changes in melt viscosity and constitutive behaviour, operates within the Transport Zone to progressively increase the width of apertures upwards. Melt can also be driven horizontally by gradients in topography; these horizontal fluxes can be similar in magnitude to vertical fluxes. Fluxes induced by deformation can compete with both buoyancy and topographic-driven flow over all length scales and results locally in transient 'ponds' of melt. Pluton emplacement is controlled by the transition in constitutive behaviour of the melt/magma from elastic-viscous at high temperatures to elastic-plastic-viscous approaching the melt solidus enabling finite thickness plutons to develop. The system involves coupled feedback processes that grow at the expense of heat supplied to the system and compete with melt advection. The result is that limits are placed on the size and time scale of the system. Optimal characteristics of the system coincide with a state of maximum entropy production rate. This journal is © 2010 The Royal Society

  12. Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes.

    Science.gov (United States)

    Schallhorn, Steven C; Schallhorn, Julie M; Pelouskova, Martina; Venter, Jan A; Hettinger, Keith A; Hannan, Stephen J; Teenan, David

    2017-01-01

    To compare refractive and visual outcomes, patient satisfaction, and complication rates among different age categories of patients who underwent refractive lens exchange (RLE). A stratified, simple random sample of patients matched on preoperative sphere and cylinder was selected for four age categories: 45-49 years (group A), 50-54 years (group B), 55-59 years (group C), and 60-65 years (group D). Each group contained 320 patients. All patients underwent RLE with a multifocal intraocular lens at least in one eye. Three months postoperative refractive/visual and patient-reported outcomes are presented. The percentage of patients that achieved binocular uncorrected distance visual acuity 20/20 or better was 91.6% (group A), 93.8% (group B), 91.6% (group C), 88.8% (group D), P =0.16. Binocularly, 80.0% of patients in group A, 84.7% in group B, 78.9% in group C, and 77.8% in group D achieved 20/30 or better uncorrected near visual acuity ( P =0.13). The proportion of eyes within 0.50 D of emmetropia was 84.4% in group A, 86.8% in group B, 85.7% in group C, and 85.8% in group D ( P =0.67). There was no statistically significant difference in postoperative satisfaction, visual phenomena, dry eye symptoms, distance or near vision activities. Apart from higher rate of iritis in the age group 50-55 years, there was no statistically significant difference in postoperative complication rates. RLE can be safely performed in younger as well as older presbyopes. No significant difference was found in clinical or patient-reported outcomes.

  13. Characteristics, outcome and predictors of one year mortality rate in patients with acute heart failure

    Directory of Open Access Journals (Sweden)

    Banović Marko

    2011-01-01

    Full Text Available Background/Aim. Acute heart failure (AHF is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and longterm mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population. Methods. This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade and were followed for one year after the discharge. Results. Mean age of the patients was 63.6 ± 12.6 years and 59.4% were males. Acute congestion (43.8% and pulmonary edema (39.1% were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF was 39.7% ± 9.25%, while 44.4% of the patients had LVEF ≥ 50%. At discharge, 55.9% of the patients received therapy with β-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blokcers (ARB. The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS and a higher tricuspid velocity. Conclusion. One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity.

  14. Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical Cancer: 4-Year Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Tinkle, Christopher L.; Weinberg, Vivian [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chen, Lee-May [Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California (United States); Littell, Ramey [Gynecologic Oncology, The Permanente Medical Group, San Francisco, California (United States); Cunha, J. Adam M.; Sethi, Rajni A. [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chan, John K. [Gynecologic Oncology, California Pacific Medical Center, San Francisco, California (United States); Hsu, I-Chow, E-mail: ichow.hsu@ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, California (United States)

    2015-08-01

    Purpose: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. Methods and Materials: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. Results: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. Conclusions: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall

  15. Managing Safety and Operations: The Effect of Joint Management System Practices on Safety and Operational Outcomes.

    Science.gov (United States)

    Tompa, Emile; Robson, Lynda; Sarnocinska-Hart, Anna; Klassen, Robert; Shevchenko, Anton; Sharma, Sharvani; Hogg-Johnson, Sheilah; Amick, Benjamin C; Johnston, David A; Veltri, Anthony; Pagell, Mark

    2016-03-01

    The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices. Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses. Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices. Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

  16. Unprotected autogenous bone block grafts in anterior maxilla: Resorption rates and clinical outcomes

    Directory of Open Access Journals (Sweden)

    Kosanić Ivan

    2017-01-01

    Full Text Available Background/Aim. The use of autogenous bone grafts for augmentation of the resorbed alveolar ridge is still considered the gold standard in implant dentistry. The aim of this study was to analyze the resorption rate of autogenous bone block grafts from the retromolar region placed in the frontal segment of the upper jaw unprotected by barrier membranes, to assess the stability of implants placed into the grafted bone, as well as to monitor its changes during the healing period. Methods. The study included 18 patients with a total of 20 grafted sites. The residual alveolar ridge was measured before and after the augmentation and prior to implant placement. All implants were restored with provisional crowns within 48 hours after the placement. Implant stability was assessed using resonance frequency analysis. Results. The average period from ridge augmentation to reentry was 5.4 months (range 4–6 months. At reentry the healed alveolar ridge had a mean width of 6.1 ± 1.27 mm. The mean calculated width gain was 3.04 ± 1.22 mm. The overall surface resorption of block grafts was 0.68 ± 0.69 mm (18.85%. At the time of implant placement the mean value of implant stability quotient (ISQ was 71.25 ± 5.77. The lowest ISQ values were noted after three weeks of healing, followed by a gradual increase until week 12. After 12 weeks implants showed significantly higher ISQ values compared to primary stability (p < 0.05 Wilcoxon signed ranks test. During the 3-years followup period no cases of implant loss were recorded. Conclusion. Despite a significant resorption of bone grafts, it was possible to place implants in all the cases and to use the immediate loading protocol without affecting implant survival rate. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no.175021

  17. Penicillin-susceptible Staphylococcus aureus: susceptibility testing, resistance rates and outcome of infection.

    Science.gov (United States)

    Hagstrand Aldman, Malin; Skovby, Annette; I Påhlman, Lisa

    2017-06-01

    Staphylococcus aureus (SA) is an important human pathogen that causes both superficial and invasive infections. Penicillin is now rarely used in the treatment of SA infections due to widespread resistance and a concern about the accuracy of existing methods for penicillin susceptibility testing. The aims of the present study were to determine the frequency of penicillin-susceptible SA isolates from blood and wound cultures in Lund, Sweden, and to evaluate methods for penicillin testing in SA. We also wanted to investigate if penicillin-susceptible isolates are associated with higher mortality. Hundred blood culture isolates collected 2008/2009, 140 blood culture isolates from 2014/2015, and 141 superficial wound culture strains from 2015 were examined. Penicillin susceptibility was tested with disk diffusion according to EUCAST guidelines, and results were confirmed with a cloverleaf assay and PCR amplification of the BlaZ gene. Patient data for all bacteraemia cases were extracted from medical records. The disk diffusion method with assessment of both zone size and zone edge appearance had high accuracy in our study. About 57% of bacteraemia isolates from 2008/2009 were sensitive to penicillin compared to 29% in 2014/2015 (p penicillin susceptible. There was no difference in co-morbidity or mortality rates between patients with penicillin resistant and penicillin sensitive SA bacteraemia. Disk-diffusion is a simple and reliable method to detect penicillin resistance in SA, and susceptibility rates are significant. Penicillin has many theoretical advantages and should be considered in the treatment of SA bacteraemia when susceptible.

  18. Distraction rate and latency: factors in the outcome of paediatric maxillary distraction.

    Science.gov (United States)

    Higuera, Stephen; Cole, Patrick; Stephenson, J B; Hollier, Larry

    2009-12-01

    Over 50 years ago, current tenets of distraction osteogenesis were developed through work on the lower extremity; however, the application of these tenets in the paediatric craniofacial skeleton remains questionable. Prompted by recent concern that traditional aspects of distraction may be either outdated or wholly inapplicable to the paediatric maxilla, we retrospectively evaluated maxillary distraction protocol using a 24-h latency period in conjunction with a distraction rate of 2mm/day. Following maxillary advancement via a distraction protocol consisting of a 24-h latency period and a distraction rate of 2mm/day, seven consecutive paediatric cases were evaluated. Standard profile photos and cephalometric films taken preoperatively, at device removal and at 1-year follow-up were compared. With the sella as the point of registration, pre- and post-distraction films were superimposed on the sella-nasion plane. Sella-nasion-subspinale, the angle of convexity, the distance from incisal edges to the y-axis, and angulation of the upper incisor to the sella-nasion plane were analysed to evaluate hard-tissue changes. Patient age ranged from 3 to 14 years (mean=7.43 years). Maxillary distraction length averaged 11 mm (range=10-12 mm). Interval from device application to removal averaged 98 days (range=75-180 days). The interval of the active distraction ranged from 11 to 65 days (mean=24 days). From distraction completion to device removal averaged 85 days (range=60-150). Follow-up intervals ranged from 52 to 24 months (mean=34 months). All patients demonstrated substantial clinical advancement of the maxilla with correction of midfacial deficiencies. A single patient developed mild cellulitis at one skin-device interface; no other complications were noted. Cephalometric and clinical evaluations at 1 year post-distraction demonstrated stable results, and parental satisfaction was qualitatively high. The surgical dogma of lower-extremity distraction osteogenesis is not

  19. An Auto Telematics System For Insurance Premium Rating amp Pricing.

    Directory of Open Access Journals (Sweden)

    Irode Philip Luvuga

    2017-12-01

    Full Text Available Insurance telematics is a new technology that has been poised to transform and change the way we buy and underwrite insurance by 2030. Insurance Premium Rate is a major variable that determines if a client will buy or take up a policy cover or not. With the current stiff competition being felt in the Industry the local insurance industry continues to suffer big losses due to unhealthy business practice of competitor undercutting among the insurers to attract more clients but exposing the underwriting companies to potential high risks. This in most cases means that the product is totally underpriced to the extent that it would be uneconomical and unsustainable in the long run for the insurance firms. This research outlines a technology defined model that should be used to determine the ideal premium rate payable in the Motor Insurance industry taking into account all the variables and the risk exposure of the policy holder. The system model is able to determine the insurable risk based on the drivers attributes and profile location of the vehicle in relation to risk geo-locations map monitoring the driving parameters of the vehicle by the driver and the driving style. This enable the insurance company determines costs associated with the risk cover based on factual facts which are scientifically determined by the real risks.

  20. Positive outcomes influence the rate and time to publication, but not the impact factor of publications of clinical trial results.

    Directory of Open Access Journals (Sweden)

    Pilar Suñé

    Full Text Available OBJECTIVES: Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. METHODS AND FINDINGS: All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication. Published articles were identified by searching Pubmed and other electronic databases. Clinical study final reports submitted to the ethics committee, final reports synopses available online and meeting abstracts were also considered as sources of study results. Study outcomes were classified as positive (when statistical significance favoring experimental drug was achieved, negative (when no statistical significance was achieved or it favored control drug and descriptive (for non-controlled studies. Time to publication was defined as time from study closure to publication. A survival analysis was performed using a Cox regression model to analyze time to publication. Journal impact factors of identified publications were recorded. Publication rate was 48·4% (380/785. Study results were identified for 68·9% of all completed clinical trials (541/785. Publication rate was 84·9% (180/212 for studies with results classified as positive and 68·9% (128/186 for studies with results classified as negative (p<0·001. Median time to publication was 2·09 years (IC95 1·61-2·56 for studies with results classified as positive and 3·21 years (IC95 2·69-3·70 for studies with results classified as negative (hazard ratio 1·99 (IC95 1·55-2·55. No differences were found in publication impact factor between positive (median 6·308, interquartile range: 3·141-28·409 and negative result studies (median 8·266, interquartile range: 4·135-17·157. CONCLUSIONS

  1. Effects of diagnosis-related group payment system on appendectomy outcomes.

    Science.gov (United States)

    Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

    2016-12-01

    The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Mind-Body Medicine and Immune System Outcomes: A Systematic Review

    OpenAIRE

    Wahbeh, Helané; Haywood, Ashley; Kaufman, Karen; Zwickey, Heather

    2009-01-01

    This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Rel...

  3. Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program.

    Science.gov (United States)

    Muluneh, Benyam; Schneider, Molly; Faso, Aimee; Amerine, Lindsey; Daniels, Rowell; Crisp, Brett; Valgus, John; Savage, Scott

    2018-06-01

    To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

  4. The importance of rating scale design in the measurement of patient-reported outcomes using questionnaires or item banks.

    Science.gov (United States)

    Khadka, Jyoti; McAlinden, Colm; Gothwal, Vijaya K; Lamoureux, Ecosse L; Pesudovs, Konrad

    2012-06-26

    To investigate the effect of rating scale designs (question formats and response categories) on item difficulty calibrations and assess the impact that rating scale differences have on overall vision-related activity limitation (VRAL) scores. Sixteen existing patient-reported outcome instruments (PROs) suitable for cataract assessment, with different rating scales, were self-administered by patients on a cataract surgery waiting list. A total of 226 VRAL items from these PROs in their native rating scales were included in an item bank and calibrated using Rasch analysis. Fifteen item/content areas (e.g., reading newspapers) appearing in at least three different PROs were identified. Within each content area, item calibrations were compared and their range calculated. Similarly, five PROs having at least three items in common with the Visual Function (VF-14) were compared in terms of average item measures. A total of 614 patients (mean age ± SD, 74.1 ± 9.4 years) participated. Items with the same content varied in their calibration by as much as two logits; "reading the small print" had the largest range (1.99 logits) followed by "watching TV" (1.60). Compared with the VF-14 (0.00 logits), the rating scale of the Visual Disability Assessment (1.13 logits) produced the most difficult items and the Cataract Symptom Scale (0.24 logits) produced the least difficult items. The VRAL item bank was suboptimally targeted to the ability level of the participants (2.00 logits). Rating scale designs have a significant effect on item calibrations. Therefore, constructing item banks from existing items in their native formats carries risks to face validity and transmission of problems inherent in existing instruments, such as poor targeting.

  5. The evaluation system of city's smart growth success rates

    Science.gov (United States)

    Huang, Yifan

    2018-04-01

    "Smart growth" is to pursue the best integrated perform+-ance of the Economically prosperous, socially Equitable, and Environmentally Sustainable(3E). Firstly, we establish the smart growth evaluation system(SGI) and the sustainable development evaluation system(SDI). Based on the ten principles and the definition of three E's of sustainability. B y using the Z-score method and the principal component analysis method, we evaluate and quantify indexes synthetically. Then we define the success of smart growth as the ratio of the SDI to the SGI composite score growth rate (SSG). After that we select two cities — Canberra and Durres as the objects of our model in view of the model. Based on the development plans and key data of these two cities, we can figure out the success of smart growth. And according to our model, we adjust some of the growth indicators for both cities. Then observe the results before and after adjustment, and finally verify the accuracy of the model.

  6. Outcome of Pregnancy in Patients with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Chiong-Hee Wong

    2006-06-01

    Conclusion: Pregnancy is relatively safe in women with SLE in remission but should be considered as a high-risk pregnancy. APS is associated with poor pregnancy outcome. The patient needs to cooperate with obstetricians and physicians for optimal disease control and detailed monitoring throughout the gestation.

  7. A Distributed Flow Rate Control Algorithm for Networked Agent System with Multiple Coding Rates to Optimize Multimedia Data Transmission

    Directory of Open Access Journals (Sweden)

    Shuai Zeng

    2013-01-01

    Full Text Available With the development of wireless technologies, mobile communication applies more and more extensively in the various walks of life. The social network of both fixed and mobile users can be seen as networked agent system. At present, kinds of devices and access network technology are widely used. Different users in this networked agent system may need different coding rates multimedia data due to their heterogeneous demand. This paper proposes a distributed flow rate control algorithm to optimize multimedia data transmission of the networked agent system with the coexisting various coding rates. In this proposed algorithm, transmission path and upload bandwidth of different coding rate data between source node, fixed and mobile nodes are appropriately arranged and controlled. On the one hand, this algorithm can provide user nodes with differentiated coding rate data and corresponding flow rate. On the other hand, it makes the different coding rate data and user nodes networked, which realizes the sharing of upload bandwidth of user nodes which require different coding rate data. The study conducts mathematical modeling on the proposed algorithm and compares the system that adopts the proposed algorithm with the existing system based on the simulation experiment and mathematical analysis. The results show that the system that adopts the proposed algorithm achieves higher upload bandwidth utilization of user nodes and lower upload bandwidth consumption of source node.

  8. Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality

    Directory of Open Access Journals (Sweden)

    Harris PR

    2014-08-01

    Full Text Available Patricia R E Harris,1 Phyllis K Stein,2 Gordon L Fung,3 Barbara J Drew4 1Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San Francisco, CA, USA; 2Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA; 3Cardiology Services, Mount Zion, Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA; 4School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San Francisco, CA, USA Objective: This study sought to examine the prognostic value of heart rate variability (HRV measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS. Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193. Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. Results: During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms2 predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4–3.8, P=0.001. Variables significantly associated with death included natural logs of total power and ultra low frequency

  9. Interstitial high-dose-rate brachytherapy boost: The feasibility and cosmetic outcome of a fractionated outpatient delivery scheme

    International Nuclear Information System (INIS)

    Manning, Matthew A.; Arthur, Douglas W.; Schmidt-Ullrich, Rupert K.; Arnfield, Mark R.; Amir, Cyrus; Zwicker, Robert D.

    2000-01-01

    Purpose: To evaluate the feasibility, potential toxicity, and cosmetic outcome of fractionated interstitial high dose rate (HDR) brachytherapy boost for the management of patients with breast cancer at increased risk for local recurrence. Methods and Materials: From 1994 to 1996, 18 women with early stage breast cancer underwent conventionally fractionated whole breast radiotherapy (50-50.4 Gy) followed by interstitial HDR brachytherapy boost. All were considered to be at high risk for local failure. Seventeen had pathologically confirmed final surgical margins of less than 2 mm or focally positive. Brachytherapy catheter placement and treatment delivery were conducted on an outpatient basis. Preplanning was used to determine optimal catheter positions to enhance dose homogeneity of dose delivery. The total HDR boost dose was 15 Gy delivered in 6 fractions of 2.5 Gy over 3 days. Local control, survival, late toxicities (LENT-SOMA), and cosmetic outcome were recorded in follow-up. In addition, factors potentially influencing cosmesis were analyzed by logistic regression analysis. Results: The minimum follow-up is 40 months with a median 50 months. Sixteen patients were alive without disease at last follow-up. There have been no in-breast failures observed. One patient died with brain metastases, and another died of unrelated causes without evidence of disease. Grade 1-2 late toxicities included 39% with hyperpigmentation, 56% with detectable fibrosis, 28% with occasional discomfort, and 11% with visible telangiectasias. Grade 3 toxicity was reported in one patient as persistent discomfort. Sixty-seven percent of patients were considered to have experienced good/excellent cosmetic outcomes. Factors with a direct relationship to adverse cosmetic outcome were extent of surgical defect (p = 0.00001), primary excision volume (p = 0.017), and total excision volume (p = 0.015). Conclusions: For high risk patients who may benefit from increased doses, interstitial HDR

  10. Educational outcomes in a system of care for children with emotional disturbance.

    Science.gov (United States)

    Strompolis, Melissa; Vishnevsky, Tanya; Reeve, Charlie L; Munsell, Eylin Palamaro; Cook, James R; Kilmer, Ryan P

    2012-01-01

    In North Carolina, only 69% of high school students graduate in 4 years; however, recent data suggest that only 42% of students with mental and emotional disabilities graduate. MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. The SOC philosophy is a prominent family-focused approach intended to provide comprehensive, coordinated networks of services, tailored to the needs of the child and family, while emphasizing the strengthening of natural community supports. In addition to other mental health objectives, a particular goal of MeckCARES is to address specific school-based needs of system-identified youth to improve educational outcomes and reduce the risk of dropping out. This study sought to assess empirically the impact that enrollment in MeckCARES has on graduation precursors; namely, grades, suspensions, and absences. This study found that, on average, enrollment in MeckCARES is not associated with positive changes in educational variables. Implications of these findings are discussed, as are future directions. For example, additional research is needed with more sensitive measurement and data collection procedures (i.e., access to graduation rates and Medicaid information) to adequately assess the impact of enrollment in MeckCARES on educational outcomes. © 2012 American Orthopsychiatric Association.

  11. Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes

    Directory of Open Access Journals (Sweden)

    Schallhorn SC

    2017-08-01

    Full Text Available Steven C Schallhorn,1–3 Julie M Schallhorn,1 Martina Pelouskova,3 Jan A Venter,3 Keith A Hettinger,3 Stephen J Hannan,3 David Teenan3 1Department of Ophthalmology, University of California, San Francisco, CA, USA; 2Roski Eye Institute, University of Southern California, Los Angeles, CA, USA; 3Optical Express, Glasgow UK Purpose: To compare refractive and visual outcomes, patient satisfaction, and complication rates among different age categories of patients who underwent refractive lens exchange (RLE. Methods: A stratified, simple random sample of patients matched on preoperative sphere and cylinder was selected for four age categories: 45–49 years (group A, 50–54 years (group B, 55–59 years (group C, and 60–65 years (group D. Each group contained 320 patients. All patients underwent RLE with a multifocal intraocular lens at least in one eye. Three months postoperative refractive/visual and patient-reported outcomes are presented. Results: The percentage of patients that achieved binocular uncorrected distance visual acuity 20/20 or better was 91.6% (group A, 93.8% (group B, 91.6% (group C, 88.8% (group D, P=0.16. Binocularly, 80.0% of patients in group A, 84.7% in group B, 78.9% in group C, and 77.8% in group D achieved 20/30 or better uncorrected near visual acuity (P=0.13. The proportion of eyes within 0.50 D of emmetropia was 84.4% in group A, 86.8% in group B, 85.7% in group C, and 85.8% in group D (P=0.67. There was no statistically significant difference in postoperative satisfaction, visual phenomena, dry eye symptoms, distance or near vision activities. Apart from higher rate of iritis in the age group 50–55 years, there was no statistically significant difference in postoperative complication rates. Conclusion: RLE can be safely performed in younger as well as older presbyopes. No significant difference was found in clinical or patient-reported outcomes. Keywords: refractive lens exchange, multifocal IOLs, younger

  12. Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Oesch, Sebastian L; Rentsch, Cyrill A; Isaak, Bernhard; Cihoric, Nikola; Manser, Peter; Thalmann, George N; Aebersold, Daniel M

    2014-01-01

    To determine the 5-year outcome after high-dose-rate brachytherapy (HDR-BT) as a monotherapy. Between 10/2003 and 06/2006, 36 patients with low (28) and intermediate (8) risk prostate cancer were treated by HDR-BT monotherapy. All patients received one implant and 4 fractions of 9.5 Gy within 48 hours for a total prescribed dose (PD) of 38 Gy. Five patients received concomitant androgen deprivation therapy (ADT). Toxicity was scored according to the common terminology criteria for adverse events from the National Cancer Institute (CTCAE) version 3.0. Biochemical recurrence was defined according to the Phoenix criteria and analyzed using the Kaplan Meier method. Predictors for late grade 3 GU toxicity were analyzed using univariate and multivariate Cox regression analyses. The median follow-up was 6.9 years (range, 1.5-8.0 years). Late grade 2 and 3 genitourinary (GU) toxicity was observed in 10 (28%) and 7 (19%) patients, respectively. The actuarial proportion of patients with late grade 3 GU toxicity at 5 years was 17.7%. Late grade 2 and 3 gastrointestinal (GI) toxicities were not observed. The crude erectile function preservation rate in patients without ADT was 75%. The 5 year biochemical recurrence-free survival (bRFS) rate was 97%. Late grade 3 GU toxicity was associated with the urethral volume (p = 0.001) and the urethral V 120 (urethral volume receiving ≥120% of the PD; p = 0.0005) after multivariate Cox regression. After HDR-BT monotherapy late grade 3 GU was observed relatively frequently and was associated with the urethral V 120 . GI toxicity was negligible, the erectile function preservation rate and the bRFS rate was excellent

  13. Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality.

    Science.gov (United States)

    Harris, Patricia R E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

    2014-01-01

    This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms(2) predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4-3.8, P=0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power 0.3 ng/mL (HR =4.0; 95% CI =1.3-12.1; P=0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes. HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study.

  14. Managing Clutter in a High Pulse Rate Echolocation System

    Directory of Open Access Journals (Sweden)

    Jacob Isbell

    2018-03-01

    Full Text Available The use of echolocation for navigating in dense, cluttered environments is a challenge due to the need for rapid sampling of nearby objects in the face of delayed echoes from distant objects. In the wild, echolocating bats frequently encounter this situation when leaving the roost or while hunting. If long-delay echoes from a distant object are received after the next pulse is sent out, these “aliased” echoes appear as close-range phantom objects. Little is known about how bats cope with these situations. In this work, we demonstrate a novel strategy to manage aliasing in cases where a single target is actively being tracked at close range. This paper presents three reactive strategies for a high pulse-rate sonar system to combat aliased echoes: (1 changing the interpulse interval to move the aliased echoes away in time from the tracked target, (2 changing positions to create a geometry without aliasing, and (3 a phase-based, transmission beam-shaping strategy to illuminate the target and not the aliasing object.

  15. Smart integrated containment leakage rate test system using wireless communication

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Hwan; Lee, Sang Yong; Kim, Jung Sun; Kim, Gun Soo; Kim, Jong Myeong; Ahn, Jong Han [Research and Development Center, Ulsan (Korea, Republic of)

    2012-10-15

    Integrated Leakage Rate Test (ILRT) is the important test the confidentiality and integrity of the containment building, which is the last barrier when Design basis accidents (DBA) of Nuclear Power plant occur. Since the result of this test is the basis to guarantee the safety of nuclear power plants, the test process, test procedure, and the test equipment are required to have high reliability. The test devices previously used have been products of VOLUMERTRICS and GRAFTEL of USA. These devices have been inconvenient to calibrate and use. Thus improved devices needed to be developed to remove the inconveniences, to verify the safety of Korean nuclear power plants with Korea's own technology, and to secure core technology. A new leak test system was developed by domestic technology for that purpose and needed to be verified. In this paper, technical details of the newly developed easy to use and highly reliable measuring test device, which is in operation at the nuclear power plant sites, will be introduced. State of art technology was applied to the device to address the shortcomings of previous US made devices and the difficulties to use on site.

  16. Mixing rates of particle systems with energy exchange

    International Nuclear Information System (INIS)

    Grigo, A; Khanin, K; Szász, D

    2012-01-01

    A fundamental problem of non-equilibrium statistical mechanics is the derivation of macroscopic transport equations in the hydrodynamic limit. The rigorous study of such limits requires detailed information about rates of convergence to equilibrium for finite sized systems. In this paper, we consider the finite lattice {1, 2, …, N}, with an energy x i ∈ (0, ∞) associated with each site. The energies evolve according to a Markov jump process with nearest neighbour interaction such that the total energy is preserved. We prove that for an entire class of such models the spectral gap of the generator of the Markov process scales as O(N -2 ). Furthermore, we provide a complete classification of reversible stationary distributions of product type. We demonstrate that our results apply to models similar to the billiard lattice model considered in Gaspard and Gilbert (2009 J. Stat. Mech.: Theory Exp. 2009 24), and hence provide a first step in the derivation of a macroscopic heat equation for a microscopic stochastic evolution of mechanical origin. (paper)

  17. Evaluation of CROES Nephrolithometry Nomogram as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes.

    Science.gov (United States)

    Kumar, Sumit; Sreenivas, Jayaram; Karthikeyan, Vilvapathy Senguttuvan; Mallya, Ashwin; Keshavamurthy, Ramaiah

    2016-10-01

    Scoring systems have been devised to predict outcomes of percutaneous nephrolithotomy (PCNL). CROES nephrolithometry nomogram (CNN) is the latest tool devised to predict stone-free rate (SFR). We aim to compare predictive accuracy of CNN against Guy stone score (GSS) for SFR and postoperative outcomes. Between January 2013 and December 2015, 313 patients undergoing PCNL were analyzed for predictive accuracy of GSS, CNN, and stone burden (SB) for SFR, complications, operation time (OT), and length of hospitalization (LOH). We further stratified patients into risk groups based on CNN and GSS. Mean ± standard deviation (SD) SB was 298.8 ± 235.75 mm 2 . SB, GSS, and CNN (area under curve [AUC]: 0.662, 0.660, 0.673) were found to be predictors of SFR. However, predictability for complications was not as good (AUC: SB 0.583, GSS 0.554, CNN 0.580). Single implicated calix (Adj. OR 3.644; p = 0.027), absence of staghorn calculus (Adj. OR 3.091; p = 0.044), single stone (Adj. OR 3.855; p = 0.002), and single puncture (Adj. OR 2.309; p = 0.048) significantly predicted SFR on multivariate analysis. Charlson comorbidity index (CCI; p = 0.020) and staghorn calculus (p = 0.002) were independent predictors for complications on linear regression. SB and GSS independently predicted OT on multivariate analysis. SB and complications significantly predicted LOH, while GSS and CNN did not predict LOH. CNN offered better risk stratification for residual stones than GSS. CNN and GSS have good preoperative predictive accuracy for SFR. Number of implicated calices may affect SFR, and CCI affects complications. Studies should incorporate these factors in scoring systems and assess if predictability of PCNL outcomes improves.

