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Sample records for outcome variables findings

  1. CT findings and outcome in head injury

    Energy Technology Data Exchange (ETDEWEB)

    Yamaura, Akira

    1984-12-01

    CT findings and outcome were discussed in head injuries. Parenchymal findings were classified into 5 categories; ''normal'', ''hemispheric (isodense) swelling'', ''hemorrhagic lesions'', ''diffuse cerebral swelling'', and ''low density''. The worst outcome (73% mortality) was seen in ''hemispheric swelling''. This abnormality was quite often associated with acute subdural hematoma. Multiple ''hemorrhagic lesions'' were associated with much poorer outcome than single lesions. The older groups had more acute subdural hematomas and more ''hemorrhagic lesions''. And ''hemorrhagic lesions'' were more often multiple and larger in the older group. (author).

  2. Variable ultrasonography findings of extremity lymphangioma: Pathologic correlation

    International Nuclear Information System (INIS)

    Oh, Jong Young; Nam, Kyung Jin; Lee, Ki Nam; Kim, Chan Sung; Lee, Jin Hwa; Kim, Dae Chul

    2002-01-01

    The great majority of lymphangiomas occur in the neck (75%) and axilla (20%), but extremity lymphangioma is rare. We correlate variable sonographic features of extremity lymphangioma with pathologic findings. We reviewed the sonographic findings of extremity lymphangioma in 14 patients (M:F=8:6). The all cases were histologically confirmed by operation. The variable sonographic features of extremity lymphangioma were compared to pathologic findings. The multilocular cystic mass with ill defined boundaries was distinctive sonographic appearance of extremity lymphangioma. But there were variable sonographic findings such as heterogeneous echogenic mass or homogeneous echogenic portion. The histologic section of echogenic lesion reveals clusters of abnormal

  3. Nurse dose: linking staffing variables to adverse patient outcomes.

    Science.gov (United States)

    Manojlovich, Milisa; Sidani, Souraya; Covell, Christine L; Antonakos, Cathy L

    2011-01-01

    Inconsistent findings in more than 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. The aim of this study was to examine the construct validity of nurse dose by determining its association with methicillin-resistant Staphylococcus aureus (MRSA) infections and reported patient falls on a sample of inpatient adult acute care units. Staffing data came from 26 units in Ontario, Canada, and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from infection control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were associated significantly with both outcomes. Active ingredient (education, experience, skill mix) and intensity (full-time employees, registered nurse [RN]:patient ratio, RN hours per patient day) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls, and coefficients were again negative, but coefficient sizes differed. By conceptualizing nurse and staffing variables (education, experience, skill mix, full-time employees, RN:patient ratio, RN hours per patient day) as attributes of nurse dose and by including these in the same analysis, it is possible to determine their relative influence on MRSA infections and reported patient falls.

  4. Hippocampal sclerosis: correlation of MR imaging findings with surgical outcome

    International Nuclear Information System (INIS)

    Kim, Yoon Hee; Chang, Kee Hyun; Kim, Kyung Won; Han, Moon Hee; Park, Sung Ho; Nam, Hyun Woo; Choi, Kyu Ho; Cho, Woo Ho

    2001-01-01

    Atrophy and a high T2 signal of the hippocampus are known to be the principal MR imaging findings of hippocampal sclerosis. The purpose of this study was to determine whether or not individual MRI findings correlate with surgical outcome in patients with this condition. Preoperative MR imaging findings in 57 consecutive patients with pathologically-proven hippocampal sclerosis who underwent anterior temporal lobectomy and were followed-up for 24 months or more were retrospectively reviewed, and the results were compared with the postsurgical outcome (Engel classification). The MR images included routine sagittal T1-weighted and axial T2-weighted spin-echo images, and oblique coronal T1-weighted 3D gradient-echo and T2-weighted 2D fast spin-echo images obtained on either a 1.5 T or 1.0 T unit. The images were visually evaluated by two neuroradiologists blinded to the outcome; their focus was the presence or absence of atrophy and a high T2 hippocampal signal. Hippocampal atrophy was seen in 96% of cases (55/57) [100% (53/53) of the good outcome group (Engel class I and II), and 50% (2/4) of the poor outcome group (class III and IV)]. A high T2 hippocampal signal was seen in 61% of cases (35/57) [62% (33/53) of the good outcome group and 50% (2/4) of the poor outcome group]. All 35 patients with a high T2 signal had hippocampal atrophy. 'Normal' hippocampus, as revealed by MR imaging, occurred in 4% of patients (2/57), both of whom showed a poor outcome (Engel class III). The presence or absence of hippocampal atrophy correlated well with surgical outcome (p 0.05). Compared with a high T2 hippocampal signal, hippocampal atrophy is more common and correlates better with surgical outcome. For the prediction of this, it thus appears to be the more useful indicator

  5. Variability Study between Pap Smear, Colposcopy and Cervical Histopathology Findings

    International Nuclear Information System (INIS)

    Akhter, S.; Bari, A.; Hayat, Z.

    2015-01-01

    Objective: To determine the agreement/variability between colposcopic findings, Pap smear cytology and histopathological diagnosis in gynaecology patients. Methods: The cross-sectional cohort study was conducted from October 2010 to September 2011 at the Fauji Foundation Hospital, Rawalpindi, and comprised women who presented to the out-patient department with various gynaecological complaints. Colposcopy was performed in all women with unhealthy cervix during gynaecological examination, abnormal Pap smear report, recurrent vaginal discharge and postcoital bleeding. Pap smear was performed before colposcopy if not done earlier. Colposcopic findings were recorded on a specially-designed proforma. Biopsies from abnormal areas were taken and sent for histopathology. Colposcopic findings were compared with histopathology and Pap smear reports The agreement between the methods was evaluated by using Kappa coefficient and chi square test at a significance level of 5 percent. Results: The mean age of the 143 women was 44 8.5 years (range: 25-72 years). Colposcopic findings were normal in 66(46 percent) women, while 77(54 percent) had abnormal findings and among the latter, 62(80.5 percent) had abnormal histopathology, indicating strong agreement (K=0.65; p<0.001). Pap smear report was abnormal in 48(33.5 percent) cases and among them histopathology was abnormal in 28(58 percent). In the remaining 95(66.4 percent) patients with normal Pap smear, histopathology was abnormal in 44((46 percent), indicating weak agreement between Pap smear and histopathological diagnosis (K=0.10; p=0.08). Conclusion: There was a strong agreement between colposcopic findings and histopathological diagnosis. However, agreement between cytological findings and colposcopic findings and cytology and histopathological diagnosis remained weak. (author)

  6. Econometrics in outcomes research: the use of instrumental variables.

    Science.gov (United States)

    Newhouse, J P; McClellan, M

    1998-01-01

    We describe an econometric technique, instrumental variables, that can be useful in estimating the effectiveness of clinical treatments in situations when a controlled trial has not or cannot be done. This technique relies upon the existence of one or more variables that induce substantial variation in the treatment variable but have no direct effect on the outcome variable of interest. We illustrate the use of the technique with an application to aggressive treatment of acute myocardial infarction in the elderly.

  7. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    Science.gov (United States)

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Instrumental variable estimation of treatment effects for duration outcomes

    NARCIS (Netherlands)

    G.E. Bijwaard (Govert)

    2007-01-01

    textabstractIn this article we propose and implement an instrumental variable estimation procedure to obtain treatment effects on duration outcomes. The method can handle the typical complications that arise with duration data of time-varying treatment and censoring. The treatment effect we

  9. Imaging findings and referral outcomes of rapid assessment stroke clinics

    International Nuclear Information System (INIS)

    Widjaja, E.; Manuel, D.; Hodgson, T.J.; Connolly, D.J.A.; Coley, S.C.; Romanowski, C.A.J.; Gaines, P.; Cleveland, T.; Thomas, S.; Griffiths, P.D.; Doyle, C.; Venables, G.S.

    2005-01-01

    AIM: A rapid assessment stroke clinic (RASC) was established to provide a rapid diagnostic service to individuals with suspected transient cerebral or ocular ischaemia or recovered non-hospitalized strokes. In this report we review imaging findings and clinical outcomes of patients proceeding to the carotid surgery programme. METHODS: Between October 2000 and December 2002, 1339 people attended the RASC. The findings of head CT and carotid Doppler ultrasound of the 1320 patients who underwent brain and carotid imaging were reviewed, and the number subsequently proceeding to carotid angiography and intervention was reported. RESULTS: CT head scans were normal in 57% of cases; 38% demonstrated ischaemia or infarction; and 3% yielded incidental or other significant findings not related to ischaemia. On screening with carotid Doppler ultrasound, 7.5% showed greater than 50% stenosis on the symptomatic side. A total of 83 patients (6.2%) proceeded to cerebral angiography and 65 (4.8%) underwent carotid endarterectomy or endovascular repair. CONCLUSION: Rapid-access neurovascular clinics are efficient in selecting patients for carotid intervention, but this is at a cost and the number of potential strokes prevented is small. Alternative management pathways based on immediate medical treatment need to be evaluated

  10. The functional variable method for finding exact solutions of some ...

    Indian Academy of Sciences (India)

    Abstract. In this paper, we implemented the functional variable method and the modified. Riemann–Liouville derivative for the exact solitary wave solutions and periodic wave solutions of the time-fractional Klein–Gordon equation, and the time-fractional Hirota–Satsuma coupled. KdV system. This method is extremely simple ...

  11. Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes.

    Science.gov (United States)

    Torres, Carlos; Khaikin, Marat; Bracho, Jorge; Luo, Cheng Hua; Weiss, Eric G; Sands, Dana R; Cera, Susan; Nogueras, Juan J; Wexner, Steven D

    2007-11-01

    Solitary rectal ulcer syndrome (SRUS) is a rare disorder often misdiagnosed as a malignant ulcer. Histopathological features of SRUS are characteristic and pathognomonic; nevertheless, the endoscopic and clinical presentations may be confusing. The aim of the present study was to assess the clinical findings, surgical treatment, and outcomes in patients who suffer from SRUS. A retrospective chart review was undertaken, from January 1989 to May 2005 for all patients who were diagnosed with SRUS. Data recorded included: patient's age, gender, clinical presentation, past surgical history, diagnostic and preoperative workup, operative procedure, complications, and outcomes. During the study period, 23 patients were diagnosed with SRUS. Seven patients received only medical treatment, and in three patients, the ulcer healed after medical treatment. Sixteen patients underwent surgical treatment. In four patients, the symptoms persisted after surgery. Two patients presented with postoperative rectal bleeding requiring surgical intervention. Three patients developed late postoperative sexual dysfunction. One patient continued suffering from rectal pain after a colostomy was constructed. Median follow-up was 14 (range 2-84) months. The results of this study show clearly that every patient with SRUS must be assessed individually. Initial treatment should include conservative measures. In patients with refractory symptoms, surgical treatment should be considered. Results of anterior resection and protocolectomy are satisfactory for solitary rectal ulcer.

  12. Education and Health Matters: School Nurse Interventions, Student Outcomes, and School Variables

    Science.gov (United States)

    Wolfe, Linda C.

    2013-01-01

    This paper presents findings from a quantitative, correlational study that examined selected school nursing services, student academic outcomes, and school demographics. Ex post facto data from the 2011-2012 school year of Delaware public schools were used in the research. The selected variables were school nurse interventions provided to students…

  13. Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes.

    Science.gov (United States)

    Hugues, Clara; Le Bras, Yann; Coatleven, Frederic; Brun, Jean-Luc; Trillaud, Hervé; Grenier, Nicolas; Cornelis, François

    2015-12-01

    To retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors. Between 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19-62). Follow-up was 32 months in mean (1-78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n=2), MR (n=5) and angiographic (n=26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors. No information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11 g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2-23). Recurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Correlation of CT and MR findings with clinical outcome

    International Nuclear Information System (INIS)

    Kim, Hak Soo; Kim, In One; Choi, Du Hwan; Yeon, Kyung Mo; Hwang, Yong Seung

    1991-01-01

    A retrospective analysis of the CT and MR findings of 14 pediatric patients with brain stem tumors was performed to evaluate whether the clinical outcome could be predicted from a radiographic pattern of the tumors. CT was performed in 11 patients and MR was performed in 14 patients. Ten patients were treated with radiation therapy (RT) alone, 2 patients with RT and chemotherapy, and 2 patients underwent subtotal resection. After treatment, 9 patients died within 10 months, and 5 patients were alive for 9 months to 51 months. There was no statistically significant correlation between survival and tumor location or size, but in 2 cases of exophytic growing tumor, a subtotal resection of the tumor was possible and the patients were alive for 9 months and 24 months, respectively. The tumors with a cystic portion and definite rim enhancement revealed a poor response to conventional RT, and all 6 patients died within 10 months. In conclusion, a better prognosis is predicted in the case of an exophytic growing tumor after surgical resection, but the definite ring-enhancing tumor showed a poor response on conventional RT. Also, we should consider a more active therapeutic approach such as hyperfractionated RT or combinations of chemotherapy to improve the prognosis

  15. Imaging findings predicting the outcome of cervical facet joint blocks

    International Nuclear Information System (INIS)

    Hechelhammer, Lukas; Pfirrmann, Christian W.A.; Zanetti, Marco; Hodler, Juerg; Schmid, Marius R.; Boos, Norbert

    2007-01-01

    To determine which cross-sectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJBs. (orig.)

  16. Endoscopic findings and treatment outcome in cases presenting with dysphagia.

    Science.gov (United States)

    Hafeez, Muhammad; Salamat, Amjad; Saeed, Farrukh; Zafar, Hafiz; Hassan, Fayyaz; Farooq, Asif

    2011-01-01

    Dysphagia results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Our objective was to find out the frequency of different endoscopic lesions and outcome of the endoscopic therapeutic interventions in patients presenting with dysphagia. This descriptive study was conducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May 2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevant biochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopy were carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures were further evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility, pressure manometery was done before specific therapy. Seventy nine patients were enrolled. Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twenty-nine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) related peptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out of them. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery. Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with Savary-Gillard dilators. Pneumatic balloon dilation was done in patients of achalasia. The commonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERD related peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard of treatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allay dysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasia dilatations are effective ways of treatment.

  17. Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014.

    Science.gov (United States)

    Kuehne, Anna; Hauer, Barbara; Brodhun, Bonita; Haas, Walter; Fiebig, Lena

    2018-03-01

    BackgroundGermany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Conclusion: Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities.

  18. Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014

    Science.gov (United States)

    Kuehne, Anna; Hauer, Barbara; Brodhun, Bonita; Haas, Walter; Fiebig, Lena

    2018-01-01

    Background Germany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Conclusion: Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities. PMID:29560856

  19. High Variability in Outcome Reporting Patterns in High-Impact ACL Literature.

    Science.gov (United States)

    Makhni, Eric C; Padaki, Ajay S; Petridis, Petros D; Steinhaus, Michael E; Ahmad, Christopher S; Cole, Brian J; Bach, Bernard R

    2015-09-16

    ACL (anterior cruciate ligament) reconstruction is one of the most commonly performed and studied procedures in modern sports medicine. A multitude of objective and subjective patient outcome measures exists; however, nonstandardized reporting patterns of these metrics may create challenges in objectively analyzing pooled results from different studies. The goal of this study was to document the variability in outcome reporting patterns in high-impact orthopaedic studies of ACL reconstruction. All clinical studies pertaining to ACL reconstruction in four high-impact-factor orthopaedic journals over a five-year period were reviewed. Biomechanical, basic science, and imaging studies were excluded, as were studies with fewer than fifty patients, yielding 119 studies for review. Incorporation of various objective and subjective outcomes was noted for each study. Substantial variability in reporting of both objective and subjective measures was noted in the study cohort. Although a majority of studies reported instrumented laxity findings, there was substantial variability in the type and method of laxity reporting. Most other objective outcomes, including range of motion, strength, and complications, were reported in <50% of all studies. Return to pre-injury level of activity was infrequently reported (24% of studies), as were patient satisfaction and pain assessment following surgery (8% and 13%, respectively). Of the patient-reported outcomes, the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores were most often reported (71%, 63%, and 42%, respectively). Substantial variability in outcome reporting patterns exists among high-impact studies of ACL reconstruction. Such variability may create challenges in interpreting results and pooling them across different studies. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  20. The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables

    Science.gov (United States)

    Rafiei, Sima; Pourreza, Abolghasem

    2013-01-01

    Background: Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. Methods: This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Results: Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Conclusion: Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities. PMID:24596840

  1. The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables.

    Science.gov (United States)

    Rafiei, Sima; Pourreza, Abolghasem

    2013-06-01

    Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities.

  2. The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables

    Directory of Open Access Journals (Sweden)

    Abolghasem Pourreza

    2013-05-01

    Full Text Available Background Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. Methods This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Results Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Conclusion Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities.

  3. Relationship of age to outcome and clinicopathologic findings in men submitted to radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Athanase Billis

    2005-12-01

    Full Text Available OBJECTIVE: It is controversial whether age is associated with higher grade and worse outcome. Some studies have not found age to be related to outcome nor younger age to be associated with better response to therapy. MATERIALS AND METHODS: The study population consisted of 27 patients aged 55 years or younger and 173 patients 56 years or older submitted to radical prostatectomy. The variables studied were preoperative PSA, time to PSA progression following radical prostatectomy and pathologic findings in surgical specimens: Gleason score, Gleason predominant grade, positive surgical margins, tumor extent, extraprostatic extension (pT3a, and seminal vesicle invasion (pT3b. RESULTS: Comparing patients aged 55 years or younger and 56 years or older, there was no statistically significant difference for all variables studied: preoperative PSA (p = 0.4417, Gleason score (p = 0.3934, Gleason predominant grade (p = 0.2653, tumor extent (p = 0.1190, positive surgical margins (p = 0.8335, extraprostatic extension (p = 0.3447 and seminal vesicle invasion (p > 0.9999. During the study period, 44 patients (22% developed PSA progression. No difference was found in the time to biochemical progression between men aged 55 years or younger and 56 years or older. CONCLUSION: Our findings suggest that age alone do not influence the biological aggressiveness of prostate cancer.

  4. Clinical Operations Variables are Associated With Blood Pressure Outcomes.

    Science.gov (United States)

    Kressin, Nancy R; Lasser, Karen E; Paasche-Orlow, Michael; Allison, Jeroan; Ash, Arlene S; Adams, William G; Shanahan, Christopher W; Legler, Aaron; Pizer, Steven D

    2015-06-01

    Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. To assess clinical operations factors' effects on normalization of uncontrolled BP. Observational cohort study. Patients diagnosed with hypertension from a large urban clinical practice (2005-2009). We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians' appointment volume, overall practice-level PCP staffing, and number of unique PCPs. Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (Ppercentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization. Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.

  5. Measuring Networking as an Outcome Variable in Undergraduate Research Experiences.

    Science.gov (United States)

    Hanauer, David I; Hatfull, Graham

    2015-01-01

    The aim of this paper is to propose, present, and validate a simple survey instrument to measure student conversational networking. The tool consists of five items that cover personal and professional social networks, and its basic principle is the self-reporting of degrees of conversation, with a range of specific discussion partners. The networking instrument was validated in three studies. The basic psychometric characteristics of the scales were established by conducting a factor analysis and evaluating internal consistency using Cronbach's alpha. The second study used a known-groups comparison and involved comparing outcomes for networking scales between two different undergraduate laboratory courses (one involving a specific effort to enhance networking). The final study looked at potential relationships between specific networking items and the established psychosocial variable of project ownership through a series of binary logistic regressions. Overall, the data from the three studies indicate that the networking scales have high internal consistency (α = 0.88), consist of a unitary dimension, can significantly differentiate between research experiences with low and high networking designs, and are related to project ownership scales. The ramifications of the networking instrument for student retention, the enhancement of public scientific literacy, and the differentiation of laboratory courses are discussed. © 2015 D. I. Hanauer and G. Hatfull. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  6. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  7. The association between tax structure and cigarette price variability: findings from the ITC Project.

    Science.gov (United States)

    Shang, Ce; Chaloupka, Frank J; Fong, Geoffrey T; Thompson, Mary; O'Connor, Richard J

    2015-07-01

    Recent studies have shown that more opportunities exist for tax avoidance when cigarette excise tax structure departs from a uniform specific structure. However, the association between tax structure and cigarette price variability has not been thoroughly studied in the existing literature. To examine how cigarette tax structure is associated with price variability. The variability of self-reported prices is measured using the ratios of differences between higher and lower prices to the median price such as the IQR-to-median ratio. We used survey data taken from the International Tobacco Control Policy Evaluation (ITC) Project in 17 countries to conduct the analysis. Cigarette prices were derived using individual purchase information and aggregated to price variability measures for each surveyed country and wave. The effect of tax structures on price variability was estimated using Generalised Estimating Equations after adjusting for year and country attributes. Our study provides empirical evidence of a relationship between tax structure and cigarette price variability. We find that, compared to the specific uniform tax structure, mixed uniform and tiered (specific, ad valorem or mixed) structures are associated with greater price variability (p≤0.01). Moreover, while a greater share of the specific component in total excise taxes is associated with lower price variability (p≤0.05), a tiered tax structure is associated with greater price variability (p≤0.01). The results suggest that a uniform and specific tax structure is the most effective tax structure for reducing tobacco consumption and prevalence by limiting price variability and decreasing opportunities for tax avoidance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. An effective method for finding special solutions of nonlinear differential equations with variable coefficients

    International Nuclear Information System (INIS)

    Qin Maochang; Fan Guihong

    2008-01-01

    There are many interesting methods can be utilized to construct special solutions of nonlinear differential equations with constant coefficients. However, most of these methods are not applicable to nonlinear differential equations with variable coefficients. A new method is presented in this Letter, which can be used to find special solutions of nonlinear differential equations with variable coefficients. This method is based on seeking appropriate Bernoulli equation corresponding to the equation studied. Many well-known equations are chosen to illustrate the application of this method

  9. Diastolic blood pressure variability in 24 hour-ABPM and outcomes of chronic kidney disease
.

    Science.gov (United States)

    Sahutoglu, Tuncay; Sakaci, Tamer

    2018-04-10

    Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce. Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD. Coefficient of variation (CV) in diastolic blood pressure (DBP) was used as an index of BPV. Data of 191 patients (mean age 59.7 ± 12.4 years, 54.9% males, 42.1% diabetic, mean eGFR-EPI (Chronic Kidney Disease Epidemiology Collaboration) 51.7 ± 22.0 mL/min/1.73m2, mean follow-up 26.2 ± 10.4 months) were available for the analysis. On multivariate linear regression analysis, greater DBP-CV was associated with slower decline in eGFR-EPI per year (B -0.648, p = 0.000). Likewise, the hazard ratio (HR) for dialysis inception (occurred in 9.4%) was found significantly lower with increasing DBP-CV in unadjusted and fully adjusted Cox models (HR 0.730, 95% CI 0.618 - 0.861, p = 0.000, and HR 0.678, 95% CI 0.526 - 0.874, p = 0.003, respectively). These findings suggest that DBP variability in 24-hour ABPM may be a good prognostic factor for the outcomes of CKD. Further studies are needed to determine the impact of 24-hour ABPM BPV on CKD progression and its differences from VVV.
.

  10. Metacognition as a Mediating Variable Between Neurocognition and Functional Outcome in First Episode Psychosis.

    Science.gov (United States)

    Davies, Geoff; Fowler, David; Greenwood, Kathryn

    2017-07-01

    Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and neurocognition has been found to account for functional disability to a greater extent than psychopathology. Much of the variance in functional outcome however still remains unexplained and metacognition may mediate the relationship between neurocognition, functional capacity, and self-reported social and occupational function. Eighty first episode psychosis participants were recruited and completed measures of neurocognition (memory, executive function, and intelligence quotient), metacognition (Beck Cognitive Insight Scale, Metacognitive Awareness Interview), psychopathology (PANSS), and both functional capacity (UPSA) and real-life social and occupational function (The Time Use Survey). Path analyses investigated the relationships between variables through structural equation modeling. A series of path models demonstrated that metacognition partially mediates the relationship between neurocognition and functional capacity, and fully mediates the relationship between functional capacity and social and occupational function. The present study findings identify that metacognition may be critical to translating cognitive and functional skills into real-world contexts, and this relationship is found at early stages of illness. Understanding how individuals translate cognitive and functional skills into the real-world (the competence-performance gap) may offer valuable guidance to intervention programs. This finding is important to models of recovery as it suggests that intervention programs that focus on enhancing metacognition abilities may have a greater impact than traditional rehabilitation programs focusing on cognitive abilities, on social and occupational outcomes. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com

  11. Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes

    Directory of Open Access Journals (Sweden)

    E. Jason Abel

    2013-12-01

    Full Text Available Objectives To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. Materials and Methods After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. Results From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years. Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66. At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%, all with initial grade 3 renal pelvis lesions, developed metastatic disease. Conclusions Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks.

  12. Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

    Directory of Open Access Journals (Sweden)

    Abbass, Ibrahim

    2015-05-01

    Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

  13. The Influence Of Learning Model Guided Findings Of Student Learning Outcomes

    Directory of Open Access Journals (Sweden)

    A. SaefulBahri

    2015-03-01

    Full Text Available Abstract This study examines the influence of the learning model guided findings on student learning outcomes in subjects PAI eighth grade students of SMP Plus al Masoem. The research method used in this study is a quantitative method in the form of quasi-experiment Quasi-Experimental Design. The findings of the study are expected to demonstrate 1 the difference significant increase in learning outcomes between the experimental class using guided discovery method that uses the control class discussion of learning models 2 Constraints in the method of guided discovery activities and the limited ability of educators in the experimental class in implements the method of guided discovery and constraints faced by students while digging the information they need so we need special strategies to motivate students in the experimental class in order for them creatively find the right way to gather information that supports learning PAI.

  14. Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis.