  18. Development and validation of a new global well-being outcomes rating scale for integrative medicine research

    Directory of Open Access Journals (Sweden)

    Bell Iris R

    2004-01-01

    Full Text Available Abstract Background Researchers are finding limitations of currently available disease-focused questionnaire tools for outcome studies in complementary and alternative medicine/integrative medicine (CAM/IM. Methods Three substudies investigated the new one-item visual analogue Arizona Integrative Outcomes Scale (AIOS, which assesses self-rated global sense of spiritual, social, mental, emotional, and physical well-being over the past 24 hours and the past month. The first study tested the scale's ability to discriminate unhealthy individuals (n = 50 from healthy individuals (n = 50 in a rehabilitation outpatient clinic sample. The second study examined the concurrent validity of the AIOS by comparing ratings of global well-being to degree of psychological distress as measured by the Brief Symptom Inventory (BSI in undergraduate college students (N = 458. The third study evaluated the relationships between the AIOS and positively- and negatively-valenced tools (Positive and Negative Affect Scale and the Positive States of Mind Scale in a different sample of undergraduate students (N = 62. Results Substudy (i Rehabilitation patients scored significantly lower than the healthy controls on both forms of the AIOS and a current global health rating. The AIOS 24-hours correlated moderately and significantly with global health (patients r = 0.50; controls r = 0.45. AIOS 1-month correlations with global health were stronger within the controls (patients r = 0.36; controls r = 0.50. Controls (r = 0.64 had a higher correlation between the AIOS 24-hour and 1-month forms than did the patients (r = 0.33, which is consistent with the presumptive improvement in the patients' condition over the previous 30 days in rehabilitation. Substudy (ii In undergraduate students, AIOS scores were inversely related to distress ratings, as measured by the global severity index on the BSI (rAIOS24h = -0.42, rAIOS1month = -0.40. Substudy (iii AIOS scores were significantly

  19. Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system.

    Science.gov (United States)

    Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2015-10-01

    Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.

  20. Evolving Systems of Care with Total Clinical Outcomes Management

    Science.gov (United States)

    Lyons, John S.; Epstein, Richard A.; Jordan, Neil

    2010-01-01

    The current article proposes that further specification of the system of care concept is required. Based on the assertions that the system of care concept (a) refers to an ideal as opposed to an observable phenomenon, and (b) is engaged in offering transformational experiences, the authors propose that the system of care definition must be…

  1. One-year results of maxillary overdentures supported by 2 titanium-zirconium implants - implant survival rates and radiographic outcomes.

    Science.gov (United States)

    Zembic, Anja; Tahmaseb, Ali; Jung, Ronald E; Wismeijer, Daniel

    2017-07-01

    To assess implant survival rates and peri-implant bone loss of 2 titanium-zirconium implants supporting maxillary overdentures at 1 year of loading. Twenty maxillary edentulous patients (5 women and 15 men) being dissatisfied with their complete dentures were included. In total, 40 diameter-reduced titanium-zirconium implants were placed in the anterior maxilla. Local guided bone regeneration (GBR) was allowed if the treatment did not compromise implant stability. Following 3 to 5 months of healing, implant-supported overdentures were inserted on two ball anchors. Implants and overdentures were assessed at 1, 2, 4, and 8 weeks after implant insertion and 2, 4, and 12 months after insertion of overdentures (baseline). Standardized radiographs were taken at implant loading and 1 year. Implant survival rates and bone loss were the primary outcomes. Nineteen patients (1 dropout) with 38 implants were evaluated at a mean follow-up of 1.1 years (range 1.0-1.7 years). One implant failed resulting in an implant survival rate of 97.3%. There was a significant peri-implant bone loss of the implants at 1 year of function (mean, 0.7 mm, SD = 1.1 mm; median: 0.48 mm, IQR = 0.56 mm). There was a high 1-year implant survival rate for edentulous patients receiving 2 maxillary implants and ball anchors as overdenture support. However, several implants exhibited an increased amount of bone loss of more than 2 mm. Overdentures supported by 2 maxillary implants should thus be used with caution as minimally invasive treatment for specific patients encountering problems with their upper dentures until more long-term data is available. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Outcomes of 847 childhood-onset systemic lupus erythematosus patients in three age groups.

    Science.gov (United States)

    Lopes, S R M; Gormezano, N W S; Gomes, R C; Aikawa, N E; Pereira, R M R; Terreri, M T; Magalhães, C S; Ferreira, J C; Okuda, E M; Sakamoto, A P; Sallum, A M E; Appenzeller, S; Ferriani, V P L; Barbosa, C M; Lotufo, S; Jesus, A A; Andrade, L E C; Campos, L M A; Bonfá, E; Silva, C A

    2017-08-01

    Objective The objective of this study was to assess outcomes of childhood systemic lupus erythematosus (cSLE) in three different age groups evaluated at last visit: group A early-onset disease (Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) (0 (0-9) vs 0 (0-6) vs 0 (0-7), p = 0.065) was comparable in the three groups. Further analysis of organ/system damage revealed that frequencies of neuropsychiatric (21% vs 10% vs 7%, p = 0.007), skin (10% vs 1% vs 3%, p = 0.002) and peripheral vascular involvements (5% vs 3% vs 0.3%, p = 0.008) were more often observed in group A compared to groups B and C. Frequencies of severe cumulative lupus manifestations such as nephritis, thrombocytopenia, and autoimmune hemolytic anemia were similar in all groups ( p > 0.05). Mortality rate was significantly higher in group A compared to groups B and C (15% vs 10% vs 6%, p = 0.028). Out of 69 deaths, 33/69 (48%) occurred within the first two years after diagnosis. Infections accounted for 54/69 (78%) of the deaths and 38/54 (70%) had concomitant disease activity. Conclusions This large multicenter study provided evidence that early-onset cSLE group had distinct outcomes. This group was characterized by higher mortality rate and neuropsychiatric/vascular/skin organ damage in spite of comparable frequencies of severe cumulative lupus manifestations. We also identified that overall death in cSLE patients was an early event mainly attributed to infection associated with disease activity.

  3. Avatar Web-Based Self-Report Survey System Technology for Public Health Research: Technical Outcome Results and Lessons Learned.

    Science.gov (United States)

    Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, Aids

    2016-01-01

    This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting.

  4. Titanium/Polyetheretherketone Cages for Cervical Arthrodesis with Degenerative and Traumatic Pathologies: Early Clinical Outcomes and Fusion Rates.

    Science.gov (United States)

    Chong, Elizabeth; Mobbs, Ralph J; Pelletier, Matthew H; Walsh, William R

    2016-02-01

    Anterior cervical discectomy and fusion is the most commonly employed surgical technique for treating cervical spondylosis. Although autologous bone grafts are considered the gold standard in achieving fusion, associated short- and long-term morbidities have led to a search for alternative materials. These have included carbon-fiber, titanium alloy (Ti) and ceramic and polyetheretherketone (PEEK) based implants. Recent attempts to optimize cage implants through using composite designs have combined Ti and PEEK. However, there are few published reports on the clinical and radiological outcomes of commercially available composite cages. Our study aimed to provide and evaluate initial outcomes of a composite Ti/PEEK cage. In this prospective single senior surgeon cohort study, 31 consecutive patients underwent a modified Smith-Robinson technique under general anesthesia and relevant data were collected. The study patients were aged between 18 and 75 years and underwent surgery from November 2013 to May 2014. Indications for surgery included traumatic and degenerative cervical disease that was unsuitable for or unresponsive to conservative management. All cages were between 5 and 8 mm and packed with super critical fluid sterilized allograft and bone marrow aspirate before insertion. Patients were followed-up for a minimum of 12 months. Fusion was assessed using fine cut CT and anteroposterior and lateral radiographs. Clinical outcomes were measured using a Visual Analogue Scale, Neck Oswestry Disability Index and Patient's Satisfaction Index. Six of the original cohort were unavailable for adequate follow-up. The remaining 25 patients (17 men, 8 women; 33 operative levels) were observed for a mean of 14.6 months (range, 12-16 months). All operation levels were between C4 and C7 . Single-level operations were performed in 19 patients and additional plating in 14 patients. A fusion rate of 96% was achieved. Patients in both plated and non-plated groups experienced

  5. Outcomes Associated With 3 Treatment Schedules of High-Dose-Rate Brachytherapy Monotherapy for Favorable-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jawad, Maha Saada; Dilworth, Joshua T.; Gustafson, Gary S.; Ye, Hong; Wallace, Michelle [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Martinez, Alvaro [Michigan HealthCare Professionals/21" s" t Century Oncology, Farmington Hills, Michigan (United States); Chen, Peter Y. [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Krauss, Daniel J., E-mail: DKrauss@beaumont.edu [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2016-03-15

    Purpose: We report the outcomes associated with 3 high-dose-rate (HDR) brachytherapy regimens used as monotherapy for favorable-risk prostate cancer. Methods and Materials: Four hundred ninety-four patients with stage ≤T2b prostate cancer, Gleason score ≤7, and prostate-specific antigen levels ≤15 ng/mL underwent HDR brachytherapy as monotherapy. Of those, 319 received 38 Gy in 4 fractions, 79 received 24 Gy in 2 fractions, and 96 received 27 Gy in 2 fractions. Acute and chronic genitourinary (GU) and gastrointestinal (GI) toxicities were defined as side effects occurring ≤6 and >6 months, respectively, after radiation therapy (RT) and were graded according to the Common Terminology Criteria for Adverse Events version 3.0. The time to toxicity was calculated from the date of RT completion. Variables were analyzed with χ{sup 2} test. P values <.05 were considered significant. Results: The median overall follow-up time was 4 years (range, 5.5, 3.5, and 2.5 years for 38 Gy, 24 Gy, and 27 Gy, respectively, P<.001). Acute and chronic grade ≥2 GU and GI toxicity profiles were similar among groups. Acceptable rates of grade 2 GU toxicities were seen with overall acute/chronic frequency/urgency, dysuria, retention, incontinence, and hematuria rates of 14%/20%, 6%/7%, 7%/4%, 1.5%/2%, and 1.5%/7%, respectively. Minimal grade 3 and no grade 4 or 5 toxicities were seen. Grade 1, 2, and 3 chronic urethral stricture rates were 0.3%, 2%, and 1%, respectively. All GI toxicities were similar between groups, with overall rates of acute/chronic grade 2 diarrhea, rectal pain/tenesmus, rectal bleeding, and proctitis of 1%/1%, <1%/0.5%, 0%/2%, and <1%/1%, respectively. No grade 3, 4, or 5 toxicities were seen. All comparisons were similar for hormone-naïve patients. The median time to maximal GU/GI toxicity was similar between groups, ranging from 1 to 1.6 to 0.9 to 1.2 years, respectively. There were no differences in clinical outcomes between the 3 groups at 5

  6. Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system.

    Science.gov (United States)

    Kim, Min Kyoung; Lee, Seung Mi; Bae, Sung-Hee; Kim, Hyun Joo; Lim, Nam Gu; Yoon, Seok-Jun; Lee, Jin Yong; Jo, Min-Woo

    2018-01-05

    Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery

  7. ANALYSIS OF MEASURES FOR INCREASING THE RATING OF UNIVERSITY IN INTERNATIONAL RATING SYSTEM

    Directory of Open Access Journals (Sweden)

    В.П. Харченко

    2011-02-01

    Full Text Available The principles of forming the world's most popular international Internet-ranking of universities are considered. The principles of forming the international rating of electronic resources known as Webometrics, which results are defined by summing four values based on quantity of unique external links to the site page and by the quantity of “valuable” files placed on website are represented.  Мost Internet ratings make slope on the  Web activity of the university and its researchers, therefore the participation of entire staff at university is required

  8. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort

    NARCIS (Netherlands)

    Williams, T.A.; Lenders, J.W.M.; Mulatero, P.; Burrello, J.; Rottenkolber, M.; Adolf, C.; Satoh, F.; Amar, L.; Quinkler, M.; Deinum, J.; Beuschlein, F.; Kitamoto, K.K.; Pham, U.; Morimoto, R.; Umakoshi, H.; Prejbisz, A.; Kocjan, T.; Naruse, M.; Stowasser, M.; Nishikawa, T.; Young, W.F., Jr.; Gomez-Sanchez, C.E.; Funder, J.W.; Reincke, M.

    2017-01-01

    BACKGROUND: Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension, no standard criteria exist to classify surgical outcomes. We aimed to create consensus criteria for clinical and biochemical outcomes and follow-up of adrenalectomy for unilateral

  9. Accelerated partial breast irradiation: An analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy

    International Nuclear Information System (INIS)

    Wazer, David E.; Kaufman, Seth; Cuttino, Laurie; Di Petrillo, Thomas; Arthur, Douglas W.

    2006-01-01

    Purpose: To perform a detailed analysis of variables associated with late tissue effects of high-dose-rate (HDR) interstitial brachytherapy accelerated partial breast irradiation (APBI) in a large cohort of patients with prolonged follow-up. Methods and Materials: Beginning in 1995, 75 women with Stage I/II breast cancer were enrolled in identical institutional trials evaluating APBI as monotherapy after lumpectomy. Patients eligible included those with T1-2, N0-1 (≤3 nodes positive), M0 tumors of nonlobular histology with negative surgical margins, no extracapsular nodal extension, and negative results on postexcision mammogram. All patients underwent surgical excision and postoperative irradiation with HDR interstitial brachytherapy. The planning target volume was defined as the excision cavity plus a 2-cm margin. Treatment was delivered with a high-activity Ir-192 source at 3.4 Gy per fraction twice daily for 5 days to a total dose of 34 Gy. Dosimetric analyses were performed with three-dimensional postimplant dose and volume reconstructions. All patients were evaluated at 3-6-month intervals and assessed with a standardized cosmetic rating scale and according to Radiation Therapy Oncology Group late normal tissue toxicity scoring criteria. Clinical and therapy-related features were analyzed for their relationship to cosmetic outcome and toxicity rating. Clinical features analyzed included age, volume of resection, history of diabetes or hypertension, extent of axillary surgery, and systemic therapies. Therapy-related features analyzed included volume of tissue encompassed by the 100%, 150%, and 200% isodose lines (V100, V150, and V200, respectively), the dose homogeneity index (DHI), number of source dwell positions, and planar separation. Results: The median follow-up of all patients was 73 months (range, 43-118 months). The cosmetic outcome at last follow-up was rated as excellent, good, and fair/poor in 67%, 24%, and 9% of patients, respectively

  10. Large Scale System Safety Integration for Human Rated Space Vehicles

    Science.gov (United States)

    Massie, Michael J.

    2005-12-01

    concurrence on these non-compliant conditionsAnother area of challenge lies in determining the credibility of a proposed hazard. For example, NASA's definition of a credible hazard is accurate but does not provide specific guidance about contractors declaring a hazard "not credible" and ceasing working on that item.Unfortunately, this has the side effect of taking valuable resources from high-risk areas and using them to investigate whether these extremely low risk items have the potential to become worse than they appear.In order to deal with these types of issues, there must exist the concept of a "Safe State" and it must be used as a building block to help address many of the technical and social challenges in working safety and risk management. This "Safe State" must serve as the foundation for building the cultural modifications needed to assure that safety issues are properly identified, heard, and dispositioned by our space program management.As the space program and the countries involved in it move forward in development of human rated spacecraft, they must learn from the recent Columbia accident and establish new/modified basis for safety risk decisions. Those involved must also become more cognizant of the diversity in safety approaches and agree on how to deal with them. Most of all, those involved must never forget that while the System Safety duty maybe difficult, their efforts help to preserve the lives of space crews and their families.

  11. A generalized window energy rating system for typical office buildings

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Cheng; Chen, Tingyao; Yang, Hongxing; Chung, Tse-ming [Research Center for Building Environmental Engineering, Department of Building Services Engineering, The Hong Kong Polytechnic University, Hong Kong (China)

    2010-07-15

    Detailed computer simulation programs require lengthy inputs, and cannot directly provide an insight to relationship between the window energy performance and the key window design parameters. Hence, several window energy rating systems (WERS) for residential houses and small buildings have been developed in different countries. Many studies showed that utilization of daylight through elaborate design and operation of windows leads to significant energy savings in both cooling and lighting in office buildings. However, the current WERSs do not consider daylighting effect, while most of daylighting analyses do not take into account the influence of convective and infiltration heat gains. Therefore, a generalized WERS for typical office buildings has been presented, which takes all primary influence factors into account. The model includes embodied and operation energy uses and savings by a window to fully reflect interactions among the influence parameters. Reference locations selected for artificial lighting and glare control in the current common simulation practice may cause uncompromised conflicts, which could result in over- or under-estimated energy performance. Widely used computer programs, DOE2 and ADELINE, for hourly daylighting and cooling simulations have their own weaknesses, which may result in unrealistic or inaccurate results. An approach is also presented for taking the advantages of the both programs and avoiding their weaknesses. The model and approach have been applied to a typical office building of Hong Kong as an example to demonstrate how a WERS in a particular location can be established and how well the model can work. The energy effect of window properties, window-to-wall ratio (WWR), building orientation and lighting control strategies have been analyzed, and can be indicated by the localized WERS. An application example also demonstrates that the algebraic WERS derived from simulation results can be easily used for the optimal design of

  12. Design of mass flow rate measurement system for SST-1 superconducting magnet system

    Energy Technology Data Exchange (ETDEWEB)

    Varmora, P., E-mail: pvamora@ipr.res.in; Sharma, A.N.; Khristi, Y.; Prasad, U.; Patel, D.; Doshi, K.; Pradhan, S.

    2016-11-15

    Highlights: • Design of Venturi meter for SST-1 magnet system. • Details of Helium mass flow measurement system used in SST-1. • Instruments and measurement techniques for flow measurement. • VME based data acquisition system details and flow calculation and results from SST-1 campaigns. - Abstract: Superconducting Magnet System (SCMS) of Steady State Superconducting Tokamak – 1 (SST-1) is forced-flow cooled by a closed cycle 1.3 kW (at 4.5 K) class Helium Refrigerator cum Liquefier (HRL) system. An accurate measurement of helium mass flow rate in different coils is required to ensure the uniform cooling of the cold mass in the entire range of operating temperature (300 K to 4.5 K) and pressure (0.9–0.4 MPa). To meet this requirement, indigenously designed and fabricated venturi meters are installed on 27 different coils of SST-1 SCMS. A VME based Data Acquisition System (DAS) has been developed and used to acquire the flow measurement data from different flowmeters. The details of the design of venturi meter, its different measurement and signal conditioning components, the data acquisition system and the mass flow rate calculation method are described in this paper. The mass flow rate measurement data from cryogenic acceptance and SST-1 magnet commissioning experiments are also presented and discussed in this paper.

  13. Design of mass flow rate measurement system for SST-1 superconducting magnet system

    International Nuclear Information System (INIS)

    Varmora, P.; Sharma, A.N.; Khristi, Y.; Prasad, U.; Patel, D.; Doshi, K.; Pradhan, S.

    2016-01-01

    Highlights: • Design of Venturi meter for SST-1 magnet system. • Details of Helium mass flow measurement system used in SST-1. • Instruments and measurement techniques for flow measurement. • VME based data acquisition system details and flow calculation and results from SST-1 campaigns. - Abstract: Superconducting Magnet System (SCMS) of Steady State Superconducting Tokamak – 1 (SST-1) is forced-flow cooled by a closed cycle 1.3 kW (at 4.5 K) class Helium Refrigerator cum Liquefier (HRL) system. An accurate measurement of helium mass flow rate in different coils is required to ensure the uniform cooling of the cold mass in the entire range of operating temperature (300 K to 4.5 K) and pressure (0.9–0.4 MPa). To meet this requirement, indigenously designed and fabricated venturi meters are installed on 27 different coils of SST-1 SCMS. A VME based Data Acquisition System (DAS) has been developed and used to acquire the flow measurement data from different flowmeters. The details of the design of venturi meter, its different measurement and signal conditioning components, the data acquisition system and the mass flow rate calculation method are described in this paper. The mass flow rate measurement data from cryogenic acceptance and SST-1 magnet commissioning experiments are also presented and discussed in this paper.

  14. Achievable Performance of Zero-Delay Variable-Rate Coding in Rate-Constrained Networked Control Systems with Channel Delay

    DEFF Research Database (Denmark)

    Barforooshan, Mohsen; Østergaard, Jan; Stavrou, Fotios

    2017-01-01

    This paper presents an upper bound on the minimum data rate required to achieve a prescribed closed-loop performance level in networked control systems (NCSs). The considered feedback loop includes a linear time-invariant (LTI) plant with single measurement output and single control input. Moreover......, in this NCS, a causal but otherwise unconstrained feedback system carries out zero-delay variable-rate coding, and control. Between the encoder and decoder, data is exchanged over a rate-limited noiseless digital channel with a known constant time delay. Here we propose a linear source-coding scheme...

  15. 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.

  16. Potential for erroneous interpretation of poisoning outcomes due to changes in National Poison Data System reporting.

    Science.gov (United States)

    Anderson, Bruce; Ke, Xuehua; Klein-Schwartz, Wendy

    2010-08-01

    In 2006, the annual report of poison centers in the United States changed the method of reporting profiles for generic substance categories from all exposures to single-substance exposures only. The objective of this study is to describe the potential impact of this reporting change on longitudinal analysis of outcomes. Generic substance categories with data available for all years of the study were manually extracted from Table 22 of the National Poison Data System (NPDS) annual reports for 2002-2007. For each generic substance category, the following data were extracted for each of the 6 years: total number of substance mentions (2002-2005) or single-substance exposures (2006-2007), reason (unintentional or intentional), pediatric exposures (children age average annual number of reported deaths by substance category decreased by 80.8%, from 2,229 in year 2002-2005 to 428 after the 2006 reporting change (p average annual number of reported major outcomes by substance category dropped by 76.0% (p average number of deaths and major effects by substance category decreased by about 50% from 394 and 4,639 per year during 2002-2005 to 198 deaths (p average rates of reported deaths (61.7 and 35.9%) and major effects (36.3 and 11.2%) for drug categories and nondrug categories, respectively (p change in 2006 will yield inaccurate results if the change in reporting methodology is not taken into account.

  17. Using a retention in care protocol to promote positive health and systems related outcomes.

    Science.gov (United States)

    Larbi, Alfred A; Spielberg, Freya; Kamanu Elias, Nnemdi; Athey, Erin; Ogbuawa, Ngozi; Murphy, Nancy

    2018-04-18

    People living with HIV can experience the full benefits of retention when they are continuously engaged in care. Continuous engagement in care promotes improved adherence to ART and positive health outcomes. An infectious disease clinic has implemented a protocol to primarily improve patient retention. The retrospective, facility-based, costing study took place in an infectious disease clinic in Washington DC. Retention was defined in two ways and over a 12-month period. Micro-costing direct measurement methods were used to collect unit costs in time series. Return on investment accounted for the cost of treatment based on CD4 strata. ROI was expressed in 2016USD. The difference in CD4 and viral load levels between the two periods of analysis were determined for active patients, infected with HIV. The year before the intervention was compared to the year of the intervention. Total treatment expenditure decreased from $2,435,653.00 to $2,283,296.23, resulting in a $152,356.77 gain from investment for the healthcare system over a 12-month investment period. The viral load suppression rate increased from 81 to 95 (p = 0.04) over the investment period. The number of patients in need of HIV related opportunistic infection prophylaxis decreased from 21 to 13 (p = 0.06). Improved immunologic, virologic and healthcare expenditure outcomes can be linked to the quality of retention practice.

  18. Stem cell transplantation as a dynamical system: are clinical outcomes deterministic?

    Science.gov (United States)

    Toor, Amir A; Kobulnicky, Jared D; Salman, Salman; Roberts, Catherine H; Jameson-Lee, Max; Meier, Jeremy; Scalora, Allison; Sheth, Nihar; Koparde, Vishal; Serrano, Myrna; Buck, Gregory A; Clark, William B; McCarty, John M; Chung, Harold M; Manjili, Masoud H; Sabo, Roy T; Neale, Michael C

    2014-01-01

    Outcomes in stem cell transplantation (SCT) are modeled using probability theory. However, the clinical course following SCT appears to demonstrate many characteristics of dynamical systems, especially when outcomes are considered in the context of immune reconstitution. Dynamical systems tend to evolve over time according to mathematically determined rules. Characteristically, the future states of the system are predicated on the states preceding them, and there is sensitivity to initial conditions. In SCT, the interaction between donor T cells and the recipient may be considered as such a system in which, graft source, conditioning, and early immunosuppression profoundly influence immune reconstitution over time. This eventually determines clinical outcomes, either the emergence of tolerance or the development of graft versus host disease. In this paper, parallels between SCT and dynamical systems are explored and a conceptual framework for developing mathematical models to understand disparate transplant outcomes is proposed.

  19. Warfarin Management and Outcomes in Patients with Nonvalvular Atrial Fibrillation Within an Integrated Health Care System.

    Science.gov (United States)

    An, JaeJin; Niu, Fang; Zheng, Chengyi; Rashid, Nazia; Mendes, Robert A; Dills, Diana; Vo, Lien; Singh, Prianka; Bruno, Amanda; Lang, Daniel T; Le, Paul T; Jazdzewski, Kristin P; Aranda, Gustavus

    2017-06-01

    Warfarin is a common treatment option to manage patients with nonvalvular atrial fibrillation (NVAF) in clinical practice. Understanding current pharmacist-led anticoagulation clinic management patterns and associated outcomes is important for quality improvement; however, currently little evidence associating outcomes with management patterns exists. To (a) describe warfarin management patterns and (b) evaluate associations between warfarin treatment and clinical outcomes for patients with NVAF in an integrated health care system. A retrospective cohort study was conducted among NVAF patients with warfarin therapy between January 1, 2006, and December 31, 2011, using Kaiser Permanente Southern California data, and followed until December 31, 2013. Management patterns related to international normalized ratio (INR) monitoring, anticoagulation clinic pharmacist intervention (consultation), and warfarin dose adjustments were investigated along with yearly attrition rates, time-in-therapeutic ranges (TTRs), and clinical outcomes (stroke or systemic embolism and major bleeding). Descriptive statistics and multivariable Cox proportional hazard models were used to determine associations between TTR and clinical outcomes. A total of 32,074 NVAF patients on warfarin treatment were identified and followed for a median of 3.8 years. About half (49%) of the patients were newly initiating warfarin therapy. INR monitoring and pharmacist interventions were conducted roughly every 3 weeks after 6 months of warfarin treatment. Sixty-three percent of the study population had ≥ 1 warfarin dose adjustments with a mean (SD) of 6.7 (6.3) annual dose adjustments. Warfarin dose adjustments occurred at a median of 1 day (interquartile ranges [IQR] 1-3) after the INR measurement. Yearly attrition rate was from 3.3% to 6.3% during the follow-up, and median (IQR) TTR was 61% (46%-73%). Patients who received frequent INR monitoring (≥ 27 times per year), pharmacist interventions (≥ 24

  20. Validation of Patient-Reported Outcomes Measurement Information System Short Forms for Use in Childhood-Onset Systemic Lupus Erythematosus.

    Science.gov (United States)

    Jones, Jordan T; Carle, Adam C; Wootton, Janet; Liberio, Brianna; Lee, Jiha; Schanberg, Laura E; Ying, Jun; Morgan DeWitt, Esi; Brunner, Hermine I

    2017-01-01

    To validate the pediatric Patient-Reported Outcomes Measurement Information System short forms (PROMIS-SFs) in childhood-onset systemic lupus erythematosus (SLE) in a clinical setting. At 3 study visits, childhood-onset SLE patients completed the PROMIS-SFs (anger, anxiety, depressive symptoms, fatigue, physical function-mobility, physical function-upper extremity, pain interference, and peer relationships) using the PROMIS assessment center, and health-related quality of life (HRQoL) legacy measures (Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters [SMILEY], and visual analog scales [VAS] of pain and well-being). Physicians rated childhood-onset SLE activity on a VAS and completed the Systemic Lupus Erythematosus Disease Activity Index 2000. Using a global rating scale of change (GRC) between study visits, physicians rated change of childhood-onset SLE activity (GRC-MD1: better/same/worse) and change of patient overall health (GRC-MD2: better/same/worse). Questionnaire scores were compared in support of validity and responsiveness to change (external standards: GRC-MD1, GRC-MD2). In this population-based cohort (n = 100) with a mean age of 15.8 years (range 10-20 years), the PROMIS-SFs were completed in less than 5 minutes in a clinical setting. The PROMIS-SF scores correlated at least moderately (Pearson's r ≥ 0.5) with those of legacy HRQoL measures, except for the SMILEY. Measures of childhood-onset SLE activity did not correlate with the PROMIS-SFs. Responsiveness to change of the PROMIS-SFs was supported by path, mixed-model, and correlation analyses. To assess HRQoL in childhood-onset SLE, the PROMIS-SFs demonstrated feasibility, internal consistency, construct validity, and responsiveness to change in a clinical setting. © 2016, American College of Rheumatology.

  1. Correlation of the Rock Mass Rating (RMR) System with the Unified Soil Classification System (USCS): Introduction of the Weak Rock Mass Rating System (W-RMR)

    Science.gov (United States)

    Warren, Sean N.; Kallu, Raj R.; Barnard, Chase K.

    2016-11-01

    Underground gold mines in Nevada are exploiting increasingly deeper ore bodies comprised of weak to very weak rock masses. The Rock Mass Rating (RMR) classification system is widely used at underground gold mines in Nevada and is applicable in fair to good-quality rock masses, but is difficult to apply and loses reliability in very weak rock mass to soil-like material. Because very weak rock masses are transition materials that border engineering rock mass and soil classification systems, soil classification may sometimes be easier and more appropriate to provide insight into material behavior and properties. The Unified Soil Classification System (USCS) is the most likely choice for the classification of very weak rock mass to soil-like material because of its accepted use in tunnel engineering projects and its ability to predict soil-like material behavior underground. A correlation between the RMR and USCS systems was developed by comparing underground geotechnical RMR mapping to laboratory testing of bulk samples from the same locations, thereby assigning a numeric RMR value to the USCS classification that can be used in spreadsheet calculations and geostatistical analyses. The geotechnical classification system presented in this paper including a USCS-RMR correlation, RMR rating equations, and the Geo-Pick Strike Index is collectively introduced as the Weak Rock Mass Rating System (W-RMR). It is the authors' hope that this system will aid in the classification of weak rock masses and more usable design tools based on the RMR system. More broadly, the RMR-USCS correlation and the W-RMR system help define the transition between engineering soil and rock mass classification systems and may provide insight for geotechnical design in very weak rock masses.

  2. Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study.

    Science.gov (United States)

    Malla, Ashok; Norman, Ross; Schmitz, Norbert; Manchanda, Rahul; Béchard-Evans, Laura; Takhar, Jatinder; Haricharan, Raj

    2006-05-01

    The evidence regarding the independent influence of duration of untreated psychosis (DUP) on rate and time to remission is far from unequivocal. The goal of the current study was to examine the role of predictors for rate and time to remission in first-episode psychosis (FEP). The differential effect of age, gender, age of onset, duration of untreated psychosis (DUP), duration of untreated illness (DUI), pre-morbid adjustment, co-morbid diagnosis of substance abuse and adherence to medication on the rate of and time to remission were estimated using a logistic and Poisson regression, and survival analysis respectively, in FEP patients. In a sample of 107 FEP patients 82.2% achieved remission over a period of 2 years after a mean of 10.3 weeks (range 1-72). Regression analysis, based on complete data on all variables of interest (n=80), showed status of remission to be positively influenced by better pre-morbid adjustment (RR 0.57, 95% CI 0.34-0.95, p<0.05), later age of onset (RR 1.09, 95% CI 1.05-1.13, p<0.0001), higher level of adherence to medication (RR 1.96, 95% CI 1.38-2.76, p<0.001) and shorter DUI (RR 0.99, 95% CI 0.997-0.999, p<0.005). Time to remission was influenced by age of onset (HR 1.04, 95% CI 1.00-1.08, p<0.04) and adherence to medication (HR 1.58, 95% CI 1.11-2.23, p<0.01). Improving adherence to medication early in the course of treatment may be an important intervention to improve short-term outcome.

  3. The National Outcomes Measurement System for Pediatric Speech-Language Pathology

    Science.gov (United States)

    Mullen, Robert; Schooling, Tracy

    2010-01-01

    Purpose: The American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) was developed in the late 1990s. The primary purpose was to serve as a source of data for speech-language pathologists (SLPs) who found themselves called on to provide empirical evidence of the functional outcomes associated with their…

  4. Treatment outcomes and late toxicities in patients with embryonal central nervous system tumors

    International Nuclear Information System (INIS)

    Odagiri, Kazumasa; Omura, Motoko; Hata, Masaharu; Aida, Noriko; Niwa, Tetsu; Goto, Hiroaki; Ito, Susumu; Adachi, Masanori; Yoshida, Haruyasu; Yuki, Hiroko; Inoue, Tomio

    2014-01-01

    Standard treatment strategies for embryonal central nervous system (CNS) tumors have not yet been established. We treated these tumors using an original chemoradiation therapy protocol; the clinical outcomes and toxicities were retrospectively evaluated. Twenty-four patients were enrolled including sixteen with medulloblastoma, four with supratentorial primitive neuroectodermal tumor (sPNET), three with atypical teratoid/rhabdoid tumor, and one with pineoblastoma. Immediately after diagnosis, all patients underwent surgery initially. They were then categorized as high- or average-risk groups independent of tumor type/pathogenesis. The average-risk group included patients who were aged ≥3 years at diagnosis, had non-metastatic disease at diagnosis (M0), and had undergone gross total resection. Other patients were categorized as the high-risk group; this group received more intensive treatment than the average-risk group, including high-dose chemotherapy with autologous stem-cell transplantation. All patients received craniospinal irradiation (CSI). The CSI dose was 23.4 Gy for M0 patients aged ≥5 years, 18 Gy for M0 patients aged <5 years, and 30–36 Gy for all patients with M + disease. The total dose to the primary tumor bed was 54 Gy. The median follow-up time was 73.5 (range, 19–118) months. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 71.1 and 88.9%, respectively in the average-risk group (n = 9) and 66.7 and 71.1%, respectively in the high-risk group (n = 15). The PFS and OS rates were not significantly different between the average- and high-risk groups. In patients with medulloblastoma only, these rates were also not significantly different between the average- and high-risk groups. Three of four patients with sPNET were disease free. The height standard deviation score (SDS) was significantly decreased at the last assessment relative to that at diagnosis (P < 0.0001). The latest median height SDS was -1.6 (range, 0

  5. Safety Characteristics in System Application Software for Human Rated Exploration

    Science.gov (United States)

    Mango, E. J.

    2016-01-01

    NASA and its industry and international partners are embarking on a bold and inspiring development effort to design and build an exploration class space system. The space system is made up of the Orion system, the Space Launch System (SLS) and the Ground Systems Development and Operations (GSDO) system. All are highly coupled together and dependent on each other for the combined safety of the space system. A key area of system safety focus needs to be in the ground and flight application software system (GFAS). In the development, certification and operations of GFAS, there are a series of safety characteristics that define the approach to ensure mission success. This paper will explore and examine the safety characteristics of the GFAS development.

  6. Environmental Outcomes in the South African Learnership System

    African Journals Online (AJOL)

    ... responsible for the implementation of government policy on environmental management. ... responsibility towards the environment and health of others. ... social, economic and political systems and in the world views, institutions and lifestyle.

  7. Evolving Systems: An Outcome of Fondest Hopes and Wildest Dreams

    Science.gov (United States)

    Frost, Susan A.; Balas, Mark J.

    2012-01-01

    New theory is presented for evolving systems, which are autonomously controlled subsystems that self-assemble into a new evolved system with a higher purpose. Evolving systems of aerospace structures often require additional control when assembling to maintain stability during the entire evolution process. This is the concept of Adaptive Key Component Control that operates through one specific component to maintain stability during the evolution. In addition, this control must often overcome persistent disturbances that occur while the evolution is in progress. Theoretical results will be presented for Adaptive Key Component control for persistent disturbance rejection. An illustrative example will demonstrate the Adaptive Key Component controller on a system composed of rigid body and flexible body modes.

  8. Effect of an office worksite-based yoga program on heart rate variability: outcomes of a randomized controlled trial

    Science.gov (United States)

    2013-01-01

    Background Chronic work-related stress is an independent risk factor for cardiometabolic diseases and associated mortality, particularly when compounded by a sedentary work environment. The purpose of this study was to determine if an office worksite-based hatha yoga program could improve physiological stress, evaluated via heart rate variability (HRV), and associated health-related outcomes in a cohort of office workers. Methods Thirty-seven adults employed in university-based office positions were randomized upon the completion of baseline testing to an experimental or control group. The experimental group completed a 10-week yoga program prescribed three sessions per week during lunch hour (50 min per session). An experienced instructor led the sessions, which emphasized asanas (postures) and vinyasa (exercises). The primary outcome was the high frequency (HF) power component of HRV. Secondary outcomes included additional HRV parameters, musculoskeletal fitness (i.e. push-up, side-bridge, and sit & reach tests) and psychological indices (i.e. state and trait anxiety, quality of life and job satisfaction). Results All measures of HRV failed to change in the experimental group versus the control group, except that the experimental group significantly increased LF:HF (p = 0.04) and reduced pNN50 (p = 0.04) versus control, contrary to our hypotheses. Flexibility, evaluated via sit & reach test increased in the experimental group versus the control group (p yoga sessions (n = 11) to control (n = 19) yielded the same findings, except that the high adherers also reduced state anxiety (p = 0.02) and RMSSD (p = 0.05), and tended to improve the push-up test (p = 0.07) versus control. Conclusions A 10-week hatha yoga intervention delivered at the office worksite during lunch hour did not improve HF power or other HRV parameters. However, improvements in flexibility, state anxiety and musculoskeletal fitness were noted with high adherence

  9. A packet-based dual-rate PID control strategy for a slow-rate sensing Networked Control System.

    Science.gov (United States)

    Cuenca, A; Alcaina, J; Salt, J; Casanova, V; Pizá, R

    2018-05-01

    This paper introduces a packet-based dual-rate control strategy to face time-varying network-induced delays, packet dropouts and packet disorder in a Networked Control System. Slow-rate sensing enables to achieve energy saving and to avoid packet disorder. Fast-rate actuation makes reaching the desired control performance possible. The dual-rate PID controller is split into two parts: a slow-rate PI controller located at the remote side (with no permanent communication to the plant) and a fast-rate PD controller located at the local side. The remote side also includes a prediction stage in order to generate the packet of future, estimated slow-rate control actions. These actions are sent to the local side and converted to fast-rate ones to be used when a packet does not arrive at this side due to the network-induced delay or due to occurring dropouts. The proposed control solution is able to approximately reach the nominal (no-delay, no-dropout) performance despite the existence of time-varying delays and packet dropouts. Control system stability is ensured in terms of probabilistic Linear Matrix Inequalities (LMIs). Via real-time control for a Cartesian robot, results clearly reveal the superiority of the control solution compared to a previous proposal by authors. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

  10. Highlights of trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

    Science.gov (United States)

    Ventura, S J; Mosher, W D; Curtin, S C; Abma, J C; Henshaw, S

    1999-12-15

    This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics including age, race, Hispanic origin, and marital status. Summary data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity and contraceptive practices, as well as women's reports of pregnancy intentions. Tabular and graphic data on pregnancy rates by demographic characteristics are presented and interpreted. Birth data are from the birth registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.

  11. 78 FR 58153 - Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System...

    Science.gov (United States)

    2013-09-23

    ... American Industry Classification System Based Federal Wage System Wage Surveys AGENCY: U.S. Office of... in Federal Wage System wage survey industry regulations with the 2012 NAICS revisions published by.... Applicability date: This rule applies for local wage surveys beginning on or after February 21, 2014. FOR...

  12. The Effect of Significant International Sports Events on Qualified Detoxification Treatment Outcome - Do Drop-Out Rates Change during UEFA European Championship?

    Directory of Open Access Journals (Sweden)

    Yvonne Sofin

    Full Text Available No previous studies have evaluated the influence of significant international sports events on qualified detoxification treatment outcome. This prospective study examines the impact of the 2012 UEFA European Football Championship on inpatient treatment outcome of alcohol dependent patients. Hospital admission and premature drop-out rates of consecutively admitted alcohol dependent patients were determined before, during and immediately after the UEFA Championship in the year 2012. The admission rate of male patients increased significantly after the European Football Championship had ended whereas for female patients, no change in admission rate was found. Daily average discharge rate was calculated. No statistically relevant differences between the treatment days before, during and after the UEFA Championship was found for the discharges. During the tournament, exclusively male patients dropped out. Our results are consistent with an interpretation of an association between European Football Championship and detoxification treatment outcome. Further research to replicate and extend our findings is necessary.

  13. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

    2016-01-01

    Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

  14. Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system.

    Science.gov (United States)

    Ponzio, Vinicius; Camargo, Luis F A; Medina-Pestana, José O; Perfect, John R; Colombo, Arnaldo L

    2018-04-20

    Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less-resourced health care settings. Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13 years. Graft dysfunction, graft loss and mortality rates were evaluated. Predictors of mortality and graft loss were estimated. A total of 38 (97.4%) patients treated with amphotericin B deoxycholate (AMBd) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30 days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels and graft dysfunction concomitant to AMBd therapy and an additional nephrotoxic condition. The 30-day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high CSF opening pressure, positive CSF India ink, creatinine levels greater than 2.0 mg/dL at admission, graft dysfunction in patients treated with AMBd and an additional nephrotoxic condition and graft loss within 30 days. Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. The Implementation of Data Warehouse and OLAP for Rehabilitation Outcome Evaluation: ReDWinE System

    Science.gov (United States)

    Guo, Fei-Ran; Parmanto, Bambang; Irrgang, James J.; Wang, Jiunjie; Fang, Huaijin

    2000-01-01

    We created a data warehouse and OLAP system on the web for outcome evaluation of rehabilitation services. Thirteen outcome indicators were use in this research. Efficiency of therapists and clinics, expected utility of treatments and graphic patterns were generated for data exploration, data mining and decision support. Users can retrieve plenty of graphs and statistical tables without knowing database structure or attributes. Our experiences showed that multi-dimensional database and OLAP could serve as a decision support system.

  16. System reliability evaluation of a touch panel manufacturing system with defect rate and reworking

    International Nuclear Information System (INIS)

    Lin, Yi-Kuei; Huang, Cheng-Fu; Chang, Ping-Chen

    2013-01-01

    In recent years, portable consumer electronic products, such as cell phone, GPS, digital camera, tablet PC, and notebook are using touch panel as interface. With the demand of touch panel increases, performance assessment is essential for touch panel production. This paper develops a method to evaluate system reliability of a touch panel manufacturing system (TPMS) with defect rate of each workstation and takes reworking actions into account. The system reliability which evaluates the possibility of demand satisfaction can provide to managers with an understanding of the system capability and can indicate possible improvements. First, we construct a capacitated manufacturing network (CMN) for a TPMS. Second, a decomposition technique is developed to determine the input flow of each workstation based on the CMN. Finally, we generate the minimal capacity vectors that should be provided to satisfy the demand. The system reliability is subsequently evaluated in terms of the minimal capacity vectors. A further decision making issue is discussed to decide a reliable production strategy. -- Graphical abstract: The proposed procedure to evaluate system reliability of the touch panel manufacturing system (TPMS). Highlights: • The system reliability of a touch panel manufacturing system (TPMS) is evaluated. • The reworking actions are taken into account in the TPMS. • A capacitated manufacturing network is constructed for the TPMS. • A procedure is proposed to evaluate system reliability of TPMS

  17. Flow rate control systems for coolants for BWR type reactors

    International Nuclear Information System (INIS)

    Igarashi, Yoko; Kato, Naoyoshi.

    1981-01-01

    Purpose: To increase spontaneous recycling flow rate of coolants in BWR type reactors when the water level in the reactor decreases, by communicating a downcomer with a lower plenum. Constitution: An opening is provided to the back plate disposed at the lower end of a reactor core shroud for communicating a downcomer with a lower plenum, and an ON-OFF valve actuated by an operation rod is provided to the opening. When abnormal water level or pressure in the reactor is detected by a level metal or pressure meter, the operation rod is driven to open the ON-OFF valve, whereby coolants fed from a jet pump partially flows through the opening to increase the spontaneous recycling flow rate of the coolants. This can increase the spontaneous recycling flow rate of the coolants upon spontaneous recycling operation, thereby maintaining the reactor safety and the fuel soundness. (Moriyama, K.)

  18. Treatment outcome in early diffuse cutaneous systemic sclerosis

    DEFF Research Database (Denmark)

    Herrick, Ariane L; Pan, Xiaoyan; Peytrignet, Sébastien

    2017-01-01

    OBJECTIVES: The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches. METHODS: This was a prospective, observational cohort study...

  19. 38 CFR 4.104 - Schedule of ratings-cardiovascular system.

    Science.gov (United States)

    2010-07-01

    ...-cardiovascular system. 4.104 Section 4.104 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Cardiovascular System § 4.104 Schedule of ratings—cardiovascular system. Diseases of the Heart Rating Note (1): Evaluate cor pulmonale, which is a form of...

  20. 38 CFR 4.97 - Schedule of ratings-respiratory system.

    Science.gov (United States)

    2010-07-01

    ...-respiratory system. 4.97 Section 4.97 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Respiratory System § 4.97 Schedule of ratings—respiratory system. Rating DISEASES OF THE NOSE AND THROAT 6502Septum, nasal, deviation of: Traumatic only...

  1. Capital Controls and Foreign Investor Subsidies Implicit in South Africa's Dual Exchange Rate System

    NARCIS (Netherlands)

    Huizinga, H.P.; Schaling, E.; van der Windt, P.C.

    2007-01-01

    Both in theory and practice, capital controls and dual exchange rate systems can be part of a country's optimal tax policy. We first show how a dual exchange rate system can be interpreted as a tax (or subsidy) on international capital income. We show that a dual exchange rate system, with separate

  2. 75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-27

    ... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...

  3. 76 FR 68525 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012

    Science.gov (United States)

    2011-11-04

    ... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...

  4. 75 FR 76293 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2010-12-08

    ... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...

  5. 38 CFR 4.119 - Schedule of ratings-endocrine system.

    Science.gov (United States)

    2010-07-01

    ... minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system...-endocrine system. 4.119 Section 4.119 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Endocrine System § 4.119 Schedule of ratings...

  6. Adolescent sexual assault victims and the legal system: building community relationships to improve prosecution rates.

    Science.gov (United States)

    Campbell, Rebecca; Greeson, Megan R; Bybee, Deborah; Fehler-Cabral, Giannina

    2012-09-01

    Adolescents are at high risk for sexual assault, but few of these crimes are reported to the police and prosecuted by the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary interventions to improve post-assault care for victims and increase prosecution rates. The two most commonly implemented interventions are Sexual Assault Nurse Examiner (SANE) Programs and Sexual Assault Response Teams (SARTs). The purpose of this study was to determine whether community-level context (i.e., stakeholder engagement and collaboration) was predictive of adolescent legal case outcomes, after accounting for "standard" factors that affect prosecution success (i.e., victim, assault, and evidence characteristics). Overall, 40% of the adolescent cases from these two SANE-SART programs (over a 10-year period) were successfully prosecuted. Cases were more likely to be prosecuted for younger victims, those with disabilities, those who knew their offenders, and instances in which the rape evidence collection kit was submitted by police for analysis. After accounting for these influences, multi-level modeling results revealed that in one site decreased allocation of community resources to adolescent sexual assault cases had a significant negative effect on prosecution case outcomes. Results are explained in terms of Wolff's (Am J Community Psychol 29:173-191, 2001) concept of "over-coalitioned" communities and Kelly's (1968) ecological principles.

  7. Benchmarking outcomes in the Neonatal Intensive Care Unit: Cytogenetic and molecular diagnostic rates in a retrospective cohort.

    Science.gov (United States)

    Malam, Faheem; Hartley, Taila; Gillespie, Meredith K; Armour, Christine M; Bariciak, Erika; Graham, Gail E; Nikkel, Sarah M; Richer, Julie; Sawyer, Sarah L; Boycott, Kym M; Dyment, David A

    2017-05-09

    Genetic disease and congenital anomalies continue to be a leading cause of neonate mortality and morbidity. A genetic diagnosis in the neonatal intensive care unit (NICU) can be a challenge given the associated genetic heterogeneity and early stage of a disease. We set out to evaluate the outcomes of Medical Genetics consultation in the NICU in terms of cytogenetic and molecular diagnostic rates and impact on management. We retrospectively reviewed 132 charts from patients admitted to the NICU who received a Medical Genetics diagnostic evaluation over a 2 year period. Of the 132 patients reviewed, 26% (34/132) received a cytogenetic or molecular diagnosis based on the Medical Genetics diagnostic evaluation; only 10% (13/132) received a diagnosis during their admission. The additional 16% (21 patients) received their diagnosis following NICU discharge, but based on a genetic test initiated during hospital-stay. Mean time from NICU admission to confirmed diagnosis was 24 days. For those who received a genetic diagnosis, the information was considered beneficial for clinical management in all, and a direct change to medical management occurred for 12% (4/32). For those non-diagnosed infants seen in out-patient follow-up clinic, diagnoses were made in 8% (3/37). The diagnoses made post-discharge from the NICU comprised a greater number of Mendelian disorders and represent an opportunity to improve genetic care. The adoption of diagnostic tools, such as exome sequencing, used in parallel with traditional approaches will improve rate of diagnoses and will have a significant impact, in particular when the differential diagnosis is broad. © 2017 Wiley Periodicals, Inc.

  8. Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes.

    Science.gov (United States)

    Prekker, Matthew E; Delgado, Fernanda; Shin, Jenny; Kwok, Heemun; Johnson, Nicholas J; Carlbom, David; Grabinsky, Andreas; Brogan, Thomas V; King, Mary A; Rea, Thomas D

    2016-01-01

    Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. We performed a retrospective analysis of EMS responses between 2006 and 2012 that involved attempted intubation of children younger than 13 years by paramedics in a large, metropolitan EMS system. We calculated the incidence rate of attempted pediatric intubation with EMS and county census data. To summarize the intubation process, we linked a detailed out-of-hospital airway registry with clinical records from EMS, hospital, or autopsy encounters for each child. The main outcome measures were procedural challenges, procedural success, complications, and patient disposition. Paramedics attempted intubation in 299 cases during 6.3 years, with an incidence of 1 pediatric intubation per 2,198 EMS responses. Less than half of intubations (44%) were for patients in cardiac arrest. Two thirds of patients were intubated on the first attempt (66%), and overall success was 97%. The most prevalent challenge was body fluids obscuring the laryngeal view (33%). After a failed first intubation attempt, corrective actions taken by paramedics included changing equipment (33%), suctioning (32%), and repositioning the patient (27%). Six patients (2%) experienced peri-intubation cardiac arrest and 1 patient had an iatrogenic tracheal injury. No esophageal intubations were observed. Of patients transported to the hospital, 86% were admitted to intensive care and hospital mortality was 27%. Pediatric intubation by paramedics was performed infrequently in this EMS system. Although overall intubation success was high, a detailed evaluation of the process of intubation revealed specific

  9. The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health.

    Science.gov (United States)

    Fink, Per; Ørnbøl, Eva; Christensen, Kaj Sparle

    2010-03-24

    Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of

  10. The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health.

    Directory of Open Access Journals (Sweden)

    Per Fink

    Full Text Available BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21 and severe Health anxiety (N = 81 and Hypochondriasis according to the DSM-IV (N = 59 were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968. Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale. They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36. The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred

  11. Expert System Constant False Alarm Rate (CFAR) Processor

    National Research Council Canada - National Science Library

    Wicks, Michael C

    2006-01-01

    An artificial intelligence system improves radar signal processor performance by increasing target probability of detection and reducing probability of false alarm in a severe radar clutter environment...

  12. On the equivalence between the minimum entropy generation rate and the maximum conversion rate for a reactive system

    International Nuclear Information System (INIS)

    Bispo, Heleno; Silva, Nilton; Brito, Romildo; Manzi, João

    2013-01-01

    Highlights: • Minimum entropy generation (MEG) principle improved the reaction performance. • MEG rate and the maximum conversion equivalence have been analyzed. • Temperature and residence time are used to the domain establishment of MEG. • Satisfying the temperature and residence time relationship results a optimal performance. - Abstract: The analysis of the equivalence between the minimum entropy generation (MEG) rate and the maximum conversion rate for a reactive system is the main purpose of this paper. While being used as a strategy of optimization, the minimum entropy production was applied to the production of propylene glycol in a Continuous Stirred-Tank Reactor (CSTR) with a view to determining the best operating conditions, and under such conditions, a high conversion rate was found. The effects of the key variables and restrictions on the validity domain of MEG were investigated, which raises issues that are included within a broad discussion. The results from simulations indicate that from the chemical reaction standpoint a maximum conversion rate can be considered as equivalent to MEG. Such a result can be clearly explained by examining the classical Maxwell–Boltzmann distribution, where the molecules of the reactive system under the condition of the MEG rate present a distribution of energy with reduced dispersion resulting in a better quality of collision between molecules with a higher conversion rate

  13. Clinical Long-Term Outcome and Reinterventional Rate After Uterine Fibroid Embolization with Nonspherical Versus Spherical Polyvinyl Alcohol Particles

    Energy Technology Data Exchange (ETDEWEB)

    Duvnjak, Stevo, E-mail: stevo.duvnjak@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark); Ravn, Pernille [Odense University Hospital, Department of Gynecology (Denmark); Green, Anders [Odense University Hospital, Odense Patient Data Explorative Network (Denmark); Andersen, Poul Erik [Odense University Hospital, Department of Radiology (Denmark)

    2016-02-15

    PurposeThis study was designed to evaluate the long-term clinical outcome and frequency of reinterventions in patients with uterine fibroids treated with embolization at a single center using polyvinyl alcohol microparticles.MethodsThe study included all patients with symptomatic uterine fibroids treated with uterine fibroid embolization (UFE) with spherical (s-PVA) and nonspherical (ns-PVA) polyvinyl alcohol microparticles during the period January 2001 to January 2011. Clinical success and secondary interventions were examined. Hospital records were reviewed during follow-up, and symptom-specific questionnaires were sent to all patients.ResultsIn total, 515 patients were treated with UFE and 350 patients (67 %) were available for long-term clinical follow-up. Median time of follow-up was 93 (range 76–120.2) months. Eighty-five patients (72 %) had no reinterventions during follow-up in the group embolized with ns-PVA compared with 134 patients (58 %) treated with s-PVA. Thirty-three patients (28 %) underwent secondary interventions in the ns-PVA group compared with 98 patients (42 %) in s-PVA group (χ{sup 2} test, p < 0.01).ConclusionsSpherical PVA particles 500–700 µm showed high reintervention rate at long-term follow-up, and almost one quarter of the patients underwent secondary interventions, suggesting that this type of particle is inappropriate for UFE.

  14. Antral follicle counts are strongly associated with live-birth rates after assisted reproduction, with superior treatment outcome in women with polycystic ovaries.

    Science.gov (United States)

    Holte, Jan; Brodin, Thomas; Berglund, Lars; Hadziosmanovic, Nermin; Olovsson, Matts; Bergh, Torbjörn

    2011-09-01

    To evaluate the association of antral follicle count (AFC) with in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) outcome in a large unselected cohort of patients covering the entire range of AFC. Prospective observational study. University-affiliated private infertility center. 2,092 women undergoing 4,308 IVF-ICSI cycles. AFC analyzed for associations with treatment outcome and statistically adjusted for repeated treatments and age. Pregnancy rate, live-birth rate, and stimulation outcome parameters. The AFC was log-normally distributed. Pregnancy rates and live-birth rates were positively associated with AFC in a log-linear way, leveling out above AFC ∼30. Treatment outcome was superior among women with polycystic ovaries, independent from ovulatory status. The findings were significant also after adjustment for age and number of oocytes retrieved. Pregnancy and live-birth rates are log-linearly related to AFC. Polycystic ovaries, most often excluded from studies on ovarian reserve, fit as one extreme in the spectrum of AFC; a low count constitutes the other extreme, with the lowest ovarian reserve and poor treatment outcome. The findings remained statistically significant also after adjustment for the number of oocytes retrieved, suggesting this measure of ovarian reserve comprises information on oocyte quality and not only quantity. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. 76 FR 39159 - Schedule for Rating Disabilities; The Digestive System

    Science.gov (United States)

    2011-07-05

    ... of this change is to incorporate medical advances that have occurred since the last review, insert current medical terminology, and provide clear criteria. DATES: Comments must be received by VA on or... the rating schedule, and implement current medical criteria and terminology that reflect recent...

  16. A new system for rating impact sound insulation

    NARCIS (Netherlands)

    Gerretsen, E.

    1976-01-01

    The rating of impact sound insulation on the basis of tapping machine measurements with the ISO reference values has proved to be unsatisfactory in practice. This is mainly due to the differences in spectrum shape of tapping machine noise and real life impact noises, such as walking. The problem can

  17. Survival rates in bankruptcy systems : overlooking the evidence

    NARCIS (Netherlands)

    Couwenberg, Oscar

    2001-01-01

    Extensive research on bankruptcy still has not made it possible to end the efficiency discussion concerning the need for a reorganization provision in bankruptcy laws. In this paper, I discuss the pervasiveness of asset sales in bankruptcy procedures and the effect it has on survival rates. Without

  18. Impact of Pretreatment Tumor Growth Rate on Outcome of Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Atallah, Soha; Cho, B.C. John; Allibhai, Zishan; Taremi, Mojgan; Giuliani, Meredith [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Brade, Anthony; Sun, Alexander; Bezjak, Andrea [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Hope, Andrew J., E-mail: andrew.hope@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2014-07-01

    Purpose: To determine the influence of pretreatment tumor growth rate on outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Methods and Materials: A review was conducted on 160 patients with T1-T2N0M0 NSCLC treated with SBRT at single institution. The patient's demographic and clinical data, time interval (t) between diagnostic and planning computed tomography (CT), vital status, disease status, and cause of death were extracted from a prospectively kept database. Differences in gross tumor volume between diagnostic CT (GTV1) and planning CT (GTV2) were recorded, and growth rate was calculated by use of specific growth rate (SGR). Kaplan-Meier curves were constructed for overall survival (OS). Differences between groups were compared with a log-rank test. Multivariate analyses were performed by use of the Cox proportional hazard model with SGR and other relevant clinical factors. Cumulative incidence was calculated for local, regional, and distant failures by use of the competing risk approach and was compared with Gray's test. Results: The median time interval between diagnostic and planning CT was 82 days. The patients were divided into 2 groups, and the median SGR was used as a cut-off. The median survival times were 38.6 and 27.7 months for the low and high SGR groups, respectively (P=.03). Eastern Cooperative Oncology Group performance status (P=.01), sex (P=.04), SGR (P=.03), and GTV2 (P=.002) were predictive for OS in multivariable Cox regression analysis and, except sex, were similarly predictive for failure-free survival (FFS). The 3-year cumulative incidences of regional failure were 19.2% and 6.0% for the high and low SGR groups, respectively (P=.047). Conclusion: High SGR was correlated with both poorer OS and FFS in patients with early-stage NSCLC treated with SBRT. If validated, this measurement may be useful in identifying patients most likely to benefit from

  19. System Identification of a Non-Uniformly Sampled Multi-Rate System in Aluminium Electrolysis Cells

    Directory of Open Access Journals (Sweden)

    Håkon Viumdal

    2014-07-01

    Full Text Available Standard system identification algorithms are usually designed to generate mathematical models with equidistant sampling instants, that are equal for both input variables and output variables. Unfortunately, real industrial data sets are often disrupted by missing samples, variations of sampling rates in the different variables (also known as multi-rate systems, and intermittent measurements. In industries with varying events based maintenance or manual operational measures, intermittent measurements are performed leading to uneven sampling rates. Such is the case with aluminium smelters, where in addition the materials fed into the cell create even more irregularity in sampling. Both measurements and feeding are mostly manually controlled. A simplified simulation of the metal level in an aluminium electrolysis cell is performed based on mass balance considerations. System identification methods based on Prediction Error Methods (PEM such as Ordinary Least Squares (OLS, and the sub-space method combined Deterministic and Stochastic system identification and Realization (DSR, and its variants are applied to the model of a single electrolysis cell as found in the aluminium smelters. Aliasing phenomena due to large sampling intervals can be crucial in avoiding unsuitable models, but with knowledge about the system dynamics, it is easier to optimize the sampling performance, and hence achieve successful models. The results based on the simulation studies of molten aluminium height in the cells using the various algorithms give results which tally well with the synthetic data sets used. System identification on a smaller data set from a real plant is also implemented in this work. Finally, some concrete suggestions are made for using these models in the smelters.