    Directory of Open Access Journals (Sweden)

    Pekka Kuittinen

    Full Text Available To study the predictive value of preoperative magnetic resonance imaging (MRI findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS.84 patients (mean age 63±11 years, male 43% with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0-100% and treadmill test (0-1000 m, pain symptoms with the overall Visual Analogue Scale (VAS 0-100 mm, and specific low back pain (LBP and specific leg pain (LP separately with a numeric rating scale from 0-10 (NRS-11. Satisfaction with the surgical outcome was also assessed.Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05. Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029. Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031 and lowered the walking distance in the treadmill test (p = 0.001. The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026. No significant differences were detected between quantitative measurements and the patient outcome.Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.

  15. Age differences in IDA savings outcomes: findings from the American Dream Demonstration.

    Science.gov (United States)

    Putnam, Michelle; Sherraden, Michael; Zhang, Lin; Morrow-Howell, Nancy

    2008-01-01

    This study aims to develop a greater understanding of age differences in savings outcomes within Individual Development Accounts (IDAs). Participant data from the American Dream Demonstration (ADD) are examined for age differences in accumulated net deposits, average monthly net deposits, and deposit frequency. ADDprogram data are examined for savings match rates, monthly savings targets, direct deposit, and hours of financial education offered. Results indicate that, on average, older IDA participants have better savings outcomes than younger participants. Findings from this study suggest that impoverished middleaged and older adults can save if provided an opportunity and incentives. However, success will depend on the characteristics of the programs.

  16. Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury.

    Science.gov (United States)

    Matsushima, Kazuhide; Peng, Monica; Velasco, Carlos; Schaefer, Eric; Diaz-Arrastia, Ramon; Frankel, Heidi

    2012-04-01

    Significant glycemic excursions (so-called glucose variability) affect the outcome of generic critically ill patients but has not been well studied in patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of glucose variability on long-term functional outcome of patients with TBI. A noncomputerized tight glucose control protocol was used in our intensivist model surgical intensive care unit. The relationship between the glucose variability and long-term (a median of 6 months after injury) functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed using ordinal logistic regression models. Glucose variability was defined by SD and percentage of excursion (POE) from the preset range glucose level. A total of 109 patients with TBI under tight glucose control had long-term GOSE evaluated. In univariable analysis, there was a significant association between lower GOSE score and higher mean glucose, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not POE 80 to 110. After adjusting for possible confounding variables in multivariable ordinal logistic regression models, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL were significantly associated with lower GOSE score. Glucose variability was significantly associated with poorer long-term functional outcome in patients with TBI as measured by the GOSE score. Well-designed protocols to minimize glucose variability may be key in improving long-term functional outcome. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease.

    Science.gov (United States)

    Garrett, Kevin M; Levitt, Marc A; Peña, Alberto; Kraus, Steven J

    2012-09-01

    The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation. We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis. Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n = 11), Soave (n = 20) or Swenson (n = 3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child's initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow. Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1). Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema

  18. Intraindividual change and variability in daily stress processes: Findings from two measurement-burst diary studies

    Science.gov (United States)

    Sliwinski, Martin J.; Almeida, David M.; Smyth, Joshua; Stawski, Robert S.

    2010-01-01

    There is little longitudinal information on aging-related changes in emotional responses to negative events. The present manuscript examined intraindividual change and variability in the within-person coupling of daily stress and negative affect (NA) using data from two-measurement burst daily diary studies. Three main findings emerged. First, average reactivity to daily stress increased longitudinally, and this increase was evident across most the adult lifespan. Second, individual differences in emotional reactivity to daily stress exhibited long-term temporal stability, but this stability was greatest in midlife and decreased in old age. And third, reactivity to daily stress varied reliably within-persons (across-time), with individual exhibiting higher levels of reactivity during times when reporting high levels of global subject stress in previous month. Taken together, the present results emphasize the importance of modeling dynamic psychosocial and aging processes that operate across different time scales for understanding age-related changes in daily stress processes. PMID:20025399

  19. Using the Kepler Full Frame Images to Find Long-Period Variables in the Milky Way

    Science.gov (United States)

    Mullen, Melissa A.; Kraemer, Kathleen; Kuchar, T. A.; Sloan, G. C.

    2018-01-01

    We are using the monthly Full Frame Images (FFIs) images from the 4+ year Kepler mission to conduct a uniform census of long-period variables (LPVs, primarily Miras and semiregular variables) in the Milky Way disk. Our goal is to help understand how stellar pulsation and dust production interact as these dying stars eject their envelopes and enrich the interstellar medium with new fusion products and dust. To that end, we are processing the monthly FFIs for the entire 116 square-degree Kepler field to identify the LPVs and determine their period, pulsation mode, and amplitude measured with the same instrument for the 4+ year mission. Since the FFIs are not fully calibrated, we must first remove the instrumental systematics from the data and determine the flux calibration factors that can then be applied to all the stars in the field. To find these corrections, we use aperture photometry and PRF-fitting from well-characterized stars known to be stable – those with exoplanet candidates. We remove effects of the quarterly spacecraft rolls as well as longterm trends in the responsivity, which reduces the scatter in each star from 5-10% to <1-3%. We examine the effects of the optical distortions that are present in the outer parts of the array, as well as source crowding throughout the field. The fluxes from the PRF fits are typically ~1% higher than those from the aperture photometry. We present preliminary results on previously known and new, candidate, variable stars in a test field near the center of the FFIs.This work is supported by NASA ADAP grant NNX16AF45G.

  20. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom

    2010-01-01

    Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...

  1. Fetal musculoskeletal malformations with a poor outcome: ultrasonographic, pathologic, and radiographic findings

    International Nuclear Information System (INIS)

    Lee, Soo Hyun; Cho, Jeong Yeon; Song, Mi Jin; Min, Jee Yeon; Han, Byoung Hee; Lee, Young Ho; Cho, Byung Jae; Kim, Seung Hyup

    2002-01-01

    The early and accurate antenatal diagnosis of fetal musculoskeletal malfomations with a poor outcome has important implications for the management of a pregnancy. Careful ultrasonographic examination of a fetus helps detect such anomalies, and a number of characteristic features may suggest possible differential diagnoses. During the last five years, we have encountered 39 cases of such anomalies, and the typical prenatal ultrasonographic and pathologic findings of a number of those are described in this article

  2. Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections

    Energy Technology Data Exchange (ETDEWEB)

    Lechmann, Marco; Rosskopf, Andrea; Ehrmann, Christine; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [University of Zuerich, Department of Radiology, Orthopaedic University Hospital Balgrist, Zuerich (Switzerland)

    2016-12-15

    To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis. A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall 'improvement' was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to 'improvement'. NRS change scores were compared to MRI findings with the unpaired t-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis. The only abnormality linked to 'improvement' (p = 0.03) and higher NRS change scores (p = 0.0001) at 1 month was the disc herniation morphology 'protrusion + sequestration'. Patients with degeneration by osteophytes (p = 0.034), grade 3 foraminal nerve root compression (p = 0.01) and foraminal/extraforaminal location of herniation (p = 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was 'fair' to 'substantial' depending on MRI findings. Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location. (orig.)

  3. Relationships of site of impact to CT findings and outcome in diffuse brain injury

    International Nuclear Information System (INIS)

    Saito, Akihito; Kuwana, Nobumasa; Mochimatsu, Yasuhiko; Tanaka, Naoki; Fujino, Hideyo

    1985-01-01

    The relationships of the site of impact to the CT findings and to the severity and outcome of an injury were analysed based on 50 cases of diffuse brain injury (DBI). The CT findings of DBI were classified into 5 types: diffuse cerebral swelling (DCS); isodensity hemispheric swelling (IHS); deep-seated brain injury (DSI); subarachnoid hemorrhage (SAH), and normal finding (N). The sites of the impact were frontal in 19 cases, temporal in 8 cases, parietal in 4 cases, occipital in 12 cases, and multiple or undetermined in 7 cases. Frontal blows resulted in the lowest mortality rate (5.3%); on the other hand, occipital blows resulted in the highest (58%). Additionally, occipital blows caused the highest primary brain-stem injury, i.e., 41.7%. The frontal region was the most common impact area, revealing DCS and N. Temporal blows commonly resulted in DSI. Parietal blows were characteristic causes of IHS cases. However, occipital blows generally demonstrated no specific tendencies with regard to the type of CT finding. Based on this study, it is evident that CT findings and outcomes are influenced by the location of the impact. It is the authors' impression that, in severe head-injury cases, occipital blows, which are usually associated with primary brain-stem injuries, are the most serious. (author)

  4. Relationships of site of impact to CT findings and outcome in diffuse brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Akihito; Kuwana, Nobumasa; Mochimatsu, Yasuhiko; Tanaka, Naoki; Fujino, Hideyo

    1985-02-01

    The relationships of the site of impact to the CT findings and to the severity and outcome of an injury were analysed based on 50 cases of diffuse brain injury (DBI). The CT findings of DBI were classified into 5 types: diffuse cerebral swelling (DCS); isodensity hemispheric swelling (IHS); deep-seated brain injury (DSI); subarachnoid hemorrhage (SAH), and normal finding (N). The sites of the impact were frontal in 19 cases, temporal in 8 cases, parietal in 4 cases, occipital in 12 cases, and multiple or undetermined in 7 cases. Frontal blows resulted in the lowest mortality rate (5.3%); on the other hand, occipital blows resulted in the highest (58%). Additionally, occipital blows caused the highest primary brain-stem injury, i.e., 41.7%. The frontal region was the most common impact area, revealing DCS and N. Temporal blows commonly resulted in DSI. Parietal blows were characteristic causes of IHS cases. However, occipital blows generally demonstrated no specific tendencies with regard to the type of CT finding. Based on this study, it is evident that CT findings and outcomes are influenced by the location of the impact. It is the authors' impression that, in severe head-injury cases, occipital blows, which are usually associated with primary brain-stem injuries, are the most serious. (author).

  5. The Effects of Job Autonomy on Work Outcomes: Self Efficacy as an Intervening Variable

    OpenAIRE

    Susanti Saragih

    2011-01-01

    The purpose of this research was to examine the relationship between job autonomy and work outcomes (job performance, job satisfaction and job stress), self efficacy as a mediating variable. This research also investigated the impact of job satisfaction on job performance and job stress on job performance. Va-riables in this research were measured via a survey of 190 banking salespersons in D.I. Yogyakarta and Solo. Structural Equation Modeling (SEM) were used to examine the effects of job au...

  6. Early studies reported extreme findings with large variability: a meta-epidemiologic study in the field of endocrinology.

    Science.gov (United States)

    Wang, Zhen; Alahdab, Fares; Almasri, Jehad; Haydour, Qusay; Mohammed, Khaled; Abu Dabrh, Abd Moain; Prokop, Larry J; Alfarkh, Wedad; Lakis, Sumaya; Montori, Victor M; Murad, Mohammad Hassan

    2016-04-01

    To evaluate the presence of extreme findings and fluctuation in effect size in endocrinology. We systematically identified all meta-analyses published in 2014 in the field of endocrinology. Within each meta-analysis, the effect size of the primary binary outcome was compared across studies according to their order of publication. We pooled studies using the DerSimonian and Laird random-effects method. Heterogeneity was evaluated using the I(2) and tau(2). Twelve percent of the included 100 meta-analyses reported the largest effect size in the very first published study. The largest effect size occurred in the first 2 earliest studies in 31% of meta-analyses. When the effect size was the largest in the first published study, it was three times larger than the final pooled effect (ratio of rates, 3.26; 95% confidence interval: 1.80, 5.90). The largest heterogeneity measured by I(2) was observed in 18% of the included meta-analyses when combining the first 2 studies or 17% when combing the first 3 studies. In endocrinology, early studies reported extreme findings with large variability. This behavior of the evidence needs to be taken into account when used to formulate clinical policies. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Variable reporting of functional outcomes and return to play in superior labrum anterior and posterior tear.

    Science.gov (United States)

    Steinhaus, Michael E; Makhni, Eric C; Lieber, Adam C; Kahlenberg, Cynthia A; Gulotta, Lawrence V; Romeo, Anthony A; Verma, Nikhil N

    2016-11-01

    Outcomes assessments after superior labrum anterior and posterior (SLAP) tear/repair are highly varied, making it difficult to draw comparisons across the literature. This study examined the inconsistency in outcomes reporting in the SLAP tear literature. We hypothesize that there is significant variability in outcomes reporting and that although most studies may report return to play, time to return reporting will be highly variable. The PubMed, Medline, Scopus, and Embase databases were systematically reviewed for studies from January 2000 to December 2014 reporting outcomes after SLAP tear/repair. Two reviewers assessed each study, and those meeting inclusion criteria were examined for pertinent data. Outcomes included objective (range of motion, strength, clinical examinations, and imaging) and subjective (patient-reported outcomes, satisfaction, activities of daily living, and return to play) measures. Of the 56 included studies, 43% documented range of motion, 14% reported strength, and 16% noted postoperative imaging. There was significant variation in use of patient-reported outcomes measures, with the 3 most commonly noted measures reported in 20% to 55% of studies. Return to play was noted in 75% of studies, and 23% reported time to return, with greater rates in elite athletes. Eleven studies (20%) did not report follow-up or noted data with <12 months of follow-up. The SLAP literature is characterized by substantial variability in outcomes reporting, with time to return to play noted in few studies. Efforts to standardize outcomes reporting would facilitate comparisons across the literature and improve our understanding of the prognosis of this injury. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes.

    Science.gov (United States)

    Cvetanovich, Gregory L; Harris, Joshua D; Erickson, Brandon J; Bach, Bernard R; Bush-Joseph, Charles A; Nho, Shane J

    2015-07-01

    To determine indications for, operative findings of, and outcomes of revision hip arthroscopy. A systematic review was registered with PROSPERO and performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Therapeutic clinical outcome studies reporting the indications for, operative findings of, and outcomes of revision hip arthroscopy were eligible for inclusion. All study-, patient-, and hip-specific data were extracted and analyzed. The Modified Coleman Methodology Score was used to assess study quality. Five studies were included (348 revision hip arthroscopies; 333 patients; mean age, 31.4 ± 4.2 years; 60% female patients). All 5 studies were either Level III or IV evidence. The surgeon performing revision hip arthroscopy was the same as the primary hip surgeon in only 25% of cases. The mean time between primary and revision hip arthroscopy was 27.8 ± 7.0 months (range, 2 to 193 months). Residual femoroacetabular impingement was the most common indication for and operative finding of revision hip arthroscopy (81% of cases). The most commonly reported revision procedures were femoral osteochondroplasty (24%) and acetabuloplasty (18%). The modified Harris Hip Score was used in all 5 analyzed studies, with significant (P arthroscopy, subsequent reported operations were hip arthroplasty in 11 patients and re-revision hip arthroscopy in 8 patients (5% total reoperation rate). Revision hip arthroscopy is most commonly performed for residual femoroacetabular impingement, with statistically significant and clinically relevant improvements shown in multiple patient-reported clinical outcome scores at short-term follow-up. The reoperation rate after revision hip arthroscopy is 5% within 2 years, including further arthroscopy or conversion to hip arthroplasty. Level IV, systematic review of Level III and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  9. Bacterial meningitis in newborn and infant: correlation between organism, CT findings and clinical outcome

    International Nuclear Information System (INIS)

    Choi, Hye Young; Park, Young Seo; Yoo, Shi Joon; Suh, Dae Chul; Chung, Young Kyo

    1993-01-01

    Acute bacterial meningitis often results in significant neurologic complications regardless of the antibiotics treatment Computed tomographic (CT) finding of tuberculous meningitis is fairly well known but not the findings of bacterial meningitis. This study was performed to determine the incidence of causative organisms and to correlate between the organisms and computed tomographic (CT) findings with clinical outcome of bacterial meningitis in newborns and infants. We analyzed the brain CT and clinical records of 15 infants who had been diagnosed as bacterial meningitis by CSF culture. We found that the most common organisms were Group B streptococcus in neonates without no neurologic complications in all but one and Hemophilus influenza in infants whose clinical outcomes were poor in all except one. CT findings related with poor prognosis in this study were cerebral edema, basal cisternal obliteration and enhancement, and cerebral infarction on initial CT and ventriculomegaly on follow-up CT. We concluded that CT diagnosed intracranial complications of bacterial meningitis well and could contributed to better treatment of bacterial meningitis

  10. Relationship between MRI findings and outcome in supratentorial branch atheromatous disease (BAD)

    International Nuclear Information System (INIS)

    Moriya, Saori; Adachi, Tomohide; Goto, Jun; Arakawa, Chiaki; Takagi, Makoto; Mizoi, Yoshikazu

    2006-01-01

    Branch atheromatous disease has been recognized as one of the types of stroke which is often associated with clinical deterioration. We investigated the correlation between diffusion weighted imaging (DWI) findings and clinical courses of 33 patients with branch atheromatous diseases (BADs) in the territory of the lenticulostriate arteries. The DWI findings associated with the poor outcomes (modified Rankin Scale mRS>or=3) are (1) the larger lesion size in a direction perpendicular to axial section and (2) the lesions located in the inferior portion of basal ganglia. The findings correlated with progressive motor deficits are (1) the lesions closer to the posterior limb of internal capsule (medial type) and (2) the lesions located in the inferior portion of basal ganglia. These characteristics of DWI may play an important role to distinguish the progressing ischemic strokes as BAD from non-progressing ones. (author)

  11. MRI findings and spreading patterns of necrotizing external otitis: Is a poor outcome predictable?

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, B.J. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, M.H. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of) and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of) and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)]. E-mail: hanmh@radcom.snu.ac.kr; Oh, S.H. [Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Song, J.J. [Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chang, K.-H. [Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2006-06-15

    AIM: To evaluate spreading patterns of necrotizing external otitis (NEO) by magnetic resonance imaging (MRI) and to identify spreading patterns related to a poor outcome. MATERIALS AND METHODS: Fourteen patients with NEO were divided into good and poor outcome groups according to their final clinical outcomes. Initial MRI images were retrospectively reviewed for regional abnormalities, and follow-up MRI images were reviewed for ICA flow void abnormality and for the following five spreading patterns: medial, crossed, anterior, intracranial, and combined. The frequencies of the abnormal flow void or spreading patterns were compared between the good and poor response groups. RESULTS: Seven (50%) and seven (50%) patients were respectively allocated to the good and poor outcome groups. Retrocondylar fat infiltration was the most commonest finding on initial MRI images (93%). The frequencies of the abnormal flow void and spreading patterns in the good and poor groups, respectively, were: abnormal flow void, 0 and four (57%); anterior, two (29%) and three (43%); medial, six (86%) and seven (100%); crossed, six (86%) and seven (100%); intracranial middle cranial fossa, one (14%) and four (57%); intracranial posterior cranial fossa, four (57%) and six (86%); intracranial foramen magnum, one (14%) and six (86%). CONCLUSIONS: NEO almost always involves the retrocondylar fat and spreads via various pathways to extracranial or intracranial spaces. The presence of an abnormal flow void and intracranial dural enhancement, particularly in the middle cranial fossa and foramen magnum, may indicate a poor prognosis.

  12. MRI findings and spreading patterns of necrotizing external otitis: Is a poor outcome predictable?

    International Nuclear Information System (INIS)

    Kwon, B.J.; Han, M.H.; Oh, S.H.; Song, J.J.; Chang, K.-H.

    2006-01-01

    AIM: To evaluate spreading patterns of necrotizing external otitis (NEO) by magnetic resonance imaging (MRI) and to identify spreading patterns related to a poor outcome. MATERIALS AND METHODS: Fourteen patients with NEO were divided into good and poor outcome groups according to their final clinical outcomes. Initial MRI images were retrospectively reviewed for regional abnormalities, and follow-up MRI images were reviewed for ICA flow void abnormality and for the following five spreading patterns: medial, crossed, anterior, intracranial, and combined. The frequencies of the abnormal flow void or spreading patterns were compared between the good and poor response groups. RESULTS: Seven (50%) and seven (50%) patients were respectively allocated to the good and poor outcome groups. Retrocondylar fat infiltration was the most commonest finding on initial MRI images (93%). The frequencies of the abnormal flow void and spreading patterns in the good and poor groups, respectively, were: abnormal flow void, 0 and four (57%); anterior, two (29%) and three (43%); medial, six (86%) and seven (100%); crossed, six (86%) and seven (100%); intracranial middle cranial fossa, one (14%) and four (57%); intracranial posterior cranial fossa, four (57%) and six (86%); intracranial foramen magnum, one (14%) and six (86%). CONCLUSIONS: NEO almost always involves the retrocondylar fat and spreads via various pathways to extracranial or intracranial spaces. The presence of an abnormal flow void and intracranial dural enhancement, particularly in the middle cranial fossa and foramen magnum, may indicate a poor prognosis

  13. Blood Pressure Variability and Outcome in Patients with Acute Nonlobar Intracerebral Hemorrhage following Intensive Antihypertensive Treatment

    Directory of Open Access Journals (Sweden)

    Jin Pyeong Jeon

    2018-01-01

    Conclusions: The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH. Therefore, sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.

  14. Assessing the Impact of Socioeconomic Variables on Small Area Variations in Suicide Outcomes in England

    Directory of Open Access Journals (Sweden)

    Peter Congdon

    2012-12-01

    Full Text Available Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.

  15. High glucose variability is associated with poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy.

    Science.gov (United States)

    Al Shafouri, N; Narvey, M; Srinivasan, G; Vallance, J; Hansen, G

    2015-01-01

    In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population. To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE. In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (-0.28 to -0.03, 95% CI, p = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance. Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies.

  16. Outcome of Blunt Abdominal Traumas with Stable Hemodynamic and Positive FAST Findings

    Directory of Open Access Journals (Sweden)

    Firooz Behboodi

    2016-04-01

    Full Text Available Introduction: Focused assessment with sonography for trauma (FAST is a highly effective first screening tool for initial classification of abdominal trauma patients. The present study was designed to evaluate the outcome of patients with blunt abdominal trauma and positive FAST findings. Methods: The present prospective cross-sectional study was done on patients over 7 years old with normal abdominal examination, positive FAST findings, and available abdominopelvic computed tomography (CT scan findings. The frequency of need for laparotomy as well as its probable risk factors were calculated. Results: 180 patients were enrolled (mean age: 28.0 ± 11.5 years; 76.7% male. FAST findings were confirmed by abdominopelvic CT scan in only 124 (68.9% cases. Finally, 12 (6.6% patients needed laparotomy. Mean age of those in need of laparotomy was significantly higher than others (36.75 ± 11.37 versus 27.34 ± 11.37, p = 0.006. Higher grading of spleen (p = 0.001 and hepatic (p = 0.038 ruptures increased the probability of need for laparotomy. Conclusion: 68.9% of the positive FAST findings in patients with blunt abdominal trauma and stable hemodynamics was confirmed by abdominopelvic CT scan and only 6.6% needed laparotomy. Simultaneous presence of free fluid and air in the abdominal area, old age, and higher grading o solid organ injuries were factors that had a significant correlation with need for laparotomy.

  17. Outcome of Blunt Abdominal Traumas with Stable Hemodynamic and Positive FAST Findings.

    Science.gov (United States)

    Behboodi, Firooz; Mohtasham-Amiri, Zahra; Masjedi, Navid; Shojaie, Reza; Sadri, Peyman

    2016-01-01

    Focused assessment with sonography for trauma (FAST) is a highly effective first screening tool for initial classification of abdominal trauma patients. The present study was designed to evaluate the outcome of patients with blunt abdominal trauma and positive FAST findings. The present prospective cross-sectional study was done on patients over 7 years old with normal abdominal examination, positive FAST findings, and available abdominopelvic computed tomography (CT) scan findings. The frequency of need for laparotomy as well as its probable risk factors were calculated. 180 patients were enrolled (mean age: 28.0 ± 11.5 years; 76.7% male). FAST findings were confirmed by abdominopelvic CT scan in only 124 (68.9%) cases. Finally, 12 (6.6%) patients needed laparotomy. Mean age of those in need of laparotomy was significantly higher than others (36.75 ± 11.37 versus 27.34 ± 11.37, p = 0.006). Higher grading of spleen (p = 0.001) and hepatic (p = 0.038) ruptures increased the probability of need for laparotomy. 68.9% of the positive FAST findings in patients with blunt abdominal trauma and stable hemodynamics was confirmed by abdominopelvic CT scan and only 6.6% needed laparotomy. Simultaneous presence of free fluid and air in the abdominal area, old age, and higher grading o solid organ injuries were factors that had a significant correlation with need for laparotomy.

  18. Leg pain and psychological variables predict outcome 2-3 years after lumbar fusion surgery.

    Science.gov (United States)

    Abbott, Allan D; Tyni-Lenné, Raija; Hedlund, Rune

    2011-10-01

    Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

  19. 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.

  20. Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Starling, Rebecca M; Shekdar, Karuna; Licht, Dan; Nadkarni, Vinay M; Berg, Robert A; Topjian, Alexis A

    2015-07-01

    Head CT after out-of-hospital cardiac arrest is often obtained to evaluate intracranial pathology. Among children admitted to the PICU following pediatric out-of-hospital cardiac arrest, we hypothesized that loss of gray-white matter differentiation and basilar cistern and sulcal effacement are associated with mortality and unfavorable neurologic outcome. Retrospective, cohort study. Single, tertiary-care center PICU. Seventy-eight patients less than 18 years old who survived out-of-hospital cardiac arrest to PICU admission and had a head CT within 24 hours of return of spontaneous circulation were evaluated from July 2005 through May 2012. None. Median time to head CT from return of spontaneous circulation was 3.3 hours (1.0, 6.0). Median patient age was 2.3 years (0.4, 9.5). Thirty-nine patients (50%) survived, of whom 29 (74%) had favorable neurologic outcome. Nonsurvivors were more likely than survivors to have 1) loss of gray-white matter differentiation (Hounsfield unit ratios, 0.96 [0.88, 1.07] vs 1.1 [1.07, 1.2]; p pediatric out-of-hospital cardiac arrest. Select patients may have favorable outcomes despite these findings.

  1. Acute carbon monoxide intoxication : the relation between MR findings and clinical outcome

    International Nuclear Information System (INIS)

    Chang, Jin Bae; Jeong, Hae Woong; Kim, Ki Nam; Kim, Dong Wook; Kim, Chang Soo

    1999-01-01

    To analyse MR findings of various involving sites and the relation between such findings and clinical outcome, the authors retrospectively reviewed MR images of acute carbon monoxide intoxication. In 12 patients, MR images obtained from several hours to 12 days after acute carbon monoxide intoxication were reviewed. The images were analysed with regard to involved sites, symmetricity, signal intensity, and the presence or absence of hemorrhage, and the relationship between MR findings and clinical outcome; the presence of delayed encephalopathy was then determined. The globus pallidus(n=9), white matter(n=3), [centrum semiovale(n=2), periventricular white matter(n=1)] and gyrus(n=6) [inferior temporal gyrus(n=2), cingulate gyrus(n=1), precentral gyrus(n=1), hippocampal gyrus(n=1), parahippocampal gyrus(n=1)] were typically involved, and there was also involvenent of the corpus callosum(n=3), thalamus(n=2) and midbrain(n=2). All lesions of the globus pallidus, thalamus, midbrain and temporal lobe were bilaterally symmetric. In all these cases, subtle or prominent low signal intensity was seen on spin-echo T1WI, and high signal intensity on PDWI and T2WI. Some lesions of the globus pallidus(n=1), thalamus(n=1) and midbrain(n=1) were associated with hemorrhage, which occurred during the early subacute stage and was seen on high/low signal intensity T1/T2WI images. Acute cerebral(n=1) and cerebellar(n=1) infarctions were also seen. Cerebral white matter involvement correlated with poor clinical outcome, and in two cases, delayed encephalopathy developed. In these cases of acute carbon monoxide intoxication, the globus pallidus, white matter, cortex and hippocampus were frequently involved, and there was also involvement of various sites such as the corpus callosum, thalamus and midbrain. Lesions of the temporal lobe, thalamus and midbrain were bilaterally symmetric. The involvement of cerebral white matter and the presence of delayed encephalopathy can influence

  2. Pulmonary Lipiodol Accumulation after Transarterial Chemoembolization: CT Findings and Its Radiologic Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Youn, In Young; Chong, Se Min; Kwak, Byung Kook; Shin, Hyung Jin; Seo, Gi Young; Seo, Jae Seung; Kim, Jae Kyun [Dept. of Radiology, Chung Ang University Medical Center, Chung Ang University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    To evaluate CT findings and radiologic outcomes of pulmonary lipiodol accumulation (PLA) after transarterial chemoembolization (TACE). This retrospective study involved 488 TACEs for hepatocellular carcinoma (HCC) (n = 160) and hepatic metastasis for non-hepatic malignancies (n = 7) in 167 patients. We reviewed the patient clinicoradiologic findings before and after TACE and calculated the incidence of PLA and PLA resolution time after initial CT and after TACE. Lipiodol accumulation in the lungs was seen under CT after TACE in seven patients (M : F = 6 : 1, mean age 61 years). The incidence of PLA at CT was 4.1% (7/167 patients). In five patients, associated intrathoracic abnormalities including pleural effusion with (n 3) or without consolidation (n = 2) were revealed at CT scans. The CT resolution time and PLA recovery time were 56 {+-} 54 days and 66 {+-} 52 days, respectively. The recovery time for lipiodol accumulation was 66 days. It is believed that the clinical and radiologic outcome of PLA without respiratory failure is promising, and conservative treatment will suffice when lipiodol accumulation in the lungs is seen in CT images after TACE.

  3. Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

    Energy Technology Data Exchange (ETDEWEB)

    Koplas, Monica C.; Ilaslan, Hakan; Sundaram, Murali [Cleveland Clinic, Imaging Institute/A21, Cleveland, OH (United States); Lefkowitz, Robert A.; Landa, Jonathan [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Bauer, Thomas W. [Cleveland Clinic, Anatomic Pathology/L25, Cleveland, OH (United States); Joyce, Michael J. [Cleveland Clinic, Orthopaedic and Rheumatologic Institute/A41, Cleveland, OH (United States)

    2010-08-15

    To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor. A retrospective search of files from two institutions identified 28 patients with malignant fibrous histiocytoma (MFH) of bone. Microscope slides were reviewed to confirm diagnosis and identify any pre-existing lesions. Medical records were reviewed with respect to patients' demographic characteristics and outcomes. Radiographic features demonstrated an aggressive osteolytic lesion with a permeative pattern of bone destruction. Periosteal reaction was seen in three of 13 lesions. T1-weighted images (T1WIs) demonstrated signal intensity iso- to slightly hyperintense to muscle. T2-weighted images (T2WIs) demonstrated mildly higher signal intensity than that of muscle. The 5-year survival rate was 53%. The tumor arose secondarily in pre-existing lesions in 43% of patients. Metastases occurred in 46% of patients during the course of the disease, with pulmonary and osseous metastases being the most common. Secondary MFH of bone was slightly less common than primary MFH and had a prognosis similar to that of primary MFH of bone. MR imaging showed variable and somewhat unusual low to intermediate T2 signal characteristics for a radiographically malignant osteolytic lesion. (orig.)

  4. Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

    International Nuclear Information System (INIS)

    Koplas, Monica C.; Ilaslan, Hakan; Sundaram, Murali; Lefkowitz, Robert A.; Landa, Jonathan; Bauer, Thomas W.; Joyce, Michael J.

    2010-01-01

    To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor. A retrospective search of files from two institutions identified 28 patients with malignant fibrous histiocytoma (MFH) of bone. Microscope slides were reviewed to confirm diagnosis and identify any pre-existing lesions. Medical records were reviewed with respect to patients' demographic characteristics and outcomes. Radiographic features demonstrated an aggressive osteolytic lesion with a permeative pattern of bone destruction. Periosteal reaction was seen in three of 13 lesions. T1-weighted images (T1WIs) demonstrated signal intensity iso- to slightly hyperintense to muscle. T2-weighted images (T2WIs) demonstrated mildly higher signal intensity than that of muscle. The 5-year survival rate was 53%. The tumor arose secondarily in pre-existing lesions in 43% of patients. Metastases occurred in 46% of patients during the course of the disease, with pulmonary and osseous metastases being the most common. Secondary MFH of bone was slightly less common than primary MFH and had a prognosis similar to that of primary MFH of bone. MR imaging showed variable and somewhat unusual low to intermediate T2 signal characteristics for a radiographically malignant osteolytic lesion. (orig.)

  5. Fetal cardiac axis in tetralogy of Fallot: associations with prenatal findings, genetic anomalies and postnatal outcome.

    Science.gov (United States)

    Zhao, Y; Edington, S; Fleenor, J; Sinkovskaya, E; Porche, L; Abuhamad, A

    2017-07-01

    To compare prenatal findings, associated genetic anomalies and postnatal outcome in fetuses with tetralogy of Fallot (TOF) with normal cardiac axis (CAx) and those with abnormal CAx. In this retrospective cohort study, 85 cases diagnosed with TOF by prenatal ultrasound at our clinic between 2005 and 2015 were reviewed. Follow-up ultrasound and postnatal outcome were available for 68 cases. One case complicated with absent pulmonary valve syndrome and a further seven cases diagnosed postnatally with anomalies other than TOF were excluded from the study. The remaining 60 cases of postnatally confirmed TOF were divided according to CAx into two groups: those with normal CAx (n = 33) and those with abnormal CAx (n = 27). CAx was defined as the angle between the interventricular septum and midline of the fetal thorax at the level of the four-chamber view. CAx > 65° or < 25° was considered abnormal. Prenatal sonographic findings, associated genetic anomalies and postnatal outcome were compared between the two groups. Fetuses with TOF and abnormal CAx were more likely to have pulmonary atresia (40.7% vs 15.2%; P = 0.026) and right-sided aortic arch (48.1% vs 21.2%; P = 0.028) than those with normal CAx. Postnatal death occurred in 30.4% of infants with abnormal CAx vs 6.5% with normal CAx (P = 0.028). Incidence of tested genetic anomalies was similar between the two groups. In fetuses with TOF, abnormal CAx is associated with the presence of pulmonary atresia, right-sided aortic arch and a higher risk of postnatal death. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  6. Clinical Findings and Treatment Outcomes in Patients with Extraprostatic Extension Identified on Prostate Biopsy.

    Science.gov (United States)

    Fleshner, Katherine; Assel, Melissa; Benfante, Nicole; Lee, Justin; Vickers, Andrew; Fine, Samson; Carlsson, Sigrid; Eastham, James

    2016-09-01

    We describe histopathological, clinical and imaging findings among men with extraprostatic extension on prostate biopsy. We searched our institutional pathology database between 2004 and 2015 for pathology reports detailing extraprostatic extension on prostate biopsy in untreated patients. Patient characteristics, biopsy features, imaging interpretations and outcomes were examined. Of 19,950 patients with prostate cancer on biopsy 112 had extraprostatic extension for a prevalence of 0.6% (95% CI 0.5-0.7). Most of the 112 patients had palpable, high grade (Gleason score 9), high volume disease, which was classified as high risk in 34 (30%), locally advanced in 17 (15%) and metastatic in 39 (35%). Most patients had 1 or 2 cores with extraprostatic extension, typically at the base and with concomitant perineural invasion. Extraprostatic extension was identified by magnetic resonance imaging in 32 of 40 patients (80%). Median followup in those who did not die was 1.3 years (IQR 0.3-4.2). Outcomes in the subgroup of 24 men treated with radical prostatectomy were consistent with high risk disease, including positive margins in 14 (58%), seminal vesicle invasion in 10 (42%) and lymph node invasion in 11 (46%). In the entire cohort the 3-year risks of metastasis and overall mortality were 32% (95% CI 22-44) and 37% (95% CI 27-50), respectively. We did not find evidence to suggest that the proportion of cores with cancer that also had extraprostatic extension was associated with overall mortality (p = 0.09). Extraprostatic extension is a rare finding on prostate biopsy. It is strongly associated with other features of aggressive prostate cancer. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. Regulating task-monitoring systems in response to variable reward contingencies and outcomes in cocaine addicts.

    Science.gov (United States)

    Morie, Kristen P; De Sanctis, Pierfilippo; Garavan, Hugh; Foxe, John J

    2016-03-01

    We investigated anticipatory and consummatory reward processing in cocaine addiction. In addition, we set out to assess whether task-monitoring systems were appropriately recalibrated in light of variable reward schedules. We also examined neural measures of task-monitoring and reward processing as a function of hedonic tone, since anhedonia is a vulnerability marker for addiction that is obviously germane in the context of reward processing. High-density event-related potentials were recorded while participants performed a speeded response task that systematically varied anticipated probabilities of reward receipt. The paradigm dissociated feedback regarding task success (or failure) from feedback regarding the value of reward (or loss), so that task-monitoring and reward processing could be examined in partial isolation. Twenty-three active cocaine abusers and 23 age-matched healthy controls participated. Cocaine abusers showed amplified anticipatory responses to reward predictive cues, but crucially, these responses were not as strongly modulated by reward probability as in controls. Cocaine users also showed blunted responses to feedback about task success or failure and did not use this information to update predictions about reward. In turn, they showed clearly blunted responses to reward feedback. In controls and users, measures of anhedonia were associated with reward motivation. In cocaine users, anhedonia was also associated with diminished monitoring and reward feedback responses. Findings imply that reward anticipation and monitoring deficiencies in addiction are associated with increased responsiveness to reward cues but impaired ability to predict reward in light of task contingencies, compounded by deficits in responding to actual reward outcomes.

  8. Cerebral amyloid angiopathy-related inflammation: imaging findings and clinical outcome

    International Nuclear Information System (INIS)

    Martucci, Matia; Sarria, Silvana; Coscojuela, Pilar; Vert, Carla; Siurana, Sahyly; Auger, Cristina; Rovira, Alex; Toledo, Manuel

    2014-01-01

    We aim to investigate the clinical onset, computed tomography (CT) and magnetic resonance (MR) imaging findings, and follow-up of patients with cerebral amyloid angiopathy (CAA)-related inflammation, an uncommon but clinically striking presentation of CAA. We retrospectively reviewed the clinical manifestations, CT/MR imaging findings, and outcome of ten consecutive patients with CAA-related inflammation. In each patient, a brain CT study was performed at hospital admission, and brain MR imaging was carried out 2 to 4 days later. Clinical and radiologic follow-up findings were evaluated in all patients. The most common clinical onset was rapidly progressive cognitive decline, followed by focal neurological signs. Brain CT/MR showed unenhanced expansive subcortical lesions, corresponding to areas of vasogenic edema, associated with chronic lobar, cortical, or cortical-subcortical micro/macrohemorrhages. Clinical symptoms recovered in a few weeks under treatment in eight patients and spontaneously in the remaining two. MRI follow-up at 2 to 12 months after treatment showed resolution of the lesions. Three patients experienced symptomatic disease recurrence, with new lesions on CT/MR. In the absence of histological data, early recognition of the clinical symptoms and typical radiologic features of CAA-related inflammation is essential to enable timely establishment of proper treatment. (orig.)

  9. Cerebral amyloid angiopathy-related inflammation: imaging findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Martucci, Matia [Vall d' Hebron University Hospital, Neuroradiology Unit, Radiology Department (IDI), Barcelona (Spain); Catholic University of Sacred Heart, ' ' A. Gemelli' ' University Hospital, Department of Radiological Sciences, Rome (Italy); Sarria, Silvana; Coscojuela, Pilar; Vert, Carla; Siurana, Sahyly; Auger, Cristina; Rovira, Alex [Vall d' Hebron University Hospital, Neuroradiology Unit, Radiology Department (IDI), Barcelona (Spain); Toledo, Manuel [Vall d' Hebron University Hospital, Epilepsy Unit, Neurology Department, Barcelona (Spain)

    2014-04-15

    We aim to investigate the clinical onset, computed tomography (CT) and magnetic resonance (MR) imaging findings, and follow-up of patients with cerebral amyloid angiopathy (CAA)-related inflammation, an uncommon but clinically striking presentation of CAA. We retrospectively reviewed the clinical manifestations, CT/MR imaging findings, and outcome of ten consecutive patients with CAA-related inflammation. In each patient, a brain CT study was performed at hospital admission, and brain MR imaging was carried out 2 to 4 days later. Clinical and radiologic follow-up findings were evaluated in all patients. The most common clinical onset was rapidly progressive cognitive decline, followed by focal neurological signs. Brain CT/MR showed unenhanced expansive subcortical lesions, corresponding to areas of vasogenic edema, associated with chronic lobar, cortical, or cortical-subcortical micro/macrohemorrhages. Clinical symptoms recovered in a few weeks under treatment in eight patients and spontaneously in the remaining two. MRI follow-up at 2 to 12 months after treatment showed resolution of the lesions. Three patients experienced symptomatic disease recurrence, with new lesions on CT/MR. In the absence of histological data, early recognition of the clinical symptoms and typical radiologic features of CAA-related inflammation is essential to enable timely establishment of proper treatment. (orig.)

  10. What Variables are Associated with Successful Weight Loss Outcomes for Bariatric Surgery After One Year?

    Science.gov (United States)

    Robinson, Athena H.; Adler, Sarah; Stevens, Helen B.; Darcy, Alison M.; Morton, John M.; Safer, Debra L.

    2014-01-01

    Background Prior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors; 2) postsurgical psychosocial variables (e.g., support group attendance); 3) postsurgical eating patterns; 4) postsurgical physical activity; and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g., ≥50% excess weight loss) when considering the 5 domains simultaneously. Objectives Specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes. Setting On-line survey. Methods Signal Detection Analysis evaluated associations between 84 pre-and postsurgical behavioral variables (within the 5 domains) and successful weight loss at ≥1 year in 274 post-gastric bypass surgery patients. Results Successful weight loss was highest (92.6%) among those reporting dietary adherence of >3 on a 9 point scale (median=5) who grazed no more than once-per-day. Among participants reporting dietary adherence <3 and grazing daily or less, success rates more than doubled when highest lifetime Body Mass Index was <53.7 kg/m2. Success rates also doubled for participants with dietary adherence =3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall model’s sensitivity =.62, specificity =.92. Conclusions To our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions. PMID:24913590

  11. Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia

    Science.gov (United States)

    Cambell, C. L.; Ade, S.; Bhat, P.; Harries, A. D; Wilkinson, E.; Cooper, C. T.

    2017-01-01

    Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013–March 2014), during (April 2014–June 2015) and after (July–December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola (n = 7032, 12%), Ebola (n = 6147, 10%) and post-Ebola (n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period (n = 855), to the Ebola (n = 640, P < 0.001) and post-Ebola (n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola (P < 0.001) and 73% post-Ebola (P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found. PMID:28744441

  12. Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia.

    Science.gov (United States)

    Konwloh, P K; Cambell, C L; Ade, S; Bhat, P; Harries, A D; Wilkinson, E; Cooper, C T

    2017-06-21

    Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola ( n = 7032, 12%), Ebola ( n = 6147, 10%) and post-Ebola ( n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period ( n = 855), to the Ebola ( n = 640, P < 0.001) and post-Ebola ( n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola ( P < 0.001) and 73% post-Ebola ( P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.

  13. Microinvasive ductal carcinoma in situ: Clinical presentation, imaging features, pathologic findings, and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Vieira, Cristina C. [Department of Radiology, New York University School of Medicine (United States); Mercado, Cecilia L. [Department of Radiology, New York University School of Medicine (United States)], E-mail: Cecilia.mercado@nyumc.org; Cangiarella, Joan F. [Department of Pathology, New York University School of Medicine (United States); Moy, Linda; Toth, Hildegard K. [Department of Radiology, New York University School of Medicine (United States); Guth, Amber A. [Department of Surgery, New York University School of Medicine (United States)

    2010-01-15

    Objective: The purpose of our study was to describe the clinical features, imaging characteristics, pathologic findings and outcome of microinvasive ductal carcinoma in situ (DCISM). Materials and methods: The records of 21 women diagnosed with microinvasive ductal carcinoma in situ (DCISM) from November 1993 to September 2006 were retrospectively reviewed. The clinical presentation, imaging and histopathologic features, and clinical follow-up were reviewed. Results: The 21 lesions all occurred in women with a mean age of 56 years (range, 27-79 years). Clinical findings were present in ten (48%): 10 with palpable masses, four with associated nipple discharge. Mean lesion size was 21 mm (range, 9-65 mm). The lesion size in 62% was 15 mm or smaller. Mammographic findings were calcifications only in nine (43%) and an associated or other finding in nine (43%) [mass (n = 7), asymmetry (n = 1), architectural distortion (n = 1)]. Three lesions were mammographically occult. Sonographic findings available in 11 lesions showed a solid hypoechoic mass in 10 cases (eight irregular in shape, one round, one oval). One lesion was not seen on sonography. On histopathologic examination, all lesions were diagnosed as DCISM, with a focus of invasive carcinoma less than or equal to 1 mm in diameter within an area of DCIS. Sixteen (76%) lesions were high nuclear grade, four (19%) were intermediate and one was low grade (5%). Sixteen (76%) had the presence of necrosis. Positivity for ER and PR was noted in 75% and 38%. Nodal metastasis was present in one case with axillary lymph node dissection. Mean follow-up time for 16 women was 36 months without evidence of local or systemic recurrence. One patient developed a second primary in the contralateral breast 3 years later. Conclusion: The clinical presentation and radiologic appearance of a mass are commonly encountered in DCISM lesions (48% and 57%, respectively), irrespective of lesion size, mimicking findings seen in invasive carcinoma

  14. Microinvasive ductal carcinoma in situ: Clinical presentation, imaging features, pathologic findings, and outcome

    International Nuclear Information System (INIS)

    Vieira, Cristina C.; Mercado, Cecilia L.; Cangiarella, Joan F.; Moy, Linda; Toth, Hildegard K.; Guth, Amber A.

    2010-01-01

    Objective: The purpose of our study was to describe the clinical features, imaging characteristics, pathologic findings and outcome of microinvasive ductal carcinoma in situ (DCISM). Materials and methods: The records of 21 women diagnosed with microinvasive ductal carcinoma in situ (DCISM) from November 1993 to September 2006 were retrospectively reviewed. The clinical presentation, imaging and histopathologic features, and clinical follow-up were reviewed. Results: The 21 lesions all occurred in women with a mean age of 56 years (range, 27-79 years). Clinical findings were present in ten (48%): 10 with palpable masses, four with associated nipple discharge. Mean lesion size was 21 mm (range, 9-65 mm). The lesion size in 62% was 15 mm or smaller. Mammographic findings were calcifications only in nine (43%) and an associated or other finding in nine (43%) [mass (n = 7), asymmetry (n = 1), architectural distortion (n = 1)]. Three lesions were mammographically occult. Sonographic findings available in 11 lesions showed a solid hypoechoic mass in 10 cases (eight irregular in shape, one round, one oval). One lesion was not seen on sonography. On histopathologic examination, all lesions were diagnosed as DCISM, with a focus of invasive carcinoma less than or equal to 1 mm in diameter within an area of DCIS. Sixteen (76%) lesions were high nuclear grade, four (19%) were intermediate and one was low grade (5%). Sixteen (76%) had the presence of necrosis. Positivity for ER and PR was noted in 75% and 38%. Nodal metastasis was present in one case with axillary lymph node dissection. Mean follow-up time for 16 women was 36 months without evidence of local or systemic recurrence. One patient developed a second primary in the contralateral breast 3 years later. Conclusion: The clinical presentation and radiologic appearance of a mass are commonly encountered in DCISM lesions (48% and 57%, respectively), irrespective of lesion size, mimicking findings seen in invasive carcinoma

  15. Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.

    Science.gov (United States)

    Thipmontree, Wilawan; Tantibhedhyangkul, Wiwit; Silpasakorn, Saowaluk; Wongsawat, Ekkarat; Waywa, Duangdao; Suputtamongkol, Yupin

    2016-10-05

    Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome. © The American Society of Tropical Medicine and Hygiene.

  16. Designing Biodiversity Friendly Communities. Liveable Cities Forum: Key outcomes and findings

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-10-15

    The Liveable Cities Forum, held 21-22 August in Montreal Canada, created a platform to share best practices on biodiversity management and application at the local level. The Forum also highlighted the importance of partnership building and presented instruments (such as the Singapore Index on Cities' Biodiversity) that help to move the biodiversity agenda forward. A findings report on the Forum has recently been released, offering panel and workshop summaries, key outcomes, and a scope of future opportunities for local governments. Some of the key outcomes are as follows: Biodiversity protection is at its core a local issue, and in order to mitigate biodiversity loss in cities, there is an undeniable need for local governments to come together and work through solutions collectively; Urban centers influence local, regional and global biodiversity. Therefore, it is important that cities con-serve their local biodiversity through the sustainable use of resources beyond their borders; It is important for municipalities to engage and partner with local residents, academic institutions, and organizations, not only to have a finger on the pulse, but also to have local allies and secure long-term support; and Integrated policies help drive action. To effectively mainstream biodiversity at the local level, it is important to incorporate biodiversity considerations into multiple departments, plans and programs.

  17. Cystic periventricular leukomalacia in the neonate: analysis of sequential sonographic findings and neurologic outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Seok; Yoo, Dong Soo [Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2003-07-01

    To analyse the sequential sonographic findings of cystic PVL and to evaluate relationship between sonographic grading of PVL and patterns of neurologic outcomes. Authors have retrospectively analysed the sequential sonographic findings of 36 cases of PVL in the preterm neonates. Initial sonographic features done within 3 days of life were divided into 3 patients such as normal, localized, and diffuse hyperechogenic flare. Grading of PVL confirmed by follow-up studies was classified as involvement of one lobe (grade 1), two lobes (grade 2) and more than extent of grade 2 (grade 3). The relationship between sonographic grading of leukomalacia and later neurologic outcomes were also analysed. Initial sonographic patterns according to grading of PVL were normal pattern in seven of nine (77.8%) of grade 1, diffuse hyperechogenic flares in five of eight cases of grade 2 and in 13 of 16 cases of grade 3. There was a significant difference between the grades and frequency of pattern of diffuse hyperechoic flare (p=0.021). Average detection timing of cystic PVL was 38.4{+-}18.9 days in grade 1, 29.8{+-}14 days in grade 2, and 19.1{+-}5.6 days in grade 3 with a significant statistical difference between the detection time and grades (p=0.037). Cerebral palsy has occurred in 62.5% of grade 1 and 100% of grade 2 and grade 3 (p=0.043). Frequency of spastic quadriplegia was higher in grade 3 (76.5%) than in grade 1 (25%) and grade 2 (12.5%) (p=0.001). Most of grade 1 cystic PVL revealed normal pattern of white matter echogenicity in initial ultrasonography and needed follow up examination over one month period. Spastic quadriplegia occured mainly in patients with grade 3 cystic PVL.