  20. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.

    Science.gov (United States)

    Williams, Tracy A; Lenders, Jacques W M; Mulatero, Paolo; Burrello, Jacopo; Rottenkolber, Marietta; Adolf, Christian; Satoh, Fumitoshi; Amar, Laurence; Quinkler, Marcus; Deinum, Jaap; Beuschlein, Felix; Kitamoto, Kanako K; Pham, Uyen; Morimoto, Ryo; Umakoshi, Hironobu; Prejbisz, Aleksander; Kocjan, Tomaz; Naruse, Mitsuhide; Stowasser, Michael; Nishikawa, Tetsuo; Young, William F; Gomez-Sanchez, Celso E; Funder, John W; Reincke, Martin

    2017-09-01

    Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension, no standard criteria exist to classify surgical outcomes. We aimed to create consensus criteria for clinical and biochemical outcomes and follow-up of adrenalectomy for unilateral primary aldosteronism and apply these criteria to an international cohort to analyse the frequency of remission and identify preoperative determinants of successful outcome. The Primary Aldosteronism Surgical Outcome (PASO) study was an international project to develop consensus criteria for outcomes and follow-up of adrenalectomy for unilateral primary aldosteronism. An international panel of 31 experts from 28 centres, including six endocrine surgeons, used the Delphi method to reach consensus. We then retrospectively analysed follow-up data from prospective cohorts for outcome assessment of patients diagnosed with unilateral primary aldosteronism by adrenal venous sampling who had undergone a total adrenalectomy, consecutively included from 12 referral centres in nine countries. On the basis of standardised criteria, we determined the proportions of patients achieving complete, partial, or absent clinical and biochemical success in accordance with the consensus. We then used logistic regression analyses to identify preoperative factors associated with clinical and biochemical outcomes. Consensus was reached for criteria for six outcomes (complete, partial, and absent success of clinical and biochemical outcomes) based on blood pressure, use of antihypertensive drugs, plasma potassium and aldosterone concentrations, and plasma renin concentrations or activities. Consensus was also reached for two recommendations for the timing of follow-up assessment. For the international cohort analysis, we analysed clinical data from 705 patients recruited between 1994 and 2015, of whom 699 also had biochemical data. Complete clinical success was achieved in 259 (37%) of 705 patients, with a

  1. Exchange rate system and policy in the present world

    OpenAIRE

    Grubišić Zoran

    2005-01-01

    The choice of exchange rate regime is important, not only in terms of its effect on trade flows, but also with respect to inflation expectations. Countries facing disinflation may find that pegs regimes are more appropriate solution. But where the trade balance account is significantly deteriorated and growth has been sluggish, a more flexible regime might be called for. The natural classification in eighties and early nineties suggests that intermediate regimes may provide important advantag...

  2. Exchange rate system and policy in the present world

    Directory of Open Access Journals (Sweden)

    Grubišić Zoran

    2005-01-01

    Full Text Available The choice of exchange rate regime is important, not only in terms of its effect on trade flows, but also with respect to inflation expectations. Countries facing disinflation may find that pegs regimes are more appropriate solution. But where the trade balance account is significantly deteriorated and growth has been sluggish, a more flexible regime might be called for. The natural classification in eighties and early nineties suggests that intermediate regimes may provide important advantages – to capture some of the benefits of both extremes while avoiding many of the costs. However today many experts predicted that exchange rate regimes would move in a "bipolar" manner to the extremes of "hard" pegs or free floats. An increasing number of countries did announce their intent to allow greater exchange rate flexibility. But, in practice, countries had a "fear of floating ". Distinction is made among advanced, emerging and other developing countries. Emerging markets have stronger links to international capital markets than do other developing economies. Thus, while non-emerging market developing economies may gain credibility through pegging their exchange rates, emerging markets find it harder to do so and could benefit from investing in "learning to float". More advanced economies with their access to international capital market are best positioned to enjoy the benefits of flexibility. It is found that the proportion of countries adopting intermediate regimes has indeed been shrinking in favor of greater flexibility or greater fixity, especially for countries more integrated with international markets. But, there is no final conclusion on the idea that intermediate regimes will dissapear.

  3. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate.

    Science.gov (United States)

    Grams, Morgan E; Sang, Yingying; Ballew, Shoshana H; Carrero, Juan Jesus; Djurdjev, Ognjenka; Heerspink, Hiddo J L; Ho, Kevin; Ito, Sadayoshi; Marks, Angharad; Naimark, David; Nash, Danielle M; Navaneethan, Sankar D; Sarnak, Mark; Stengel, Benedicte; Visseren, Frank L J; Wang, Angela Yee-Moon; Köttgen, Anna; Levey, Andrew S; Woodward, Mark; Eckardt, Kai-Uwe; Hemmelgarn, Brenda; Coresh, Josef

    2018-03-24

    Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m 2 . Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73m 2 and 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73m 2 and a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  4. An expert system for the esthetic rating of bridges.

    Science.gov (United States)

    1990-01-01

    The expert system presented should facilitate the in-depth analysis of bridge esthetics and encourage high standards for the appearance of bridges. The procedure described systematically evaluates features of a target bridge in relation to a similar ...

  5. Executive Information System Modelling to Monitor Indonesian Criminal Rate

    Directory of Open Access Journals (Sweden)

    Josef Bernadi

    2016-05-01

    Full Text Available Similar to any other governments, Indonesia government has the role of protecting the security of its citizens via the established police unit. However, the executive unit is often unable to provide response in timely manner due to the huge data size. For the reason, an executive information system (EIS is established in order to provide necessary information to leverage the decision making process. This work intends to establish and evaluate the executive information system and its support to facilitate the efforts to fight crimes in Indonesia territory. The EIS prototype is established and is evaluated on the basis of the six information system success factors where the required data are collected by means of questionnaire. The results suggest that the factors of system quality, information quality, easy-of-use, user satisfaction, and individual and organization impacts are very significant.

  6. Influence of implant properties and local delivery systems on the outcome in operative fracture care.

    Science.gov (United States)

    Metsemakers, W-J; Moriarty, T F; Nijs, S; Pape, H C; Richards, R G

    2016-03-01

    Fracture fixation devices are implanted into a growing number of patients each year. This may be attributed to an increase in the popularity of operative fracture care and the development of ever more sophisticated implants, which may be used in even the most difficult clinical cases. Furthermore, as the general population ages, fragility fractures become more frequent. With the increase in number of surgical interventions, the absolute number of complications of these surgical treatments will inevitably rise. Implant-related infection and compromised fracture healing remain the most challenging and prevalent complications in operative fracture care. Any strategy that can help to reduce these complications will not only lead to a faster and more complete resumption of activities, but will also help to reduce the socio-economic impact. In this review we describe the influence of implant design and material choice on complication rates in trauma patients. Furthermore, we discuss the importance of local delivery systems, such as implant coatings and bone cement, and how these systems may have an impact on the prevalence, prevention and treatment outcome of these complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Development and application of course-embedded assessment system for program outcome evaluation in the Korean nursing education: A pilot study.

    Science.gov (United States)

    Park, Jee Won; Seo, Eun Ji; You, Mi-Ae; Song, Ju-Eun

    2016-03-01

    Program outcome evaluation is important because it is an indicator for good quality of education. Course-embedded assessment is one of the program outcome evaluation methods. However, it is rarely used in Korean nursing education. The study purpose was to develop and apply preliminarily a course-embedded assessment system to evaluate one program outcome and to share our experiences. This was a methodological study to develop and apply the course-embedded assessment system based on the theoretical framework in one nursing program in South Korea. Scores for 77 students generated from the three practicum courses were used. The course-embedded assessment system was developed following the six steps suggested by Han's model as follows. 1) One program outcome in the undergraduate program, "nursing process application ability", was selected and 2) the three clinical practicum courses related to the selected program outcome were identified. 3) Evaluation tools including rubric and items were selected for outcome measurement and 4) performance criterion, the educational goal level for the program, was established. 5) Program outcome was actually evaluated using the rubric and evaluation items in the three practicum courses and 6) the obtained scores were analyzed to identify the achievement rate, which was compared with the performance criterion. Achievement rates for the selected program outcome in adult, maternity, and pediatric nursing practicum were 98.7%, 100%, and 66.2% in the case report and 100% for all three in the clinical practice, and 100%, 100%, and 87% respectively for the conference. These are considered as satisfactory levels when compared with the performance criterion of "at least 60% or more". Course-embedded assessment can be used as an effective and economic method to evaluate the program outcome without running an integrative course additionally. Further studies to develop course-embedded assessment systems for other program outcomes in nursing

  8. A meta-analytic comparison of the Beck Depression Inventory and the Hamilton Rating Scale for Depression as measures of treatment outcome.

    Science.gov (United States)

    Edwards, B C; Lambert, M J; Moran, P W; McCully, T; Smith, K C; Ellingson, A G

    1984-05-01

    Some clinicians have considered the Beck Depression Inventory, a self-rating scale, too reactive to patient halo effects and, therefore, a liberal measure of treatment outcome. On the other hand, interviewer-rating scales, like the Hamilton Rating Scale for Depression have been viewed as more conservative measures of treatment gain. Studies which compared the Beck Depression Inventory to the Hamilton Rating Scale, as dependent measures, were reviewed for the purpose of determining if the scales provided comparable data for assessing treatment effects. The use of meta-analysis techniques resulted in a comparison of effect sizes which indicated that the Beck Depression Inventory was significantly less liberal than the Hamilton Rating Scale for Depression. The implications of these results for selecting outcome measures and the application of meta-analysis techniques for comparing dependent measures are discussed.

  9. Economic and ecological outcomes of flexible biodiversity offset systems.

    Science.gov (United States)

    Habib, Thomas J; Farr, Daniel R; Schneider, Richard R; Boutin, Stan

    2013-12-01

    The commonly expressed goal of biodiversity offsets is to achieve no net loss of specific biological features affected by development. However, strict equivalency requirements may complicate trading of offset credits, increase costs due to restricted offset placement options, and force offset activities to focus on features that may not represent regional conservation priorities. Using the oil sands industry of Alberta, Canada, as a case study, we evaluated the economic and ecological performance of alternative offset systems targeting either ecologically equivalent areas (vegetation types) or regional conservation priorities (caribou and the Dry Mixedwood natural subregion). Exchanging dissimilar biodiversity elements requires assessment via a generalized metric; we used an empirically derived index of biodiversity intactness to link offsets with losses incurred by development. We considered 2 offset activities: land protection, with costs estimated as the net present value of profits of petroleum and timber resources to be paid as compensation to resource tenure holders, and restoration of anthropogenic footprint, with costs estimated from existing restoration projects. We used the spatial optimization tool MARXAN to develop hypothetical offset networks that met either the equivalent-vegetation or conservation-priority targets. Networks that required offsetting equivalent vegetation cost 2-17 times more than priority-focused networks. This finding calls into question the prudence of equivalency-based systems, particularly in relatively undeveloped jurisdictions, where conservation focuses on limiting and directing future losses. Priority-focused offsets may offer benefits to industry and environmental stakeholders by allowing for lower-cost conservation of valued ecological features and may invite discussion on what land-use trade-offs are acceptable when trading biodiversity via offsets. Resultados Económicos y Ecológicos de Sistemas de Compensación de

  10. The Active Management of Risk in Multiparous Pregnancy at Term: association between a higher preventive labor induction rate and improved birth outcomes

    Science.gov (United States)

    Nicholson, James M.; Caughey, Aaron; Stenson, Ms. Morghan H.; Cronholm, Peter; Kellar, Lisa; Bennett, Ian; Margo, Katie; Stratton, Joseph

    2009-01-01

    Objective To determine if exposure of multiparous women to a high rate of preventive labor induction was associated with a significantly lower cesarean delivery rate. Study Design Retrospective cohort study involving 123 multiparas, who were exposed to the frequent use of preventive labor induction, and 304 multiparas, who received standard management. Rates of cesarean delivery and other adverse birth outcomes were compared in the two groups. Logistic regression controlled for confounding covariates. Results The exposed group had a lower cesarean delivery rate (aOR 0.09, 0.8% vs. 9.9%, p = 0.02) and a higher uncomplicated vaginal delivery rate (OR 0.53, 78.9% vs. 66.4%, p=0.01). Exposure was not associated with higher rates of other adverse birth outcomes. Conclusion Exposure of multiparas to a high rate of preventive labor induction was significantly associated with improved birth outcomes including a very low cesarean delivery rate. A prospective randomized trial is needed to determine causality. PMID:19254584

  11. Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-Year Outcomes From a Prospective Trial

    Energy Technology Data Exchange (ETDEWEB)

    Hattangadi, Jona A. [Harvard Radiation Oncology Program, Boston, MA (United States); Powell, Simon N. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); MacDonald, Shannon M.; Mauceri, Thomas; Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Freer, Phoebe [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Lawenda, Brian [21st Century Oncology, Las Vegas, NV (United States); Alm El-Din, Mohamed A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Department of Clinical Oncology, Tanta University Hospital, Tanta (Egypt); Gadd, Michele A.; Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2012-07-01

    Purpose: To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods: Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I-II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall's tau ({tau}{sub {beta}}) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results: The median follow-up period was 11.2 years (range, 4-14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome ({tau}{sub {beta}} 0.6, p < .0001), lower patient satisfaction ({tau}{sub {beta}} 0.5, p < .001), and worse fibrosis ({tau}{sub {beta}} 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias {>=}1 cm{sup 2}. Grade 3-4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose ({tau}{sub {beta}} 0.3-0.5, p {<=} .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence

  12. Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-Year Outcomes From a Prospective Trial

    International Nuclear Information System (INIS)

    Hattangadi, Jona A.; Powell, Simon N.; MacDonald, Shannon M.; Mauceri, Thomas; Ancukiewicz, Marek; Freer, Phoebe; Lawenda, Brian; Alm El-Din, Mohamed A.; Gadd, Michele A.; Smith, Barbara L.; Taghian, Alphonse G.

    2012-01-01

    Purpose: To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods: Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I-II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall’s tau (τ β ) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results: The median follow-up period was 11.2 years (range, 4–14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome (τ β 0.6, p β 0.5, p β 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias ≥1 cm 2 . Grade 3–4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose (τ β 0.3–0.5, p ≤ .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence-free survival, and overall survival rate was 85% (95% confidence interval, 70–97%), 72% (95% confidence interval, 54–86%), and 87% (95

  13. Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system

    Science.gov (United States)

    Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.

    2015-03-01

    Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.

  14. High rate amplifier-digitizer system for liquid argon calorimeters

    International Nuclear Information System (INIS)

    Droege, T.F.; Lobkowicz, F.; Fukushima, Y.

    1978-01-01

    A low-cost charge amplifier for a liquid argon photon detector and a new method for pulse height analysis are described. This scheme is suitable for high-energy photon detection with high counting rate. Samples of preamplifer output are taken just before and just after the arrival of the charge from the detector. The difference of these samples provides a stable pedestal and rejects low frequency noise. Short two-pulse resolving time (approximately equal to 200ns) is achieved. 6 refs

  15. Calculating Outcrossing Rates used in Decision Support Systems for Ships

    DEFF Research Database (Denmark)

    Nielsen, Ulrik Dam

    2008-01-01

    Onboard decision support systems (DSS) are used to increase the operational safety of ships. Ideally, DSS can estimate - in the statistical sense - future ship responses on a time scale of the order of 1-3 hours taking into account speed and course changes. The calculations depend on both...... analysis, and the paper derives and describes the main ideas. The concept is illustrated by an example, where the limit state of a non-linear ship response is considered. The results from the parallel system analysis are in agreement with corresponding Monte Carlo simulations. However, the computational...

  16. Validating severity of illness scoring systems in the prediction of outcomes in Staphylococcus aureus bacteremia.

    Science.gov (United States)

    Sharma, Mamta; Szpunar, Susan; Khatib, Riad

    2013-08-01

    Severity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. All adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. A total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P < 0.0001) and 1.45 (P < 0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. REMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.

  17. Features, Treatment, and Outcomes of Macrophage Activation Syndrome in Childhood-Onset Systemic Lupus Erythematosus.

    Science.gov (United States)

    Borgia, R Ezequiel; Gerstein, Maya; Levy, Deborah M; Silverman, Earl D; Hiraki, Linda T

    2018-04-01

    To describe the features and treatment of macrophage activation syndrome (MAS) in a single-center cohort of patients with childhood-onset systemic lupus erythematosus (SLE), and to compare childhood-onset SLE manifestations and outcomes between those with and those without MAS. We included all patients with childhood-onset SLE followed up at The Hospital for Sick Children from 2002 to 2012, and identified those also diagnosed as having MAS. Demographic, clinical, and laboratory features of MAS and SLE, medication use, hospital and pediatric intensive care unit (PICU) admissions, as well as damage indices and mortality data were extracted from the Lupus database. Student's t-tests and Fisher's exact tests were used to compare continuous and categorical variables, respectively. We calculated incidence rate ratios of hospital and PICU admissions comparing patients with and those without MAS, using Poisson models. Kaplan-Meier survival analysis was used to examine the time to disease damage accrual. Of the 403 patients with childhood-onset SLE, 38 (9%) had MAS. The majority (68%) had concomitant MAS and SLE diagnoses. Fever was the most common MAS clinical feature. The frequency of renal and central nervous system disease, hospital admissions, the average daily dose of steroids, and time to disease damage were similar between those with and those without MAS. We observed a higher mortality rate among those with MAS (5%) than those without MAS (0.2%) (P = 0.02). MAS was most likely to develop concomitantly with childhood-onset SLE diagnosis. The majority of the MAS patients were successfully treated with corticosteroids with no MAS relapses. Although the numbers were small, there was a higher risk of death associated with MAS compared to SLE without MAS. © 2018, American College of Rheumatology.

  18. Congenital toxoplasma infection: monthly prenatal screening decreases transmission rate and improves clinical outcome at age 3 years.

    Science.gov (United States)

    Wallon, M; Peyron, F; Cornu, C; Vinault, S; Abrahamowicz, M; Kopp, C Bonithon; Binquet, C

    2013-05-01

    Toxoplasma infection during pregnancy exposes the fetus to risks of congenital infection and sequelae that depend heavily on gestational age (GA) at time of infection. Accurate risk estimates by GA are necessary to counsel parents and improve clinical decisions. We analyzed data from pregnant women diagnosed with acute Toxoplasma infection in Lyon (France) from 1987 to 2008 and assessed how the risks of congenital toxoplasmosis and of clinical signs at age 3 years vary depending on GA at the time of maternal infection. Among 2048 mother-infant pairs, 93.2% of mothers received prenatal treatment and 513 (24.7%) fetuses were infected. Because of a significant reduction in risk since 1992 when monthly screening was introduced (59.4% vs 46.6% at 26 GA weeks; P = .038), probabilities of infection were estimated on the basis of maternal infections diagnosed after mid-1992 (n = 1624). Probabilities of congenital infection were <10% for maternal infections before 12 weeks of gestation, rose to 20.0% at 19 weeks, and then continued increasing to 52.3% and almost 70% at 28 and 39 GA weeks, respectively. Because of a significant reduction in risk of clinical signs of congenital toxoplasmosis in infected children born from mothers diagnosed after 1995 when polymerase chain reaction testing on amniotic fluid was initiated (87/794 vs 46/1150; P = .012), probabilities of clinical signs at 3 years were estimated based on 1015 maternal infections diagnosed after 1995 including 207 infected children, with symptoms in 46 (22.2%). These analyses demonstrated that introduction of monthly prenatal screening and improvement in antenatal diagnosis were associated with a significant reduction in the rate of congenital infection and a better outcome at 3 years of age in infected children. Our updated estimates will improve individual management and counseling in areas where genotype II Toxoplasma is predominant.

  19. Measuring IBS patient reported outcomes with an abdominal pain numeric rating scale: results from the proof cohort

    Science.gov (United States)

    SPIEGEL, B.; BOLUS, R.; HARRIS, L. A.; LUCAK, S.; NALIBOFF, B.; ESRAILIAN, E.; CHEY, W. D.; LEMBO, A.; KARSAN, H.; TILLISCH, K.; TALLEY, J.; MAYER, E.; CHANG, L.

    2009-01-01

    Background Controversy exists about how to effectively measure patient reported outcomes in IBS clinical trials. Pain numeric rating scales (NRS) are widely used in the non-IBS pain literature. The FDA has proposed using the NRS in IBS. Aim To test the psychometrics of an abdominal pain NRS in IBS. Methods We analyzed data from a longitudinal cohort of Rome III IBS subjects. At entry, subjects completed a 10-point NRS, bowel symptoms, IBS severity measurements (IBSSS, FBDSI), health related quality of life indices (IBS-QOL, EQ5D), and the worker productivity activity index (WPAI). We repeated assessments at 3 months along with a response scale to calculate the minimal clinically important difference (MCID). Results There were 277 subjects (82% women; age=42±15) at baseline and 90 at 3 months. The NRS correlated cross-sectionally with IBSSS (r=0.60; p<0.0011), FBDSI (r=0.49; p<0.0001), IBS-QOL (r=0.43; p<0.0001), EQ5D (r=0.48; p<0.0001), presenteeism (r=0.39; p<0.0001), absenteeism (r=0.17; p=0.04), and distension (r=0.46; p<0.0001), but not stool frequency or form. The MCID was 2.2 points, correlating with a 29.5% reduction over time. Conclusions An abdominal pain NRS exhibits excellent validity and can be readily interpreted with an MCID in patients with IBS. These data support the use of the NRS in IBS clinical trials. PMID:19751360

  20. Secret-key rates and privacy leakage in biometric systems

    NARCIS (Netherlands)

    Ignatenko, T.

    2009-01-01

    In this thesis both the generation of secret keys from biometric data and the binding of secret keys to biometric data are investigated. These secret keys can be used to regulate access to sensitive data, services, and environments. In a biometric secrecy system a secret key is generated or chosen

  1. Renin-angiotensin system antagonists and clinical outcomes in stable coronary artery disease without heart failure.

    Science.gov (United States)

    Sorbets, Emmanuel; Labreuche, Julien; Simon, Tabassome; Delorme, Laurent; Danchin, Nicolas; Amarenco, Pierre; Goto, Shinya; Meune, Christophe; Eagle, Kim A; Bhatt, Deepak L; Steg, Philippe Gabriel

    2014-07-01

    The aim of this study was to determine whether angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) use is associated with lower rates of cardiovascular events in patients with stable coronary artery disease (CAD) but without heart failure (HF) receiving contemporary medical management. Using data from the Reduction of Atherothrombosis for Continued Health (REACH) registry, we examined, using propensity score approaches, relationships between cardiovascular outcomes and ACEI/ARB use (64.1% users) in 20 909 outpatients with stable CAD and free of HF at baseline. As internal control, we assessed the relation between statin use and outcomes. At 4-year follow-up, the risk of cardiovascular death, MI, or stroke (primary outcome) was similar in ACEI/ARB users compared with non-users (hazard ratio, 1.03; 95% confidence interval [CI], 0.91-1.16; P = 0.66). Similarly, the risk of the primary outcome and cardiovascular hospitalization for atherothrombotic events (secondary outcome) was not reduced in ACEI/ARB users (hazard ratio, 1.08; 95% CI, 1.01-1.16; P = 0.04), nor were the rates of any of its components. Analyses using propensity score matching yielded similar results, as did sensitivity analyses accounting for missing covariates, changes in medications over time, or analysing separately ACEI and ARB use. In contrast, in the same cohort, statin use was associated with lower rates for all outcomes. Use of ACEI/ARB was not associated with better outcomes in stable CAD outpatients without HF. The benefit of ACEI/ARB seen in randomized clinical trials was not replicated in this large contemporary cohort, which questions their value in this specific subset. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  2. Patient-Reported Outcomes in Latin America: Implementation in Research and Role in Emerging HTA Systems.

    Science.gov (United States)

    Winnette, Randall; Zárate, Victor; Machnicki, Gerardo; DeMuro, Carla; Gawlicki, Mary; Gnanasakthy, Ari

    2015-12-01

    Patient-reported outcomes (PROs) are increasingly used to demonstrate the value of interventions and support health technology assessment (HTA). The objective of this work was to analyze trends regarding PROs in Latin America (LatAm), highlight challenges in the application of PROs in this region, and suggest solutions. A team of researchers with expertise in PROs conducted a nonsystematic PubMed literature search pertaining to the use of PROs in LatAm. The experts also drew on their experience working with PROs to assess the application of PROs in LatAm. The literature search yielded more than 4000 publications, with an increasing publication rate in recent years. PROs are being used in LatAm in various study types: instrument validation, phase III international clinical trials, health service research. A large Inter-American Development Bank study demonstrates the growing importance of PROs in the region. The growth in local value sets for the EuroQol five-dimensional questionnaire in LatAm reflects the regional emergence of HTA systems. Operational challenges relate to ensuring the use of good-quality questionnaires that, at a minimum, have undergone appropriate cultural adaptation and ideally have established psychometric properties. PROs are increasingly important in LatAm. Future efforts should aim to strengthen the operational and research infrastructure around PROs in the region. Innovation should be encouraged, including studying alternative methods of eliciting health utilities for economic evaluation. A wider scope around PRO uses for decision making by HTA bodies is an international trend with potential positive prospects in LatAm. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy.

    Science.gov (United States)

    Greaves, Nicholas S; Moore, Aiden; Seriki, Dare; Ghosh, Jonathan

    2018-04-01

    The aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy. A retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms. Ovation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55-107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3-48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices. The mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  4. Mind-Body Medicine and Immune System Outcomes: A Systematic Review.

    Science.gov (United States)

    Wahbeh, Helané; Haywood, Ashley; Kaufman, Karen; Zwickey, Heather

    2009-01-01

    This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

  5. Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes.

    Science.gov (United States)

    Denburg, Avram E; Knaul, Felicia M; Atun, Rifat; Frazier, Lindsay A; Barr, Ronald D

    2014-03-01

    Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions. © 2013 Wiley Periodicals, Inc.

  6. 78 FR 60182 - Prevailing Rate Systems; Definition of Broward County, Florida, to a Nonappropriated Fund Federal...

    Science.gov (United States)

    2013-10-01

    ... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM83 Prevailing Rate Systems; Definition of... wage area. The Federal Prevailing Rate Advisory Committee, the national labor-management committee... follows: PART 532--PREVAILING RATE SYSTEMS 0 1. The authority citation for part 532 continues to read as...

  7. 78 FR 29658 - Prevailing Rate Systems; Definition of Broward County, Florida, to a Nonappropriated Fund Federal...

    Science.gov (United States)

    2013-05-21

    ... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM83 Prevailing Rate Systems; Definition of... and Palm Beach Counties, FL. The Federal Prevailing Rate Advisory Committee, the national labor... 532--PREVAILING RATE SYSTEMS 0 1. The authority citation for part 532 continues to read as follows...

  8. 77 FR 9226 - Physical Systems Integration, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Science.gov (United States)

    2012-02-16

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. ER12-1013-000] Physical Systems Integration, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for... Physical Systems Integration, LLC's application for market-based rate authority, with an accompanying rate...

  9. Adaptive discrete rate and power transmission for spectrum sharing systems

    KAUST Repository

    Abdallah, Mohamed M.

    2012-04-01

    In this paper we develop a framework for optimizing the performance of the secondary link in terms of the average spectral efficiency assuming quantized channel state information (CSI) of the secondary and the secondary-to-primary interference channels available at the secondary transmitter. We consider the problem under the constraints of maximum average interference power levels at the primary receiver. We develop a sub-optimal computationally efficient iterative algorithm for finding the optimal CSI quantizers as well as the discrete power and rate employed at the cognitive transmitter for each quantized CSI level so as to maximize the average spectral efficiency. We show via analysis and simulations that the proposed algorithm converges for Rayleigh fading channels. Our numerical results give the number of bits required to sufficiently represent the CSI to achieve almost the maximum average spectral efficiency attained using full knowledge of the CSI. © 2012 IEEE.

  10. Comparison of HIV-1 genotypic resistance test interpretation systems in predicting virological outcomes over time

    NARCIS (Netherlands)

    D. Frentz (Dineke); C.A.B. Boucher (Charles); M. Assel (Matthias); A. de Luca (Andrea); M. Fabbiani (Massimiliano); F. Incardona (Francesca); P. Libin (Pieter); N. Manca (Nino); V. Müller (Viktor); B.O. Nualláin (Breanndán); R. Paredes (Roger); M. Prosperi (Mattia); E. Quiros-Roldan (Eugenia); L. Ruiz (Lidia); P.M.A. Sloot (Peter); C. Torti (Carlo); A.M. Vandamme (Anne Mieke); K. Laethem (Kristel); M. Zazzi (Maurizio); D.A.M.C. van de Vijver (David)

    2010-01-01

    textabstractBackground: Several decision support systems have been developed to interpret HIV-1 drug resistance genotyping results. This study compares the ability of the most commonly used systems (ANRS, Rega, and Stanford's HIVdb) to predict virological outcome at 12, 24, and 48 weeks.