  18. Cystic periventricular leukomalacia in the neonate: analysis of sequential sonographic findings and neurologic outcomes

    International Nuclear Information System (INIS)

    Lee, Young Seok; Yoo, Dong Soo

    2003-01-01

    To analyse the sequential sonographic findings of cystic PVL and to evaluate relationship between sonographic grading of PVL and patterns of neurologic outcomes. Authors have retrospectively analysed the sequential sonographic findings of 36 cases of PVL in the preterm neonates. Initial sonographic features done within 3 days of life were divided into 3 patients such as normal, localized, and diffuse hyperechogenic flare. Grading of PVL confirmed by follow-up studies was classified as involvement of one lobe (grade 1), two lobes (grade 2) and more than extent of grade 2 (grade 3). The relationship between sonographic grading of leukomalacia and later neurologic outcomes were also analysed. Initial sonographic patterns according to grading of PVL were normal pattern in seven of nine (77.8%) of grade 1, diffuse hyperechogenic flares in five of eight cases of grade 2 and in 13 of 16 cases of grade 3. There was a significant difference between the grades and frequency of pattern of diffuse hyperechoic flare (p=0.021). Average detection timing of cystic PVL was 38.4±18.9 days in grade 1, 29.8±14 days in grade 2, and 19.1±5.6 days in grade 3 with a significant statistical difference between the detection time and grades (p=0.037). Cerebral palsy has occurred in 62.5% of grade 1 and 100% of grade 2 and grade 3 (p=0.043). Frequency of spastic quadriplegia was higher in grade 3 (76.5%) than in grade 1 (25%) and grade 2 (12.5%) (p=0.001). Most of grade 1 cystic PVL revealed normal pattern of white matter echogenicity in initial ultrasonography and needed follow up examination over one month period. Spastic quadriplegia occured mainly in patients with grade 3 cystic PVL

  19. Visit-to-visit cholesterol variability correlates with coronary atheroma progression and clinical outcomes.

    Science.gov (United States)

    Clark, Donald; Nicholls, Stephen J; St John, Julie; Elshazly, Mohamed B; Kapadia, Samir R; Tuzcu, E Murat; Nissen, Steven E; Puri, Rishi

    2018-04-21

    Utilizing serial intravascular ultrasonography (IVUS), we aimed to exam the association of intra-individual lipid variability, coronary atheroma progression, and clinical outcomes. We performed a post hoc patient-level analysis of nine clinical trials involving 4976 patients with coronary artery disease who underwent serial coronary IVUS in the setting of a range of medical therapies. We assessed the associations between progression in percent atheroma volume (ΔPAV), clinical outcomes, and visit-to-visit lipid variability including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, total cholesterol (TC)/HDL-C, and apolipoprotein B (ApoB). Variability of lipid parameters was measured using intra-individual standard deviation over 3, 6, 12, 18, and 24 months. Atherogenic lipoprotein variability significantly associated with ΔPAV [odds ratio (95% confidence interval; P-value), LDL-C: 1.09 (1.02, 1.17, P = 0.01); non-HDL-C: 1.10 (1.02, 1.18, P = 0.01); TC/HDL-C: 1.14 (1.06, 1.24, P = 0.001); ApoB: 1.13 (1.03, 1.24, P = 0.01)]. Survival curves revealed significant stepwise relationships between cumulative major adverse cardiovascular events and increasing quartiles of atherogenic lipoprotein variability at 24-months follow-up (log-rank P C). Stronger associations were noted between achieved lipoprotein levels and ΔPAV [LDL-C: 1.27 (1.17, 1.39; P C: 1.32 (1.21, 1.45; P C: 1.31 (1.19, 1.45; P < 0.001); ApoB: 1.20 (1.07, 1.35; P = 0.003)]. Greater visit-to-visit variability in atherogenic lipoprotein levels significantly associates with coronary atheroma progression and clinical outcomes, although the association between achieved atherogenic lipoproteins and atheroma progression appears stronger. These data highlight the importance of achieving low and consistent atherogenic lipoprotein levels to promote plaque regression and improve clinical outcomes.

  20. Epigenetic variability in conversion to psychosis: novel findings from an innovative longitudinal methylomic analysis.

    Science.gov (United States)

    Kebir, Oussama; Chaumette, Boris; Krebs, Marie-Odile

    2018-04-26

    Conversion to psychosis is a longitudinal process during which several epigenetic changes have been described. We tested the hypothesis that epigenetic variability in the methylomes of ultra-high risk (UHR) individuals may contribute to the risk of conversion. We studied a longitudinal cohort of UHR individuals (n = 39) and compared two groups (converters, n = 14 vs. non-converters, n = 25). A longitudinal methylomic study was conducted using Infinium HumanMethylation450 BeadChip covering half a million cytosine-phosphate-guanine (CpG) sites across the human genome from whole-blood samples. We used two statistical methods to investigate the variability of methylation probes. (i) The search for longitudinal variable methylation probes (VMPs) based on median comparisons identified two VMPs in converters only. The first CpG was located in the MACROD2 gene and the second CpG was in an intergenic region at 8q24.21. (ii) The detection of outliers using variance analysis related to private epimutations identified a dozen CpGs in converters only and highlighted two genes (RAC1 and SPHK1) from the sphingolipid signaling pathway. Our study is the first to support increased methylome variability during conversion to psychosis. We speculate that stochastic factors could increase DNA methylation variability and have a role in the complex pathophysiology of conversion to psychosis as well as in other psychiatric diseases.

  1. Evaluation of standardized and applied variables in predicting treatment outcomes of polytrauma patients.

    Science.gov (United States)

    Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Muhovic, Samir; Gavric, Igor

    2011-01-01

    Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

  2. The Association between Tax Structure and Cigarette Price Variability: Findings from the International Tobacco Control Policy Evaluation (ITC) Project

    Science.gov (United States)

    Shang, Ce; Chaloupka, Frank J.; Fong, Geoffrey T; Thompson, Mary; O’Connor, Richard J

    2015-01-01

    Background Recent studies have shown that more opportunities exist for tax avoidance when cigarette excise tax structure departs from a uniform specific structure. However, the association between tax structure and cigarette price variability has not been thoroughly studied in the existing literature. Objective To examine how cigarette tax structure is associated with price variability. The variability of self-reported prices is measured using the ratios of differences between higher and lower prices to the median price such as the IQR-to-median ratio. Methods We used survey data taken from the International Tobacco Control Policy Evaluation (ITC) Project in 17 countries to conduct the analysis. Cigarette prices were derived using individual purchase information and aggregated to price variability measures for each surveyed country and wave. The effect of tax structures on price variability was estimated using Generalised Estimating Equations after adjusting for year and country attributes. Findings Our study provides empirical evidence of a relationship between tax structure and cigarette price variability. We find that, compared to the specific uniform tax structure, mixed uniform and tiered (specific, ad valorem or mixed) structures are associated with greater price variability (p≤0.01). Moreover, while a greater share of the specific component in total excise taxes is associated with lower price variability (p≤0.05), a tiered tax structure is associated with greater price variability (p≤0.01). The results suggest that a uniform and specific tax structure is the most effective tax structure for reducing tobacco consumption and prevalence by limiting price variability and decreasing opportunities for tax avoidance. PMID:25855641

  3. Brown dwarf photospheres are patchy: A Hubble space telescope near-infrared spectroscopic survey finds frequent low-level variability

    International Nuclear Information System (INIS)

    Buenzli, Esther; Apai, Dániel; Radigan, Jacqueline; Reid, I. Neill; Flateau, Davin

    2014-01-01

    Condensate clouds strongly impact the spectra of brown dwarfs and exoplanets. Recent discoveries of variable L/T transition dwarfs argued for patchy clouds in at least some ultracool atmospheres. This study aims to measure the frequency and level of spectral variability in brown dwarfs and to search for correlations with spectral type. We used Hubble Space Telescope/Wide Field Camera 3 to obtain spectroscopic time series for 22 brown dwarfs of spectral types ranging from L5 to T6 at 1.1-1.7 μm for ≈40 minutes per object. Using Bayesian analysis, we find six brown dwarfs with confident (p > 95%) variability in the relative flux in at least one wavelength region at sub-percent precision, and five brown dwarfs with tentative (p > 68%) variability. We derive a minimum variability fraction f min =27 −7 +11 % over all covered spectral types. The fraction of variables is equal within errors for mid-L, late-L, and mid-T spectral types; for early-T dwarfs we do not find any confident variable but the sample is too small to derive meaningful limits. For some objects, the variability occurs primarily in the flux peak in the J or H band, others are variable throughout the spectrum or only in specific absorption regions. Four sources may have broadband peak-to-peak amplitudes exceeding 1%. Our measurements are not sensitive to very long periods, inclinations near pole-on and rotationally symmetric heterogeneity. The detection statistics are consistent with most brown dwarf photospheres being patchy. While multiple-percent near-infrared variability may be rare and confined to the L/T transition, low-level heterogeneities are a frequent characteristic of brown dwarf atmospheres.

  4. Clinical significance of pneumatosis intestinalis - correlation of MDCT-findings with treatment and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Treyaud, Marc-Olivier; Duran, Rafael; Knebel, Jean-Francois; Meuli, Reto A.; Schmidt, Sabine [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Zins, Marc [Fondation Hopital St Joseph, Department of Radiology, Paris (France)

    2017-01-15

    To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome. Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome. The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03). In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia. (orig.)

  5. Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

    International Nuclear Information System (INIS)

    Venkatesh, Sudhakar K.; Phadke, Rajendra V.; Kalode, Ravi R.; Kumar, Sunil; Jain, Vijendra K.

    2000-01-01

    AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90.9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms. Venkatesh, S.K. (2000)

  6. Manometric findings in relation to functional outcomes in different types of anorectal malformations.

    Science.gov (United States)

    Kyrklund, Kristiina; Pakarinen, Mikko P; Rintala, Risto J

    2017-04-01

    To compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. A single-institution, cross-sectional study. After ethical approval, all patients ≥7years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM). Patients with mild ARMs (AA females and PF males) had been treated with minimally invasive perineal procedures. Females with VF/PF and males with RUF had undergone internal-sphincter saving sagittal repairs. 55 of 132 respondents (42%; median age 12 (7-29) years; 42% male) underwent AM. Patients with mild ARMs displayed good anorectal function after minimally invasive treatments. The median anal resting and squeeze pressures among patients with mild ARMs (60 cm H2O and 116 cm H2O respectively) were significantly higher than among patients with more severe ARMs (50 cm H2O, and 80cm H2O respectively; p≤0.002). The rectoanal inhibitory reflex was preserved in 100% of mild ARMs and 83% of patients with more severe malformations after IAS-saving sagittal repair. The functional outcome was poor in 4/5 patients with an absent RAIR (BFS≤11 or antegrade continence enema-dependence). Rectal sensation correlated significantly with the BFS. Our findings support the appropriateness of our minimally invasive approaches to the management of mild ARMs, and IAS-saving anatomical repairs for patients with more severe malformations. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Further evidence that culture media affect perinatal outcome: findings after transfer of fresh and cryopreserved embryos.

    Science.gov (United States)

    Nelissen, Ewka C; Van Montfoort, Aafke P; Coonen, Edith; Derhaag, Josien G; Geraedts, Joep P; Smits, Luc J; Land, Jolande A; Evers, Johannes L; Dumoulin, John C

    2012-07-01

    We have previously shown that the medium used for culturing IVF embryos affects the birthweight of the resulting newborns. This observation with potentially far-reaching clinical consequences during later life, was made in singletons conceived during the first IVF treatment cycle after the transfer of fresh embryos. In the present study, we hypothesize that in vitro culture of embryos during the first few days of preimplantation development affects perinatal outcome, not only in singletons conceived in all rank order cycles but also in twins and in children born after transfer of frozen embryos. Furthermore, we investigated the effect of culture medium on gestational age (GA) at birth. Oocytes and embryos from consecutive treatment cycles were alternately assigned to culture in either medium from Vitrolife or from Cook. Data on a cohort of 294 live born singletons conceived after fresh transfer during any of a patient's IVF treatment cycles, as well as data of 67 singletons conceived after frozen embryo transfer (FET) and of 88 children of 44 twin pregnancies after fresh transfer were analysed by means of multiple linear regression. In vitro culture in medium from Cook resulted in singletons after fresh transfer with a lower mean birthweight (adjusted mean difference, 112 g, P= 0.03), and in more singletons with low birthweight (LBW) culture in medium from Vitrolife AB. GA at birth was not related to the medium used (adjusted difference, 0.05 weeks, P = 0.83). Among twins in the Cook group, higher inter-twin mean birthweight disparity and birthweight discordance were found. Z-scores after FET were -0.04 (± 0.14) in the Cook group compared with 0.18 (± 0.21) in the Vitrolife group (P> 0.05). Our findings support our hypothesis that culture medium influences perinatal outcome of IVF singletons and twins. A similar trend is seen in case of singletons born after FET. GA was not affected by culture medium. These results indicate that in vitro culture might be an

  8. Progression of Common Variable Immunodeficiency Interstitial Lung Disease Accompanies Distinct Pulmonary and Laboratory Findings.

    Science.gov (United States)

    Maglione, Paul J; Overbey, Jessica R; Cunningham-Rundles, Charlotte

    2015-01-01

    Common variable immunodeficiency may be complicated by interstitial lung disease, which leads to worsened morbidity and mortality in some. Although immunomodulatory treatment has efficacy, choice of patient, duration of treatment, and long-term follow-up are not available. Interstitial lung disease appears stable in certain instances, so it is not known whether all patients will develop progressive disease or require immunomodulatory therapy. This study aims to determine if all common variable immunodeficiency patients with interstitial lung disease have physiological worsening, and if clinical and/or laboratory parameters may correlate with disease progression. A retrospective review of medical records at Mount Sinai Medical Center in New York was conducted for referred patients with common variable immunodeficiency, CT scan-confirmed interstitial lung disease, and periodic pulmonary function testing covering 20 or more months before immunomodulatory therapy. Fifteen patients were identified from the retrospective review and included in this study. Of the 15 patients with common variable immunodeficiency, 9 had physiological worsening of interstitial lung disease adapted from consensus guidelines, associated with significant reductions in forced expiratory volume in 1 second, forced vital capacity, and diffusion capacity of the lung for carbon monoxide. Those with progressive lung disease also had significantly lower mean immunoglobulin G levels, greater increases and highest levels of serum immunoglobulin M (IgM), and more significant thrombocytopenia. Interstitial lung disease resulted in physiological worsening in many, but not all subjects, and was associated with suboptimal immunoglobulin G replacement. Those with worsening pulmonary function tests, elevated IgM, and severe thrombocytopenic episodes appear to be at highest risk for progressive disease. Such patients may benefit from immunomodulatory treatment. Copyright © 2015 American Academy of Allergy

  9. Long-term outcome of major depressive disorder in psychiatric patients is variable.

    Science.gov (United States)

    Holma, K Mikael; Holma, Irina A K; Melartin, Tarja K; Rytsälä, Heikki J; Isometsä, Erkki T

    2008-02-01

    The prevailing view of outcome of major depressive disorder (MDD), based on mostly inpatient cohorts sampled from tertiary centers, emphasizes chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.5% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6 months, 18 months, and 5 years with a life chart between February 1, 1997, and April 30, 2004. The effects of comorbid disorders and other predictors on outcome were comprehensively investigated. Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria, and 88.4% reached full remission, with the median time to full remission being 11.0 months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced 1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences. Preceding dysthymic disorder (p = .028), cluster C personality disorder (p = .041), and longer MDE duration prior to entry (p = .011) were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one tenth of patients having poor, one third having intermediate, and one half having favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.

  10. Perceived match or mismatch on the Gottman conflict styles: associations with relationship outcome variables.

    Science.gov (United States)

    Busby, Dean M; Holman, Thomas B

    2009-12-01

    Gottman has proposed that there are 3 functional styles of conflict management in couple relationships, labeled Avoidant, Validating, and Volatile, and 1 dysfunctional style, labeled Hostile. Using a sample of 1,983 couples in a committed relationship, we test the association of perceived matches or mismatches on these conflict styles with relationship outcome variables. The results indicate that 32% of the participants perceive there is a mismatch with their conflict style and that of their partner. The Volatile-Avoidant mismatch was particularly problematic and was associated with more stonewalling, relationship problems, and lower levels of relationship satisfaction and stability than the Validating matched style and than other mismatched styles. The most problematic style was the Hostile style. Contrary to existing assumptions by Gottman, the 3 matched functional styles were not equivalent, as the Validating Style was associated with substantially better results on relationship outcome measures than the Volatile and Avoidant styles.

  11. All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record.

    Science.gov (United States)

    Jensen, Roxanne E; Snyder, Claire F; Basch, Ethan; Frank, Lori; Wu, Albert W

    2016-11-01

    In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.

  12. Rape treatment outcome research: empirical findings and state of the literature.

    Science.gov (United States)

    Vickerman, Katrina A; Margolin, Gayla

    2009-07-01

    This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery.

  13. Abdominal ultrasonographic findings at diagnosis of osteosarcoma in dogs and association with treatment outcome.

    Science.gov (United States)

    Sacornrattana, O; Dervisis, N G; McNiel, E A

    2013-09-01

    The purpose of this study was to describe abdominal ultrasonographic findings present at diagnosis of osteosarcoma (OSA) in dogs and to investigate for associations with treatment outcome. Medical records from 118 dogs diagnosed with OSA that had abdominal ultrasonography performed as part of their initial evaluation were reviewed. Fifty-seven percent had ultrasonographic abnormalities identified. The organ with the highest frequency of ultrasonographic changes was the spleen. While most sonographic changes were considered to be either benign or of unknown clinical consequences, metastases were identified in three dogs (2.5%), two of which (1.7%) did not have other evidence of metastasis. Dogs with any ultrasonographic abnormality were less likely to receive definitive therapy (P = 0.005) and exhibited shorter survival, although the latter observation was not statistically significant (P = 0.071). However, the identification of lesions in either the liver (P = 0.021) or the kidney (P = 0.003) was statistically associated with shorter survival. © 2012 John Wiley & Sons Ltd.

  14. Acute intramural hematoma of ascending aorta. CT findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Toshio; Sakuyama, Keiko; Hiekata, Tomizou; Yamanaka, Ikuo [St. Marianna Univ., Kanagawa (Japan). Yokohama Seibu Hospital; Kuroki, Kazunori; Ohyama, Yukio; Ishikawa, Tohru; Kawada, Tadanori; Akashi, Katsuya

    1997-12-01

    The purpose of this study was to describe the CT findings and clinical outcomes of nineteen patients with acute intramural hematoma (IMH) of the ascending aorta. Six patients underwent surgery on the emergency basis (3 patients) due to cardiac tamponade (n=2) and dilated aorta (n=1), and on the elective basis (3 patients) due to patent and enlarging false lumen. Among the 13 patients with medical management, four patients died from complications of IMH during the follow-up period (2 days-2.5 years). Transition to aortic dissection or enlargement of an intimal tear was noted in 5 patients (31%) in 1 to 6 weeks after onset. Three patients died of causes not related to IMH. Six patients had been alive 2 to 9 years after onset. Retrospective review revealed 10 patients (53%) as possible surgical candidates, and the other 9 patients as medically treated patients in the long-term follow-up. The surgical group showed cardiac tamponade or shock in 6 patients on admission and had pericardial effusion in all the patients on the initial CT scan. In the patients with acute IMH of the ascending aorta, surgery should be considered for severe clinical symptoms, pericardial effusion and large size of the ascending aorta (more than 4 cm) on CT scan, and for converting to a typical type A aortic dissection. CT scan had a major role in making an early diagnosis, in depicting a dangerous sign, and in monitoring its progression or resolution of IMH. (author)

  15. Rape Treatment Outcome Research: Empirical Findings and State of the Literature

    Science.gov (United States)

    Vickerman, Katrina A.; Margolin, Gayla

    2009-01-01

    This article reviews empirical support for treatments targeting women sexually assaulted during adolescence or adulthood. Thirty-two articles were located using data from 20 separate samples. Of the 20 samples, 12 targeted victims with chronic symptoms, three focused on the acute period post-assault, two included women with chronic and acute symptoms, and three were secondary prevention programs. The majority of studies focus on posttraumatic stress disorder (PTSD), depression, and/or anxiety as treatment targets. Cognitive Processing Therapy and Prolonged Exposure have garnered the most support with this population. Stress Inoculation Training and Eye Movement Desensitization and Reprocessing also show some efficacy. Of the four studies that compared active treatments, few differences were found. Overall, cognitive behavioral interventions lead to better PTSD outcomes than supportive counseling does. However, even in the strongest treatments more than one-third of women retain a PTSD diagnosis at post-treatment or drop out of treatment. Discussion highlights the paucity of research in this area, methodological limitations of examined studies, generalizability of findings, and important directions for future research at various stages of trauma recovery. PMID:19442425

  16. Occupational physical activities, working hours and outcome of pregnancy: findings from the Southampton Women's Survey.

    Science.gov (United States)

    Bonzini, M; Coggon, D; Godfrey, K; Inskip, H; Crozier, S; Palmer, K T

    2009-10-01

    To investigate risks of physical activity at work by pregnancy trimester, including the effects on head and abdominal circumference. At 34 weeks of gestation we interviewed 1327 mothers from the prospective Southampton Women's Survey (SWS); we asked about their activities (working hours, standing/walking, kneeling/squatting, trunk bending, lifting and night shifts) in jobs held at each of 11, 19 and 34 weeks of gestation, and subsequently ascertained four birth outcomes (preterm delivery, small for gestational age (SGA) and reduced head or abdominal circumference) blinded to employment history. Risk of preterm delivery was elevated nearly threefold in women whose work at 34 weeks entailed trunk bending for >1 h/day. Small head circumference was more common in babies born to women who worked for >40 h/week. However, no statistically significant associations were found with SGA or small abdominal circumference, and preterm delivery showed little association with long working hours, lifting, standing or shift work. There is a need for more research on trunk bending late in pregnancy, and on the relationship of work to reduced head circumference. Our findings on several other occupational exposures common among pregnant workers are reassuring.

  17. Meta-modeling of occupancy variables and analysis of their impact on energy outcomes of office buildings

    International Nuclear Information System (INIS)

    Wang, Qinpeng; Augenbroe, Godfried; Kim, Ji-Hyun; Gu, Li

    2016-01-01

    Highlights: • A meta-analysis framework for a stochastic characterization of occupancy variables. • Sensitivity ranking of occupancy variability against all other sources of uncertainty. • Sensitivity of occupant presence for building energy consumption is low. • Accurate mean knowledge is sufficient for predicting building energy consumption. • Prediction of peak demand behavior requires stochastic occupancy modeling. - Abstract: Occupants interact with buildings in various ways via their presence (passive effects) and control actions (active effects). Therefore, understanding the influence of occupants is essential if we are to evaluate the performance of a building. In this paper, we model the mean profiles and variability of occupancy variables (presence and actions) separately. We will use a multi-variate Gaussian distribution to generate mean profiles of occupancy variables, while the variability will be represented by a multi-dimensional time series model, within a framework for a meta-analysis that synthesizes occupancy data gathered from a pool of buildings. We then discuss variants of occupancy models with respect to various outcomes of interest such as HVAC energy consumption and peak demand behavior via a sensitivity analysis. Results show that our approach is able to generate stochastic occupancy profiles, requiring minimum additional input from the energy modeler other than standard diversity profiles. Along with the meta-analysis, we enable the generalization of previous research results and statistical inferences to choose occupancy variables for future buildings. The sensitivity analysis shows that for aggregated building energy consumption, occupant presence has a smaller impact compared to lighting and appliance usage. Specifically, being accumulatively 55% wrong with regard to presence, only translates to 2% error in aggregated cooling energy in July and 3.6% error in heating energy in January. Such a finding redirects focus to the

  18. Finding Solvable Units of Variables in Nonlinear ODEs of ECM Degradation Pathway Network

    Directory of Open Access Journals (Sweden)

    Shuji Kawasaki

    2017-01-01

    Full Text Available We consider ordinary differential equation (ODE model for a pathway network that arises in extracellular matrix (ECM degradation. For solving the ODEs, we propose applying the mass conservation law (MCL, together with a stoichiometry called doubling rule, to them. Then it leads to extracting new units of variables in the ODEs that can be solved explicitly, at least in principle. The simulation results for the ODE solutions show that the numerical solutions are indeed in good accord with theoretical solutions and satisfy the MALs.

  19. Finding Solvable Units of Variables in Nonlinear ODEs of ECM Degradation Pathway Network.

    Science.gov (United States)

    Kawasaki, Shuji; Minerva, Dhisa; Itano, Keiko; Suzuki, Takashi

    2017-01-01

    We consider ordinary differential equation (ODE) model for a pathway network that arises in extracellular matrix (ECM) degradation. For solving the ODEs, we propose applying the mass conservation law (MCL), together with a stoichiometry called doubling rule , to them. Then it leads to extracting new units of variables in the ODEs that can be solved explicitly, at least in principle. The simulation results for the ODE solutions show that the numerical solutions are indeed in good accord with theoretical solutions and satisfy the MALs.

  20. Clinicopathologic findings and outcome in dogs with infective endocarditis: 71 cases (1992-2005).

    Science.gov (United States)

    Sykes, Jane E; Kittleson, Mark D; Chomel, Bruno B; Macdonald, Kristin A; Pesavento, Patricia A

    2006-06-01

    To evaluate clinical, laboratory, and necropsy findings in dogs with infective endocarditis (IE). Retrospective case series. 71 dogs with possible or definite IE. Medical records were reviewed for signalment, clinical features, and results of clinicopathologic testing and diagnostic imaging. Yearly incidence and the effect of variables on survival were determined by use of survival curve analysis. The overall incidence of IE was 0.05%. Most affected dogs were of large breeds, and > 75% were older than 5 years. The aortic valve was affected in 36 of the 71 (51%) dogs, and the mitral valve was affected in 59%. Lameness caused by immune-mediated polyarthritis, septic arthritis, or peripheral arterial thromboembolism was observed in 53% of the dogs. Neurologic complications were diagnosed in 17 of 71 (24%) dogs. Thromboembolic disease was suspected in 31 of 71 (44%) of dogs. The mortality rate associated with IE was 56%, and median survival time was 54 days. Factors negatively associated with survival included thrombocytopenia, high serum creatinine concentration, renal complications, and thromboembolic complications. A diagnosis of IE should be suspected in dogs with fever, systolic or diastolic murmur, and locomotor problems. Dogs with thrombocytopenia, high serum creatinine concentration, thromboembolism, or renal complications may have a shorter survival time.

  1. Adolescent over-general memory, life events and mental health outcomes: Findings from a UK cohort study.

    Science.gov (United States)

    Crane, Catherine; Heron, Jon; Gunnell, David; Lewis, Glyn; Evans, Jonathan; Williams, J Mark G

    2016-01-01

    Previous research suggesting that over-general memory (OGM) may moderate the effect of life events on depressive symptoms and suicidality has sampled older adolescents or adults, or younger adolescents in high-risk populations, and has been conducted over relatively short follow-up periods. The authors examined the relationship between OGM at age 13 and life events and mental health outcomes (depression, self-harm, suicidal ideation and planning) at age 16 years within a sample of 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), approximately 3800 of whom had also provided data on depression and self-harm. There was no clear evidence of either direct or interactive effects of OGM at age 13 on levels of depression at age 16. Similarly there was no clear evidence of either direct or interactive effects of OGM on suicidal ideation and self-harm. Although there was some evidence that over-general autobiographical memory was associated with reduced risk of suicidal planning and increased risk of self-harm, these associations were absent when confounding variables were taken into account. The findings imply that although OGM is a marker of vulnerability to depression and related psychopathology in high-risk groups, this cannot be assumed to generalise to whole populations.