  11. Progress and outcomes of health systems reform in the United Arab Emirates: A systematic review

    NARCIS (Netherlands)

    E.J. Koornneef (Erik J.); P.B.M. Robben (Paul); Blair, I. (Iain)

    2017-01-01

    textabstractBackground: The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent

  12. Predicting prey population dynamics from kill rate, predation rate and predator-prey ratios in three wolf-ungulate systems.

    Science.gov (United States)

    Vucetich, John A; Hebblewhite, Mark; Smith, Douglas W; Peterson, Rolf O

    2011-11-01

    1. Predation rate (PR) and kill rate are both fundamental statistics for understanding predation. However, relatively little is known about how these statistics relate to one another and how they relate to prey population dynamics. We assess these relationships across three systems where wolf-prey dynamics have been observed for 41 years (Isle Royale), 19 years (Banff) and 12 years (Yellowstone). 2. To provide context for this empirical assessment, we developed theoretical predictions of the relationship between kill rate and PR under a broad range of predator-prey models including predator-dependent, ratio-dependent and Lotka-Volterra dynamics. 3. The theoretical predictions indicate that kill rate can be related to PR in a variety of diverse ways (e.g. positive, negative, unrelated) that depend on the nature of predator-prey dynamics (e.g. structure of the functional response). These simulations also suggested that the ratio of predator-to-prey is a good predictor of prey growth rate. That result motivated us to assess the empirical relationship between the ratio and prey growth rate for each of the three study sites. 4. The empirical relationships indicate that PR is not well predicted by kill rate, but is better predicted by the ratio of predator-to-prey. Kill rate is also a poor predictor of prey growth rate. However, PR and ratio of predator-to-prey each explained significant portions of variation in prey growth rate for two of the three study sites. 5. Our analyses offer two general insights. First, Isle Royale, Banff and Yellowstone are similar insomuch as they all include wolves preying on large ungulates. However, they also differ in species diversity of predator and prey communities, exploitation by humans and the role of dispersal. Even with the benefit of our analysis, it remains difficult to judge whether to be more impressed by the similarities or differences. This difficulty nicely illustrates a fundamental property of ecological

  13. 78 FR 29657 - Prevailing Rate Systems; Definition of Vanderburgh County, Indiana, to a Nonappropriated Fund...

    Science.gov (United States)

    2013-05-21

    ...-AM82 Prevailing Rate Systems; Definition of Vanderburgh County, Indiana, to a Nonappropriated Fund... County, IN; and Jefferson and Pulaski Counties, MO. The Federal Prevailing Rate Advisory Committee, the... as follows: [[Page 29658

  14. Bit Error Rate Minimizing Channel Shortening Equalizers for Single Carrier Cyclic Prefixed Systems

    National Research Council Canada - National Science Library

    Martin, Richard K; Vanbleu, Koen; Ysebaert, Geert

    2007-01-01

    .... Previous work on channel shortening has largely been in the context of digital subscriber lines, a wireline system that allows bit allocation, thus it has focused on maximizing the bit rate for a given bit error rate (BER...

  15. Congenital Cutaneous Candidiasis: Prompt Systemic Treatment Is Associated With Improved Outcomes in Neonates.

    Science.gov (United States)

    Kaufman, David A; Coggins, Sarah A; Zanelli, Santina A; Weitkamp, Jörn-Hendrik

    2017-05-15

    Congenital cutaneous candidiasis (CCC) is a challenging diagnosis due to various rash presentations. Inadequate early treatment is associated with high rates of dissemination and death. The effects of early diagnosis, dermatologic presentation, and antifungal treatment on outcomes are lacking. CCC cases were reviewed from 2 academic neonatal intensive care units (NICUs) from 2004 to 2015. We defined CCC as a diffuse rash involving the body, extremities, face or scalp, and/or funisitis, presenting in the first week (≤7 days), with identification of Candida species from skin or mucous membrane cultures, and/or by culture or staining of the placenta or umbilical cord. CCC occurred in 0.1% of all NICU admissions (21 of 19 303) and 0.6% of infants <1000 grams birth weight. Median gestational age of CCC infants was 26 3/7 (range, 23 0/7-40 4/7) weeks. Skin findings were commonly present on the day of birth [median (range): 0 (0-6) days], appearing most frequently as a desquamating, maculopapular, papulopustular, and/or erythematous diffuse rash. When systemic antifungal therapy was started empirically at the time of rash presentation and continued for a median (interquartile range) of 14 (14-15) days, all patients survived and none developed dissemination. Delaying systemic treatment, exclusive use of nystatin, and treating for <10 days was associated with Candida bloodstream dissemination. CCC is an invasive infection that presents as a diffuse rash in preterm and term infants. Prompt systemic antifungal treatment at the time of skin presentation for ≥14 days prevents dissemination and Candida-related mortality. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  16. Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review.

    Science.gov (United States)

    Clay-Williams, Robyn; Nosrati, Hadis; Cunningham, Frances C; Hillman, Kenneth; Braithwaite, Jeffrey

    2014-09-03

    While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes. A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review. Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised. Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate

  17. 76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Science.gov (United States)

    2011-02-18

    ... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...

  18. A Text Steganographic System Based on Word Length Entropy Rate

    Directory of Open Access Journals (Sweden)

    Francis Xavier Kofi Akotoye

    2017-10-01

    Full Text Available The widespread adoption of electronic distribution of material is accompanied by illicit copying and distribution. This is why individuals, businesses and governments have come to think of how to protect their work, prevent such illicit activities and trace the distribution of a document. It is in this context that a lot of attention is being focused on steganography. Implementing steganography in text document is not an easy undertaking considering the fact that text document has very few places in which to embed hidden data. Any minute change introduced to text objects can easily be noticed thus attracting attention from possible hackers. This study investigates the possibility of embedding data in text document by employing the entropy rate of the constituent characters of words not less than four characters long. The scheme was used to embed bits in text according to the alphabetic structure of the words, the respective characters were compared with their neighbouring characters and if the first character was alphabetically lower than the succeeding character according to their ASCII codes, a zero bit was embedded otherwise 1 was embedded after the characters had been transposed. Before embedding, the secret message was encrypted with a secret key to add a layer of security to the secret message to be embedded, and then a pseudorandom number was generated from the word counts of the text which was used to paint the starting point of the embedding process. The embedding capacity of the scheme was relatively high compared with the space encoding and semantic method.

  19. Fuzzy production planning models for an unreliable production system with fuzzy production rate and stochastic/fuzzy demand rate

    Directory of Open Access Journals (Sweden)

    K. A. Halim

    2011-01-01

    Full Text Available In this article, we consider a single-unit unreliable production system which produces a single item. During a production run, the production process may shift from the in-control state to the out-of-control state at any random time when it produces some defective items. The defective item production rate is assumed to be imprecise and is characterized by a trapezoidal fuzzy number. The production rate is proportional to the demand rate where the proportionality constant is taken to be a fuzzy number. Two production planning models are developed on the basis of fuzzy and stochastic demand patterns. The expected cost per unit time in the fuzzy sense is derived in each model and defuzzified by using the graded mean integration representation method. Numerical examples are provided to illustrate the optimal results of the proposed fuzzy models.

  20. Silicon Detector System for High Rate EXAFS Applications.

    Science.gov (United States)

    Pullia, A; Kraner, H W; Siddons, D P; Furenlid, L R; Bertuccio, G

    1995-08-01

    A multichannel silicon pad detector for EXAFS (Extended X-ray Absorption Fine Structure) applications has been designed and built. The X-ray spectroscopic measurements demonstrate that an adequate energy resolution of 230 eV FWHM (corresponding to 27 rms electrons in silicon) can be achieved reliably at -35 °C. A resolution of 190 eV FWHM (corresponding to 22 rms electrons) has been obtained from individual pads at -35 °C. At room temperature (25 °C) an average energy resolution of 380 eV FWHM is achieved and a resolution of 350 eV FWHM (41 rms electrons) is the best performance. A simple cooling system constituted of Peltier cells is sufficient to reduce the reverse currents of the pads and their related shot noise contribution, in order to achieve resolutions better than 300 eV FWHM which is adequate for the EXAFS applications.

  1. Serum tryptase monitoring in indolent systemic mastocytosis: association with disease features and patient outcome.

    Directory of Open Access Journals (Sweden)

    Almudena Matito

    Full Text Available BACKGROUND: Serum baseline tryptase (sBT is a minor diagnostic criterion for systemic mastocytosis (SM of undetermined prognostic impact. We monitored sBT levels in indolent SM (ISM patients and investigated its utility for predicting disease behaviour and outcome. METHODS: In total 74 adult ISM patients who were followed for ≥48 months and received no cytoreductive therapy were retrospectively studied. Patients were classified according to the pattern of evolution of sBT observed. RESULTS: Overall 16/74 (22% cases had decreasing sBT levels, 48 (65% patients showed increasing sBT levels and 10 (13% patients showed a fluctuating pattern. Patients with significantly increasing sBT (sBT slope ≥0.15 after 48 months of follow-up showed a slightly greater rate of development of diffuse bone sclerosis (13% vs. 2% and hepatomegaly plus splenomegaly (16% vs. 5%, as well as a significantly greater frequency of multilineage vs. mast cells (MC-restricted KIT mutation (p = 0.01 together with a greater frequency of cases with progression of ISM to smouldering and aggressive SM (p = 0.03, and a shorter progression-free survival (p = 0.03. CONCLUSIONS: Monitoring of sBT in ISM patients is closely associated with poor prognosis disease features as well as with disease progression, pointing out the need for a closer follow-up in ISM patients with progressively increasing sBT values.

  2. Implementation of learning outcome attainment measurement system in aviation engineering higher education

    Science.gov (United States)

    Salleh, I. Mohd; Mat Rani, M.

    2017-12-01

    This paper aims to discuss the effectiveness of the Learning Outcome Attainment Measurement System in assisting Outcome Based Education (OBE) for Aviation Engineering Higher Education in Malaysia. Direct assessments are discussed to show the implementation processes that become a key role in the successful outcome measurement system. A case study presented in this paper involves investigation on the implementation of the system in Aircraft Structure course for Bachelor in Aircraft Engineering Technology program in UniKL-MIAT. The data has been collected for five semesters, starting from July 2014 until July 2016. The study instruments used include the report generated in Learning Outcomes Measurements System (LOAMS) that contains information on the course learning outcomes (CLO) individual and course average performance reports. The report derived from LOAMS is analyzed and the data analysis has revealed that there is a positive significant correlation between the individual performance and the average performance reports. The results for analysis of variance has further revealed that there is a significant difference in OBE grade score among the report. Independent samples F-test results, on the other hand, indicate that the variances of the two populations are unequal.

  3. Systemic inflammation, heart rate variability and air pollution in a cohort of senior adults.

    Science.gov (United States)

    Luttmann-Gibson, Heike; Suh, Helen H; Coull, Brent A; Dockery, Douglas W; Sarnat, Stefanie Ebelt; Schwartz, Joel; Stone, Peter H; Gold, Diane R

    2010-09-01

    Short-term elevation of ambient particulate air pollution has been associated with autonomic dysfunction and increased systemic inflammation, but the interconnections between these pathways are not well understood. We examined the association between inflammation and autonomic dysfunction and effect modification of inflammation on the association between air pollution and heart rate variability (HRV) in elderly subjects. 25 elderly subjects in Steubenville, Ohio, were followed up to 24 times with repeated 30-min ECG Holter monitoring (545 observations). C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), soluble inter-cellular adhesion molecule 1 (sICAM-1), and white blood cell and platelet counts were measured in peripheral blood samples collected in the first month of the study. Increased systemic inflammation was defined for subjects within the upper 20% of the distribution for each marker. A central ambient monitoring station provided daily fine particle (PM(2.5)) and sulphate (SO(4)(2-)) data. Linear mixed models were used to identify associations between inflammatory markers and HRV and to assess effect modification of the association between air pollution and HRV due to inflammatory status. A 5.8 mg/l elevation in CRP was associated with decreases of between -8% and -33% for time and frequency domain HRV outcomes. A 5.1 microg/m(3) increase in SO(4)(2-) on the day before the health assessment was associated with a decrease of -6.7% in the SD of normal RR intervals (SDNN) (95% CI -11.8% to -1.3%) in subjects with elevated CRP, but not in subjects with lower CRP (p value interaction=0.04), with similar findings for PM(2.5). Increased systemic inflammation is associated with autonomic dysfunction in the elderly. Air pollution effects on reduced SDNN are stronger in subjects with elevated systemic inflammation.

  4. Singapore Indian Eye Study-2: methodology and impact of migration on systemic and eye outcomes.

    Science.gov (United States)

    Sabanayagam, Charumathi; Yip, Wanfen; Gupta, Preeti; Mohd Abdul, Riswana Bb; Lamoureux, Ecosse; Kumari, Neelam; Cheung, Gemmy Cm; Cheung, Carol Y; Wang, Jie Jin; Cheng, Ching-Yu; Wong, Tien Yin

    2017-11-01

    Asian Indians are the fastest growing migration groups in the world. Studies evaluating the impact of migration on disease outcomes in this population are rare. We describe the methodology of the Singapore Indian Eye Study-2 (SINDI-2) aimed to evaluate the impact of migration status on diabetic retinopathy and other major age-related eye diseases in Asian Indians living in an urban environment. Population-based cohort study. A total of 2200 adults had participated in baseline SINDI (2007-2009, mean age [range] = 57.8 [42.7-84.1] years) and SINDI-2 (2013-2015, 56.5 [48.4-90.2] years). Participants were classified as 'first generation' if they were Indian residents born outside of Singapore and as 'second-generation' immigrants (59.7% in SINDI vs. 63.6% in SINDI-2) if they were born in Singapore. Response rate, participant characteristics and prevalence of systemic diseases were stratified by migration status. Of the 2914 eligible SINDI participants invited to participate, 2200 participated in SINDI-2 (response rate of 75.2%). In both SINDI and SINDI-2, compared with first-generation immigrants, second-generation immigrants were younger, less likely to have income <1000 SGD, had lower levels of pulse pressure, higher levels of high-density lipoprotein cholesterol, had lower prevalence of hypertension and chronic kidney disease and had higher prevalence of current smoking and obesity (all P < 0.05). In both SINDI and SINDI-2, second-generation immigrants had lower prevalence of cardiovascular risk factors except smoking and obesity compared with first-generation immigrants. The final report will confirm if these differences between generations are evident with regard to eye diseases. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  5. Choice of optimal exchange rate system For the Republic of Croatia

    OpenAIRE

    Dražen Koški

    2008-01-01

    The aim of research whose results are presented in this article was to choose the optimal system of exchange rate for the Republic of Croatia, of course before its accession to EU. The analyzed exchange rate systems here range from free-floating exchange rate to system without domestic currency in circulation. Naturally, the classification of International Monetary Fond is included in it. After that, the comparison of basic economic advantages and disadvantages of the fixed exchan...

  6. Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Joo-Young; Belli, Anna-Maria [St. George' s Hospital, Department of Radiology, London (United Kingdom)

    2010-03-15

    To evaluate the immediate and long-term results of arterial embolisation in the management of haemoptysis and to identify factors influencing outcome. A retrospective analysis was carried out of the medical records and angiograms of 50 patients who underwent transarterial embolisation for haemoptysis. The most frequent causes of haemoptysis included bronchiectasis (16%), active tuberculosis (12%) and aspergilloma (12%). A total of 126 bronchial and non-bronchial systemic arteries were embolised in 62 procedures. Immediate cessation of haemoptysis was achieved in 43 patients (86%). Haemoptysis was controlled in 36 patients (72%), recurred in 14 (28%) and 11 (22%) required repeat embolisation. The worst outcomes were observed in patients with aspergilloma: all six suffered recurrent bleeding and three (50%) died from massive haemoptysis. Aspergilloma was also associated with an increased risk of haemoptysis recurrence (p<0.05). A good clinical outcome was achieved in those with active tuberculosis and malignancy. Complication rates were low and included transient chest pain, false aneurysm and one case of lower limb weakness. Bronchial artery embolisation (BAE) is an effective and safe procedure for haemoptysis control in most cases. However, high recurrence and mortality rates are associated with aspergilloma. Early intervention with repeat embolisation is recommended in these patients and elective surgery should be considered. (orig.)

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

    Science.gov (United States)

    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.

  8. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kaneyasu, Yuko, E-mail: kaneyasu@hiroshima-u.ac.jp [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kita, Midori [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Department of Clinical Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo (Japan); Okawa, Tomohiko [Evaluation and Promotion Center, Utsunomiya Memorial Hospital, Tochigi (Japan); Maebayashi, Katsuya [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kohno, Mari [Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Sonoda, Tatsuo; Hirabayashi, Hisae [Department of Radiology, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Nagata, Yasushi [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-09-01

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women's Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  9. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    International Nuclear Information System (INIS)

    Kaneyasu, Yuko; Kita, Midori; Okawa, Tomohiko; Maebayashi, Katsuya; Kohno, Mari; Sonoda, Tatsuo; Hirabayashi, Hisae; Nagata, Yasushi; Mitsuhashi, Norio

    2012-01-01

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women’s Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  10. A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

    Science.gov (United States)

    Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

    2018-03-01

    The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

  11. System-justifying ideologies and academic outcomes among first-year Latino college students.

    Science.gov (United States)

    O'Brien, Laurie T; Mars, Dustin E; Eccleston, Collette

    2011-10-01

    The present study examines the relationship between system-justifying ideologies and academic outcomes among 78 first-year Latino college students (21 men, 57 women, mean age = 18.1 years) attending a moderately selective West Coast university. Endorsement of system-justifying ideologies was negatively associated with grade point average (GPA); however it was positively associated with feelings of belonging at the university. In addition, system-justifying ideologies were negatively associated with perceptions of personal discrimination. In contrast, ethnic identity centrality was unrelated to GPA, feelings of belonging, and perceptions of personal discrimination once the relationship between system-justifying ideologies and these outcomes was statistically taken into account. The results of the present study suggest that endorsement of system-justifying ideologies may be a double-edged sword for Latino college students, involving trade-offs between academic success and feelings of belonging.

  12. Nonequilibrium Contribution to the Rate of Reaction. III. Isothermal Multicomponent Systems

    Science.gov (United States)

    Shizgal, B.; Karplus, M.

    1970-10-01

    The nonequilibrium contribution to the reaction rate of an isothermal multicomponent system is obtained by solution of the appropriate Chapman-Enskog equation; the system is composed of reactive species in contact with a heat bath of inert atoms M.

  13. Confidence Intervals Verification for Simulated Error Rate Performance of Wireless Communication System

    KAUST Repository

    Smadi, Mahmoud A.; Ghaeb, Jasim A.; Jazzar, Saleh; Saraereh, Omar A.

    2012-01-01

    In this paper, we derived an efficient simulation method to evaluate the error rate of wireless communication system. Coherent binary phase-shift keying system is considered with imperfect channel phase recovery. The results presented demonstrate

  14. Outcome-centered antiepileptic therapy: Rate, rhythm and relief.: Implementing AAN Epilepsy Quality Measures in clinical practice.

    Science.gov (United States)

    D'Cruz, O'Neill

    2015-12-01

    Clinicians who manage patients with epilepsy are expected to assess the relevance of clinical trial results to their practice, integrate new treatments into the care algorithm, and implement epilepsy quality measures, with the overall goal of improving patient outcomes. A disease-based clinical framework that helps with choice and combinations of interventions facilitates provision of efficient, cost-effective, and high-quality care. This article addresses the current conceptual framework that informs clinical evaluation of epilepsy, explores gaps between development of treatment options, quality measures and clinical goals, and proposes an outcome-centered approach that bridges these gaps with the aim of improving patient and population-level clinical outcomes in epilepsy. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

  15. Prostate Specific Antigen (PSA) as Predicting Marker for Clinical Outcome and Evaluation of Early Toxicity Rate after High-Dose Rate Brachytherapy (HDR-BT) in Combination with Additional External Beam Radiation Therapy (EBRT) for High Risk Prostate Cancer.

    Science.gov (United States)

    Ecke, Thorsten H; Huang-Tiel, Hui-Juan; Golka, Klaus; Selinski, Silvia; Geis, Berit Christine; Koswig, Stephan; Bathe, Katrin; Hallmann, Steffen; Gerullis, Holger

    2016-11-10

    High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer (PCa). Seventy-nine male patients (median age 71 years, range 50 to 79) with high-risk PCa underwent HDR-BT following EBRT between December 2009 and January 2016 with a median follow-up of 21 months. HDR-BT was administered in two treatment sessions (one week interval) with 9 Gy per fraction using a planning system and the Ir192 treatment unit GammaMed Plus iX. EBRT was performed with CT-based 3D-conformal treatment planning with a total dose administration of 50.4 Gy with 1.8 Gy per fraction and five fractions per week. Follow-up for all patients was organized one, three, and five years after radiation therapy to evaluate early and late toxicity side effects, metastases, local recurrence, and prostate-specific antigen (PSA) value measured in ng/mL. The evaluated data included age, PSA at time of diagnosis, PSA density, BMI (body mass index), Gleason score, D'Amico risk classification for PCa, digital rectal examination (DRE), PSA value after one/three/five year(s) follow-up (FU), time of follow-up, TNM classification, prostate volume, and early toxicity rates. Early toxicity rates were 8.86% for gastrointestinal, and 6.33% for genitourinary side effects. Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1. PSA density at time of diagnosis ( p = 0.009), PSA on date of first HDR-BT ( p = 0.033), and PSA on date of first follow-up after one year ( p = 0.025) have statistical significance on a higher risk to get a local recurrence during follow-up. HDR-BT in combination with additional EBRT in the presented design for high-risk PCa results in high biochemical control rates with minimal side-effects. PSA is a negative predictive biomarker for local recurrence during follow-up. A longer follow-up is needed to assess long-term outcome and toxicities.

  16. Comparison of three scoring systems in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding: a prospective observational study.

    Science.gov (United States)

    Zhong, Min; Chen, Wan Jun; Lu, Xiao Ye; Qian, Jie; Zhu, Chang Qing

    2016-12-01

    To compare the performances of the Glasgow-Blatchford score (GBS), modified GBS (mGBS) and AIMS65 in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding (AUGIB). This study enrolled 320 consecutive patients with AUGIB. Patients at high and low risks of developing adverse clinical outcomes (rebleeding, the need of clinical intervention and death) were categorized according to the GBS, mGBS and AIMS65 scoring systems. The outcome of the patients were the occurrences of adverse clinical outcomes. The areas under the receiver operating characteristics curve (AUROC) of three scoring systems were compared. Irrespective of the systems used, the high-risk groups showed higher rates of rebleeding, intervention and death compared with the low-risk groups (P < 0.05). For the prediction of rebleeding, AIMS65 (AUROC 0.735, 95% CI 0.667-0.802) performed significantly better than GBS (AUROC 0.672, 95% CI 0.597-0.747; P < 0.01) and mGBS (AUROC 0.677, 95% CI 0.602-0.753; P < 0.01). For the prediction of interventions, there was no significant difference among the three systems (GBS: AUROC 0.769, 95% CI 0.668-0.870; mGBS: AUROC 0.745, 95% CI 0.643-0.847; AIMS65: AUROC 0.746, 95% CI 0.640-0.851). For the prediction of in-hospital mortality, there was no significant difference among the three systems (GBS: AUROC 0.796, 95% CI 0.694-0.898; mGBS: AUROC 0.803, 95% CI 0.703-0.904; AIMS65: AUROC 0.786, 95% CI 0.670-0.903). The three scoring systems are reliable and accurate in predicting the rates of rebleeding, surgery and mortality in AUGIB. However, AIMS65 outperforms GBS and mGBS in predicting rebleeding. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  17. Concordance Between Self-Reported Childhood Maltreatment Versus Case Record Reviews for Child Welfare–Affiliated Adolescents: Prevalence Rates and Associations With Outcomes

    Science.gov (United States)

    Negriff, Sonya; Schneiderman, Janet U.; Trickett, Penelope K.

    2017-01-01

    The present study used data from an ongoing longitudinal study of the effects of maltreatment on adolescent development to (1) describe rates of maltreatment experiences obtained from retrospective self-report versus case record review for adolescents with child welfare–documented maltreatment histories, (2) examine self-reported versus child welfare–identified maltreatment in relation to mental health and risk behavior outcomes by maltreatment type, and (3) examine the association between the number of different types of maltreatment and mental health and risk behavior outcomes. Maltreatment was coded from case records using the Maltreatment Case Record Abstraction Instrument (MCRAI) and participants were asked at mean age = 18.49 about childhood maltreatment experiences using the Comprehensive Trauma Interview (CTI). Results showed that an average of 48% of maltreatment found by the MCRAI for each type of maltreatment were unique cases not captured by the CTI, whereas an average of 40% self-reported maltreatment (CTI) was not indicated by the MCRAI. Analyses with outcomes showed generally, self-reported maltreatment, regardless of concordance with MCRAI, was related to the poorest outcomes. The difference in associations with the outcomes indicates both self-report and case record review data may have utility depending on the outcomes being assessed. PMID:27777329

  18. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.

    Science.gov (United States)

    Valentine, Nicole Britt; Bonsel, Gouke J

    2016-01-01

    Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child

  19. Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study.

    Science.gov (United States)

    Brzoska, P; Sauzet, O; Yilmaz-Aslan, Y; Widera, T; Razum, O

    2016-03-28

    In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany. We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals. Of the 239,811 respondents 0.9% were nationals from Turkey, 0.8% had a nationality from a former Yugoslavian country, 0.9% held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9% were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95%-confidence interval [95%-CI]: 1.12-1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95%-CI: 1.45-1.80) for Turkish nationals and 1.68 (95%-CI: 1.52-1.85) for nationals from Former Yugoslavia. Knowledge on health outcomes from the patients' point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of

  20. 76 FR 9694 - Prevailing Rate Systems; Redefinition of the Northeastern Arizona and Colorado Appropriated Fund...

    Science.gov (United States)

    2011-02-22

    ... 3206-AM33 Prevailing Rate Systems; Redefinition of the Northeastern Arizona and Colorado Appropriated... changes are based on recent consensus recommendations of the Federal Prevailing Rate Advisory Committee to... Northeastern Arizona wage area. The Federal Prevailing Rate Advisory Committee (FPRAC), the national labor...

  1. 76 FR 70321 - Prevailing Rate Systems; Redefinition of the Northern Mississippi and Memphis, TN, Appropriated...

    Science.gov (United States)

    2011-11-14

    ... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM37 Prevailing Rate Systems; Redefinition... on a consensus recommendation of the Federal Prevailing Rate Advisory Committee (FPRAC) to best match... which OPM received no comments. The Federal Prevailing Rate Advisory Committee (FPRAC), the national...

  2. 75 FR 58339 - Prevailing Rate Systems; Redefinition of the Shreveport, LA; Texarkana, TX; Milwaukee, WI; and...

    Science.gov (United States)

    2010-09-24

    ... 3206-AM28 Prevailing Rate Systems; Redefinition of the Shreveport, LA; Texarkana, TX; Milwaukee, WI... area. These changes are based on recent consensus recommendations of the Federal Prevailing Rate... below. The Federal Prevailing Rate Advisory Committee (FPRAC), the national labor-management committee...

  3. 76 FR 31885 - Prevailing Rate Systems; Redefinition of the Northern Mississippi and Memphis, TN, Appropriated...

    Science.gov (United States)

    2011-06-02

    ... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM37 Prevailing Rate Systems; Redefinition... Prevailing Rate Advisory Committee (FPRAC) to best match the county proposed for redefinition to a nearby FWS... Memphis wage area. The Federal Prevailing Rate Advisory Committee (FPRAC), the national labor-management...

  4. A Paradigm for Student Learning Outcome Assessment in Information Systems Education: Continuous Improvement or Chasing Rainbows?

    Science.gov (United States)

    Saulnier, Bruce

    2014-01-01

    A paradigm is presented for student learning outcome assessment in information systems education. Successful deployment of the paradigm is illustrated using the author's home institution. The paradigm is consistent with both the scholarship of teaching and learning and the scholarship of assessment. It is concluded that the deployment of the…

  5. Systems of educational specialization and labor market outcomes in Norway, Australia and the Netherlands

    NARCIS (Netherlands)

    van de Werfhorst, H.G.

    2004-01-01

    To account for differences between systems of education of highly educated societies, we argue that the impact of academic discipline (field of study) on labor market outcomes should be central. Three modifications of earlier typologies are needed to account for cross-national differences in the

  6. Persistent systemic inflammation is associated with poor clinical outcomes in COPD

    DEFF Research Database (Denmark)

    Agustí, Alvar; Edwards, Lisa D; Rennard, Stephen I

    2012-01-01

    Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed...

  7. "AfterZone:" Outcomes for Youth Participating in Providence's Citywide After-School System. Executive Summary

    Science.gov (United States)

    Kauh, Tina J.

    2011-01-01

    This executive summary highlights the main findings from our participation and outcomes analysis of the "AfterZone" initiative--a citywide system-building effort in Providence, Rhode Island, that aims to provide high-quality, accessible out-of-school-time services to middle school youth. The summary briefly defines the AfterZone's unique…

  8. Meningococcal Two-Partner Secretion Systems and Their Association with Outcome in Patients with Meningitis

    Science.gov (United States)

    Piet, Jurgen R.; van Ulsen, Peter; ur Rahman, Sadeeq; Bovenkerk, Sandra; Bentley, Stephen D.