  2. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews.

    Science.gov (United States)

    Saini, Pooja; Loke, Yoon K; Gamble, Carrol; Altman, Douglas G; Williamson, Paula R; Kirkham, Jamie J

    2014-11-21

    To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews. Cohort study of systematic reviews from two databases. Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events. 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort). A 13 point classification system for missing outcome data on harm was developed and applied to the studies. 86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393). The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews. © Saini et al 2014.

  3. Effects of surgeon variability on oncologic and functional outcomes in a population-based setting.

    Science.gov (United States)

    Carlsson, Sigrid; Berglund, Anders; Sjoberg, Daniel; Khatami, Ali; Stranne, Johan; Bergdahl, Svante; Lodding, Pär; Aus, Gunnar; Vickers, Andrew; Hugosson, Jonas

    2014-03-06

    Oncologic and functional outcomes after radical prostatectomy (RP) can vary between surgeons to a greater extent than is expected by chance. We sought to examine the effects of surgeon variation on functional and oncologic outcomes for patients undergoing RP for prostate cancer in a European center. The study comprised 1,280 men who underwent open retropubic RP performed by one of nine surgeons at an academic institution in Sweden between 2001 and 2008. Potency and continence outcomes were measured preoperatively and 18 months postoperatively by patient-administered questionnaires. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value > 0.2 ng/mL with at least one confirmatory rise. Multivariable random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix (age, PSA, pathological stage and grade), year of surgery, and surgical experience. Of 679 men potent at baseline, 647 provided data at 18 months with 122 (19%) reporting potency. We found no evidence for heterogeneity of potency outcomes between surgeons (P = 1). The continence rate for patients at 18 months was 85%, with 836 of the 979 patients who provided data reporting continence. There was statistically significant heterogeneity between surgeons (P = 0.001). We did not find evidence of an association between surgeons' adjusted probabilities of functional recovery and 5-year probability of freedom from BCR. Our data support previous studies regarding a large heterogeneity among surgeons in continence outcomes for patients undergoing RP. This indicates that some patients are receiving sub-optimal care. Quality assurance measures involving performance feedback, should be considered. When surgeons are aware of their outcomes, they can improve them to provide better care to patients.

  4. Medico-legal findings, legal case progression, and outcomes in South African rape cases: retrospective review.

    Directory of Open Access Journals (Sweden)

    Rachel Jewkes

    2009-10-01

    .036, ano-genital injuries alone (AOR 7.00, 95% CI 1.44-33.9, p = 0.017, or both nongenital and ano-genital injuries (AOR 12.34, 95% CI 2.87-53.0, p = 0.001. DNA was not associated with case outcome. CONCLUSIONS: This is the first study, to our knowledge, to show an association between documentation of ano-genital injuries, trials commencing, and convictions in rape cases in a developing country. Its findings are of particular importance because they show the value of good basic medical practices in documentation of injuries, rather than more expensive DNA evidence, in assisting courts in rape cases. Health care providers need training to provide high quality health care responses after rape, but we have shown that the core elements of the medico-legal response require very little technology. As such they should be replicable in low- and middle-income country settings. Our findings raise important questions about the value of evidence that requires the use of forensic laboratories at a population level in countries like South Africa that have substantial inefficiencies in their police services. Please see later in the article for the Editors' Summary.

  5. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Medical System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Badillo, Andrea T. [Children' s National Medical System, Division of General and Thoracic Surgery, Washington, DC (United States)

    2017-04-15

    Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

  6. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

    International Nuclear Information System (INIS)

    Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I.; Badillo, Andrea T.

    2017-01-01

    Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

  7. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome.

    Science.gov (United States)

    Varghese, George M; Janardhanan, Jeshina; Trowbridge, Paul; Peter, John V; Prakash, John A J; Sathyendra, Sowmya; Thomas, Kurien; David, Thambu S; Kavitha, M L; Abraham, Ooriapadickal C; Mathai, Dilip

    2013-11-01

    This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  8. High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Dawn L. Goodall, MSc

    2017-08-01

    Conclusions. This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes.

  9. Intraindividual variability in reaction time predicts cognitive outcomes 5 years later.

    Science.gov (United States)

    Bielak, Allison A M; Hultsch, David F; Strauss, Esther; Macdonald, Stuart W S; Hunter, Michael A

    2010-11-01

    Building on results suggesting that intraindividual variability in reaction time (inconsistency) is highly sensitive to even subtle changes in cognitive ability, this study addressed the capacity of inconsistency to predict change in cognitive status (i.e., cognitive impairment, no dementia [CIND] classification) and attrition 5 years later. Two hundred twelve community-dwelling older adults, initially aged 64-92 years, remained in the study after 5 years. Inconsistency was calculated from baseline reaction time performance. Participants were assigned to groups on the basis of their fluctuations in CIND classification over time. Logistic and Cox regressions were used. Baseline inconsistency significantly distinguished among those who remained or transitioned into CIND over the 5 years and those who were consistently intact (e.g., stable intact vs. stable CIND, Wald (1) = 7.91, p < .01, Exp(β) = 1.49). Average level of inconsistency over time was also predictive of study attrition, for example, Wald (1) = 11.31, p < .01, Exp(β) = 1.24. For both outcomes, greater inconsistency was associated with a greater likelihood of being in a maladaptive group 5 years later. Variability based on moderately cognitively challenging tasks appeared to be particularly sensitive to longitudinal changes in cognitive ability. Mean rate of responding was a comparable predictor of change in most instances, but individuals were at greater relative risk of being in a maladaptive outcome group if they were more inconsistent rather than if they were slower in responding. Implications for the potential utility of intraindividual variability in reaction time as an early marker of cognitive decline are discussed. (c) 2010 APA, all rights reserved

  10. Interplay of task and outcome interdependence in generating work team members' affective responses : Some new findings

    NARCIS (Netherlands)

    Emans, B J M; Van der Vegt, G S; Van de Vliert, E; Vartiainen, M; Avallone, F; Anderson, N

    2000-01-01

    Two distinct, basic dimensions of a work team's internal structure are outcome interdependence and task interdependence. Task interdependence is a characteristic of team members' jobs. It is defined as their interconnectedness with jobs of co-members. Outcome interdependence is a characteristic of

  11. Relationship between brain’s CT scan findings and consciousness level, surgical findings and outcome of the patients with traumatic intracranial hemorrhage

    Directory of Open Access Journals (Sweden)

    Elham Shobeiri

    2014-06-01

    Full Text Available Background: Traumatic brain injury is one of the most common causes of death among 1-45 year-old people. The aim of this study was to determine the relationship between CT scan findings of brain and consciousness level, surgical findings and outcome of the patients with traumatic intracranial hemorrhage. Method: This study was a descriptive-analytical study which was conducted on 41 patients with visible and measurable traumatic intracranial hematoma detected by CT scan who referred to Taleghani hospital in Kermanshah. The patients’ consciousness level was measured and recorded by GCS (Glasco Coma Score on admission and in intervals of 6 and 24 hours after operation. Data were analyzed by statistical tests run bySPSS software (version 20. Results: Based on the CT scan findings, the hematoma location in 18 patients (43.9% was epidural, in 11 (26.8% patients was subdural and in 12 (29.3 % patients was intraparenchymal. Loss of consciousness on admission in 48.4% of patients was mild in degree, in 29% of patients was moderate and in 22.6% of patients was severe. In the operated patients, there was a significant correlation between the patients’ outcome and consciousness level on admission, before surgery, 24 hours after surgery and on discharge time. Also, there was a significant correlation between the outcome of non-operated patients and consciousness level on discharge. Conclusion: The results of this study indicate that the outcome of the patients with brain injury was dependent on the consciousness level and there was a reverse correlation between hematoma volume and amount of midline shift in CT scan.

  12. The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables.

    Science.gov (United States)

    Flay, B R; Miller, T Q; Hedeker, D; Siddiqui, O; Britton, C F; Brannon, B R; Johnson, C A; Hansen, W B; Sussman, S; Dent, C

    1995-01-01

    This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California. The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7. We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior. Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior.

  13. Comparison of logistic regression and neural models in predicting the outcome of biopsy in breast cancer from MRI findings

    International Nuclear Information System (INIS)

    Abdolmaleki, P.; Yarmohammadi, M.; Gity, M.

    2004-01-01

    Background: We designed an algorithmic model based on regression analysis and a non-algorithmic model based on the Artificial Neural Network. Materials and methods: The ability of these models was compared together in clinical application to differentiate malignant from benign breast tumors in a study group of 161 patient's records. Each patient's record consisted of 6 subjective features extracted from MRI appearance. These findings were enclosed as features extracted for an Artificial Neural Network as well as a logistic regression model to predict biopsy outcome. After both models had been trained perfectly on samples (n=100), the validation samples (n=61) were presented to the trained network as well as the established logistic regression models. Finally, the diagnostic performance of models were compared to the that of the radiologist in terms of sensitivity, specificity and accuracy, using receiver operating characteristic curve analysis. Results: The average out put of the Artificial Neural Network yielded a perfect sensitivity (98%) and high accuracy (90%) similar to that one of an expert radiologist (96% and 92%) while specificity was smaller than that (67%) verses 80%). The output of the logistic regression model using significant features showed improvement in specificity from 60% for the logistic regression model using all features to 93% for the reduced logistic regression model, keeping the accuracy around 90%. Conclusion: Results show that Artificial Neural Network and logistic regression model prove the relationship between extracted morphological features and biopsy results. Using statistically significant variables reduced logistic regression model outperformed of Artificial Neural Network with remarkable specificity while keeping high sensitivity is achieved

  14. The mediation proportion: a structural equation approach for estimating the proportion of exposure effect on outcome explained by an intermediate variable

    DEFF Research Database (Denmark)

    Ditlevsen, Susanne; Christensen, Ulla; Lynch, John

    2005-01-01

    It is often of interest to assess how much of the effect of an exposure on a response is mediated through an intermediate variable. However, systematic approaches are lacking, other than assessment of a surrogate marker for the endpoint of a clinical trial. We review a measure of "proportion...... of several intermediate variables. Binary or categorical variables can be included directly through threshold models. We call this measure the mediation proportion, that is, the part of an exposure effect on outcome explained by a third, intermediate variable. Two examples illustrate the approach. The first...... example is a randomized clinical trial of the effects of interferon-alpha on visual acuity in patients with age-related macular degeneration. In this example, the exposure, mediator and response are all binary. The second example is a common problem in social epidemiology-to find the proportion...

  15. Longitudinal assessment of maternal parenting capacity variables and child adjustment outcomes in pediatric cancer.

    Science.gov (United States)

    Fedele, David A; Mullins, Larry L; Wolfe-Christensen, Cortney; Carpentier, Melissa Y

    2011-04-01

    This preliminary investigation aimed to longitudinally examine parenting capacity variables, namely parental overprotection, perceived child vulnerability, and parenting stress and their relation to child adjustment in mothers of children on treatment for cancer. As part of a larger study, biological mothers (N=22) completed measures of parental overprotection, perceived child vulnerability, parenting stress, and child adjustment at Time 1 and a follow-up time point. Analyses were conducted to determine whether (1) levels of parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up and (2) if Time 1 parenting capacity variables were associated with child adjustment at follow-up. Results revealed that parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up, and levels of parental overprotection, perceived child vulnerability, and parenting stress at Time 1 were significantly related to child adjustment at follow-up. Collectively, the preliminary findings of this study indicate that mothers of children with cancer evidence improved parenting capacity over time. Furthermore, it seems that Time 1 parenting capacity variables are significantly related to later child adjustment.

  16. Disaster media coverage and psychological outcomes: descriptive findings in the extant research.

    Science.gov (United States)

    Pfefferbaum, Betty; Newman, Elana; Nelson, Summer D; Nitiéma, Pascal; Pfefferbaum, Rose L; Rahman, Ambreen

    2014-09-01

    This review of the literature on disaster media coverage describes the events, samples, and forms of media coverage (television, newspapers, radio, internet) studied and examines the association between media consumption and psychological outcomes. A total of 36 studies representing both man-made and natural events met criteria for review in this analysis. Most studies examined disaster television viewing in the context of terrorism and explored a range of outcomes including posttraumatic stress disorder (PTSD) caseness and posttraumatic stress (PTS), depression, anxiety, stress reactions, and substance use. There is good evidence establishing a relationship between disaster television viewing and various psychological outcomes, especially PTSD caseness and PTS, but studies are too few to draw definitive conclusions about the other forms of media coverage that have been examined. As media technology continues to advance, future research is needed to investigate these additional media forms especially newer forms such as social media.

  17. Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

    Science.gov (United States)

    Cvetanovich, Gregory L.; Heyworth, Benton E.; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S.; Millis, Michael B.

    2015-01-01

    To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery. PMID:27011852

  18. Rurality and Birth Outcomes: Findings from Southern Appalachia and the Potential Role of Pregnancy Smoking

    Science.gov (United States)

    Bailey, Beth A.; Cole, Laura K. Jones

    2009-01-01

    Context: Rates of preterm birth (PTB) and low birth weight (LBW) vary by region, with disparities particularly evident in the Appalachian region of the South. Community conditions related to rurality likely contribute to adverse birth outcomes in this region. Purpose: This study examined associations between rurality and related community…

  19. Pathways Post-Participation Outcomes: Preliminary Findings. Carnegie Math Pathways Research Brief

    Science.gov (United States)

    Norman, Jon

    2017-01-01

    The Carnegie Foundation for the Advancement of Teaching's Math Pathways seek to improve outcomes for community college students who take remedial math courses. The Pathways include two comprehensive instructional systems--Statway® and Quantaway® and are described in this report. They are designed to support students to achieve the necessary math…

  20. Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register.

    Science.gov (United States)

    Greene, Meridith E; Rolfson, Ola; Nemes, Szilard; Gordon, Max; Malchau, Henrik; Garellick, Göran

    2014-06-01

    Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known. We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA. All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes. High education attainment was associated with higher HRQoL (EQ-5D index ß(high) = 0.03 ± 0.01; EQ VAS ß(high) = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ß(high) = -3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA. Level III

  1. Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes.

    Science.gov (United States)

    Ghidini, Filippo; Sekulovic, Sasa; Castagnetti, Marco

    2016-03-01

    Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients. Copyright © 2016 American Urological Association Education and Research, Inc

  2. The influence of caregiver depression on adolescent mental health outcomes: findings from refugee settlements in Uganda

    OpenAIRE

    Meyer, Sarah R; Steinhaus, Mara; Bangirana, Clare; Onyango-Mangen, Patrick; Stark, Lindsay

    2017-01-01

    Background Family-level predictors, including caregiver depression, are considered important influences on adolescent mental health. Adolescent depression and anxiety in refugee settings is known to be a significant public health concern, yet there is very limited literature from humanitarian settings focusing on the relationship between caregiver mental health and adolescent mental health. In the context of a larger study on child protection outcomes in refugee settings, researchers explored...

  3. ARTHROSCOPIC REPAIR OF LARGE AND MASSIVE ROTATOR CUFF TEARS: CLINICAL OUTCOMES AND POSTOPERATIVE MRI FINDINGS

    Directory of Open Access Journals (Sweden)

    S. Yu. Dokolin

    2017-01-01

    Full Text Available Purpose of the study – to identify incidence rate of recurrent rotator cuff (RC tears, to evaluate outcomes of arthroscopic bone-tendon anchor suture, to determine the factors influencing arthroscopic treatment outcomes.Materials and methods. Medical history data, pre-operative x-rays and MRI of shoulder joints of 305 patients (main group who underwent arthroscopic bone-tendon anchor suture repair of large or massive RC tears during 2010-2016 were included in the study. Follow up period ranged from 1 to 6 years postoperatively with mean value of 25,6±4,5 months. Telephone survey of patients was conducted after the surgery as well as a single examination of patients with evaluation by functional scales – UCLA, ASES, CS, VAS, DN4. Preoperative standard x-rays in AP and axial views were done in all patients. Arthropathy severity was evaluated by K.Hamada classification. Comparison of patient specific data, features of RC lesions and surgical treatment was made by Kruskal-Wallis test.Results. Good outcomes by ASES, CS and UCLA functional scales were obtained in 15 (5% of patients, satisfactory – in 213 (69.8%, poor – in 77 (25.2%. Postoperative MRI data provided the following sub-distribution of patients: 49 (41.1% patients with complete repair of RC tendons lesions, 38 (31.9% patients with partial repair and 33 (27.0% patients with recurrent tear of reconstructed tendon. Correlation analysis allowed to establish the limits for achieving good outcomes of arthroscopic bone-tendon anchor suturing for significant association with infraspinatus muscle atrophy (not exceeding 40% and fatty infiltration of supraspinatus muscle (not exceeding 23.5%. 

  4. Case Report of Left Retrocaval Ureter: Pre-Transplant CT Urographic Findings and Post-Transplant Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ah Yeong; Park, Byung Kwan; Kim, Chan Kyo; Park, Sung Yoon; Han, Deok Hyun [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-02-15

    A left retrocaval ureter is an extremely rare congenital anomaly, in which the left ureter passes behind the left inferior vena cava (IVC). The compression of the ureter between the IVC and the vertebrae results in a progressive hydronephrosis. Recently, the left kidney with a retrocaval ureter was detected on CT urographic images in a living-related donor and achieved a good outcome after allograft transplantation. We report the CT urographic findings of a left retrocaval ureter and the short-term outcome of allograft transplantation.

  5. The relationship between history and physical examination findings and the outcome of electrodiagnostic testing in patients with sciatica referred to physical therapy.

    Science.gov (United States)

    Savage, Nathan J; Fritz, Julie M; Thackeray, Anne

    2014-07-01

    Cross-sectional diagnostic accuracy study. To investigate the relationship between history and physical examination findings and the outcome of electrodiagnostic testing in patients with sciatica referred to physical therapy. Electrodiagnostic testing is routinely used to evaluate patients with sciatica. Recent evidence suggests that the presence of radiculopathy identified with electrodiagnostic testing may predict better functional outcomes in these patients. While some patient history and physical examination findings have been shown to predict the presence of disc herniation or neurological insult, little is known about their relationship to the results of electrodiagnostic testing. Electrodiagnostic testing was performed on 38 patients with sciatica who participated in a randomized trial that compared different physical therapy interventions. The diagnostic gold standard was the presence or absence of radiculopathy, based on the results of the needle electromyographic examination. Diagnostic sensitivity and specificity values were calculated, along with corresponding likelihood ratios, for select patient history and physical examination variables. No significant relationship was found between select patient history and physical examination findings, analyzed individually or in combination, and the outcome of electrodiagnostic testing. Diagnostic sensitivity values ranged from 0.03 (95% confidence interval [CI]: 0.00, 0.24) to a high of 0.95 (95% CI: 0.72, 0.99), and specificity values ranged from 0.10 (95% CI: 0.02, 0.34) to a high of 0.95 (95% CI: 0.72, 0.99). Positive likelihood ratios ranged from 0.15 (95% CI: 0.01, 2.87) to a high of 2.33 (95% CI: 0.71, 7.70), and negative likelihood ratios ranged from 2.00 (95% CI: 0.35, 11.48) to a low of 0.50 (95% CI: 0.03, 8.10). In this investigation, the relationship between patient history and physical examination findings and the outcome of electrodiagnostic testing among patients with sciatica was not found to be

  6. Early childhood growth and cognitive outcomes: Findings from the MAL-ED study.

    Science.gov (United States)

    Scharf, Rebecca J; Rogawski, Elizabeth T; Murray-Kolb, Laura E; Maphula, Angelina; Svensen, Erling; Tofail, Fahmida; Rasheed, Muneera; Abreu, Claudia; Vasquez, Angel Orbe; Shrestha, Rita; Pendergast, Laura; Mduma, Estomih; Koshy, Beena; Conaway, Mark R; Platts-Mills, James A; Guerrant, Richard L; DeBoer, Mark D

    2018-02-02

    Although many studies around the world hope to measure or improve developmental progress in children to promote community flourishing and productivity, growth is sometimes used as a surrogate because cognitive skills are more difficult to measure. Our objective was to assess how childhood measures of anthropometry correlate with measures of child development in low-income settings with high prevalence of poor nutrition and enteric disease, to inform studies considering growth outcomes in the absence of direct child developmental skill assessment. Children from the MAL-ED study were followed from birth to 24 months of age in field sites in 8 low- and middle-income countries across 3 continents. Monthly weight, length, and head circumference measurements were performed. At 24 months, the Bayley Scales of Infant and Toddler Development was administered. We correlated cognitive measures at 24 months with anthropometric measurements from birth to 2 years comparing 3 constructs: absolute attained monthly measures, summative difference in measures from the mean growth curve, and rate of change in measures. Growth faltering at multiple time periods is related to Bayley cognitive outcomes at 24 months. Birthweight, overall growth by 18-24 months, and rate of growth in the 6- to 18-month period were most associated with 24-month developmental scores. In this study, head circumference measurements, compared with length, was more closely linked to cognitive scores at 24 months. Notably, all studies between growth and cognitive outcomes exhibited low r 2 values (0.001-0.049). Anthropometric measures, particularly head circumference, were related to cognitive development, although explaining a low percent of variance. When feasible, direct measures of child development may be more useful. © 2018 John Wiley & Sons Ltd.

  7. Outcomes of splenectomy in patients with common variable immunodeficiency (CVID): a survey of 45 patients

    Science.gov (United States)

    Wong, G K; Goldacker, S; Winterhalter, C; Grimbacher, B; Chapel, H; Lucas, M; Alecsandru, D; McEwen, D; Quinti, I; Martini, H; Schmidt, R E; Ernst, D; Espanol, T; Vidaller, A; Carbone, J; Fernandez-Cruz, E; Lougaris, V; Plebani, A; Kutukculer, N; Gonzalez-Granado, L I; Contreras, R; Kiani-Alikhan, S; Ibrahim, M A A; Litzman, J; Jones, A; Gaspar, H B; Hammarstrom, L; Baumann, U; Warnatz, K; Huissoon, A P

    2013-01-01

    Splenectomy has been used in patients with common variable immunodeficiency disorders (CVID), mainly in the context of refractory autoimmune cytopenia and suspected lymphoma, but there are understandable concerns about the potential of compounding an existing immunodeficiency. With increasing use of rituximab as an alternative treatment for refractory autoimmune cytopenia, the role of splenectomy in CVID needs to be re-examined. This retrospective study provides the largest cohesive data set to date describing the outcome of splenectomy in 45 CVID patients in the past 40 years. Splenectomy proved to be an effective long-term treatment in 75% of CVID patients with autoimmune cytopenia, even in some cases when rituximab had failed. Splenectomy does not worsen mortality in CVID and adequate immunoglobulin replacement therapy appears to play a protective role in overwhelming post-splenectomy infections. Future trials comparing the effectiveness and safety of rituximab and splenectomy are needed to provide clearer guidance on the second-line management of autoimmune cytopenia in CVID. PMID:23480186

  8. Explaining wind power planning outcomes: some findings from a study in England and Wales

    International Nuclear Information System (INIS)

    Toke, Dave

    2005-01-01

    This paper discusses the factors that influence the outcome of onshore windfarm planning application in England and Wales. Various qualitative and quantitative methods have been employed, including regression analysis. Strong associations have been discovered between the outcome of local authority planning decisions, the opinions of local planning officers, the opinions of parish councils where the proposed windfarms are to be sited and the opinions of landscape protection groups. The attitude of people in the immediate vicinity of proposed windfarms is found to be the most important influence on the decisions made by local authorities. However, the local perception of the economic impact is of crucial importance in forming this judgement, as is the national political environment. The expected attitude of Appeal Inspectors is also important. It is concluded that there is a lot that wind power developers could do to improve the prospects of planning success. This includes engaging in local 'parish council' politics, talking to the closest residents to proposed schemes and encouraging local pro-wind power campaigns. Future projects are likely to be favoured by installing viewing towers at the tops of turbines to encourage visitors and in selling shares in the schemes to local people

  9. Incidence, clinical features, laboratory findings and outcome of patients with multiple myeloma presenting with extramedullary relapse.

    Science.gov (United States)

    Papanikolaou, Xenofon; Repousis, Panagiotis; Tzenou, Tatiana; Maltezas, Dimitris; Kotsopoulou, Maria; Megalakaki, Katerina; Angelopoulou, Maria; Dimitrakoloulou, Elektra; Koulieris, Efstathios; Bartzis, Vassiliki; Pangalis, Gerasimos; Panayotidis, Panagiotis; Kyrtsonis, Marie-Christine

    2013-07-01

    Extramedullary plasmacytomas constitute a rare and not well studied subset of multiple myeloma (MM) relapses. We report the incidence, clinical-laboratory features and outcome of patients with MM and extramedullary relapse (ExMeR). A total of 303 patients with symptomatic MM were recorded in a 13-year period in two institutions. Twenty-eight cases of ExMeR (9%) were recorded. There was an increased frequency of elevated lactate dehydrogenase (LDH) (p = 0.026), bone plasmacytomas (p = 0.001) and fractures (p = 0.002) at diagnosis, in patients with ExMeR compared to the others. ExMeR was associated with an ominous outcome, high LDH, constitutional symptoms and a statistically significant decrease of monoclonal paraprotein compared to levels at diagnosis (p = 0.009). Prior treatment with bortezomib was associated with a decreased hazard of ExMeR (p = 0.041). Overall survival (OS) was decreased in patients with ExMeR compared to the others (38 vs. 59 months, p = 0.006). Patients with MM with ExMeR have a lower OS and their clinical and laboratory features differ from those without.

  10. Learning Strategies of the Arab EFL Learners: Finding Correlation with Outcomes

    Science.gov (United States)

    Al-Ahdal, Arif Ahmed Mohammed Hassan; Al-Ma'amari, Ahmed Ali Hassan

    2015-01-01

    Socio-psychological research and findings into learner differences led to the emergence of learner strategies research in the last century. With major contributions from the emerging field of Linguistics in the mid 1970s, language learning strategies began to receive considerable attention. It is worth noting that the primary concern of most of…

  11. Congenital high airway obstruction syndrome: MR/US findings, effect on management, and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Mong, Andrew; Johnson, Ann M.; Kramer, Sandra S.; Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Coleman, Beverly G. [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Hedrick, Holly L.; Flake, Alan; Johnson, Mark; Wilson, R.D.; Adzick, N.S. [Children' s Hospital of Philadelphia, The Center for Fetal Diagnosis and Treatment, Philadelphia, PA (United States); Kreiger, Portia [Children' s Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA (United States)

    2008-11-15

    Congenital high airway obstruction syndrome (CHAOS) is a rare disorder defined as any fetal abnormality that obstructs the larynx or trachea. Prompt airway intervention at delivery after accurate prenatal diagnosis may allow survival of this otherwise fatal condition. To identify prenatal MRI findings in CHAOS, to compare these findings with those of fetal US, to determine if imaging alters diagnosis and management decisions, and to correlate prenatal with postnatal imaging findings. Records and MRI scans of ten fetuses with CHAOS were reviewed, and the findings correlated with outside and same-day fetal US and postnatal imaging findings. Fetal lung volumes were measured on MRI scans. Large lung volumes were found in 90% of the fetuses. Increased lung signal intensity, inverted diaphragm, and a dilated, fluid-filled lower airway were identified in all. The obstruction level was identified in 90%. MRI changed screening US diagnosis in 70%, but was concordant with the tertiary care US imaging in 90%. Seven fetuses were terminated or died in utero, and three fetuses survived after ex utero intrapartum tracheostomy placement. Autopsy or bronchoscopy performed in 60% confirmed CHAOS. Postnatal chest radiographs and CT showed hyperinflation, while US and fluoroscopy showed diminished diaphragmatic motion. MRI demonstrates large lung volumes, increased lung signal intensity, inverted diaphragm, and dilated fluid-filled lower airway, and usually identifies the obstruction level. The degree of correlation between MRI and tertiary prenatal US is high, but CHAOS is frequently misdiagnosed on screening US. Correct diagnosis may enable planned airway management. Voluminous lungs and diaphragmatic abnormalities persist on postnatal imaging. (orig.)

  12. Congenital high airway obstruction syndrome: MR/US findings, effect on management, and outcome

    International Nuclear Information System (INIS)

    Mong, Andrew; Johnson, Ann M.; Kramer, Sandra S.; Jaramillo, Diego; Coleman, Beverly G.; Hedrick, Holly L.; Flake, Alan; Johnson, Mark; Wilson, R.D.; Adzick, N.S.; Kreiger, Portia

    2008-01-01

    Congenital high airway obstruction syndrome (CHAOS) is a rare disorder defined as any fetal abnormality that obstructs the larynx or trachea. Prompt airway intervention at delivery after accurate prenatal diagnosis may allow survival of this otherwise fatal condition. To identify prenatal MRI findings in CHAOS, to compare these findings with those of fetal US, to determine if imaging alters diagnosis and management decisions, and to correlate prenatal with postnatal imaging findings. Records and MRI scans of ten fetuses with CHAOS were reviewed, and the findings correlated with outside and same-day fetal US and postnatal imaging findings. Fetal lung volumes were measured on MRI scans. Large lung volumes were found in 90% of the fetuses. Increased lung signal intensity, inverted diaphragm, and a dilated, fluid-filled lower airway were identified in all. The obstruction level was identified in 90%. MRI changed screening US diagnosis in 70%, but was concordant with the tertiary care US imaging in 90%. Seven fetuses were terminated or died in utero, and three fetuses survived after ex utero intrapartum tracheostomy placement. Autopsy or bronchoscopy performed in 60% confirmed CHAOS. Postnatal chest radiographs and CT showed hyperinflation, while US and fluoroscopy showed diminished diaphragmatic motion. MRI demonstrates large lung volumes, increased lung signal intensity, inverted diaphragm, and dilated fluid-filled lower airway, and usually identifies the obstruction level. The degree of correlation between MRI and tertiary prenatal US is high, but CHAOS is frequently misdiagnosed on screening US. Correct diagnosis may enable planned airway management. Voluminous lungs and diaphragmatic abnormalities persist on postnatal imaging. (orig.)

  13. The influence of caregiver depression on adolescent mental health outcomes: findings from refugee settlements in Uganda.

    Science.gov (United States)

    Meyer, Sarah R; Steinhaus, Mara; Bangirana, Clare; Onyango-Mangen, Patrick; Stark, Lindsay

    2017-12-19

    Family-level predictors, including caregiver depression, are considered important influences on adolescent mental health. Adolescent depression and anxiety in refugee settings is known to be a significant public health concern, yet there is very limited literature from humanitarian settings focusing on the relationship between caregiver mental health and adolescent mental health. In the context of a larger study on child protection outcomes in refugee settings, researchers explored the relationship between caregiver depression and adolescent mental health in two refugee settlements, Kiryandongo and Adjumani, in Uganda. Adolescents between 13 and 17 and their caregivers participated in a household survey, which included measures of adolescent anxiety and depression, and caregiver depression. Analysis was conducted using multiple logistic regression models, and results were reported for the full sample and for each site separately. In Kiryandongo, a one-unit increase in a caregiver's depression score tripled the odds that the adolescent would have high levels of anxiety symptoms (AOR: 3.0, 95% CI: 1.4, 6.1), while in Adjumani, caregiver depression did not remain significant in the final model. Caregiver depression, gender and exposure to violence were all associated with higher symptoms of adolescent depression in both sites and the full sample, for example, a one unit increase in caregiver depression more than tripled the odds of higher levels of symptoms of adolescent depression (AOR: 3.6, 95% CI: 2.0, 6.2). Caregiver depression is a consistently significantly associated with adverse mental health outcomes for adolescents in this study. Adolescent well-being is significantly affected by caregiver mental health in this refugee context. Child protection interventions in humanitarian contexts do not adequately address the influence of caregivers' mental health, and there are opportunities to integrate child protection programming with prevention and treatment of

  14. Weight change from 3-year observational data: findings from the worldwide schizophrenia outpatient health outcomes database.

    Science.gov (United States)

    Bushe, Chris J; Slooff, Cees J; Haddad, Peter M; Karagianis, Jamie L

    2012-06-01

    Weight change data from randomized clinical trials are often of limited duration and trials do not always report a full range of clinically relevant categorical end points. We conducted a post hoc analysis of data from the observational Worldwide Schizophrenia Outpatient Health Outcomes database (2000-2005) on weight change in 4,626 patients completing 3 years of antipsychotic monotherapy with amisulpride, clozapine, olanzapine, quetiapine, risperidone, and oral and depot first-generation antipsychotics (FGAs). Reported outcomes included mean and categorical weight changes and the trajectories of different measures of weight change. Mean weight gain was lowest with amisulpride (1.8 kg; 95% CI, 0.2-3.3) and highest with olanzapine (4.2 kg; 95% CI, 3.9-4.5). Weight change for all antipsychotics was most rapid during the first 6 months; subsequent weight change was slower but did not plateau. All drugs showed considerable individual variation in weight change. The proportion losing ≥7% of their baseline bodyweight was highest with quetiapine (10%; 95% CI, 7%-16%) and lowest with depot FGAs (5%; 95% CI, 3%-10%). Between 7% and 15% of patients moved into an overweight or obese body mass index (kg/m2)category (≥25). The degree of weight gain varied between antipsychotics. All antipsychotics were associated with significant (≥7%) weight loss and gain from baseline. The mean rate of weight gain was maximal during the first 6 months but continued over 3 years without a plateau in this specific cohort. Patients should receive regular monitoring of weight throughout treatment. © Copyright 2012 Physicians Postgraduate Press, Inc.

  15. Temporary brittle bone disease: relationship between clinical findings and judicial outcome

    Directory of Open Access Journals (Sweden)

    Colin R. Paterson

    2011-10-01

    Full Text Available There is a wide differential diagnosis for the child with unexplained fractures including non-accidental injury, osteogenesis imperfecta and vitamin D deficiency rickets. Over the last 20 years we and others have described a self-limiting syndrome characterised by fractures in the first year of life. This has been given the provisional name temporary brittle bone disease. This work had proved controversial mostly because the fractures, including rib fractures and metaphyseal fractures, were those previously regarded as typical or even diagnostic of non-accidental injury. Some have asserted that the condition does not exist. Over the years 1985 to 2000 we investigated 87 such cases with fractures with a view to determining the future care of the children. In 85 of these the judiciary was involved. We examined the clinical and radiological findings in the 33 cases in which there was a judicial finding of abuse, the 24 cases in which the parents were exonerated and the 28 cases in which no formal judicial finding was made. The three groups of patients were similar in terms of demographics, age at fracturing and details of the fractures. The clinical similarities between the three groups of patients contrasts with the very different results of the judicial process.

  16. Pretreatment clinical findings predict outcome for patients receiving preoperative radiation for rectal cancer

    International Nuclear Information System (INIS)

    Myerson, Robert J.; Singh, Anurag; Birnbaum, Elisa H.; Fry, Robert D.; Fleshman, James W.; Kodner, Ira J.; Lockett, Mary Ann; Picus, Joel; Walz, Bruce J.; Read, Thomas E.

    2001-01-01

    Background: As a sole modality, preoperative radiation for rectal carcinoma achieves a local control comparable to that of postoperative radiation plus chemotherapy. Although the addition of chemotherapy to preoperative treatment improves the pathologic complete response rate, there is also a substantial increase in acute and perioperative morbidity. Identification of subsets of patients who are at low or high risk for recurrence can help to optimize treatment. Methods: During the period 1977-95, 384 patients received preoperative radiation therapy for localized adenocarcinoma of the rectum. Ages ranged from 19 to 97 years (mean 64.4), and there were 171 females. Preoperative treatment consisted of conventionally fractionated radiation to 3600-5040 cGy (median 4500 cGy) 6-8 weeks before surgery in 293 cases or low doses of <3000 cGy (median 2000 cGy) immediately before surgery in 91 cases. Concurrent preoperative chemotherapy was given to only 14 cases in this study period. Postoperative chemotherapy was delivered to 55 cases. Results: Overall 93 patients have experienced recurrence (including 36 local failures). Local failures were scored if they occurred at any time, not just as first site of failure. For the group as a whole, the actuarial (Kaplan-Meier) freedom from relapse (FFR) and local control (LC) were 74% and 90% respectively at 5 years. Univariate analysis of clinical characteristics demonstrated a significant (p<0.05) adverse effect on both LC and FFR for the following four clinical factors: (1) location <5 cm from the verge, (2) circumferential lesion, (3) near obstruction, (4) tethered or fixed tumor. Size, grade, age, gender, ultrasound stage, CEA, radiation dose, and the use of chemotherapy were not associated with outcome. Background of the surgeon was significantly associated with outcome, colorectal specialists achieving better results than nonspecialist surgeons. We assigned a clinical score of 0 to 2 on the basis of how many of the above four

  17. Exploring variability among quality management system auditors when rating the severity of audit findings at a nuclear power plant

    Directory of Open Access Journals (Sweden)

    Simons, R. C.

    2017-05-01

    Full Text Available A reliable quality assurance (QA function in the nuclear environment is underpinned by the effective identification of risk, and by effective decision-making processes in relation to the risk identified. The need for competent auditors who are able to remain objective and independent at all times forms a critical component of this process. This exploratory study sought to determine reasons for the noted inconsistency among auditors when rating the severity of audit findings, and to provide recommendations to reduce this variability. The Delphi technique, a structured process to gather information from a panel of experts, was adopted to enable multiple iterations of qualitative and quantitative data collection and analysis, in an attempt to mimic the elements of a sequential exploratory strategy related to a mixed method methodology.

  18. Soft Tissue Sarcoma: A Prognostic Variables and Treatment Outcomes after Chemo - Radiotherapy and Conservative Surgery

    International Nuclear Information System (INIS)

    Abaza, A.; El-Shanshoury, H.

    2015-01-01

    Soft tissue sarcomas (STS) constitute a group of rare and heterogeneous cancers, that diverse a wide spectrum of histology and varied clinical behavior. The aim was to study, retrospectively the clinico-epidemiologic manifestation, response to therapy and prognostic factors of retroperitoneal (RPS), extremity and other STS patients treated with conservative surgery plus chemo - radiotherapy (CRT) attending the Pediatric Oncology Clinic, National Cancer Institute (NCI), Cairo University during 6 years period (inclusive). Files of 66 STS patients were revised for history, staging, investigations, treatment modalities and outcome of therapy. Their ages ranged from 6 months to 21 years. The male to female ratio was 1.87:1. Most of the patients belong to stage 3 and 1. Radiotherapy (RTH) and surgery remains the backbone of the multi - modality treatment plan. Complete remission (CR) was obtained in 80.3% of STS patients. Meanwhile, 6% of cases had disease progression and 6% died. The 2 - years overall survival rate (OS) and Disease - free survivals (DFS) we re 74.2% and 57.6% respectively. However, 20.8% of patients develop relapse>2 years after the end of treatment. Age at diagnosis, stage of the disease, tumor mass, pathological subtype and the RTH used were statistically significant prognostic variables affecting survival. Finally, the use of RTH in the treatment of STS gives positive impact on the survival of patients. Recommendation regarding further studies would be required to identify methods of increasing the radiation dose selectively. Also, using the newly developed radiation technologies to make dose escalation and sparing normal tissue

  19. Neutropenia in Patients with Common Variable Immunodeficiency: a Rare Event Associated with Severe Outcome.

    Science.gov (United States)

    Guffroy, Aurélien; Mourot-Cottet, Rachel; Gérard, Laurence; Gies, Vincent; Lagresle, Chantal; Pouliet, Aurore; Nitschké, Patrick; Hanein, Sylvain; Bienvenu, Boris; Chanet, Valérie; Donadieu, Jean; Gardembas, Martine; Karmochkine, Marina; Nove-Josserand, Raphaele; Martin, Thierry; Poindron, Vincent; Soulas-Sprauel, Pauline; Rieux-Laucat, Fréderic; Fieschi, Claire; Oksenhendler, Eric; André-Schmutz, Isabelle; Korganow, Anne-Sophie

    2017-10-01

    Common variable immunodeficiency (CVID) is characterized by infections and hypogammaglobulinemia. Neutropenia is rare during CVID. The French DEFI study enrolled patients with primary hypogammaglobulinemia. Patients with CVID and neutropenia were retrospectively analyzed. Among 473 patients with CVID, 16 patients displayed neutropenia (lowest count [0-1400]*10 6 /L). Sex ratio (M/F) was 10/6. Five patients died during the follow-up (11 years) with an increased percentage of deaths compared to the whole DEFI group (31.3 vs 3.4%, P < 0.05). Neutropenia was diagnosed for 10 patients before 22 years old. The most frequent symptoms, except infections, were autoimmune cytopenia, i.e., thrombopenia or anemia (11/16). Ten patients were affected with lymphoproliferative diseases. Two patients were in the infection only group and the others belonged to one or several other CVID groups. The median level of IgG was 2.6 g/L [0.35-4.4]. Most patients presented increased numbers of CD21 low CD38 low B cell, as already described in CVID autoimmune cytopenia group. Neutropenia was considered autoimmune in 11 cases. NGS for 52 genes of interest was performed on 8 patients. No deleterious mutations were found in LRBA, CTLA4, and PIK3. More than one potentially damaging variant in other genes associated with CVID were present in most patients arguing for a multigene process. Neutropenia is generally associated with another cytopenia and presumably of autoimmune origin during CVID. In the DEFI study, neutropenia is coupled with more severe clinical outcomes. It appears as an "alarm bell" considering patients' presentation and the high rate of deaths. Whole exome sequencing diagnosis should improve management.

  20. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients--clinical findings, MRI findings and patient-reported outcome measures at baseline.

    Science.gov (United States)

    Falvey, É C; King, E; Kinsella, S; Franklyn-Miller, A

    2016-04-01

    Athletic groin pain remains a common field-based team sports time-loss injury. There are few reports of non-surgically managed cohorts with athletic groin pain. To describe clinical presentation/examination, MRI findings and patient-reported outcome (PRO) scores for an athletic groin pain cohort. All patients had a history including demographics, injury duration, sport played and standardised clinical examination. All patients underwent MRI and PRO score to assess recovery. A clinical diagnosis of the injured anatomical structure was made based on these findings. Statistical assessment of the reliability of accepted standard investigations undertaken in making an anatomical diagnosis was performed. 382 consecutive athletic groin pain patients, all male, enrolled. Median time in pain at presentation was (IQR) 36 (16-75) weeks. Most (91%) played field-based ball-sports. Injury to the pubic aponeurosis (PA) 240 (62.8%) was the most common diagnosis. This was followed by injuries to the hip in 81 (21.2%) and adductors in 56 (14.7%) cases. The adductor squeeze test (90° hip flexion) was sensitive (85.4%) but not specific for the pubic aponeurosis and adductor pathology (negative likelihood ratio 1.95). Analysed in series, positive MRI findings and tenderness of the pubic aponeurosis had a 92.8% post-test probability. In this largest cohort of patients with athletic groin pain combining clinical and MRI diagnostics there was a 63% prevalence of PA injury. The adductor squeeze test was sensitive for athletic groin pain, but not specific individual pathologies. MRI improved diagnostic post-test probability. No hernia or incipient hernia was diagnosed. NCT02437942. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Asthma outcomes in children and adolescents with multiple morbidities: Findings from the National Health Interview Survey.

    Science.gov (United States)

    Patel, Minal R; Leo, Harvey L; Baptist, Alan P; Cao, Yanyun; Brown, Randall W

    2015-06-01

    More Americans are managing multiple chronic conditions (MCCs), and trends are particularly alarming in youth. The purpose of this study was to examine the prevalence and distribution of 9 chronic conditions in children and adolescents with and without asthma, and adverse asthma outcomes associated with having MCCs. Cross-sectional interview data from the National Health Interview Survey were analyzed (N = 66,790) between 2007 and 2012 in youth 0 to 17 years of age. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. Five percent of children with asthma had 1 or more coexisting health conditions. The prevalence of 1 or more comorbidities was greater among those with asthma than those without (5.07% [95% CI: 4.5-5.6] vs. 2.73% [95% CI: 2.6-2.9]). Those with asthma were twice as likely to have co-occurring hypertension (prevalence ratio [PR] = 2.2 [95% CI: 1.5-3.2]) and arthritis (PR = 2.7 [95% CI: 1.8-4.0]) compared with those without asthma. Every additional chronic condition with asthma was associated with a greater likelihood of an asthma attack (PR = 1.1 [95% CI: 1.0-1.2]), all-cause emergency department visits (PR = 1.3 [95% CI: 1.1-1.5]), and missed school days (PR = 2.3 [95% CI: 1.7-3.2]). Children and adolescents with asthma in the US who suffer from MCCs have increased asthma symptoms, missed school days, and all-cause emergency department visits. Further research on optimal management strategies for this group is needed. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey.

    Science.gov (United States)

    Longhurst, H J; Zanichelli, A; Caballero, T; Bouillet, L; Aberer, W; Maurer, M; Fain, O; Fabien, V; Andresen, I

    2017-04-01

    Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P types I/II, respectively. © 2016 British Society for Immunology.

  3. Childhood family income and life outcomes in adulthood: findings from a 30-year longitudinal study in New Zealand.

    Science.gov (United States)

    Gibb, Sheree J; Fergusson, David M; Horwood, L John

    2012-06-01

    The aims of this study were to use data gathered over the course of a 30-year longitudinal study to examine the linkages between economic circumstances in childhood and subsequent developmental outcomes spanning educational achievement; economic circumstances; crime; mental health; and teenage pregnancy. All of these outcomes have been linked with childhood economic conditions and it is frequently argued that reducing income inequalities will mitigate psychosocial risks of children reared in families facing economic hardship. Alternatively it may be suggested that the associations between childhood family economic circumstances and later outcomes are mediated by individual, family and social factors that are correlated with low family income and contribute to later outcomes. To examine these issues, data were drawn from a birth cohort of New Zealand children born in 1977 and followed to age 30. Declining childhood family income was associated with a range of negative outcomes in adulthood, including: lower educational achievement; poorer economic circumstances; higher rates of criminal offending; higher rates of mental health problems; and higher rates of teenage pregnancy. After covariate adjustment, childhood family income remained significantly associated with educational achievement and economic circumstances, but was no longer significantly associated with the mental health, offending and teenage pregnancy outcomes. These findings suggest that, after due allowance has been made for social, family and individual contextual factors, low family income during childhood is associated with a range of educational and economic disadvantages in adulthood but is not directly related to increased risks of crime, mental health problems or teen pregnancy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Inferior outcomes for black children with high risk acute lymphoblastic leukemia and the impact of socioeconomic variables.

    Science.gov (United States)

    Walsh, Alexandra; Chewning, Joseph; Li, Xuelin; Dai, Chen; Whelan, Kimberly; Madan-Swain, Avi; Waterbor, John; Baskin, Monica L; Goldman, Frederick D

    2017-02-01

    While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis. © 2016 Wiley Periodicals, Inc.

  5. 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

  6. Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome

    Energy Technology Data Exchange (ETDEWEB)

    Iwamoto, Toshihiko; Koshibu, Junko; Kikawada, Masayuki; Yoneda, Youichi; Uno, Masanobu; Takasaki, Masaru [Tokyo Medical Coll. (Japan); Imamura, Toshiharu

    2001-09-01

    To estimate the usefulness of the bedside swallowing assessment proposed by Smithard et al and neuroimaging findings characteristic for dysphagia, we studied the outcome of 102 patients with chronic cerebral infarction after assessment of swallowing by this test with brain computerized tomography (CT). All patients had a variety of motor disturbance and were admitted on a long-term medicare basis. They were divided into two groups according to the findings: the positive group (n=33), who showed any of the listed types of difficulty in swallowing water, and the negative group (n=69). Followed up to 2.2 years, their outcomes were studied. CT findings were studied on type of infarction, number and laterality of infarction, grade of periventricular lucency (PVL), presence of ventricular dilatation (VD), and severity of cortical atrophy (CA). The mean age was 76.4 years at registration and 61 were men. The frequency of severe dementia and disturbed ADL were significantly higher in the positive group. Eighteen patients died during the observation period and 15 of those were in the positive group, indicating higher, annual death rate (29.9% vs 2.2% in the negative group). All of the 15 patients in the positive group died of pneumonia. CT findings showed high incidence of multiple infarction, bilateral hemispheric lesion, severe PVL, VD, and severe CA in the positive group. These findings indicated that this evaluation method was useful in screening swallow function for patients with cerebral infarction in the chronic phase. Furthermore, CT findings suggested that severe white matter lesion, VD, and severe CA as well as multiple infarction seen in bilateral hemisphere was related to dysphagia, probably due to multiple factors involving pyramidal- and extrapyramidal-tracts with higher brain function. (author)

  7. Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome

    International Nuclear Information System (INIS)

    Iwamoto, Toshihiko; Koshibu, Junko; Kikawada, Masayuki; Yoneda, Youichi; Uno, Masanobu; Takasaki, Masaru; Imamura, Toshiharu

    2001-01-01

    To estimate the usefulness of the bedside swallowing assessment proposed by Smithard et al and neuroimaging findings characteristic for dysphagia, we studied the outcome of 102 patients with chronic cerebral infarction after assessment of swallowing by this test with brain computerized tomography (CT). All patients had a variety of motor disturbance and were admitted on a long-term medicare basis. They were divided into two groups according to the findings: the positive group (n=33), who showed any of the listed types of difficulty in swallowing water, and the negative group (n=69). Followed up to 2.2 years, their outcomes were studied. CT findings were studied on type of infarction, number and laterality of infarction, grade of periventricular lucency (PVL), presence of ventricular dilatation (VD), and severity of cortical atrophy (CA). The mean age was 76.4 years at registration and 61 were men. The frequency of severe dementia and disturbed ADL were significantly higher in the positive group. Eighteen patients died during the observation period and 15 of those were in the positive group, indicating higher, annual death rate (29.9% vs 2.2% in the negative group). All of the 15 patients in the positive group died of pneumonia. CT findings showed high incidence of multiple infarction, bilateral hemispheric lesion, severe PVL, VD, and severe CA in the positive group. These findings indicated that this evaluation method was useful in screening swallow function for patients with cerebral infarction in the chronic phase. Furthermore, CT findings suggested that severe white matter lesion, VD, and severe CA as well as multiple infarction seen in bilateral hemisphere was related to dysphagia, probably due to multiple factors involving pyramidal- and extrapyramidal-tracts with higher brain function. (author)

  8. Social media and patient health outcomes. Findings from the yearbook 2014 section on consumer health informatics.

    Science.gov (United States)

    Staccini, P; Douali, N

    2014-08-15

    To provide a review of the current excellent research published in the field of Consumer Health Informatics. We searched MEDLINE® and WEB OF SCIENCE® databases for papers published in 2013 in relation with Consumer Health Informatics. The authors identified 16 candidate best papers, which were then reviewed by four reviewers. Five out of the 16 candidate papers were selected as best papers. One paper presents the key features of a system to automate the collection of web-based social media content for subsequent semantic annotation. This paper emphasizes the importance of mining social media to collect novel data from which new findings in drug abuse research were uncovered. The second paper presents a practical method to predict how a community structure would impact the spreading of information within the community. The third paper presents a method for improving the quality of online health communities. The fourth presents a new social network to allow the monitoring of the evolution of individuals' health status and diagnostic deficiencies, difficulties or barriers in rehabilitation. The last paper reports on teenage patients' perception on privacy and social media. Selected papers not only show the value of using social media in the medical field but how to use these media to detect emergent diseases or risks, inform patients, promote disease prevention, and follow patients' opinion on healthcare resources.