    2016-01-01

    Two-partner secretion (TPS) systems export large TpsA proteins to the surface and extracellular milieu. In meningococci, three different TPS systems exist, and of these, TPS system 2 (TPS2) and TPS3 can be detected by the host's immune system. We evaluated the distribution of TPS systems among clinical isolates from two prospective cohort studies comprising 373 patients with meningococcal meningitis. TPS system 1 was present in 91% of isolates, and system 2 and/or 3 was present in 67%. The TPS system distribution was related to clonal complexes. Infection with strains with TPS2 and/or TPS3 resulted in less severe disease and better outcomes than infection with strains without these systems. Using whole-blood stimulation experiments, we found no differences in the host cytokine response between patients infected with TPS system 2 and 3 knockout strains and patients infected with a wild-type strain. In conclusion, meningococcal TPS system 2 and/or 3 is associated with disease severity and outcome in patients with meningitis. PMID:27324486

  9. User Impact of Literacy on Treatment Outcomes Quality Regional Financial Information System

    Directory of Open Access Journals (Sweden)

    Iskandar MUDA

    2017-06-01

    Full Text Available This study aims to determine the effectiveness of the Outcomes of the Quality Regional Financial Information System. The research is an explanatory survey exploration that explains the relationship between some variables. The population of this study is formed by 7 District Municipalities in North Sumatra. The sample comprises 197 respondents; the sampling process is a purposive random one. Variables used include User Literacy, Regional Information System, Role Ambiguity, Training and Local Government Finance Report. Treatment Outcomes Quality systems have a significant effect on the accuracy of Local Government Financial Statement Presentation. Role Ambiguity has no significant effect on the accuracy of Local Government Financial Statement Presentation. Training does not significantly influence the accuracy of Government Financial Statements literacy. The findings of this study provide recommendations for improvement of the performance manager in North Sumatra, which thus supporting the implementation of a good government system.

  10. ATLAS trigger operations: Monitoring with “Xmon” rate prediction system

    CERN Document Server

    Aukerman, Andrew Todd; The ATLAS collaboration

    2017-01-01

    We present the operations and online monitoring with the “Xmon” rate prediction system for the trigger system at the ATLAS Experiment. A two-level trigger system reduces the LHC’s bunch-crossing rate, 40 MHz at design capacity, to an average recording rate of about 1 kHz, while maintaining a high efficiency of selecting events of interest. The Xmon system uses the luminosity value to predict trigger rates that are, in turn, compared with incoming rates. The predictions rely on past runs to parameterize the luminosity dependency of the event rate for a trigger algorithm. Some examples are given to illustrate the performance of the tool during recent operations.

  11. A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy.

    Science.gov (United States)

    Hoshino, Junichi; Furuichi, Kengo; Yamanouchi, Masayuki; Mise, Koki; Sekine, Akinari; Kawada, Masahiro; Sumida, Keiichi; Hiramatsu, Rikako; Hasegawa, Eiko; Hayami, Noriko; Suwabe, Tatsuya; Sawa, Naoki; Hara, Shigeko; Fujii, Takeshi; Ohashi, Kenichi; Kitagawa, Kiyoki; Toyama, Tadashi; Shimizu, Miho; Takaichi, Kenmei; Ubara, Yoshifumi; Wada, Takashi

    2018-01-01

    The impact of the newly proposed pathological classification by the Japan Renal Pathology Society (JRPS) on renal outcome is unclear. So we evaluated that impact and created a new pathological scoring to predict outcome using this classification. A multicenter cohort of 493 biopsy-proven Japanese patients with diabetic nephropathy (DN) were analyzed. The association between each pathological factor-Tervaert' and JRPS classifications-and renal outcome (dialysis initiation or 50% eGFR decline) was estimated by adjusted Cox regression. The overall pathological risk score (J-score) was calculated, whereupon its predictive ability for 10-year risk of renal outcome was evaluated. The J-scores of diffuse lesion classes 2 or 3, GBM doubling class 3, presence of mesangiolysis, polar vasculosis, and arteriolar hyalinosis were, respectively, 1, 2, 4, 1, and 2. The scores of IFTA classes 1, 2, and 3 were, respectively, 3, 4, and 4, and those of interstitial inflammation classes 1, 2, and 3 were 5, 5, and 4 (J-score range, 0-19). Renal survival curves, when dividing into four J-score grades (0-5, 6-10, 11-15, and 16-19), were significantly different from each other (prenal outcome. Ability to predict 10-year renal outcome was improved when the J-score was added to the basic model: c-statistics from 0.661 to 0.685; category-free net reclassification improvement, 0.154 (-0.040, 0.349, p = 0.12); and integrated discrimination improvement, 0.015 (0.003, 0.028, p = 0.02). Mesangiolysis, polar vasculosis, and doubling of GBM-features of the JRPS system-were significantly associated with renal outcome. Prediction of DN patients' renal outcome was better with the J-score than without it.

  12. Total hip arthroplasty outcomes assessment using functional and radiographic scores to compare canine systems.

    Science.gov (United States)

    Iwata, D; Broun, H C; Black, A P; Preston, C A; Anderson, G I

    2008-01-01

    A retrospective multi-centre study was carried out in order to compare outcomes between cemented and uncemented total hip arthoplasties (THA). A quantitative orthopaedic outcome assessment scoring system was devised in order to relate functional outcome to a numerical score, to allow comparison between treatments and amongst centres. The system combined a radiographic score and a clinical score. Lower scores reflect better outcomes than higher scores. Consecutive cases of THA were included from two specialist practices between July 2002 and December 2005. The study included 46 THA patients (22 uncemented THA followed for 8.3 +/- 4.7M and 24 cemented THA for 26.0 +/- 15.7M) with a mean age of 4.4 +/- 3.3 years at surgery. Multi-variable linear and logistical regression analyses were performed with adjustments for age at surgery, surgeon, follow-up time, uni- versus bilateral disease, gender and body weight. The differences between treatment groups in terms of functional scores or total scores were not significant (p > 0.05). Radiographic scores were different between treatment groups. However, these scores were usually assessed within two months of surgery and proved unreliable predictors of functional outcome (p > 0.05). The findings reflect relatively short-term follow-up, especially for the uncemented group, and do not include clinician-derived measures, such as goniometry and thigh circumference. Longer-term follow-up for the radiographic assessments is essential. A prospective study including the clinician-derived outcomes needs to be performed in order to validate the outcome instrument in its modified form.

  13. Window Energy Rating System and Calculation of Energy Performance of Windows

    DEFF Research Database (Denmark)

    Laustsen, Jacob Birck; Svendsen, Svend

    The goal of reducing the energy consumption in buildings is the background for the introduction of an energy rating system of fenestration products in Denmark. The energy rating system requires that producers declare, among other things, the heat loss coefficient, U, and the total solar energy...... development, e.g. when the resulting effects of a reduced frame area are evaluated....

  14. 78 FR 60181 - Prevailing Rate Systems; Redefinition of the Clayton-Cobb-Fulton, Georgia, Nonappropriated Fund...

    Science.gov (United States)

    2013-10-01

    ... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM84 Prevailing Rate Systems; Redefinition of the Clayton-Cobb-Fulton, Georgia, Nonappropriated Fund Federal Wage System Wage Area AGENCY: U.S... Counties). The Federal Prevailing Rate Advisory Committee, the national labor-management committee...

  15. The sustainability of the pay-as-you-go system with falling birth rates

    NARCIS (Netherlands)

    van Praag, B.M.S.; Cardoso, P.

    2002-01-01

    A model is presented that explains the mix between funded and unfunded pension systems. It turns out that total pension and the relative shares of the two systems may be explained and are determined by the population growth rate, technological growth, the time-preference discount rate, the relative

  16. 76 FR 32085 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

    Science.gov (United States)

    2011-06-03

    ..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...

  17. Choice of optimal exchange rate system For the Republic of Croatia

    Directory of Open Access Journals (Sweden)

    Dražen Koški

    2008-12-01

    Full Text Available The aim of research whose results are presented in this article was to choose the optimal system of exchange rate for the Republic of Croatia, of course before its accession to EU. The analyzed exchange rate systems here range from free-floating exchange rate to system without domestic currency in circulation. Naturally, the classification of International Monetary Fond is included in it. After that, the comparison of basic economic advantages and disadvantages of the fixed exchange rate in relation to floating exchange rate were carried out. Although the question is about the extreme systems, disregarding the system without domestic currency in circulation, their comparison makes possible completely satisfactory basis for the right conclusions on the choice of optimal exchange rate system for the Republic of Croatia. Considering its economic particularities, the system of managed-floating exchange rate without proclaimed exchange direction in advance is certainly optimal for the Republic of Croatia. Namely, within the framework of this system the limited floating exchange rates decrease the foreign exchange risk allowing to monetary authorities, at least partly, the independent monetary policy

  18. Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013.

    Science.gov (United States)

    Mersereau, Jennifer; Stanhiser, Jamie; Coddington, Charles; Jones, Tiffany; Luke, Barbara; Brown, Morton B

    2017-11-01

    To analyze factors associated with high live birth rate and low multiple birth rate in fresh and frozen-thawed assisted reproductive technology (ART) cycles. Retrospective cohort analysis. Not applicable. The study population included 181,523 women undergoing in vitro fertilization with autologous fresh first cycles, 27,033 with fresh first oocyte donor cycles, 37,658 with fresh second cycles, and 35,446 with frozen-thawed second cycles. None. Live birth rate and multiple birth rate after single-embryo transfer (SET) and double embryo transfer (DET) were measured, in addition to cycle characteristics. In patients with favorable prognostic factors, including younger maternal age, transfer of a blastocyst, and additional embryos cryopreserved, the gain in the live birth rate from SET to DET was approximately 10%-15%; however, the multiple birth rate increased from approximately 2% to greater than 49% in both autologous and donor fresh and frozen-thawed transfer cycles. This study reports a 10%-15% reduction in live birth rate and a 47% decrement in multiple birth rate with SET compared with DET in the setting of favorable patient prognostic factors. Our findings present an opportunity to increase the rate of SET across the United States and thereby reduce the multiple birth rate and its associated poor perinatal outcomes with assisted reproductive technology pregnancies. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Impact of epidural analgesia on cesarean and operative vaginal delivery rates classified by the Ten Groups Classification System.

    Science.gov (United States)

    Lucovnik, M; Blajic, I; Verdenik, I; Mirkovic, T; Stopar Pintaric, T

    2018-05-01

    The Ten Group Classification System (TGCS) allows critical analysis according to the obstetric characteristics of women in labor: singleton or multiple pregnancy, nulliparous, multiparous, or multiparous with a previous cesarean delivery, cephalic, breech presentation or other malpresentation, spontaneous or induced labor, and term or preterm births. Labor outcomes associated with epidural analgesia may be different among the different labor classification groups. The aim of this study was to explore associations between epidural analgesia and cesarean delivery, and epidural analgesia and assisted vaginal delivery, in women classified using the TGCS. Slovenian National Perinatal Information System data for the period 2007-2014 were analyzed. All women after spontaneous onset or induction of labor were classified according to the TGCS, within which cesarean and vaginal assisted delivery rates were investigated (P cesarean delivery rates. Women in group 1 (nulliparous term women with singleton fetuses in cephalic presentation in spontaneous labor) with epidural analgesia had a higher cesarean delivery rate. In most TGCS groups women with epidural analgesia had higher assisted vaginal delivery rates. Epidural analgesia is associated with different effects on cesarean delivery and assisted vaginal delivery rates in different TGCS groups. Copyright © 2018. Published by Elsevier Ltd.

  20. Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

    Science.gov (United States)

    Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

    2017-11-01

    Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can

  1. Development of a high precision dosimetry system for the measurement of surface dose rate distribution for eye applicators

    Energy Technology Data Exchange (ETDEWEB)

    Eichmann, Marion; Fluehs, Dirk; Spaan, Bernhard [Fakultaet Physik, Technische Universitaet Dortmund, D 44221 Dortmund (Germany); Klinische Strahlenphysik, Universitaetsklinikum Essen, D 45122 Essen (Germany); Fakultaet Physik, Technische Universitaet Dortmund, D 44221 Dortmund (Germany)

    2009-10-15

    Purpose: The therapeutic outcome of the therapy with ophthalmic applicators is highly dependent on the application of a sufficient dose to the tumor, whereas the dose applied to the surrounding tissue needs to be minimized. The goal for the newly developed apparatus described in this work is the determination of the individual applicator surface dose rate distribution with a high spatial resolution and a high precision in dose rate with respect to time and budget constraints especially important for clinical procedures. Inhomogeneities of the dose rate distribution can be detected and taken into consideration for the treatment planning. Methods: In order to achieve this, a dose rate profile as well as a surface profile of the applicator are measured and correlated with each other. An instrumental setup has been developed consisting of a plastic scintillator detector system and a newly designed apparatus for guiding the detector across the applicator surface at a constant small distance. It performs an angular movement of detector and applicator with high precision. Results: The measurements of surface dose rate distributions discussed in this work demonstrate the successful operation of the measuring setup. Measuring the surface dose rate distribution with a small distance between applicator and detector and with a high density of measuring points results in a complete and gapless coverage of the applicator surface, being capable of distinguishing small sized spots with high activities. The dosimetrical accuracy of the measurements and its analysis is sufficient (uncertainty in the dose rate in terms of absorbed dose to water is <7%), especially when taking the surgical techniques in positioning of the applicator on the eyeball into account. Conclusions: The method developed so far allows a fully automated quality assurance of eye applicators even under clinical conditions. These measurements provide the basis for future calculation of a full 3D dose rate

  2. Development of a high precision dosimetry system for the measurement of surface dose rate distribution for eye applicators.

    Science.gov (United States)

    Eichmann, Marion; Flühs, Dirk; Spaan, Bernhard

    2009-10-01

    The therapeutic outcome of the therapy with ophthalmic applicators is highly dependent on the application of a sufficient dose to the tumor, whereas the dose applied to the surrounding tissue needs to be minimized. The goal for the newly developed apparatus described in this work is the determination of the individual applicator surface dose rate distribution with a high spatial resolution and a high precision in dose rate with respect to time and budget constraints especially important for clinical procedures. Inhomogeneities of the dose rate distribution can be detected and taken into consideration for the treatment planning. In order to achieve this, a dose rate profile as well as a surface profile of the applicator are measured and correlated with each other. An instrumental setup has been developed consisting of a plastic scintillator detector system and a newly designed apparatus for guiding the detector across the applicator surface at a constant small distance. It performs an angular movement of detector and applicator with high precision. The measurements of surface dose rate distributions discussed in this work demonstrate the successful operation of the measuring setup. Measuring the surface dose rate distribution with a small distance between applicator and detector and with a high density of measuring points results in a complete and gapless coverage of the applicator surface, being capable of distinguishing small sized spots with high activities. The dosimetrical accuracy of the measurements and its analysis is sufficient (uncertainty in the dose rate in terms of absorbed dose to water is <7%), especially when taking the surgical techniques in positioning of the applicator on the eyeball into account. The method developed so far allows a fully automated quality assurance of eye applicators even under clinical conditions. These measurements provide the basis for future calculation of a full 3D dose rate distribution, which then can be used as input for

  3. Presence of Systemic Inflammatory Response Syndrome Predicts a Poor Clinical Outcome in Dogs with a Primary Hepatitis.

    Directory of Open Access Journals (Sweden)

    Scott Kilpatrick

    Full Text Available Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT, alkaline phosphatase (ALP, bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high (p<0.001. A Cox proportional hazard model, which included all other co-variables, revealed that a SIRS high score was an independent predictor of a poor clinical outcome. The effect of modulating inflammation on treatment outcomes in dogs with a primary hepatitis is deserving of further study.

  4. Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes

    OpenAIRE

    Mauro Waiswol; Niro Kasahara

    2009-01-01

    Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients) or Marfan syndrome-associated ectopia lentis (nine patients) with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS) from grade 1 (lens on the whole pupillary area) up to grade 4 (lens absent fro...

  5. Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system

    Directory of Open Access Journals (Sweden)

    Velikova Galina

    2011-10-01

    Full Text Available Abstract Background Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service. Methods/Design Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups, within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore

  6. User Participation and Honesty in Online Rating Systems: What a Social Network Can Do

    OpenAIRE

    Davoust, Alan; Esfandiari, Babak

    2016-01-01

    An important problem with online communities in general, and online rating systems in particular, is uncooperative behavior: lack of user participation, dishonest contributions. This may be due to an incentive structure akin to a Prisoners' Dilemma (PD). We show that introducing an explicit social network to PD games fosters cooperative behavior, and use this insight to design a new aggregation technique for online rating systems. Using a dataset of ratings from Yelp, we show that our aggrega...

  7. Probing the effect of human normal sperm morphology rate on cycle outcomes and assisted reproductive methods selection.

    Directory of Open Access Journals (Sweden)

    Bo Li

    Full Text Available Sperm morphology is the best predictor of fertilization potential, and the critical predictive information for supporting assisted reproductive methods selection. Given its important predictive value and the declining reality of semen quality in recent years, the threshold of normal sperm morphology rate (NSMR is being constantly corrected and controversial, from the 4th edition (14% to the 5th version (4%. We retrospectively analyzed 4756 cases of infertility patients treated with conventional-IVF(c-IVF or ICSI, which were divided into three groups according to NSMR: ≥14%, 4%-14% and <4%. Here, we demonstrate that, with decrease in NSMR(≥14%, 4%-14%, <4%, in the c-IVF group, the rate of fertilization, normal fertilization, high-quality embryo, multi-pregnancy and birth weight of twins gradually decreased significantly (P<0.05, while the miscarriage rate was significantly increased (p<0.01 and implantation rate, clinical pregnancy rate, ectopic pregnancy rate, preterm birth rate, live birth rate, sex ratio, and birth weight(Singleton showed no significant change. In the ICSI group, with decrease in NSMR (≥14%, 4%-14%, <4%, high-quality embryo rate, multi-pregnancy rate and birth weight of twins were gradually decreased significantly (p<0.05, while other parameters had no significant difference. Considering the clinical assisted methods selection, in the NFMR ≥14% group, normal fertilization rate of c-IVF was significantly higher than the ICSI group (P<0.05, in the 4%-14% group, birth weight (twins of c-IVF were significantly higher than the ICSI group, in the <4% group, miscarriage of IVF was significantly higher than the ICSI group. Therefore, we conclude that NSMR is positively related to embryo reproductive potential, and when NSMR<4% (5th edition, ICSI should be considered first, while the NSMR≥4%, c-IVF assisted reproduction might be preferred.

  8. Effect of Room Ventilation Rates in Rodent Rooms with Direct-Exhaust IVC Systems.

    Science.gov (United States)

    Geertsema, Roger S; Lindsell, Claire E

    2015-09-01

    When IVC are directly exhausted from a rodent housing room, the air quality of the room can become independent of the intracage air quality and may reduce the need for high room ventilation rates. This study assessed the effect of decreasing the ventilation rate in rodent rooms using direct-exhaust IVC systems. The study was conducted over 16 wk and compared conditions in 8 rodent rooms that had ventilation rates of 5 to 6 air changes per hour (ACH) with those in rooms at 10 to 12 ACH. At the low ventilation rate, rooms had higher CO₂ concentrations, higher dew point temperature, and lower particulate levels and spent a greater percentage of time above the temperature set point than did rooms at the high rate. The levels of allergens and endotoxins in room air were the same regardless of the ventilation rate. Differences seen in parameters within cages at the 2 ventilation rates were operationally irrelevant. We detected no total volatile organic compounds in the room that were attributable to ammonia, regardless of the ventilation rate. Clearing the air of ethanol after a spill took longer at the low compared with high rate. However, ethanol clearance was faster at the low rate when the demand-control system was activated than at the high ventilation rate alone. Air quality in the room and in the cages were acceptable with room ventilation rates of 5 to 6 ACH in rodent rooms that use direct-exhaust IVC systems.

  9. Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

    International Nuclear Information System (INIS)

    Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G

    2015-01-01

    Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes

  10. Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

    Science.gov (United States)

    Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

    2015-08-01

    This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

  11. Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations.

    Science.gov (United States)

    Matusik, P S; Matusik, P T; Stein, P K

    2018-07-01

    Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.

  12. J-ACT II. Differences in rate of valid recanalization and of a favorable outcome by site of MCA occlusion

    International Nuclear Information System (INIS)

    Hirano, Teruyuki

    2010-01-01

    The background and purpose of this study was to elucidate whether the effects of alteplase differ with occlusion site of the middle cerebral artery (MCA). An exploratory analysis was made of 57 patients enrolled on the Japan Alteplase Clinical Trial II (J-ACT II). The residual vessel length (mm), determined on pretreatment MR angiography (MRA), was used to reflect the occluded site. The proportions of patients with valid recanalization (modified Mori grade 2-3) at 6 and 24 hours, and a favorable outcome (modified Rankin scale 0-1 at 3 months) were compared between the groups dichotomized according to their lengths of residual vessel. Multiple logistic regression models were generated to elucidate the predictors of valid recanalization and a favorable outcome. Receiver operating characteristic (ROC) analysis revealed that 5 mm was the practical cutoff length for the dichotomization. In patients with M1 length <5 mm (n=12), the frequencies of valid recanalization at 6/24 hours (16.6%/25.0%) were significantly low compared with those (62.2%/82.2%) of 45 patients with a residual M1 length of ≥5 mm and M2 occlusions (p=0.008 for 6 hours, p<0.001 for 24 hours). The proportion of a favorable outcome was also small in patients with M1 length <5 mm (8.3%), as compared to the others (57.8%, p=0.004). In logistic regression models, the site of MCA occlusion (<5 mm) was the significant predictor of valid recanalization at 6/24 hours and of a favorable outcome. In patients with acute MCA occlusion, residual vessel length <5 mm on MRA can identify poor responders. (author)

  13. Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS

    Directory of Open Access Journals (Sweden)

    Nishant Patel

    Full Text Available ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

  14. Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection.

    Science.gov (United States)

    Carew, P; Mensah, F K; Rance, G; Flynn, T; Poulakis, Z; Wake, M

    2018-01-01

    Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well-established UNHS and the general population. Linear regression adjusted for potential confounding factors was used throughout. Via a quasi-experimental design, language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n = 50; universal risk factor referral, born 2003-2005, n = 34; newly established UNHS, born 2003-2005, n = 41; and well-established UNHS, born 2007-2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217. Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language (P for trend .05) and receptive vocabulary (P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference -8.9 points, 95% CI -14.7 to -3.1). Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing

  15. Dynamical System Modeling of Immune Reconstitution after Allogeneic Stem Cell Transplantation Identifies Patients at Risk for Adverse Outcomes.

    Science.gov (United States)

    Toor, Amir A; Sabo, Roy T; Roberts, Catherine H; Moore, Bonny L; Salman, Salman R; Scalora, Allison F; Aziz, May T; Shubar Ali, Ali S; Hall, Charles E; Meier, Jeremy; Thorn, Radhika M; Wang, Elaine; Song, Shiyu; Miller, Kristin; Rizzo, Kathryn; Clark, William B; McCarty, John M; Chung, Harold M; Manjili, Masoud H; Neale, Michael C

    2015-07-01

    Systems that evolve over time and follow mathematical laws as they evolve are called dynamical systems. Lymphocyte recovery and clinical outcomes in 41 allograft recipients conditioned using antithymocyte globulin (ATG) and 4.5-Gy total body irradiation were studied to determine if immune reconstitution could be described as a dynamical system. Survival, relapse, and graft-versus-host disease (GVHD) were not significantly different in 2 cohorts of patients receiving different doses of ATG. However, donor-derived CD3(+) cell reconstitution was superior in the lower ATG dose cohort, and there were fewer instances of donor lymphocyte infusion (DLI). Lymphoid recovery was plotted in each individual over time and demonstrated 1 of 3 sigmoid growth patterns: Pattern A (n = 15) had rapid growth with high lymphocyte counts, pattern B (n = 14) had slower growth with intermediate recovery, and pattern C (n = 10) had poor lymphocyte reconstitution. There was a significant association between lymphocyte recovery patterns and both the rate of change of donor-derived CD3(+) at day 30 after stem cell transplantation (SCT) and clinical outcomes. GVHD was observed more frequently with pattern A, relapse and DLI more so with pattern C, with a consequent survival advantage in patients with patterns A and B. We conclude that evaluating immune reconstitution after SCT as a dynamical system may differentiate patients at risk of adverse outcomes and allow early intervention to modulate that risk. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  16. The relationship between the Early Childhood Environment Rating Scale and its revised form and child outcomes: A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ashley Brunsek

    Full Text Available The Early Childhood Environment Rating Scale (ECERS and its revised version (ECERS-R were designed as global measures of quality that assess structural and process aspects of Early Childhood Education and Care (ECEC programs. Despite frequent use of the ECERS/ECERS-R in research and applied settings, associations between it and child outcomes have not been systematically reviewed. The objective of this research was to evaluate the association between the ECERS/ECERS-R and children's wellbeing. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were completed up to July 3, 2015. Eligible studies provided a statistical link between the ECERS/ECERS-R and child outcomes for preschool-aged children in ECEC programs. Of the 823 studies selected for full review, 73 were included in the systematic review and 16 were meta-analyzed. The combined sample across all eligible studies consisted of 33, 318 preschool-aged children. Qualitative systematic review results revealed that ECERS/ECERS-R total scores were more generally associated with positive outcomes than subscales or factors. Seventeen separate meta-analyses were conducted to assess the strength of association between the ECERS/ECERS-R and measures that assessed children's language, math and social-emotional outcomes. Meta-analyses revealed a small number of weak effects (in the expected direction between the ECERS/ECERS-R total score and children's language and positive behavior outcomes. The Language-Reasoning subscale was weakly related to a language outcome. The enormous heterogeneity in how studies operationalized the ECERS/ECERS-R, the outcomes measured and statistics reported limited our ability to meta-analyze many studies. Greater consistency in study methodology is needed in this area of research. Despite these methodological challenges, the ECERS/ECERS-R does appear to capture aspects of quality that are important for children

  17. The relationship between the Early Childhood Environment Rating Scale and its revised form and child outcomes: A systematic review and meta-analysis.

    Science.gov (United States)

    Brunsek, Ashley; Perlman, Michal; Falenchuk, Olesya; McMullen, Evelyn; Fletcher, Brooke; Shah, Prakesh S

    2017-01-01

    The Early Childhood Environment Rating Scale (ECERS) and its revised version (ECERS-R) were designed as global measures of quality that assess structural and process aspects of Early Childhood Education and Care (ECEC) programs. Despite frequent use of the ECERS/ECERS-R in research and applied settings, associations between it and child outcomes have not been systematically reviewed. The objective of this research was to evaluate the association between the ECERS/ECERS-R and children's wellbeing. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were completed up to July 3, 2015. Eligible studies provided a statistical link between the ECERS/ECERS-R and child outcomes for preschool-aged children in ECEC programs. Of the 823 studies selected for full review, 73 were included in the systematic review and 16 were meta-analyzed. The combined sample across all eligible studies consisted of 33, 318 preschool-aged children. Qualitative systematic review results revealed that ECERS/ECERS-R total scores were more generally associated with positive outcomes than subscales or factors. Seventeen separate meta-analyses were conducted to assess the strength of association between the ECERS/ECERS-R and measures that assessed children's language, math and social-emotional outcomes. Meta-analyses revealed a small number of weak effects (in the expected direction) between the ECERS/ECERS-R total score and children's language and positive behavior outcomes. The Language-Reasoning subscale was weakly related to a language outcome. The enormous heterogeneity in how studies operationalized the ECERS/ECERS-R, the outcomes measured and statistics reported limited our ability to meta-analyze many studies. Greater consistency in study methodology is needed in this area of research. Despite these methodological challenges, the ECERS/ECERS-R does appear to capture aspects of quality that are important for children's wellbeing

  18. Concordance Between Self-Reported Childhood Maltreatment Versus Case Record Reviews for Child Welfare?Affiliated Adolescents: Prevalence Rates and Associations With Outcomes

    OpenAIRE

    Negriff, Sonya; Schneiderman, Janet U.; Trickett, Penelope K.

    2016-01-01

    The present study used data from an ongoing longitudinal study of the effects of maltreatment on adolescent development to (1) describe rates of maltreatment experiences obtained from retrospective self-report versus case record review for adolescents with child welfare?documented maltreatment histories, (2) examine self-reported versus child welfare?identified maltreatment in relation to mental health and risk behavior outcomes by maltreatment type, and (3) examine the association between th...

  19. The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health

    OpenAIRE

    Fink, Per; ?rnb?l, Eva; Christensen, Kaj Sparle

    2010-01-01

    BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family p...

  20. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy.

    Science.gov (United States)

    Courneya, Kerry S; Segal, Roanne J; Gelmon, Karen; Reid, Robert D; Mackey, John R; Friedenreich, Christine M; Proulx, Caroline; Lane, Kirstin; Ladha, Aliya B; Vallance, Jeffrey K; Liu, Qi; Yasui, Yutaka; McKenzie, Donald C

    2007-12-01

    Few exercise trials in cancer patients have reported longer-term follow-up. Here, we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients. Breast cancer patients initiating adjuvant chemotherapy (n = 242) were randomly assigned to usual care (n = 82), resistance exercise training (RET; n = 82), or aerobic exercise training (AET; n = 78) for the duration of their chemotherapy. At 6-month follow-up, participants were mailed a questionnaire that assessed quality of life, self-esteem, fatigue, anxiety, depression, and exercise behavior. Two hundred one (83.1%) participants provided 6-month follow-up data. Adjusted linear mixed-model analyses showed that, at 6-month follow-up, the RET group reported higher self-esteem [adjusted mean difference, 1.6; 95% confidence interval (95% CI), 0.1-3.2; P = 0.032] and the AET group reported lower anxiety (adjusted mean difference, -4.7; 95% CI, -0.0 to -9.3; P = 0.049) compared with the usual care group. Moreover, compared with participants reporting no regular exercise during the follow-up period, those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes, including quality of life (adjusted mean difference, 9.5; 95% CI, 1.2-17.8; P = 0.025). Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up. Moreover, adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes. Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes.

  1. Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review.