  9. Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome

    International Nuclear Information System (INIS)

    Kim, Ji Hye; Kim, In One; Lim, Myung Kwan

    2004-01-01

    The purpose of our study was to describe acute necrotizing encephalopathy in Korean infants and children, and we sought to evaluate the prognostic factors. Acute necrotizing encephalopathy was diagnosed in 14 Korean infants and children. We retrospectively analyzed the neuroimaging findings including the follow-up changes. The clinical course of the disease was graded, and we evaluated prognostic factors including age, serum level of the aminotransferase, hemorrhage, and localized atrophy of the brain. This encephalopathy predominantly affected the bilateral thalami (n = 14), pons (n = 12), and midbrain (n = 10) in a symmetrical pattern. Hemorrhage was observed in eight patients (57%). On the follow-up images (n = 12), the brain lesions were reduced in extent for all patients, and generalized atrophy was seen in six patients. Localized tissue loss was observed in five patients and a complete resolution occurred for one patient. All the patients survived and two recovered completely; mild (n = 6) to severe (n = 6) neurological deficits persisted in the remaining 12 patient. The significant prognostic factors identified in this study were the presence of hemorrhage (ρ 0.009) and localized atrophy (ρ = 0.015). Acute necrotizing encephalopathy in Korean patients showed the characteristic patterns of the post-infectious encephalopathy as described in the literature. The high survival rate and the relatively favorable clinical course observed for the present study suggest a more diverse spectrum of disease severity than was previously described. The presence of hemorrhage and localized tissue loss on MR images may suggest a poor prognosis

  10. Monitoring HIV Prevention Programme Outcomes among Key Populations in Kenya: Findings from a National Survey.

    Directory of Open Access Journals (Sweden)

    Parinita Bhattacharjee

    Full Text Available In preparation for the implementation of the Kenya AIDS Strategic Framework 2014/15-2018/19, the Kenya National AIDS and STI Control Programme facilitated a national polling booth survey as part of a baseline assessment of HIV-related risk behaviours among FSWs, MSM, and PWID, and their utilization of existing preventive interventions, as well as structural factors that may influence KPs' vulnerability to HIV. The survey was conducted among "key populations" (female sex workers, men who have sex with men, and people who inject drugs to understand current HIV risk and prevention behaviours, utilization of existing programmes and services, and experiences of violence. In total, 3,448 female sex workers, 1,308 men who have sex with men, and 690 people who inject drugs were randomly selected to participate in polling booth survey sessions from seven priority sites. Survey responses were aggregated and descriptive statistics derived. In general, reported condom use among all key populations was quite high with paying clients, and lower with regular, non-paying partners. Many participants reported unavailability of condoms or clean injecting equipment within the past month. Exposure to, and utilization of, existing HIV prevention services varied significantly among the groups, and was reported least commonly by female sex workers. Encouragingly, approximately three-quarters of all key population members reported receiving an HIV test in the past three months. All key population groups reported experiencing high levels of physical and sexual violence from partners/clients, and/or arrest and violence by law enforcement officials. Although some of the findings are encouraging, there is room for improvement in HIV prevention programmes and services for key populations across Kenya.

  11. Cerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and associated variables.

    Science.gov (United States)

    Didier, Romain; Gaglia, Michael A; Koifman, Edward; Kiramijyan, Sarkis; Negi, Smita I; Omar, Al Fazir; Gai, Jiaxing; Torguson, Rebecca; Pichard, Augusto D; Waksman, Ron

    2016-02-01

    Cerebrovascular accident (CVA) and transient ischemic attack (TIA) related to percutaneous coronary intervention (PCI) are relatively rare complications, but they are associated with high morbidity and mortality. Given the evolution of both CVA risk and PCI techniques over time, this study was conducted to evaluate trends in CVA and TIA associated with PCI and to identify variables associated with neurologic events. Consecutive patients undergoing PCI at the Washington Hospital Center between January 2002 and June 2015 were included. Prespecified data were prospectively collected, including baseline and procedural characteristics, in-hospital outcomes, and 1-year mortality. The subjects who had a CVA or TIA during or immediately after PCI were compared with those without procedure-associated CVA or TIA. Overall, 25,626 patients were included in the study. The mean age was 65.0 ± 12.4 years, 16,949 (65.2%) were male, and 7,436 (28.6%) were African American. From 2002 to 2015, 110 neurologic events post-PCI were diagnosed (0.43%); this included 86 CVAs (0.34%) and 24 TIAs (0.09%). The annual rate of postprocedural neurologic events was 0.42% ± 0.12%. There were significant changes in baseline risk factors over time, with increasing age, incidence of insulin-dependent diabetes, and chronic kidney disease. Patients with neurologic events were more often African American (43.6% vs 28.6%, P < .001) with prior history of CVA (24.5% vs 7.8%, P < .001), chronic renal insufficiency (26.6% vs 15.2%, P < .001), and insulin-dependent diabetes (19.1% vs 12.4%, P = .03). Acute myocardial infarction (56% vs 30.4%, P < .001) and cardiogenic shock (20.2% vs 3%, P < .001) were also more common among patients with neurologic events post-PCI. After multivariable adjustment, use of an intraaortic balloon pump was strongly associated with neurologic events (odds ratio [OR] 4.9, 95% CI 2.7-8.8, P < .001), as was prior CVA (OR 2.4, 95% CI 1.4-4.4, P = .002) and African American race (OR

  12. Does child gender moderate the relationship between interparental conflict and child outcomes? Findings from the Danish Longitudinal Study of Children

    Directory of Open Access Journals (Sweden)

    Siddhartha Baviskar

    2011-03-01

    Full Text Available The hypothesis that child gender moderates the relationship between interparental conflict (IPC, conceptualized as a normative phenomenon, and child outcomes was evaluated using Danish mother data from the Danish Longitudinal Survey of Children (DALSC, which follows a nationally representative sample of children born in September-October 1995. IPC was assessed at age seven using a five-item scale measuring frequency of quarrels between parents on topics common to daily family life. Child outcomes were evaluated at age eleven using three indicators of internalizing (emotional problems, somatic symptoms, psychological symptoms and two indicators of externalizing symptoms (conduct problems and hyperactivity. OLS regression analyses indicated, overall, that the longitudinal association between IPC and the chosen outcomes was weak and child gender weakly moderated the association between IPC and child outcomes. Specifically, gender differences were limited only to conduct problems after controlling for the child’s psycho-social adjustment and health characteristics, mother’s depressive symptoms and disciplinary behaviour and parents’ socio-economic status at age 7. Furthermore, contrary to expectations derived from the male vulnerability and differential reactivity models, the IPC-conduct problems association was stronger among girls than among boys. In general, IPC predicted a number of outcomes among girls but did not predict any among boys. These findings suggest that it is important in both academic and professional work to consider that the impact of IPC on boys and girls may vary depending on the nature of the conflict and the type of families affected by it. Furthermore, while IPC may not have a direct impact over time, its effects may continue to be felt through other elements of the family system, such as the parent-child relationship.

  13. Influence of presenting electrocardiographic findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Patel, Jigar H; Gupta, Raghav; Roe, Matthew T; Peng, S Andrew; Wiviott, Stephen D; Saucedo, Jorge F

    2014-01-15

    The influence of the presenting electrocardiographic (ECG) findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been studied in contemporary practice. We analyzed the clinical characteristics, in-hospital management, and in-hospital outcomes of patients with NSTEMI in the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) according to the presenting ECG findings. A total of 175,556 patients from 485 sites from January 2007 to September 2011 were stratified by the ECG findings on presentation: ST depression (n = 40,146, 22.9%), T-wave inversions (n = 24,627, 14%), transient ST-segment elevation (n = 5,050, 2.9%), and no ischemic changes (n = 105,733, 60.2%). Patients presenting with ST-segment depression were the oldest and had the greatest prevalence of major cardiac risk factors. Coronary angiography was performed most frequently in the transient ST-segment elevation group, followed by the T-wave inversion, ST-segment depression, and no ischemic changes groups. The angiogram revealed that patients with ST-segment depression had more left main, proximal left anterior descending, and 3-vessel coronary artery disease and underwent coronary artery bypass grafting most often. In contrast, patients with transient ST-segment elevation had 1-vessel CAD and underwent percutaneous coronary intervention the most. The unadjusted mortality was highest in the ST-segment depression group, followed by the no ischemic changes, transient ST-segment elevation, and T-wave inversion group. Adjusted mortality using the ACTION Registry-GWTG in-hospital mortality model with the no ischemic changes group as the reference showed that in-hospital mortality was similar in the transient ST-segment elevation (odds ratio 1.15, 95% confidence interval 0.97 to 1.37; p = 0.10), higher in the ST-segment depression group (odds ratio 1.46, 95% confidence interval 1

  14. Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions.

    Science.gov (United States)

    Fu, Michael C; Buerba, Rafael A; Long, William D; Blizzard, Daniel J; Lischuk, Andrew W; Haims, Andrew H; Grauer, Jonathan N

    2014-10-01

    Magnetic resonance imaging (MRI) is frequently used in the evaluation of degenerative conditions in the lumbar spine. The relative interrater and intrarater agreements of MRI findings across different pathologic conditions are underexplored, as most studies are focused on specific findings. The purpose of this study was to characterize the interrater and intrarater agreements of MRI findings used to assess the degenerative lumbar spine. A retrospective diagnostic study at a large academic medical center was undertaken with a panel of orthopedic surgeons and musculoskeletal radiologists to assess lumbar MRIs using standardized criteria. Seventy-five subjects who underwent routine lumbar spine MRI at our institution were included. Each MRI study was assessed for 10 lumbar degenerative findings using standardized criteria. Lumbar vertebral levels were assessed independently, where applicable, for a total of 52 data points collected per study. T2-weighted axial and sagittal MRI sequences were presented in random order to the four reviewers (two orthopedic spine surgeons and two musculoskeletal radiologists) independently to determine interrater agreement. The first 10 studies were reevaluated at the end to determine intrarater agreement. Images were assessed using standardized and pilot-tested criteria to assess disc degeneration, stenosis, and other degenerative changes. Interrater and intrarater absolute percent agreements were calculated. To highlight the most clinically important MRI disagreements, a modified agreement analysis was also performed (in which disagreements between the lowest two severity grades for applicable conditions were ignored). Fleiss kappa coefficients for interrater agreement were determined. The overall absolute and modified interrater agreements were 76.9% and 93.5%, respectively. The absolute and modified intrarater agreements were 81.3% and 92.7%, respectively. Average Fleiss kappa coefficient was 0.431, suggesting moderate overall

  15. A Correlational Study on Critical Thinking in Nursing as an Outcome Variable for Success

    Science.gov (United States)

    Porter, Rebecca Jean

    2018-01-01

    Critical thinking is a required curricular outcome for nursing education; however, the literature shows a gap related to valid and reliable tools to measure critical thinking specific to nursing and relating that critical thinking measurement to meaningful outcomes. This study examined critical thinking scores, as measured by Assessment…

  16. Does psychotherapy work with school-aged youth? A meta-analytic examination of moderator variables that influence therapeutic outcomes.

    Science.gov (United States)

    Fedewa, Alicia L; Ahn, Soyeon; Reese, Robert J; Suarez, Marietta M; Macquoid, Ahjane; Davis, Matthew C; Prout, H Thompson

    2016-06-01

    The present study is a quantitative synthesis of the available literature to investigate the efficacy of psychotherapy for children's mental health outcomes. In particular, this study focuses on potential moderating variables-study design, treatment, client, and therapist characteristics-that may influence therapeutic outcomes for youth but have not been thoroughly accounted for in prior meta-analytic studies. An electronic search of relevant databases resulted in 190 unpublished and published studies that met criteria for inclusion in the analysis. Effect sizes differed by study design. Pre-post-test designs resulted in absolute magnitudes of treatment effects ranging from |-0.02| to |-0.76| while treatment versus control group comparison designs resulted in absolute magnitudes of treatment effects ranging from |-0.14| to |-2.39|. Changes in youth outcomes larger than 20% were found, irrespective of study design, for outcomes focused on psychosomatization (29% reduction), school attendance (25% increase), and stress (48% reduction). The magnitude of changes after psychotherapy ranged from 6% (externalizing problems) to 48% (stress). Several moderator variables significantly influenced psychotherapy treatment effect sizes, including frequency and length of treatment as well as treatment format. However, results did not support the superiority of a single type of intervention for most outcomes. Implications for therapy with school-aged youth and future research are discussed. Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  17. LB01.06: VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOMES IN FELODIPINE EVENT REDUCTION STUDY.

    Science.gov (United States)

    Zhang, Y; Zhang, X; Liu, L; Zanchetti, A

    2015-06-01

    Many antihypertensive outcome trials have shown that visit-to-visit blood pressure variability is correlated closely with clinical outcomes in hypertensive patients. The objective of the study was to investigate the relationship between visit-to-visit blood pressure variability (BPV) and the major cardiovascular outcomes in the Chinese hypertensive patients. Felodipine Event Reduction (FEVER) study was a double-blind, randomized trial on 9711 Chinese hypertensive patients, in whom cardiovascular outcomes were significantly reduced by more intense therapy achieving a mean of 138 mmHg SBP compared with less-intense therapy achieving a mean of 142 mmHg. Visit-to-visit BPV during the follow-up period [defined as standard deviation (SD), coefficient of variation (CV), and average real variability(ARV)] was derived from casual cuff BP measures after six months follow-up until the end of the study. Hazard ratios (HRs), for the incidence of CVD associated with SD, CV, and ARV of SBP and DBP were calculated using Cox proportional hazard models. Overall predictive power [area under receiver operating characteristic (AUC ROC) curve] of the level of blood pressure, blood pressure variability and other baseline characteristics was calculated. In FEVER study, visit-to-visit variability in SBP were significant predictors of subsequent stroke [eg, hazard ratios [HR] for ARV, SD and CV was 1.071 (95% CI: 1.025-1.118), 1.373 (95% CI: 1.159-1.626) and 0.572 (95% CI: 0.451-0,726)]. Visit-to-visit variability in DBP were also showed similar trend [eg, HR for ARV, SD and CV was 1.066 (95% CI: 0.992-1.145), 1.931 (95% CI: 1.435-2.598) and 0.558 (95% CI: 0.438-0,710)]. However, using the analysis of AUC ROC analysis, the risk importance sequence of the stroke events in this cohort was level of SBP, age, level of DBP ARV, SD, sex, CV and treatment. Visit-to-visit blood pressure variability has some effects on the cardiovascular outcomes in the Chinese hypertensive patents in the cohort in

  18. Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica.

    Science.gov (United States)

    el Barzouhi, Abdelilah; Vleggeert-Lankamp, Carmen L A M; Lycklama à Nijeholt, Geert J; Van der Kallen, Bas F; van den Hout, Wilbert B; Koes, Bart W; Peul, Wilco C

    2014-11-01

    Gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings. To evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica. Prospective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up. Patients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year. Patients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability. In total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data. Poor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain. Reliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and

  19. Patient-Therapist Identification in Relation to Both Patient and Therapist Variables and Therapy Outcome

    Science.gov (United States)

    Melnick, Barry

    1972-01-01

    The results of the study confirmed the hypothesis that greater patient identification with the therapist, as defined by increased similarity between the patient's and therapist's semantic differential ratings, moderately correlated with more successful therapy outcome. (Author)

  20. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, Apostolos H. [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece)], E-mail: apolsen@yahoo.com; Drakonaki, Elena [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece); Karachalios, Theophilos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece); Korompilias, Anastasios V. [Department of Orthopaedic Surgery, University of Ioannina, Ioannina 451 10 (Greece); Malizos, Konstantinos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece)

    2008-07-15

    Purpose: The aim of the study was to present the MRI findings of non-traumatic edema-like lesions presented acutely in the adult knee and to correlate them with the 3-year outcome and the bone mineral density (BMD) in the spine. Materials and methods: Ninety-eight patients (40 men, 58 women, mean age 60.1 {+-} 11 years, age range 27-82 years), were followed up clinically as well as with MR imaging, when indicated, for at least 3 years. Patients were classified according to presentation in 3 groups (A: bone marrow edema (BME), B: BME and subchondral fracture, C: BME and articular collapse) and according to outcome in 2 groups (A: reversible BME, B: articular collapse). BMD measurements of the spine were carried out in males over 70 and females over 60 years old using DEXA. Results: The isolated BME pattern was observed in 64.3% (Group A), subchondral fractures without articular collapse in 11.2% (Group B) and articular collapse in 24.5% (Group C). Significant differences were found among the 3 groups at presentation, regarding the age, sex, BMD, affected area and duration of symptoms prior to imaging (p < 0.05). Localization of the lesions in the weight-bearing areas of the knee was shown in 100% of C, in 90.9% of B and in 50.8% of A. The duration of symptoms prior to imaging was longer in C (7.6 {+-} 2.8 m) than in A (2.5 {+-} 1.7 m) and B (4.0 {+-} 3.2 m) (p < 0.05). Group B progressed to articular collapse in 45.5%, the rest demonstrating a favourable outcome. Group C showed clinical improvement in 75% and persistent symptoms that required knee arthroplasty in 25% of cases. Articular collapse was the final outcome in 29.6% and transient BME in 70.4% of patients. These two groups showed significant differences regarding the age (p {approx} 0), sex (p = 0.002), low BMD (p = 0.004), affected area (p {approx} 0), presence of subchondral sparing (p {approx} 0), duration of symptoms prior to imaging (p {approx} 0), time from onset of symptoms to the final outcome (p

  1. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome

    International Nuclear Information System (INIS)

    Karantanas, Apostolos H.; Drakonaki, Elena; Karachalios, Theophilos; Korompilias, Anastasios V.; Malizos, Konstantinos

    2008-01-01

    Purpose: The aim of the study was to present the MRI findings of non-traumatic edema-like lesions presented acutely in the adult knee and to correlate them with the 3-year outcome and the bone mineral density (BMD) in the spine. Materials and methods: Ninety-eight patients (40 men, 58 women, mean age 60.1 ± 11 years, age range 27-82 years), were followed up clinically as well as with MR imaging, when indicated, for at least 3 years. Patients were classified according to presentation in 3 groups (A: bone marrow edema (BME), B: BME and subchondral fracture, C: BME and articular collapse) and according to outcome in 2 groups (A: reversible BME, B: articular collapse). BMD measurements of the spine were carried out in males over 70 and females over 60 years old using DEXA. Results: The isolated BME pattern was observed in 64.3% (Group A), subchondral fractures without articular collapse in 11.2% (Group B) and articular collapse in 24.5% (Group C). Significant differences were found among the 3 groups at presentation, regarding the age, sex, BMD, affected area and duration of symptoms prior to imaging (p < 0.05). Localization of the lesions in the weight-bearing areas of the knee was shown in 100% of C, in 90.9% of B and in 50.8% of A. The duration of symptoms prior to imaging was longer in C (7.6 ± 2.8 m) than in A (2.5 ± 1.7 m) and B (4.0 ± 3.2 m) (p < 0.05). Group B progressed to articular collapse in 45.5%, the rest demonstrating a favourable outcome. Group C showed clinical improvement in 75% and persistent symptoms that required knee arthroplasty in 25% of cases. Articular collapse was the final outcome in 29.6% and transient BME in 70.4% of patients. These two groups showed significant differences regarding the age (p ∼ 0), sex (p = 0.002), low BMD (p = 0.004), affected area (p ∼ 0), presence of subchondral sparing (p ∼ 0), duration of symptoms prior to imaging (p ∼ 0), time from onset of symptoms to the final outcome (p ∼ 0) and need for

  2. Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis.

    Science.gov (United States)

    Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A

    2017-07-01

    Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICH SITS (OR, 1.14; 95% CI, 1.06-1.23), and SICH ECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all P interaction accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association, Inc.

  3. Dynamics of melanoma tumor therapy with vesicular stomatitis virus: explaining the variability in outcomes using mathematical modeling.

    Science.gov (United States)

    Rommelfanger, D M; Offord, C P; Dev, J; Bajzer, Z; Vile, R G; Dingli, D

    2012-05-01

    Tumor selective, replication competent viruses are being tested for cancer gene therapy. This approach introduces a new therapeutic paradigm due to potential replication of the therapeutic agent and induction of a tumor-specific immune response. However, the experimental outcomes are quite variable, even when studies utilize highly inbred strains of mice and the same cell line and virus. Recognizing that virotherapy is an exercise in population dynamics, we utilize mathematical modeling to understand the variable outcomes observed when B16ova malignant melanoma tumors are treated with vesicular stomatitis virus in syngeneic, fully immunocompetent mice. We show how variability in the initial tumor size and the actual amount of virus delivered to the tumor have critical roles on the outcome of therapy. Virotherapy works best when tumors are small, and a robust innate immune response can lead to superior tumor control. Strategies that reduce tumor burden without suppressing the immune response and methods that maximize the amount of virus delivered to the tumor should optimize tumor control in this model system.

  4. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

    Science.gov (United States)

    Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

    2016-01-01

    The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case

  5. Age at disease onset and peak ammonium level rather than interventional variables predict the neurological outcome in urea cycle disorders.

    Science.gov (United States)

    Posset, Roland; Garcia-Cazorla, Angeles; Valayannopoulos, Vassili; Teles, Elisa Leão; Dionisi-Vici, Carlo; Brassier, Anaïs; Burlina, Alberto B; Burgard, Peter; Cortès-Saladelafont, Elisenda; Dobbelaere, Dries; Couce, Maria L; Sykut-Cegielska, Jolanta; Häberle, Johannes; Lund, Allan M; Chakrapani, Anupam; Schiff, Manuel; Walter, John H; Zeman, Jiri; Vara, Roshni; Kölker, Stefan

    2016-09-01

    Patients with urea cycle disorders (UCDs) have an increased risk of neurological disease manifestation. Determining the effect of diagnostic and therapeutic interventions on the neurological outcome. Evaluation of baseline, regular follow-up and emergency visits of 456 UCD patients prospectively followed between 2011 and 2015 by the E-IMD patient registry. About two-thirds of UCD patients remained asymptomatic until age 12 days [i.e. the median age at diagnosis of patients identified by newborn screening (NBS)] suggesting a potential benefit of NBS. In fact, NBS lowered the age at diagnosis in patients with late onset of symptoms (>28 days), and a trend towards improved long-term neurological outcome was found for patients with argininosuccinate synthetase and lyase deficiency as well as argininemia identified by NBS. Three to 17 different drug combinations were used for maintenance therapy, but superiority of any single drug or specific drug combination above other combinations was not demonstrated. Importantly, non-interventional variables of disease severity, such as age at disease onset and peak ammonium level of the initial hyperammonemic crisis (cut-off level: 500 μmol/L) best predicted the neurological outcome. Promising results of NBS for late onset UCD patients are reported and should be re-evaluated in a larger and more advanced age group. However, non-interventional variables affect the neurological outcome of UCD patients. Available evidence-based guideline recommendations are currently heterogeneously implemented into practice, leading to a high variability of drug combinations that hamper our understanding of optimised long-term and emergency treatment.

  6. Semiparametric methods for estimation of a nonlinear exposure‐outcome relationship using instrumental variables with application to Mendelian randomization

    Science.gov (United States)

    Staley, James R.

    2017-01-01

    ABSTRACT Mendelian randomization, the use of genetic variants as instrumental variables (IV), can test for and estimate the causal effect of an exposure on an outcome. Most IV methods assume that the function relating the exposure to the expected value of the outcome (the exposure‐outcome relationship) is linear. However, in practice, this assumption may not hold. Indeed, often the primary question of interest is to assess the shape of this relationship. We present two novel IV methods for investigating the shape of the exposure‐outcome relationship: a fractional polynomial method and a piecewise linear method. We divide the population into strata using the exposure distribution, and estimate a causal effect, referred to as a localized average causal effect (LACE), in each stratum of population. The fractional polynomial method performs metaregression on these LACE estimates. The piecewise linear method estimates a continuous piecewise linear function, the gradient of which is the LACE estimate in each stratum. Both methods were demonstrated in a simulation study to estimate the true exposure‐outcome relationship well, particularly when the relationship was a fractional polynomial (for the fractional polynomial method) or was piecewise linear (for the piecewise linear method). The methods were used to investigate the shape of relationship of body mass index with systolic blood pressure and diastolic blood pressure. PMID:28317167

  7. 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.

  8. Personality trait level and change as predictors of health outcomes: findings from a national study of Americans (MIDUS).

    Science.gov (United States)

    Turiano, Nicholas A; Pitzer, Lindsay; Armour, Cherie; Karlamangla, Arun; Ryff, Carol D; Mroczek, Daniel K

    2012-01-01

    Personality traits predict numerous health outcomes, but previous studies have rarely used personality change to predict health. The current investigation utilized a large national sample of 3,990 participants from the Midlife in the U.S. study (MIDUS) to examine if both personality trait level and personality change longitudinally predict 3 different health outcomes (i.e., self-rated physical health, self-reported blood pressure, and number of days limited at work or home due to physical health reasons) over a 10-year span. Each of the Big Five traits, except openness, predicted self-rated health. Change in agreeableness, conscientiousness, and extraversion also predicted self-rated health. Trait levels of conscientiousness and neuroticism level predicted self-reported blood pressure. All trait levels except agreeableness predicted number of work days limited. Only change in conscientiousness predicted the number of work days limited. Findings demonstrate that a full understanding of the link between personality and health requires consideration of trait change as well as trait level.

  9. Adaptive designs for dose-finding in non-cancer phase II trials: influence of early unexpected outcomes.

    Science.gov (United States)

    Resche-Rigon, Matthieu; Zohar, Sarah; Chevret, Sylvie

    2008-01-01

    In non-cancer phase II trials, dose-finding trials are usually carried out using fixed designs, in which several doses including a placebo are randomly distributed to patients. However, in certain vulnerable populations, such as neonates or infants, there is an heightened requirement for safety, precluding randomization. To estimate the minimum effective dose of a new drug from a non-cancer phase II trial, we propose the use of adaptive designs like the Continual Reassessment Method (CRM). This approach estimates the dose closest to some target response, and has been shown to be unbiased and efficient in cancer phase I trials. Based on a motivating example, we point out the individual influence of first outliers in this setting. A weighted version of the CRM is proposed as a theoretical benchmark to control for these outliers. Using simulations, we illustrate how this approach provides further insight into the behavior of the CRM. When dealing with low targets like a 10% failure rate, the CRM appears unable to rapidly overcome an early unexpected outcome. This behavior persisted despite changing the inference (Bayesian or likelihood), underlying dose-response model (though slightly improved using the power model), and the number of patients enrolled at each dose level. The choices for initial guesses of failure rates, the vague prior for the model parameter, and the log-log shape of weights can appear somewhat arbitrary. In phase II dose-finding studies in which failure targets are below 20%, the CRM appears quite sensitive to first unexpected outcomes. Using a power model for dose-response improves some behavior if the trial is started at the first dose level and includes at least three to five patients at the starting dose before applying the CRM allocation rule.