    Science.gov (United States)

    Koornneef, Erik; Robben, Paul; Blair, Iain

    2017-09-20

    The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE. We searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized. Seventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned. From the existing research literature it is not possible to conclude whether UAE health system reforms are

  2. Maternal, Fetal and Neonatal Outcomes in Pregnant Women with Systemic Lupus Erythematosus: A Comprehensive Review Study

    Directory of Open Access Journals (Sweden)

    Fatemeh Zahra Karimi

    2017-11-01

    Full Text Available Background:Systemic lupus erythematosus (SLE is an autoimmune disease with multiple organ involvement and periods of relapse and remission that mainly affects young women of childbearing age. In this regard the reproductive health is an important issue. Although diagnosis, treatment and management of pregnancy in SLE women have been improved recently, but the main concern is effects of SLE on maternal, fetal and neonatal outcomes. This study aimed to investigate the maternal, fetal and neonatal outcomes in pregnant women with SLE. Materials and Methods: The databases of PubMed, Medline, Scopus and Web of Science as well as domestic database (Persian such as SID, Magiran, Irandoc, and Google Scholar were searched with using keywords such as" Systemic lupus erythematosus"; "Pregnancy"; "Neonatal lupus"; "maternal, fetus or neonatal outcome";  and equivalent Persian words. Included were all Persian and English articles, published between 2000 and May 2017. Finally, a total of 77 studies were included. Results: Adverse perinatal outcomes increase in pregnancies with lupus. Outcomes include respiratory, cardiovascular, blood and skin disorders in mothers; stillbirth, spontaneous, and recurrent abortion in fetuses and neonatal lupus, prematurity, intrauterine growth restriction (IUGR, and small for gestational age (SGA in neonates, respectively. Conclusion: Pregnant women with SLE are at high risk due to increased complications for both mother and fetus. It seems broad control of the women before fertilization, so that they be at full remission in the beginning of pregnancy and the disease activity be in complete control, it can help to improve outcomes of pregnancy and so better results can be expected.

  3. New Frontiers in Heart Rate Variability and Social Coherence Research: Techniques, Technologies, and Implications for Improving Group Dynamics and Outcomes

    Directory of Open Access Journals (Sweden)

    Rollin McCraty

    2017-10-01

    Full Text Available Concepts embraced by the term coherence have been identified as central to fields such as quantum physics, physiology, and social science. There are different types of coherence, although the term always implies a harmonious relationship, correlations and connections between the various parts of a system. A specific measure derived from heart rate variability (HRV provides a measure of physiological coherence. Another type of coherence, social coherence, relates to the harmonious alignment between couples or pairs, family units, small groups, or larger organizations in which a network of relationships exists among individuals who share common interests and objectives. A high degree of social coherence is reflected by stable and harmonious relationships, which allows for the efficient flow and utilization of energy and communication required for optimal collective cohesion and action. Social coherence requires that group members are attuned and are emotionally connected with each other, and that the group’s emotional energy is organized and regulated by the group as a whole. A number of studies are reviewed which have explored various types of synchronization in infants, pairs and groups, indicating that feelings of cooperation, trust, compassion and increased prosocial behaviors depends largely on the establishment of a spontaneous synchronization of various physiological rhythms between individuals. This article discusses a new application using HRV monitoring in social coherence research and the importance of physiological synchronization in group developmental processes and dynamics. Building on the extensive body of research showing that providing feedback of HRV coherence level at the individual level can improve self-regulation, we suggest the following hypotheses: (1 providing feedback of individual and collective HRV coherence and the degree of heart rhythm synchronization will increase group coherence, and heart rhythm synchronization

  4. Association of heart rate variability with clinical outcome in Parkinsonian patients after subthalamic deep brain stimulation: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Shin-Yuan Chen

    2011-09-01

    Conclusion: Our study showed an improvement in autonomic cardiovascular regulation in Parkinsonian patients with >50% improvement in rating scale after STN-DBS, which implied morbidity reduction in nonmotor symptoms among such patients.

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

    Science.gov (United States)

    Davidson, Jacob G S; Guthrie, Dawn M

    2017-08-01

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

  6. A Compound Detection System Based on Ultrasonic Flow Rate and Concentration

    Directory of Open Access Journals (Sweden)

    Qing-Hui WANG

    2014-02-01

    Full Text Available This paper proposes a new detection system for monitoring gas concentration and flow rate. Velocity difference of ultrasonic wave in bi-directional propagation in measured gas is recorded and utilized for computing the online gas concentration and flow rate. Meanwhile, the temperature compensation, return signal processing and error analysis algorithms are applied to improve the accuracy. The experimental results show that, compared with the single sensor measurement of gas flow rate or concentration, the proposed detection system with lower cost and higher accuracy can be applied in the occasion which needs simultaneous monitoring of gas concentration and flow rate.

  7. Critical review of LEED system for rating sustainability of architecture of commercial interiors

    Directory of Open Access Journals (Sweden)

    Stevanović Sanja

    2010-01-01

    Full Text Available The LEED rating system for sustainability of architecture has gained large marketing potential in USA and became one of main ways American builders are attacking ecological challenges. In this paper the LEED rating system for commercial interiors is critically reviewed, pointing out its positive - focus on integrated design process - and negative impacts - low thresholds for highest ratings and tendency to gain LEED rating with projects that hardly pass the thresholds, largely neglecting the principles of energy efficiency. Based on a few prominent LEED platinum examples, the beginnings of a LEED style of designing interiors in historical landmark buildings are pointed out as well.

  8. Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.

    Science.gov (United States)

    Bordeianou, Liliana; Cauley, Christy E; Antonelli, Donna; Bird, Sarah; Rattner, David; Hutter, Matthew; Mahmood, Sadiqa; Schnipper, Deborah; Rubin, Marc; Bleday, Ronald; Kenney, Pardon; Berger, David

    2017-01-01

    Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. This study aimed to compare database concordance. This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated. This study was conducted at Boston-area hospitals. National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included. Standardized surgical site infection rates were the primary outcomes of interest. Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient

  9. Development of linear flow rate control system for eccentric butter-fly valve

    International Nuclear Information System (INIS)

    Kwak, K. K.; Cho, S. W.; Park, J. S.; Cho, J. H.; Song, I. T.; Kim, J. G.; Kwon, S. J.; Kim, I. J.; Park, W. K.

    1999-12-01

    Butter-fly valves are advantageous over gate, globe, plug, and ball valves in a variety of installations, particularly in the large sizes. The purpose of this project development of linear flow rate control system for eccentric butter-fly valve (intelligent butter-fly valve system). The intelligent butter-fly valve system consist of a valve body, micro controller. The micro controller consist of torque control system, pressure censor, worm and worm gear and communication line etc. The characteristics of intelligent butter-fly valve system as follows: Linear flow rate control function. Digital remote control function. guard function. Self-checking function. (author)

  10. Direct repair surgery with screw fixation for young patients with lumbar spondylolysis: patient-reported outcomes and fusion rate in a prospective interventional study.

    Science.gov (United States)

    Lee, Gun Woo; Lee, Sun-Mi; Suh, Bo-Gun

    2015-02-15

    Prospective interventional study. To thoroughly investigate the therapeutic outcomes of direct repair (DR) for young patients with lumbar spondylolysis. DR surgery with screw fixation for a pars defect of lumbar spondylolysis is considered a notable surgical option. However, prior studies do not provide clear information on the significance of DR and its outcomes in young patients with lumbar spondylolysis because most previous studies in this area were conducted with spondylolysis patients of all ages and with low-quality study designs that were retrospective in design and had a small sample size and short follow-up time. A total of 47 young patients with lumbar spine spondylolysis who were surgically treated with DR surgery and followed up for 1 year after surgery were enrolled in this study. The primary outcome was degree of pain assessed by visual analogue scale, which separately recorded pain intensity and pain frequency. Secondary outcomes included (1) patient satisfaction, (2) clinical outcomes based on Oswestry Disability Index score and a 12-item short form health survey, (3) fusion rate of pars defect based on computed tomographic scans, and (4) surgery-related complications. The degree of lower back pain (intensity and frequency) significantly improved at final follow-up compared with preoperative level. However, 6 patients (13%) had no significant improvement, and pain frequency tended to worsen 6 months after the operation. Only 25 patients (53%) were satisfied with DR surgery. One-year postoperative clinical outcomes (Oswestry Disability Index and 12-item short form health survey) significantly improved compared with preoperative levels, but the 2 scores also tended to decrease after 6 months. The union rate of the pars defect was 55% (26/47). There was no significant difference in clinical outcomes between fusion group and nonunion group of the pars defect at the final follow-up. Two patients (4%) experienced surgery-related complications. The

  11. Survey and online discussion groups to develop a patient-rated outcome measure on acceptability of treatment response in vitiligo

    Science.gov (United States)

    2014-01-01

    Background Vitiligo is a chronic depigmenting skin disorder which affects around 0.5-1% of the world’s population. The outcome measures used most commonly in trials to judge treatment success focus on repigmentation. Patient-reported outcome measures of treatment success are rarely used, although recommendations have been made for their inclusion in vitiligo trials. This study aimed to evaluate the face validity of a new patient-reported outcome measure of treatment response, for use in future trials and clinical practice. Method An online survey to gather initial views on what constitutes treatment success for people with vitiligo or their parents/carers, followed by online discussion groups with patients to reach consensus on what constitutes treatment success for individuals with vitiligo, and how this can be assessed in the context of trials. Participants were recruited from an existing database of vitiligo patients and through posts on the social network sites Facebook and Twitter. Results A total of 202 survey responses were received, of which 37 were excluded and 165 analysed. Three main themes emerged as important in assessing treatment response: a) the match between vitiligo and normal skin (how well it blends in); b) how noticeable the vitiligo is and c) a reduction in the size of the white patches. The majority of respondents said they would consider 80% or more repigmentation to be a worthwhile treatment response after 9 months of treatment. Three online discussion groups involving 12 participants led to consensus that treatment success is best measured by asking patients how noticeable their vitiligo is after treatment. This was judged to be best answered using a 5-point Likert scale, on which a score of 4 or 5 represents treatment success. Conclusions This study represents the first step in developing a patient reported measure of treatment success in vitiligo trials. Further work is now needed to assess its construct validity and responsiveness to

  12. Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease.

    Science.gov (United States)

    Caron, Melissa; Hoa, Sabrina; Hudson, Marie; Schwartzman, Kevin; Steele, Russell

    2018-06-30

    Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression ( i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD ( i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide ( D LCO ) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted D LCO Only five studies specifically aimed to validate the PFTs: two concluded that D LCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that D LCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression. Copyright ©ERS 2018.

  13. Public outcomes: Building a 21st century national innovation system that serves the public

    Energy Technology Data Exchange (ETDEWEB)

    Gover, J. [Sandia National Labs., Albuquerque, NM (United States); Huray, P.; Carayannis, E. [George Washington Univ., Washington, DC (United States)

    1997-09-01

    Federal R and D must be principally focused on solving public problems that the marketplace is failing to address. With few exceptions programs must be supported by roadmaps that show how the R and D is linked to public outcomes. Federal R and D and those who perform it must be judged in terms of the public outcomes. The overarching issues of federal R and D policy, what it should address, how to manage it, who should perform it, how to perform it, what works best, etc. are highly complex and lack a strong theoretical foundation. (In fact, the linear, assembly-line model used by policymakers is wrong.) It is time that policymakers recognize and acknowledge the uncertainty of their work and conduct a wide array of policy experiments (the authors consider SEMATECH such an experiment) that are supported by public outcome metrics. In addition to making federal R and D better address public needs, such an approach to policy making could raise the public`s interest in T and S policy. Of course, as in any experiment the results may be measured and if failures aren`t observed, it is likely that policies lack vision and imagination. It is time to abandon the budget driven federal R and D system where performers of federal R and D are treated as constituents, and replace it with a public problem--public outcome driven system where public problems are prioritized and the budget is distributed to agencies according to these priorities.

  14. The effectiveness of the motion picture association of America's rating system in screening explicit violence and sex in top-ranked movies from 1950 to 2006.

    Science.gov (United States)

    Nalkur, Priya G; Jamieson, Patrick E; Romer, Daniel

    2010-11-01

    Youth exposure to explicit film violence and sex is linked to adverse health outcomes and is a serious public health concern. The Motion Picture Association of America's (MPAA's) rating system's effectiveness in reducing youth exposure to harmful content has been questioned. To determine the MPAA's rating system's effectiveness in screening explicit violence and sex since the system's initiation (1968) and the introduction of the PG-13 category (1984). Also, to examine evidence of less restrictive ratings over time ("ratings creep"). Top-grossing movies from 1950 to 2006 (N = 855) were coded for explicitness of violent and sexual content. Trends in rating assignments and in the content of different rating categories since 1968 were assessed. The explicitness of violent and sexual content significantly increased following the rating system's initiation. The system did not differentiate violent content as well as sexual content, and ratings creep was only evident for violent films. Explicit violence in R-rated films increased, while films that would previously have been rated R were increasingly assigned to PG-13. This pattern was not evident for sex; only R-rated films exhibited higher levels of explicit sex compared to preratings period. While relatively effective for screening explicit sex, the rating system has allowed increasingly violent content into PG-13 films, thereby increasing youth access to more harmful content. Assignment of films in the current rating system should be more sensitive to the link between violent media exposure and youth violence. Copyright © 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. Assessment of energy credits for the enhancement of the Egyptian Green Pyramid Rating System

    International Nuclear Information System (INIS)

    Abdel Aleem, Shady H.E.; Zobaa, Ahmed F.; Abdel Mageed, Hala M.

    2015-01-01

    Energy is one of the most important categories in the Green Building Rating Systems all over the world. Green Building is a building that meets the energy requirements of the present with low energy consumption and investment costs without infringing on the rights of forthcoming generations to find their own needs. Despite having more than a qualified rating system, it is clear that each system has different priorities and needs on the other. Accordingly, this paper proposes a methodology using the Analytic Hierarchy Process (AHP) for assessment of the energy credits through studying and comparing four of the common global rating systems, the British Building Research Establishment Environmental Assessment Method (BREEAM), the American Leadership in Energy and Environmental Design (LEED), the Australian Green Stars (GS), and the PEARL assessment system of the United Arab Emirates, in order to contribute to the enhancement of the Egyptian Green Pyramid Rating System (GPRS). The results show the mandatory and optional energy credits that should be considered with their proposed weights according to the present and future needs of green Egypt. The results are compared to data gathered through desk studies and results extracted from recent questionnaires. - Highlights: • The Egyptian rating system is underway but not on track. • The main objective is the enhancement of the Egyptian rating system. • We propose a methodology for assessment of the energy credits. • The results show the optional energy credits with their optimal weights. • The results show the mandatory energy credits that should be considered.

  16. Embodied energy of building materials and green building rating systems : a case study for industrial halls

    NARCIS (Netherlands)

    Lee, B.; Trcka, M.; Hensen, J.L.M.

    2011-01-01

    Green building rating (GBR) systems are developed to provide independent assessment standards that evaluate in a few categories about the performance and sustainability of buildings. However, same category might weight differently in each of the GBR systems. A particular system might favor certain

  17. 78 FR 71036 - Pipeline Safety: Random Drug Testing Rate; Contractor Management Information System Reporting...

    Science.gov (United States)

    2013-11-27

    ... PHMSA-2013-0248] Pipeline Safety: Random Drug Testing Rate; Contractor Management Information System Reporting; and Obtaining Drug and Alcohol Management Information System Sign-In Information AGENCY: Pipeline... Management Information System (MIS) Data; and New Method for Operators to Obtain User Name and Password for...

  18. Interplay between spontaneous decay rates and Lamb shifts in open photonic systems

    Science.gov (United States)

    Lassalle, Emmanuel; Bonod, Nicolas; Durt, Thomas; Stout, Brian

    2018-05-01

    In this letter, we describe the modified decay rate and photonic Lamb (frequency) shift of quantum emitters in terms of the resonant states of a neighboring photonic resonator. This description illustrates a fundamental distinction in the behaviors of closed (conservative) and open (dissipative) systems: the Lamb shift is bounded by the emission linewidth in closed systems while it overcomes this limit in open systems.

  19. Considerations in Managing the Fill Rate of the Grand Ethiopian Renaissance Dam Reservoir Using a System Dynamics Approach.

    Science.gov (United States)

    Keith, Bruce; Ford, David N.; Horton, Radley M.

    2016-01-01

    The purpose of this study is to evaluate simulated fill rate scenarios for the Grand Ethiopian Renaissance Dam while taking into account plausible climate change outcomes for the Nile River Basin. The region lacks a comprehensive equitable water resource management strategy, which creates regional security concerns and future possible conflicts. We employ climate estimates from 33 general circulation models within a system dynamics model as a step in moving toward a feasible regional water resource management strategy. We find that annual reservoir fill rates of 8-15% are capable of building hydroelectric capacity in Ethiopia while concurrently ensuring a minimum level of stream flow disruption into Egypt before 2039. Insofar as climate change estimates suggest a modest average increase in stream flow into the Aswan, climate changes through 2039 are unlikely to affect the fill rate policies. However, larger fill rates will have a more detrimental effect on stream flow into the Aswan, particularly beyond a policy of 15%. While this study demonstrates that a technical solution for reservoir fill rates is feasible, the corresponding policy challenge is political. Implementation of water resource management strategies in the Nile River Basin specifically and Africa generally will necessitate a national and regional willingness to cooperate.

  20. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  1. Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial.

    Science.gov (United States)

    Ruilope, Luis M; Zanchetti, Alberto; Julius, Stevo; McInnes, Gordon T; Segura, Julian; Stolt, Pelle; Hua, Tsushung A; Weber, Michael A; Jamerson, Ken

    2007-07-01

    Reduced renal function is predictive of poor cardiovascular outcomes but the predictive value of different measures of renal function is uncertain. We compared the value of estimated creatinine clearance, using the Cockcroft-Gault formula, with that of estimated glomerular filtration rate (GFR), using the Modification of Diet in Renal Disease (MDRD) formula, as predictors of cardiovascular outcome in 15 245 high-risk hypertensive participants in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. For the primary end-point, the three secondary end-points and for all-cause death, outcomes were compared for individuals with baseline estimated creatinine clearance and estimated GFR or = 60 ml/min using hazard ratios and 95% confidence intervals. Coronary heart disease, left ventricular hypertrophy, age, sex and treatment effects were included as covariates in the model. For each end-point considered, the risk in individuals with poor renal function at baseline was greater than in those with better renal function. Estimated creatinine clearance (Cockcroft-Gault) was significantly predictive only of all-cause death [hazard ratio = 1.223, 95% confidence interval (CI) = 1.076-1.390; P = 0.0021] whereas estimated GFR was predictive of all outcomes except stroke. Hazard ratios (95% CIs) for estimated GFR were: primary cardiac end-point, 1.497 (1.332-1.682), P cause death, 1.231 (1.098-1.380), P = 0.0004. These results indicate that estimated glomerular filtration rate calculated with the MDRD formula is more informative than estimated creatinine clearance (Cockcroft-Gault) in the prediction of cardiovascular outcomes.

  2. A system for rating the stability and strength of medical evidence

    Directory of Open Access Journals (Sweden)

    Reston James T

    2006-10-01

    Full Text Available Abstract Background Methods for describing one's confidence in the available evidence are useful for end-users of evidence reviews. Analysts inevitably make judgments about the quality, quantity consistency, robustness, and magnitude of effects observed in the studies identified. The subjectivity of these judgments in several areas underscores the need for transparency in judgments. Discussion This paper introduces a new system for rating medical evidence. The system requires explicit judgments and provides explicit rules for balancing these judgments. Unlike other systems for rating the strength of evidence, our system draws a distinction between two types of conclusions: quantitative and qualitative. A quantitative conclusion addresses the question, "How well does it work?", whereas a qualitative conclusion addresses the question, "Does it work?" In our system, quantitative conclusions are tied to stability ratings, and qualitative conclusions are tied to strength ratings. Our system emphasizes extensive a priori criteria for judgments to reduce the potential for bias. Further, the system makes explicit the impact of heterogeneity testing, meta-analysis, and sensitivity analyses on evidence ratings. This article provides details of our system, including graphical depictions of how the numerous judgments that an analyst makes can be combined. We also describe two worked examples of how the system can be applied to both interventional and diagnostic technologies. Summary Although explicit judgments and formal combination rules are two important steps on the path to a comprehensive system for rating medical evidence, many additional steps must also be taken. Foremost among these are the distinction between quantitative and qualitative conclusions, an extensive set of a priori criteria for making judgments, and the direct impact of analytic results on evidence ratings. These attributes form the basis for a logically consistent system that can

  3. Main Clinical Outcomes of Feldspathic Porcelain and Glass-Ceramic Laminate Veneers: A Systematic Review and Meta-Analysis of Survival and Complication Rates.

    Science.gov (United States)

    Morimoto, Susana; Albanesi, Rafael Borges; Sesma, Newton; Agra, Carlos Martins; Braga, Mariana Minatel

    2016-01-01

    The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic porcelain laminate veneers. A systematic search was carried out in Cochrane and PubMed databases. From the selected studies, the survival rates for porcelain and glass-ceramic veneers were extracted, as were complication rates of clinical outcomes: debonding, fracture/chipping, secondary caries, endodontic problems, severe marginal discoloration, and influence of incisal coverage and enamel/dentin preparation. The Cochran Q test and the I(2) statistic were used to evaluate heterogeneity. Out of the 899 articles initially identified, 13 were included for analysis. Metaregression analysis showed that the types of ceramics and follow-up periods had no influence on failure rate. The estimated overall cumulative survival rate was 89% (95% CI: 84% to 94%) in a median follow-up period of 9 years. The estimated survival for glass-ceramic was 94% (95% CI: 87% to 100%), and for feldspathic porcelain veneers, 87% (95% CI: 82% to 93%). The meta-analysis showed rates for the following events: debonding: 2% (95% CI: 1% to 4%); fracture/chipping: 4% (95% CI: 3% to 6%); secondary caries: 1% (95% CI: 0% to 3%); severe marginal discoloration: 2% (95% CI: 1% to 10%); endodontic problems: 2% (95% CI: 1% to 3%); and incisal coverage odds ratio: 1.25 (95% CI: 0.33 to 4.73). It was not possible to perform meta-analysis of the influence of enamel/dentin preparation on failure rates. Glass-ceramic and porcelain laminate veneers have high survival rates. Fracture/ chipping was the most frequent complication, providing evidence that ceramic veneers are a safe treatment option that preserve tooth structure.

  4. Predicting IVF Outcome: A Proposed Web-based System Using Artificial Intelligence.

    Science.gov (United States)

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Pouliakis, Abraham; Trivella, Marialenna; Papantoniou, Nikolaos; Bettocchi, Stefano

    2016-01-01

    To propose a functional in vitro fertilization (IVF) prediction model to assist clinicians in tailoring personalized treatment of subfertile couples and improve assisted reproduction outcome. Construction and evaluation of an enhanced web-based system with a novel Artificial Neural Network (ANN) architecture and conformed input and output parameters according to the clinical and bibliographical standards, driven by a complete data set and "trained" by a network expert in an IVF setting. The system is capable to act as a routine information technology platform for the IVF unit and is capable of recalling and evaluating a vast amount of information in a rapid and automated manner to provide an objective indication on the outcome of an artificial reproductive cycle. ANNs are an exceptional candidate in providing the fertility specialist with numerical estimates to promote personalization of healthcare and adaptation of the course of treatment according to the indications. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. On the hazard rate process for imperfectly monitored multi-unit systems

    International Nuclear Information System (INIS)

    Barros, A.; Berenguer, C.; Grall, A.

    2005-01-01

    The aim of this paper is to present a stochastic model to characterize the failure distribution of multi-unit systems when the current units state is imperfectly monitored. The definition of the hazard rate process existing with perfect monitoring is extended to the realistic case where the units failure time are not always detected (non-detection events). The so defined observed hazard rate process gives a better representation of the system behavior than the classical failure rate calculated without any information on the units state and than the hazard rate process based on perfect monitoring information. The quality of this representation is, however, conditioned by the monotony property of the process. This problem is mainly discussed and illustrated on a practical example (two parallel units). The results obtained motivate the use of the observed hazard rate process to characterize the stochastic behavior of the multi-unit systems and to optimize for example preventive maintenance policies

  6. On the hazard rate process for imperfectly monitored multi-unit systems

    Energy Technology Data Exchange (ETDEWEB)

    Barros, A. [Institut des Sciences et Techonologies de l' Information de Troyes (ISTIT-CNRS), Equipe de Modelisation et Surete des Systemes, Universite de Technologie de Troyes (UTT), 12, rue Marie Curie, BP2060, 10010 Troyes cedex (France)]. E-mail: anne.barros@utt.fr; Berenguer, C. [Institut des Sciences et Techonologies de l' Information de Troyes (ISTIT-CNRS), Equipe de Modelisation et Surete des Systemes, Universite de Technologie de Troyes (UTT), 12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Grall, A. [Institut des Sciences et Techonologies de l' Information de Troyes (ISTIT-CNRS), Equipe de Modelisation et Surete des Systemes, Universite de Technologie de Troyes (UTT), 12, rue Marie Curie, BP2060, 10010 Troyes cedex (France)

    2005-12-01

    The aim of this paper is to present a stochastic model to characterize the failure distribution of multi-unit systems when the current units state is imperfectly monitored. The definition of the hazard rate process existing with perfect monitoring is extended to the realistic case where the units failure time are not always detected (non-detection events). The so defined observed hazard rate process gives a better representation of the system behavior than the classical failure rate calculated without any information on the units state and than the hazard rate process based on perfect monitoring information. The quality of this representation is, however, conditioned by the monotony property of the process. This problem is mainly discussed and illustrated on a practical example (two parallel units). The results obtained motivate the use of the observed hazard rate process to characterize the stochastic behavior of the multi-unit systems and to optimize for example preventive maintenance policies.

  7. Effect of Preserving the Pituitary Stalk During Resection of Craniopharyngioma in Children on the Diabetes Insipidus and Relapse Rates and Long-Term Outcomes.

    Science.gov (United States)

    Cheng, Jing; Fan, Yanqin; Cen, Bo

    2017-09-01

    The objective of this study was to investigate the effect of preserving an infiltrated pituitary stalk during the resection of craniopharyngioma of pituitary stalk origin on postoperative outcomes and thus provide a theoretical basis for microsurgical treatment and prognosis. We screened the clinical data of all 103 pediatric patients with craniopharyngioma undergoing surgical treatment at our department between January 2006 and January 2013 and conducted a retrospective analysis of 82 patients with craniopharyngioma originating in the pituitary stalk. The patients were followed up from 12 months to 8 years. We analyzed the effect of preserving the pituitary stalk on the early and persistent diabetes insipidus rates, postoperative relapse rate, and mortality. In the total resection group (n = 67), the early and persistent diabetes insipidus rates were significantly lower in the 46 patients (68.7%) with a pituitary stalk than in those whose pituitary stalk was removed (P  0.05). In the subtotal resection group (n = 15), a significant difference was observed in the early and persistent diabetes insipidus rates (P  0.05). For children with craniopharyngioma of pituitary stalk origin, preserving the pituitary stalk has a significant effect on the early and persistent diabetes insipidus rates. When intraoperative exploration showed excessive adhesion between the tumor and pituitary stalk, we opted to preserve the pituitary stalk, which significantly reduced the early and persistent postoperative diabetes insipidus rates, without significantly increasing the relapse or mortality rate.

  8. The role of employee HR attributions in the relationship between high-performance work systems and employee outcomes

    NARCIS (Netherlands)

    van de Voorde, F.C.; Beijer, Susanne

    2015-01-01

    Although research has shown that the use of high-performance work systems (HPWS) is associated with employee outcomes, our knowledge of the meanings employees attach to HPWS systems and how these shape employee outcomes is still limited. This study examines the signalling impact of enacted HPWS on

  9. Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

    Science.gov (United States)

    Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

    2018-04-01

    A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

  10. A balance of activity in brain control and reward systems predicts self-regulatory outcomes

    OpenAIRE

    Lopez, Richard B.; Chen, Pin-Hao A.; Huckins, Jeremy F.; Hofmann, Wilhelm; Kelley, William M.; Heatherton, Todd F.

    2017-01-01

    Abstract Previous neuroimaging work has shown that increased reward-related activity following exposure to food cues is predictive of self-control failure. The balance model suggests that self-regulation failures result from an imbalance in reward and executive control mechanisms. However, an open question is whether the relative balance of activity in brain systems associated with executive control (vs reward) supports self-regulatory outcomes when people encounter tempting cues in daily lif...

  11. A commercial outcome prediction system for university technology transfer using neural networks

    OpenAIRE

    Chu, Ling

    2007-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 26/03/2007. This thesis presents a commercial outcome prediction system (CPS) capable of predicting the likely future monetary return that would be generated by an invention. The CPS is designed to be used by university technology transfer offices for invention assessment purposes, and is based on the data from their historical invention cases. It is aimed at improving technology transfer off...

  12. A Compound Detection System Based on Ultrasonic Flow Rate and Concentration

    OpenAIRE

    Qing-Hui WANG; Fang MU; Li-Feng WEI

    2014-01-01

    This paper proposes a new detection system for monitoring gas concentration and flow rate. Velocity difference of ultrasonic wave in bi-directional propagation in measured gas is recorded and utilized for computing the online gas concentration and flow rate. Meanwhile, the temperature compensation, return signal processing and error analysis algorithms are applied to improve the accuracy. The experimental results show that, compared with the single sensor measurement of gas flow rate or conce...

  13. AUTOMATED SYSTEM OF DATA PROCESSING WITH THE IMPLEMENTATION OF RATING TECHNOLOGY OF TEACHING

    Directory of Open Access Journals (Sweden)

    О. И. Дзювина

    2014-01-01

    Full Text Available Rating technology of teaching enables independent and individual work of students, increase their motivation.Purpose: to increase the efficiency of data processing with the implementation of rating technology of teaching.Method: analysis, synthesis,experiment.Results. Developed an automated data processing system for the implementation of rating technology of teaching.Practical implication. Education.Purchase on Elibrary.ru > Buy now

  14. The Impact of Retail Rate Structures on the Economics of Commercial Photovoltaic Systems in California

    OpenAIRE

    Mills, Andrew

    2009-01-01

    This article examines the impact of retail electricity rate design on the economic value of grid-connected photovoltaic (PV) systems, focusing on commercial customers in California. Using 15-min interval building load and PV production data from a sample of 24 actual commercial PV installations, we compare the value of the bill savings across 20 commercial-customer retail electricity rates currently offered in the state. Across all combinations of customers and rates, we find that the annual ...

  15. RCSLK9: reactor coolant system leak rate determination for PWRs. User's guide

    International Nuclear Information System (INIS)

    Kirkpatrick, D.C.; Woodruff, R.W.; Holland, R.A.

    1984-12-01

    RCSLK9 is a computer program that was developed to analyze the leak tightness of the primary cooling system for any pressurized water reactor. From system conditions, water levels in tanks, and certain system design parameters, RCSLK9 calculates the loss of water from the cooling system and the increase of water in the leakage collection system during an arbitrary time interval. The program determines the system leak rates and displays or prints a report of the results. For initial application of the program at a reactor, RCSLK9 creates a file of system parameters and stores it for future use. RCSLK9 is written for use on the IBM PC

  16. Regulation and drive system for high rep-rate magnetic-pulse compressors

    International Nuclear Information System (INIS)

    Birx, D.L.; Cook, E.G.; Hawkins, S.; Meyers, A.; Reginato, L.L.; Schmidt, J.A.; Smith, M.W.

    1982-01-01

    The essentially unlimited rep-rate capability of non-linear magnetic systems has imposed strict requirements on the drive system which initiates the pulse compression. An order of magnitude increase in the rep-rates achieved by the Advanced Test Accelerator (ATA) gas blown system is not difficult to achieve in the magnetic compressor. The added requirement of having a high degree of regulation at the higher rep-rates places strict requirements on the triggerable switch for charging and de-Queing. A novel feedback technique which applies the proper bias to a magnetic core by comparing a reference voltage to the charging voltage eases considerably the regulation required to achieve low jitter in magnetic compression. The performance of the high rep-rate charging and regulation systems will be described in the following pages

  17. Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Sarah E. Rudasill, BA

    2018-06-01

    Conclusions: These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.

  18. Results on stabilization of nonlinear systems under finite data-rate constraints

    NARCIS (Netherlands)

    Persis, Claudio De

    2004-01-01

    We discuss in this paper a result concerning the stabilization problem of nonlinear systems under data-rate constraints using output feedback. To put the result in a broader context, we shall first review a number of recent contributions on the stabilization problem under data-rate constraints when

  19. Electronic circuit SG-6 type for electric differential manometer in the flow rate measuring system

    Energy Technology Data Exchange (ETDEWEB)

    Glowacki, S W; Pytel, K; Beldzikowski, W

    1978-01-01

    A system measuring the flow rate of a liquid or gas employing a ruft and a differential manometer needs the square rooting circuit providing the linearity of the output signal to the measured flow rate ratio. The paper describes the electronic circuit developed for this purpose.

  20. Initial Progress Rates as Related to Performance in a Personalized System of Instruction

    Science.gov (United States)

    Henneberry, John K.

    1976-01-01

    Discusses research which explored the hypothesis that students who are fast starters in a personalized system of instruction psychology course would perform better and maintain faster course progress rates than slow starters. Findings indicate that students' starting pace is predictive of course performance and subsequent progress rates.…

  1. Measurement of semiochemical release rates with a dedicated environmental control system

    Science.gov (United States)

    Heping Zhu; Harold W. Thistle; Christopher M. Ranger; Hongping Zhou; Brian L. Strom

    2015-01-01

    Insect semiochemical dispensers are commonly deployed under variable environmental conditions over a specified period. Predictions of their longevity are hampered by a lack of methods to accurately monitor and predict how primary variables affect semiochemical release rate. A system was constructed to precisely determine semiochemical release rates under...

  2. iHeartrate: a heart rate controlled in-flight music recommendation system

    NARCIS (Netherlands)

    Liu, H.; Hu, J.; Rauterberg, G.W.M.; Spink, A.J.; Grieco, O.E.; Krips, L.W.S.; Loijens, L.P.J.J.; Noldus, xx; Zimmerman, P.H.

    2010-01-01

    Travel by air, especially long distance, the enclosed environment of the aircraft cabin causes discomfort and even stress to flight passengers. In this paper, we present a new heart rate controlled music recommendation system. Heart rate is used as a stress indicator. If the user is stressed and

  3. 47 CFR 76.1504 - Rates, terms and conditions for carriage on open video systems.

    Science.gov (United States)

    2010-10-01

    ....1504 Rates, terms and conditions for carriage on open video systems. (a) Reasonable rate principle. An... operator will bear the burden of proof to demonstrate, using the principles set forth below, that the...; (2) Packaging, including marketing and other fees; (3) Talent fees; and (4) A reasonable overhead...

  4. Learning by Heart: Students Use Heart Rate Patterns To Identify Nervous System Imbalances.

    Science.gov (United States)

    Ackerly, Spafford C.

    2001-01-01

    Introduces a science unit on heart rate variability (HVR) patterns. Uses spectral analysis to determine the effects of environmental stimulants such as music and emotional stress on heart rate. Observes relaxation techniques and their effects on the autonomous nervous system. (Contains 12 references.) (YDS)

  5. Media rating systems: do they work? Shop floor compliance with age restrictions in the Netherlands

    NARCIS (Netherlands)

    Gosselt, Jordi Franciscus; van Hoof, Joris Jasper; de Jong, Menno D.T.

    2012-01-01

    Media rating systems have been introduced in many countries to protect minors from being exposed to harmful media content. This study examines whether retailers comply with the guidelines of media ratings in the Netherlands. In a mystery shopping study, minors tried to buy or rent media products for

  6. The principle of an NRF rating system for the humanities and social ...

    African Journals Online (AJOL)

    The National Research Foundation (NRF) is proposing to introduce a ratings system for the humanities and social sciences comparable to that which pertains in the natural sciences. The article welcomes this development, and argues for full and open consultation with the research community regarding appropriate ratings ...

  7. Library Automation Alternatives in 1996 and User Satisfaction Ratings of Library Users by Operating System.

    Science.gov (United States)

    Cibbarelli, Pamela

    1996-01-01

    Examines library automation product introductions and conversions to new operating systems. Compares user satisfaction ratings of the following library software packages: DOS/Windows, UNIX, Macintosh, and DEC VAX/VMS. Software is rated according to documentation, service/support, training, product reliability, product capabilities, ease of use,…

  8. Demo : an embedded vision system for high frame rate visual servoing

    NARCIS (Netherlands)

    Ye, Z.; He, Y.; Pieters, R.S.; Mesman, B.; Corporaal, H.; Jonker, P.P.

    2011-01-01

    The frame rate of commercial off-the-shelf industrial cameras is breaking the threshold of 1000 frames-per-second, the sample rate required in high performance motion control systems. On the one hand, it enables computer vision as a cost-effective feedback source; On the other hand, it imposes

  9. Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS).

    Science.gov (United States)

    Pilkonis, Paul A; Yu, Lan; Dodds, Nathan E; Johnston, Kelly L; Lawrence, Suzanne M; Daley, Dennis C

    2016-04-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) includes five item banks for alcohol use. There are limited data, however, regarding their validity (e.g., convergent validity, responsiveness to change). To provide such data, we conducted a prospective study with 225 outpatients being treated for substance abuse. Assessments were completed shortly after intake and at 1-month and 3-month follow-ups. The alcohol item banks were administered as computerized adaptive tests (CATs). Fourteen CATs and one six-item short form were also administered from eight other PROMIS domains to generate a comprehensive health status profile. After modeling treatment outcome for the sample as a whole, correlates of outcome from the PROMIS health status profile were examined. For convergent validity, the largest correlation emerged between the PROMIS alcohol use score and the Alcohol Use Disorders Identification Test (r=.79 at intake). Regarding treatment outcome, there were modest changes across the target problem of alcohol use and other domains of the PROMIS health status profile. However, significant heterogeneity was found in initial severity of drinking and in rates of change for both abstinence and severity of drinking during follow-up. This heterogeneity was associated with demographic (e.g., gender) and health-profile (e.g., emotional support, social participation) variables. The results demonstrated the validity of PROMIS CATs, which require only 4-6 items in each domain. This efficiency makes it feasible to use a comprehensive health status profile within the substance use treatment setting, providing important prognostic information regarding abstinence and severity of drinking. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Nursing home 5-star rating system exacerbates disparities in quality, by payer source.

    Science.gov (United States)

    Konetzka, R Tamara; Grabowski, David C; Perraillon, Marcelo Coca; Werner, Rachel M

    2015-05-01

    Market-based reforms in health care, such as public reporting of quality, may inadvertently exacerbate disparities. We examined how the Centers for Medicare and Medicare Services' five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid ("dual eligibles"), a particularly vulnerable and disadvantaged population. Specifically, we assessed the extent to which dual eligibles and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. We found that both populations resided in better-quality homes over time but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. Thus, the gap in quality, as measured by a nursing home's star rating, grew over time. Furthermore, we found that the benefit of the five-star system to dual eligibles was largely due to providers' improving their ratings, not to consumers' choosing different providers. We present evidence suggesting that supply constraints play a role in limiting dual eligibles' responses to quality ratings, since high-quality providers tend to be located close to relatively affluent areas. Increases in Medicaid payment rates for nursing home services may be the only long-term solution. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Increasing the bit rate in OCDMA systems using pulse position modulation techniques.

    Science.gov (United States)

    Arbab, Vahid R; Saghari, Poorya; Haghi, Mahta; Ebrahimi, Paniz; Willner, Alan E

    2007-09-17

    We have experimentally demonstrated two novel pulse position modulation techniques, namely Double Pulse Position Modulation (2-PPM) and Differential Pulse Position Modulation (DPPM) in Time-Wavelength OCDMA systems that will operate at a higher bit rate compared to traditional OOK-OCDMA systems with the same bandwidth. With 2-PPM technique, the number of active users will be more than DPPM while their bit rate is almost the same. Both techniques provide variable quality of service in OCDMA networks.

  12. Fair premium rate of the deposit insurance system based on banks' creditworthiness

    OpenAIRE

    Yoshino, Naoyuki; Taghizadeh-Hesary, Farhad; Nili, Farhad

    2017-01-01

    Purpose: Deposit insurance is a key element in modern banking, as it guarantees the financial safety of deposits at depository financial institutions. It is necessary to have at least a dual fair premium rate system based on the creditworthiness of financial institutions, as considering a singular premium system for all banks will have a moral hazard. In this paper, we develop a theoretical as well as an empirical model for calculating dual fair premium rates. Design/methodology/approach: Our...

  13. Experience with Floating Interbank Exchange Rate Systems in Five Developing Economies

    OpenAIRE

    Vicente Galbis

    1993-01-01

    This paper reviews the experience with floating interbank exchange rate systems in five developing countries--The Gambia, Guyana, Jamaica, Nigeria and Sri Lanka--and draws some conclusions about the stability and efficiency of these systems. The experience of these countries illustrates both the difficulties and the advantages of interbank exchange rate markets. The main conclusion is that these markets can operate relatively well with a minimum banking infrastructure, provided that the autho...

  14. Financial Prospect to The Application of High Rate Water Treatment Plant System

    Directory of Open Access Journals (Sweden)

    Mohajit Mohajit

    2015-10-01

    Full Text Available The High Rate Water Treatment Plant (HR-WTP system, which is inexpensive, effective and efficient, has been developed to reduce the common operational problems, and also as an alternative for the development of water treatment plant systems capacity in Indonesia.Implementation of HR-WTP system in up-rating of the Dekeng-WTP system at PDAM Kota Bogor proved successful in increasing the plant capacity from its original of 500 Lps to more than 1200 Lps. The performance of the WTP system was also significantly improved from poor performance to very good performance.The investment cost for up-rating proved competitive when compared to alternatively constructing a new WTP system with an equivalent capacity and performance. Application of HR-WTP systems for the development of WTP system in Indonesia, i.e. rehabilitation, up-grading, and up-rating, as well as construction of a new WTP system, is expected to bring technical, financial, and economic benefits. This new approach might be an innovative solution to the challenge of Millennium Development Goals in Water Supply Sector in Indonesia, where an additional capacity of ca 150,000 Lps should be developed within a 15 years period with an estimated budget of US $1.5 billions. This budget might be reduced to less than 50% through the application of the HR-WTP system.

  15. Clinical analysis of long-term outcomes of re-intervention of transjugular intrahepatic porto-systemic shunt

    International Nuclear Information System (INIS)

    Liu Fuquan; Yue Zhendong; Zhao Hongwei

    2012-01-01

    Objective: To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS). Methods: A retrospective study of safety and long-term outcomes of TIPS was made in 771 patients from August 1994 to August 2010. The 625 patients had follow-up data.The patients who received TIPS once, twice, and more than twice were divided into group 1, group 2 and group 3, respectively. Clinical symptoms, survival rate and restenosis rate of each group were analyzed. Clinical influencing factors of re-intervention effect were discussed. Results: The success rate of first intervention was 98.2% (757/771), the death rate was 0.7% (5/757) and severe complication rate was 2.5% (19/757). The success rate of re-intervention was 98.7% (457/463), no death and severe complications occurred. The restenosis rate in group 3 decreased significantly than group 1 (χ 2 =7.908, P<0.05) in the first year of TIPS. The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS (χ2 values were 27.046, 25.724, 37.002 and 19.046, respectively, P<0.05). The survival rate in group 3 was higher than group 1 (χ 2 =9.114, P<0.05)and group 2 was higher than group 1 (χ 2 =4.929, P<0.05) in the first year of TIPS, while there was no statistical difference between group 2 and group 3 (χ 2 =2.678, P>0.05). The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (χ 2 value were 41.314, 26.920, 13.692 and 6.713, respectively, P<0.05). 19.4% (79/406) of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6% (47/406) of patients had symptom recurrence with portal hypertension signs, 62.8% (255/406) had shunt stenosis or occlusion with portal hypertension signs. Conclusions: Restenosis or occlusion of TIPS, symptom recurrence and portal hypertension signs were important factors for re-intervention. Re-intervention of TIPS was

  16. Photovoltaic systems for Malaysian islands: Effects of interest rates, diesel prices and load sizes

    International Nuclear Information System (INIS)

    Lau, K.Y.; Tan, C.W.; Yatim, A.H.M.

    2015-01-01

    Standalone diesel systems have been widely used on Malaysian islands due to the isolated locations of the islands. Nevertheless, the high diesel prices and the high cost of transporting diesel to islands cause the use of standalone diesel systems to be uneconomical. This study analyzes the feasibility of implementing PV (photovoltaic) systems as alternatives to standalone diesel systems by considering the effects of annual real interest rates, diesel prices and load sizes, using the HOMER (hybrid optimization of multiple energy resources) software. The results indicate that, at the ordinary diesel price of $ 0.61/L, low interest rates (0–3%) are desirable for the implementation of hybrid PV/diesel with battery systems over standalone diesel systems, regardless of the load sizes. Although different load sizes may affect the decisions on the implementation of PV systems at higher interest rates (6–9%), these effects become less pronounced as the price of diesel increases to $ 1.22/L or higher. Also, under high diesel prices, the choice of optimal system configurations obtained for small load sizes should be applicable for larger load sizes, albeit with different component ratings. Although the current study is intended for Malaysian islands, the findings can be generalized for other places with similar solar radiation levels. - Highlights: • Photovoltaic systems for Malaysian islands have been analyzed using HOMER. • Interest rates, diesel prices and load sizes affect optimal system configurations. • Effects of interest rates and load sizes reduce with increasing diesel prices. • Photovoltaic systems' implementation is feasible at high diesel prices. • The findings can be generalized for places with similar solar radiation levels

  17. Validation of Patient-Reported Outcomes Measurement Information System Computerized Adaptive Tests Against the Foot and Ankle Outcome Score for 6 Common Foot and Ankle Pathologies.

    Science.gov (United States)

    Koltsov, Jayme C B; Greenfield, Stephen T; Soukup, Dylan; Do, Huong T; Ellis, Scott J

    2017-08-01

    The field of foot and ankle surgery lacks a widely accepted gold-standard patient-reported outcome instrument. With the changing infrastructure of the medical profession, more efficient patient-reported outcome tools are needed to reduce respondent burden and increase participation while providing consistent and reliable measurement across multiple pathologies and disciplines. The primary purpose of the present study was to validate 3 Patient-Reported Outcomes Measurement Information System computer adaptive tests (CATs) most relevant to the foot and ankle discipline against the Foot and Ankle Outcome Score (FAOS) and the Short Form 12 general health status survey in patients with 6 common foot and ankle pathologies. Patients (n = 240) indicated for operative treatment for 1 of 6 common foot and ankle pathologies completed the CATs, FAOS, and Short Form 12 at their preoperative surgical visits, 1 week subsequently (before surgery), and at 6 months postoperatively. The psychometric properties of the instruments were assessed and compared. The Patient-Reported Outcomes Measurement Information System CATs each took less than 1 minute to complete, whereas the FAOS took 6.5 minutes, and the Short Form 12 took 3 minutes. CAT scores were more normally distributed and had fewer floor and ceiling effects than those on the FAOS, which reached as high as 24%. The CATs were more precise than the FAOS and had similar responsiveness and test-retest reliability. The physical function and mobility CATs correlated strongly with the activities subscale of the FAOS, and the pain interference CAT correlated strongly with the pain subscale of the FAOS. The CATs and FAOS were responsive to changes with operative treatment for 6 common foot and ankle pathologies. The CATs performed as well as or better than the FAOS in all aspects of psychometric validity. The Patient-Reported Outcomes Measurement Information System CATs show tremendous potential for improving the study of patient

  18. Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study.

    Science.gov (United States)

    Salet, Nèwel; Bremmer, Rolf H; Verhagen, Marc A M T; Ekkelenkamp, Vivian E; Hansen, Bettina E; de Jonge, Pieter J F; de Man, Rob A

    2018-03-01

    To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation. Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome. 62 Dutch hospitals. 45 848 unique gastrointestinal patients discharged in 2015. A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor-patient counselling. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%. This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Development of a new energy efficiency rating system for existing residential buildings

    International Nuclear Information System (INIS)

    Koo, Choongwan; Hong, Taehoon; Lee, Minhyun; Seon Park, Hyo

    2014-01-01

    Building energy efficiency rating systems have been established worldwide to systematically manage the energy consumption of existing buildings. This study aimed to develop a new energy efficiency rating system for existing residential buildings from two perspectives: (i) establishment of reasonable and fair criteria for the building energy efficiency rating system; and (ii) establishment of comparative incentive and penalty programs to encourage the voluntary participation of all residents in the energy saving campaign. Based on the analysis of the conventional energy efficiency rating system for existing residential buildings, this study was conducted in five steps: (i) data collection and analysis; (ii) correlation analysis between the household size and the CO 2 emission density (i.e., CO 2 emission per unit area); (iii) cluster formation based on results of the correlation analysis using a decision tree; (iv) establishment of a new energy efficiency rating system for existing buildings; and (v) establishment of incentive and penalty programs using advanced case-based reasoning. The proposed system can allow a policymaker to establish a reasonable and fair energy efficiency rating system for existing residential buildings and can encourage the voluntary participation of all residents in the energy saving campaign. - Highlights: • A new energy efficiency rating system for the residential building was developed. • The incentive and penalty programs were established using an advanced CBR model. • The new system was established using reasonable and fair standards. • It allows all residents to voluntarily participate in the energy saving campaign. • It can be applied to any country or sector in the global environment

  20. [Clinical skills and outcomes of chair-side computer aided design and computer aided manufacture system].

    Science.gov (United States)

    Yu, Q

    2018-04-09

    Computer aided design and computer aided manufacture (CAD/CAM) technology is a kind of oral digital system which is applied to clinical diagnosis and treatment. It overturns the traditional pattern, and provides a solution to restore defect tooth quickly and efficiently. In this paper we mainly discuss the clinical skills of chair-side CAD/CAM system, including tooth preparation, digital impression, the three-dimensional design of prosthesis, numerical control machining, clinical bonding and so on, and review the outcomes of several common kinds of materials at the same time.

  1. Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events: secondary analysis.

    LENUS (Irish Health Repository)

    Ford, Ian

    2009-01-20

    Reduced glomerular filtration rate (GFR) is associated with increased cardiovascular risk in young and middle aged individuals. Associations with cardiovascular disease and mortality in older people are less clearly established. We aimed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants randomized in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).

  2. Variations in living donor graft rates by dialysis clinic: effect on outcome and cost of chronic renal failure therapy.

    Science.gov (United States)

    Baltzan, M A; Ahmed, S; Baltzan, R B; Marshall, R P; Thoma, E L; Nicol, M F

    1997-06-01

    Examination of nephrology practice variations in living donor renal grafts to determine their influence on organ supply, quality, and cost of chronic renal failure therapy. Saskatchewan chronic dialysis, cadaveric, and living donor renal grafts in 1983-1994 inclusive. Saskatchewan has three dialysis (I, II, III) and one transplant clinic. In the period the renal graft incidences/million population by these dialysis clinics by organ source were; Cadaveric: 23.1, 23.2, 21.1 (p = ns). Living: 5.4, 21.7, 8.3 (I or III vs II p actuarial patient survival is 92% and B 44%. Series A ten-year actuarial graft survival (including regrafts) is 77% and B 39%. Rehabilitation rate in patients with functioning grafts is 88.5%. Province-wide extension of the Clinic II living-donor graft rate in 1983-1994 would have produced 160 more renal grafts or 59% of those receiving chronic dialysis in 1994. The annual maintenance for a graft with the initial grafting cost taken over five years was $10,825 and the dialysis cost $40,100. (1) nephrology practice variations caused a 2.5-4.0-fold difference in living donor renal graft rates, indicating patient education by the attending nephrologist influences the living donor transplantation rate, (2) with such education the combined living donor and the cadaveric organ supply virtually meets graft demand, (3) living donor renal grafts yield a better quantity and quality of life and better cost control than dialysis with their annual cost being one-quarter that for dialysis.

  3. Development of ultra high speed photographic system using high repetition rate visible laser

    International Nuclear Information System (INIS)

    Lee, Jong Min; Cha, Byung Hun; Kim, Sung Ho; Kim, Jung Bog; Lim, Chang Hwan; Cha, Hyung Ki; Song, Kyu Seok; Lee, Byung Deok; Rhi, Jong Hoon; Baik, Dae Hyun; Han, Jae Min; Rho, Si Pyo; Lee, Byung Cheol; Jeong, Do Yung; Choi, An Seong; Jeong, Chan Ik; Park, Dae Ung; Jeong, Sung Min; Lee, Sang Kil; Kim, Heon Jun; Jang, Rae gak; Jo, Do Hun; Park, Min Young

    1992-12-01

    The goal of this project is to develop and commercialize a high speed photographic system equipped with a high repetition rate visible laser. The developed system provides the characteristics of high time resolution and large number of frames. The system consists of 10 W air cooled CVL or a 30 W water cooled CVL, a rotating drum-type high speed camera with the framing rate of 35,000 fps, and a automatic control device. The system has the performance of 10 nsec time resolution, 35,000 fps framing rate, and 250 picture frames. The high speed photographic systems are widely applied to the fields such as high-efficient engine development, high-speed vibration analysis, shock wave propagation study, flow visualization analysis, weapon development, etc. (Author)

  4. Contemporary rates and outcomes of single- vs. dual-coil implantable cardioverter defibrillator lead implantation: data from the Israeli ICD Registry.

    Science.gov (United States)

    Leshem, Eran; Suleiman, Mahmoud; Laish-Farkash, Avishag; Konstantino, Yuval; Glikson, Michael; Barsheshet, Alon; Goldenberg, Ilan; Michowitz, Yoav

    2017-09-01

    Dual-coil leads were traditionally considered standard of care due to lower defibrillation thresholds (DFT). Higher complication rates during extraction with parallel progression in implantable cardioverter defibrillator (ICD) technology raised questions on dual coil necessity. Prior substudies found no significant outcome difference between dual and single coils, although using higher rates of DFT testing then currently practiced. We evaluated the temporal trends in implantation rates of single- vs. dual-coil leads and determined the associated adverse clinical outcomes, using a contemporary nation-wide ICD registry. Between July 2010 and March 2015, 6343 consecutive ICD (n = 3998) or CRT-D (n = 2345) implantation patients were prospectively enrolled in the Israeli ICD Registry. A follow-up of at least 1 year of 2285 patients was available for outcome analysis. The primary endpoint was all-cause mortality. Single-coil leads were implanted in 32% of our cohort, 36% among ICD recipients, and 26% among CRT-D recipients. Secondary prevention indication was associated with an increased rate of dual-coil implantation. A significant decline in dual-coil leads with reciprocal incline of single coils was observed, despite low rates of DFT testing (11.6%) during implantation, which also declined from 31 to 2%. In the multivariate Cox model analysis, dual- vs. single-coil lead implantation was not associated with an increased risk of mortality [hazard ratio (HR) = 1.23; P= 0.33], heart failure hospitalization (HR = 1.34; P=0.13), appropriate (HR = 1.25; P= 0.33), or inappropriate ICD therapy (HR = 2.07; P= 0.12). Real-life rates of single-coil lead implantation are rising while adding no additional risk. These results of single-coil safety are reassuring and obtained, despite low and contemporary rates of DFT testing. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  5. Using value-based analysis to influence outcomes in complex surgical systems.

    Science.gov (United States)

    Kirkpatrick, John R; Marks, Stanley; Slane, Michele; Kim, Donald; Cohen, Lance; Cortelli, Michael; Plate, Juan; Perryman, Richard; Zapas, John

    2015-04-01

    Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; eliminating unsafe practices; and reducing cost. There was a significant (p value (quality/cost) in a complex surgical system. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study.

    Science.gov (United States)

    Karateke, Ates; Haliloglu, Berna; Cam, Cetin; Sakalli, Mustafa

    2009-02-01

    Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.

  7. A model for the coupling of failure rates in a redundant system

    International Nuclear Information System (INIS)

    Kleppmann, W.G.; Wutschig, R.

    1986-01-01

    A model is developed which takes into acount the coupling between failure rates or identical components in different redundancies of a safety system, i.e., the fact that the failure rates of identical components subjected to the same operating conditions will scatter less than the failure rates of any two components of the same type. It is shown that with increasing coupling the expectation value and the variance of the distribution of the failure probability of the redundant system increases. A consistent way to incorporate operating experience in a Bayesian framework is developed and the reults are presented. (orig.)

  8. Sustainability assessment, rating systems and historical buildings Case study: Rehabilitated construction in a university site

    Directory of Open Access Journals (Sweden)

    Sadrykia Somayeh

    2016-01-01

    Full Text Available This paper explores the relationship between the indicators and different factors that “rating systems for green projects” concentrates on, and principles and factors considered in the rehabilitation of historical buildings. In recent years, different methods and systems concerned and improved for assessing environmental sustainability. LEED (Leadership in Energy and Environmental Design and BREEAM (Building Research Establishment (BRE Environmental Assessment Method are two most commonly used rating systems, established in U.S and UK. These systems comprise some categories and different factors to achieve environmentally responsible design. Firstly, this study focuses on the list of rating systems indicators and criteria. Secondly this paper investigates a historical rehabilitated building in the site of Tabriz Art University, as a case study and has tried to compile its green design elements. Finally, this work intends to compare mentioned elements with indicators and factors of building rating systems. Findings of the study revealed that “Materials and Resources”, “indoor environmental quality” and also “Sustainable Sites” ,the most significant indicator of rating systems, had major and important role in the rehabilitation of the building. Beyond this materials’ life cycle was considerable in construction.

  9. Prediction of Change in Prescription Ingredient Costs and Co-payment Rates under a Reference Pricing System in South Korea.

    Science.gov (United States)

    Heo, Ji Haeng; Rascati, Karen L; Lee, Eui-Kyung

    2017-05-01

    The reference pricing system (RPS) establishes reference prices within interchangeable reference groupings. For drugs priced higher than the reference point, patients pay the difference between the reference price and the total price. To predict potential changes in prescription ingredient costs and co-payment rates after implementation of an RPS in South Korea. Korean National Health Insurance claims data were used as a baseline to develop possible RPS models. Five components of a potential RPS policy were varied: reference groupings, reference pricing methods, co-pay reduction programs, manufacturer price reductions, and increased drug substitutions. The potential changes for prescription ingredient costs and co-payment rates were predicted for the various scenarios. It was predicted that transferring the difference (total price minus reference price) from the insurer to patients would reduce ingredient costs from 1.4% to 22.8% for the third-party payer (government), but patient co-payment rates would increase from a baseline of 20.4% to 22.0% using chemical groupings and to 25.0% using therapeutic groupings. Savings rates in prescription ingredient costs (government and patient combined) were predicted to range from 1.6% to 13.7% depending on various scenarios. Although the co-payment rate would increase, a 15% price reduction by manufacturers coupled with a substitution rate of 30% would result in a decrease in the co-payment amount (change in absolute dollars vs. change in rates). Our models predicted that the implementation of RPS in South Korea would lead to savings in ingredient costs for the third-party payer and co-payments for patients with potential scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. A statistical modeling approach to build expert credit risk rating systems

    DEFF Research Database (Denmark)

    Waagepetersen, Rasmus

    2010-01-01

    This paper presents an efficient method for extracting expert knowledge when building a credit risk rating system. Experts are asked to rate a sample of counterparty cases according to creditworthiness. Next, a statistical model is used to capture the relation between the characteristics...... of a counterparty and the expert rating. For any counterparty the model can identify the rating, which would be agreed upon by the majority of experts. Furthermore, the model can quantify the concurrence among experts. The approach is illustrated by a case study regarding the construction of an application score...