  10. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland.

    LENUS (Irish Health Repository)

    Saeed, Ayman

    2012-02-01

    AIM: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). METHODS: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. RESULTS: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +\\/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+\\/-standard deviation) at presentation: 0.76 (+\\/-0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+\\/-0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). CONCLUSIONS: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.

  11. Influence of Flow Sequencing Attributed to Climate Change and Climate Variability on the Assessment of Water-dependent Ecosystem Outcomes

    Science.gov (United States)

    Wang, J.; Nathan, R.; Horne, A.

    2017-12-01

    Traditional approaches to characterize water-dependent ecosystem outcomes in response to flow have been based on time-averaged hydrological indicators, however there is increasing recognition for the need to characterize ecological processes that are highly dependent on the sequencing of flow conditions (i.e. floods and droughts). This study considers the representation of flow regimes when considering assessment of ecological outcomes, and in particular, the need to account for sequencing and variability of flow. We conducted two case studies - one in the largely unregulated Ovens River catchment and one in the highly regulated Murray River catchment (both located in south-eastern Australia) - to explore the importance of flow sequencing to the condition of a typical long-lived ecological asset in Australia, the River Red Gum forests. In the first, the Ovens River case study, the implications of representing climate change using different downscaling methods (annual scaling, monthly scaling, quantile mapping, and weather generator method) on the sequencing of flows and resulting ecological outcomes were considered. In the second, the Murray River catchment, sequencing within a historic drought period was considered by systematically making modest adjustments on an annual basis to the hydrological records. In both cases, the condition of River Red Gum forests was assessed using an ecological model that incorporates transitions between ecological conditions in response to sequences of required flow components. The results of both studies show the importance of considering how hydrological alterations are represented when assessing ecological outcomes. The Ovens case study showed that there is significant variation in the predicted ecological outcomes when different downscaling techniques are applied. Similarly, the analysis in the Murray case study showed that the drought as it historically occurred provided one of the best possible outcomes for River Red Gum

  12. Teachers' and Students' Work-Culture Variables Associated with Positive School Outcome.

    Science.gov (United States)

    Goldwater, Orna D.; Nutt, Roberta L.

    1999-01-01

    Investigates whether goodness of fit between teachers' and students' backgrounds is associated with subjective grading and objective achievement at school. One hundred one seventh graders and twenty of their teachers completed the Self-Report Family Inventory. Similarity between teachers' and students' work-culture variables was associated with…

  13. 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

  14. Variables predictive of outcome in patients with acute hypercapneic respiratory failure treated with noninvasive ventilation

    International Nuclear Information System (INIS)

    Salahuddin, N.; Irfan, M.; Khan, S.; Naeem, M.; Haque, A.S.

    2010-01-01

    To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors. This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of 35 Meq/L (adjusted Odds ratio 0.9; 95% CI 0.83, 0.98, p < 0.015) identified those less at risk for intubation. NIV was found to be both safe and effective in the management of acute hypercapneic respiratory failure. Sepsis and serum HCO/sub 3/ at admission identified patients having poor outcomes (JPMA 60:13; 2010). (author)

  15. Modelling variable dropout in randomised controlled trials with longitudinal outcomes: application to the MAGNETIC study.

    Science.gov (United States)

    Kolamunnage-Dona, Ruwanthi; Powell, Colin; Williamson, Paula Ruth

    2016-04-28

    Clinical trials with longitudinally measured outcomes are often plagued by missing data due to patients withdrawing or dropping out from the trial before completing the measurement schedule. The reasons for dropout are sometimes clearly known and recorded during the trial, but in many instances these reasons are unknown or unclear. Often such reasons for dropout are non-ignorable. However, the standard methods for analysing longitudinal outcome data assume that missingness is non-informative and ignore the reasons for dropout, which could result in a biased comparison between the treatment groups. In this article, as a post hoc analysis, we explore the impact of informative dropout due to competing reasons on the evaluation of treatment effect in the MAGNETIC trial, the largest randomised placebo-controlled study to date comparing the addition of nebulised magnesium sulphate to standard treatment in acute severe asthma in children. We jointly model longitudinal outcome and informative dropout process to incorporate the information regarding the reasons for dropout by treatment group. The effect of nebulised magnesium sulphate compared with standard treatment is evaluated more accurately using a joint longitudinal-competing risk model by taking account of such complexities. The corresponding estimates indicate that the rate of dropout due to good prognosis is about twice as high in the magnesium group compared with standard treatment. We emphasise the importance of identifying reasons for dropout and undertaking an appropriate statistical analysis accounting for such dropout. The joint modelling approach accounting for competing reasons for dropout is proposed as a general approach for evaluating the sensitivity of conclusions to assumptions regarding missing data in clinical trials with longitudinal outcomes. EudraCT number 2007-006227-12 . Registration date 18 Mar 2008.

  16. Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children

    Energy Technology Data Exchange (ETDEWEB)

    Swanson, Jonathan O. [Seattle Children' s Hospital and University of Washington, Department of Radiology, Seattle, WA (United States); Vavilala, Monica S.; Wang, Jin; Rivara, Frederick P. [Harborview Medical Center, University of Washington, Department of Pediatrics, Seattle, WA (United States); Pruthi, Sumit [Monroe Carell Jr. Children' s Hospital at Vanderbilt University, Department of Radiology, Nashville, TN (United States); Fink, James [University of Washington, Department of Radiology, Seattle, WA (United States); Jaffe, Kenneth M. [University of Washington, Department of Rehabilitation Medicine, Seattle, WA (United States); Durbin, Dennis [University of Pennsylvania, Department of Pediatrics, Center for Injury Research and Prevention, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Koepsell, Thomas [University of Washington, Department of Epidemiology, Seattle, WA (United States); Temkin, Nancy [University of Washington, Biostatistics, Seattle, WA (United States)

    2012-08-15

    Traumatic brain injury (TBI) is a leading cause of acquired disability in children and adolescents. To demonstrate the association between specific findings on initial noncontrast head CT and long-term outcomes in children who have suffered TBI. This was an IRB-approved prospective study of children ages 2-17 years treated in emergency departments for TBI and who underwent a head CT as part of the initial work-up (n = 347). The change in quality of life at 12 months after injury was measured by the PedsQL scale. Children with TBI who had intracranial injuries identified on the initial head CT had a significantly lower quality-of-life scores compared to children with TBI whose initial head CTs were normal. In multivariate analysis, children whose initial head CT scans demonstrated intraventricular hemorrhage, parenchymal injury, midline shift {>=}5 mm, hemorrhagic shear injury, abnormal cisterns or subdural hematomas {>=}3 mm had lower quality of life scores 1 year after injury than children whose initial CTs did not have these same injuries. Associations exist between findings from the initial noncontrast head CT and quality of life score 12 months after injury in children with TBI. (orig.)

  17. Alpha male replacements in nonhuman primates: Variability in processes, outcomes, and terminology.

    Science.gov (United States)

    Teichroeb, Julie A; Jack, Katharine M

    2017-07-01

    Alpha male replacements occur in all primates displaying a dominance hierarchy but the process can be extremely variable. Here, we review the primate literature to document differences in patterns of alpha male replacements, showing that group composition and dispersal patterns account for a large proportion of this variability. We also examine the consequences of alpha male replacements in terms of sexual selection theory, infanticide, and group compositions. Though alpha male replacements are often called takeovers in the literature, this term masks much of the variation that is present in these processes. We argue for more concise terminology and provide a list of terms that we suggest more accurately define these events. Finally, we introduce the papers in this special issue on alpha male replacements in the American Journal of Primatology and discuss areas where data are still lacking. © 2017 Wiley Periodicals, Inc.

  18. Variable sleep schedules and outcomes in children with psychopathological problems: preliminary observations

    Directory of Open Access Journals (Sweden)

    Spruyt K

    2012-02-01

    Full Text Available Karen Spruyt1, Danielle L Raubuck2, Katie Grogan2, David Gozal1, Mark A Stein21Department of Pediatrics and Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL; 2Institute for Juvenile Research, Hyperactivity and Learning Problems Clinic, University of Illinois at Chicago, Chicago, ILBackground: Night-to-night variability in sleep of children with attention deficit hyperactivity disorder (ADHD may be a mediator of behavioral phenotype. We examined the potential association between alertness, sleep, and eating behaviors in children with ADHD and comorbid problems.Methods: Sleep was monitored by actigraphy for 7 days. Questionnaires were used to assess sleep complaints, habits and food patterns by parental report, and sleep complaints and sleepiness by child report.Results: The group comprised 18 children, including 15 boys, aged 9.4 ± 1.7 years, 88.9% Caucasian, who took one or multiple medications. Children slept on average for 6 hours and 58 minutes with a variability of 1 hour 3 minutes relative to the mean, and their sleepiness scores were highly variable from day to day. Most children had a normal body mass index (BMI. Sleepiness and BMI were associated with sleep schedules and food patterns, such that they accounted for 76% of variance, predominantly by the association of BMI with mean wake after sleep onset and by bedtime sleepiness, with wake after sleep onset variability. Similarly, 97% of variance was shared with eating behaviors, such as desserts and snacks, and fast food meals were associated with morning sleepiness.Conclusion: Disrupted sleep and sleepiness appears to favor unhealthy food patterns and may place children with ADHD at increased risk for obesity.Keywords: sleep, child, attention deficit hyperactivity disorder, actigraphy

  19. Analysis of biopsy outcome after three-dimensional conformal radiation therapy of prostate cancer using dose-distribution variables and tumor control probability models

    International Nuclear Information System (INIS)

    Levegruen, Sabine; Jackson, Andrew; Zelefsky, Michael J.; Venkatraman, Ennapadam S.; Skwarchuk, Mark W.; Schlegel, Wolfgang; Fuks, Zvi; Leibel, Steven A.; Ling, C. Clifton

    2000-01-01

    standardized CTV definition, substantial target motion and small dose inhomogeneities, Dmean (or any variable that downplays the effect of cold spots) is a very good predictor of biopsy outcome. While our findings may indicate a general problem in the application of current TCP models to clinical data, these conclusions should not be extrapolated to other disease sites without careful analysis

  20. Discrete factor approximations in simultaneous equation models: estimating the impact of a dummy endogenous variable on a continuous outcome.

    Science.gov (United States)

    Mroz, T A

    1999-10-01

    This paper contains a Monte Carlo evaluation of estimators used to control for endogeneity of dummy explanatory variables in continuous outcome regression models. When the true model has bivariate normal disturbances, estimators using discrete factor approximations compare favorably to efficient estimators in terms of precision and bias; these approximation estimators dominate all the other estimators examined when the disturbances are non-normal. The experiments also indicate that one should liberally add points of support to the discrete factor distribution. The paper concludes with an application of the discrete factor approximation to the estimation of the impact of marriage on wages.

  1. Examining the Relationship between Equal Opportunity Climate and Individual Level Outcome Variables

    Science.gov (United States)

    2010-10-28

    individual level of analysis to determine whether subsequent findings in this inquiry would be attributable to method bias. According to Podsakoff ...23rd annual conference of the Society for Industrial and Organizational Psychologists, 10 - 12 April, 2008, San Francisco, CA. Podsakoff , P. M

  2. Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

    International Nuclear Information System (INIS)

    Byrd, Sharon E.; Elias, Dean; Abramowicz, Jacques S.; Kent, Paul; Kimura, Robert E.; Heydeman, Peter T.

    2012-01-01

    Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature. (orig.)

  3. Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Byrd, Sharon E.; Elias, Dean [Rush Medical College and Rush University Medical Center, Department of Diagnostic Radiology and Nuclear Medicine Section of Neuroradiology, Chicago, IL (United States); Abramowicz, Jacques S. [Rush Medical College and Rush University Medical Center, Department of Obstetrics and Gynecology, Rush Fetal and Neonatal Medicine Center, Chicago, IL (United States); Kent, Paul [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Hematology and Oncology, Chicago, IL (United States); Kimura, Robert E. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Neonatology, Chicago, IL (United States); Heydeman, Peter T. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Pediatric Neurology, Chicago, IL (United States)

    2012-05-15

    Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature

  4. Hypothetical Outcome Plots Outperform Error Bars and Violin Plots for Inferences about Reliability of Variable Ordering.

    Science.gov (United States)

    Hullman, Jessica; Resnick, Paul; Adar, Eytan

    2015-01-01

    Many visual depictions of probability distributions, such as error bars, are difficult for users to accurately interpret. We present and study an alternative representation, Hypothetical Outcome Plots (HOPs), that animates a finite set of individual draws. In contrast to the statistical background required to interpret many static representations of distributions, HOPs require relatively little background knowledge to interpret. Instead, HOPs enables viewers to infer properties of the distribution using mental processes like counting and integration. We conducted an experiment comparing HOPs to error bars and violin plots. With HOPs, people made much more accurate judgments about plots of two and three quantities. Accuracy was similar with all three representations for most questions about distributions of a single quantity.

  5. Hypothetical Outcome Plots Outperform Error Bars and Violin Plots for Inferences about Reliability of Variable Ordering.

    Directory of Open Access Journals (Sweden)

    Jessica Hullman

    Full Text Available Many visual depictions of probability distributions, such as error bars, are difficult for users to accurately interpret. We present and study an alternative representation, Hypothetical Outcome Plots (HOPs, that animates a finite set of individual draws. In contrast to the statistical background required to interpret many static representations of distributions, HOPs require relatively little background knowledge to interpret. Instead, HOPs enables viewers to infer properties of the distribution using mental processes like counting and integration. We conducted an experiment comparing HOPs to error bars and violin plots. With HOPs, people made much more accurate judgments about plots of two and three quantities. Accuracy was similar with all three representations for most questions about distributions of a single quantity.

  6. Penalized regression procedures for variable selection in the potential outcomes framework.

    Science.gov (United States)

    Ghosh, Debashis; Zhu, Yeying; Coffman, Donna L

    2015-05-10

    A recent topic of much interest in causal inference is model selection. In this article, we describe a framework in which to consider penalized regression approaches to variable selection for causal effects. The framework leads to a simple 'impute, then select' class of procedures that is agnostic to the type of imputation algorithm as well as penalized regression used. It also clarifies how model selection involves a multivariate regression model for causal inference problems and that these methods can be applied for identifying subgroups in which treatment effects are homogeneous. Analogies and links with the literature on machine learning methods, missing data, and imputation are drawn. A difference least absolute shrinkage and selection operator algorithm is defined, along with its multiple imputation analogs. The procedures are illustrated using a well-known right-heart catheterization dataset. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Relapse May Serve as a Mediator Variable in Longitudinal Outcomes in Multiple Sclerosis.

    Science.gov (United States)

    Stone, Lael Anne; Cutter, Gary Raymond; Fisher, Elizabeth; Richert, Nancy; McCartin, Jennifer; Ohayon, Joan; Bash, Craig; McFarland, Henry

    2016-05-01

    Contrast-enhancing lesions (CEL) on magnetic resonance imaging (MRI) are believed to represent inflammatory disease activity in multiple sclerosis (MS), but their relationship to subsequent long-term disability and progression is unclear, particularly at longer time periods such as 8-10 years. Between 1989 and 1994, 111 MS patients were seen at the National Institutes of Health for clinical evaluations and 3 monthly contrast-enhanced MRI scans. Of these, 94 patients were re-evaluated a mean of 8 years later (range 6.1-10.5 years) with a single MRI scan and clinical evaluation. CEL number and volume were determined at baseline and follow-up. The number of relapses was ascertained over the follow-up period and annualized relapse rates were calculated. Other MRI parameters, such as T2 hyperintensity volume, T1 volume, and brain parenchymal fraction, were also calculated. While there was no direct correlation between CEL number or volume at baseline and disability status at follow-up, CEL measures at baseline did correlate with number of relapses observed in the subsequent years, and the number of relapses in turn correlated with subsequent disability as well as transition to progressive MS. While number and volume of CEL at baseline do not directly correlate with disability in the longer term in MS, our data suggest that 1 route to disability involves relapses as a mediator variable in the causal sequence of MS progression from CEL to disability. Further studies using relapse as a mediator variable in a larger data set may be warranted. Copyright © 2015 by the American Society of Neuroimaging.

  8. A Two Year Longitudinal Outcome Study of Addicted Health Care Professionals: An Investigation of the Role of Personality Variables

    Directory of Open Access Journals (Sweden)

    Daniel Angres

    2013-01-01

    Full Text Available The co-morbidity of personality disorders (PDs and other dysregulatory personality patterns with addiction have been well-established, although few studies have examined this interplay on long-term sobriety outcome. In addition, health care professionals suffering from addiction have both a significant public health impact and a unique set of treatment and recovery challenges. The aim of this study was to investigate if personality variables differentiated sobriety outcome in this population over a two year interval. A clinical sample of health care professionals participated in a substance abuse hospital treatment program individually tailored with respect to personality. Participants took the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory at intake, and were tracked two years post-discharge to determine sobriety status. Univariate analyses showed antisocial personality, female gender, and alcohol dependence were independent predictors of relapse, however a significant relationship between personality and substance use did not exist in multivariate analysis when controlling for demographic variables The lack of multivariate relationships demonstrates the heterogeneity in self-report measures of personality, which suggests the interplay of personality and addiction is complex and individualized.

  9. Effects of Popular Diets without Specific Calorie Targets on Weight Loss Outcomes: Systematic Review of Findings from Clinical Trials

    Directory of Open Access Journals (Sweden)

    Stephen D. Anton

    2017-07-01

    Full Text Available The present review examined the evidence base for current popular diets, as listed in the 2016 U.S. News & World Report, on short-term (≤six months and long-term (≥one year weight loss outcomes in overweight and obese adults. For the present review, all diets in the 2016 U.S. News & World Report Rankings for “Best Weight-Loss Diets”, which did not involve specific calorie targets, meal replacements, supplementation with commercial products, and/or were not categorized as “low-calorie” diets were examined. Of the 38 popular diets listed in the U.S. News & World Report, 20 met our pre-defined criteria. Literature searches were conducted through PubMed, Cochrane Library, and Web of Science using preset key terms to identify all relevant clinical trials for these 20 diets. A total of 16 articles were identified which reported findings of clinical trials for seven of these 20 diets: (1 Atkins; (2 Dietary Approaches to Stop Hypertension (DASH; (3 Glycemic-Index; (4 Mediterranean; (5 Ornish; (6 Paleolithic; and (7 Zone. Of the diets evaluated, the Atkins Diet showed the most evidence in producing clinically meaningful short-term (≤six months and long-term (≥one-year weight loss. Other popular diets may be equally or even more effective at producing weight loss, but this is unknown at the present time since there is a paucity of studies on these diets.

  10. Analysis of risk factor of unfavorable outcome in patients with diffuse brain injury from clinical, CT and magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Ishizaka, Hideo; Goto, Tadateru; Osada, Takahiro; Shiramizu, Hideki; Shibata, Masayoshi; Matsumae, Mitsunori

    2010-01-01

    We performed a statistical investigation of poor outcome factors for diffuse brain injury using the state of consciousness, age, gender, pupil abnormality, CT, and MRI findings upon arrival of diffuse brain injury patients to the hospital. We studied 93 diffuse brain injury patients but excluded those with multiple trauma of AIS 3 or above, those who tested positive for alcohol at the time of arrival at the hospital, and those who also exhibited a focal brain injury. Based on clinical findings made at the time patients arrived at the hospital, being older than 65 years of age, Glasgow coma scale (GCS) 7 and below, and having abnormal light reflexes were poor outcome factors. Regarding CT findings, being unable to see the suprasellar cistern, poor visualization of the ambient cistern, and subarachnoid hemorrhage (SAH) on the brain surface were poor outcome factors. Regarding MRI findings, the presence of basal ganglia injury and brainstem injury were poor outcome factors. Based on a stepwise logistic regression analysis of all poor outcome factors, it was revealed that being older than 65 years of age, having light reflex abnormalities, and the existence of brainstem injuries are all poor outcome factors, independent of each other. In addition, regarding injuries to the brain stem, midbrain injuries were the most prevalent and lateral injuries of the midbrain was the most prevalent poor outcome factor. However, in cases of injury to the brainstem only, recovery was good. (author)

  11. Association of proteinuria with various clinical findings and morphologic variables of oxford classification in immunoglobulin a nephropathy patients

    Directory of Open Access Journals (Sweden)

    Hamid Nasri

    2013-01-01

    Conclusions: Our findings firstly support the prognostic value of crescent due to its association with proteinuria and secondly imply the importance of treatment of proteinuria to prevent progression of IgAN.

  12. The impact of bilinguism on cognitive aging and dementia:Finding a path through a forest of confounding variables

    OpenAIRE

    Bak, Thomas

    2016-01-01

    Within the current debates on cognitive reserve, cognitive aging and dementia, showing increasingly a positive effect of mental, social and physical activities on health in older age, bilingualism remains one of the most controversial issues. Some reasons for it might be social or even ideological. However, one of the most important genuine problems facing bilingualism research is the high number of potential confounding variables. Bilingual communities often differ from monolingual ones in a...

  13. Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

    Science.gov (United States)

    Novy, Diane M; Engle, Mitchell P; Lai, Emily A; Cook, Christina; Martin, Emily C; Trahan, Lisa; Yu, Jun; Koyyalagunta, Dhanalakshmi

    2016-07-01

    The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain.

  14. Tongue motion variability with changes of upper airway stimulation electrode configuration and effects on treatment outcomes.

    Science.gov (United States)

    Steffen, Armin; Kilic, Ayse; König, Inke R; Suurna, Maria V; Hofauer, Benedikt; Heiser, Clemens

    2017-12-27

    Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA). Previous data have demonstrated a correlation between the phenotype of tongue motion and therapy response. Closed loop hypoglossal nerve stimulation implant offers five different electrode configuration settings which may result in different tongue motion. Two-center, prospective consecutive trial in a university hospital setting. Clinical outcomes of 35 patients were analyzed after at least 12 months of device use. Tongue motion was assessed at various electrode configuration settings. Correlation between the tongue motion and treatment response was evaluated. OSA severity was significantly reduced with the use of UAS therapy (P < .001). Changes in tongue motion patterns were frequently observed (58.8%) with different electrode configuration settings. Most of the patients alternated between right and bilateral protrusion (73.5%), which are considered to be the optimal phenotypes for selective UAS responses. Different voltage settings were required to achieve functional stimulation levels when changing between the electrode settings. UAS is highly effective for OSA treatment in selected patients with an apnea-hypopnea index between 15 and 65 events per hour and higher body mass index. Attention should be given to patients with shifting tongue movement in response to change of electrode configuration. The intraoperative cuff placement should be reassessed when tongue movement shifting is observed. 4 Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Visit-to-Visit Variability in Blood Pressure and Kidney and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Nephropathy

    DEFF Research Database (Denmark)

    McMullan, Ciaran J; Lambers Heerspink, Hiddo J; Parving, Hans-Henrik

    2014-01-01

    -to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization. OUTCOMES: The kidney disease outcome was defined as time to confirmed doubling of serum creatinine level, end-stage renal disease, or death; the cardiovascular outcome was defined......BACKGROUND: Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney...... disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy. STUDY DESIGN: Observational analysis of IDNT (Irbesartan Diabetic Nephropathy Trial) and the RENAAL...

  16. Social variables affecting mate preferences, copulation and reproductive outcome in a pack of free-ranging dogs.

    Directory of Open Access Journals (Sweden)

    Simona Cafazzo

    Full Text Available Mating and reproductive outcome is often determined by the simultaneous operation of different mechanisms like intra-sexual competition, mating preferences and sexual coercion. The present study investigated how social variables affected mating outcome in a pack of free-ranging dogs, a species supposed to have lost most features of the social system of wolves during domestication. We found that, although the pack comprised multiple breeding individuals, both male copulation success and female reproductive success were positively influenced by a linear combination of dominance rank, age and leadership. Our results also suggest that mate preferences affect mating outcome by reinforcing the success of most dominant individuals. In particular, during their oestrous period bitches clearly searched for the proximity of high-ranking males who displayed affiliative behaviour towards them, while they were more likely to reject the males who intimidated them. At the same time, male courting effort and male-male competition for receptive females appeared to be stronger in the presence of higher-ranking females, suggesting a male preference for dominant females. To our knowledge, these results provide the first clear evidence of social regulation of reproductive activities in domestic dogs, and suggest that some common organizing mechanisms may contribute to shape the social organization of both dogs and wolves.

  17. Hemodynamic variables predict outcome of emergency thoracotomy in the pediatric trauma population.

    Science.gov (United States)

    Wyrick, Deidre L; Dassinger, Melvin S; Bozeman, Andrew P; Porter, Austin; Maxson, R Todd

    2014-09-01

    Limited data exist regarding indications for resuscitative emergency thoracotomy (ETR) in the pediatric population. We attempt to define the presenting hemodynamic parameters that predict survival for pediatric patients undergoing ETR. We reviewed all pediatric patients (age <18years), entered into the National Trauma Data Bank from 2007 to 2010, who underwent ETR within one hour of ED arrival. Mechanism of injury and hemodynamics were analyzed using Chi squared and Wilcoxon tests. 316 children (70 blunt, 240 penetrating) underwent ETR, 31% (98/316) survived to discharge. Less than 5% of patients survived when presenting SBP was ≤50mmHg or heart rate was ≤70bpm. For blunt injuries there were no survivors with a pulse ≤80bpm or SBP ≤60mmHg. When survivors were compared to nonsurvivors, blood pressure, pulse, and injury type were statistically significant when treated as independent variables and in a logistic regression model. When ETR was performed for SBP ≤50mmHg or for heart rate ≤70bpm less than 5% of patients survived. There were no survivors of blunt trauma when SBP was ≤60mmHg or pulse was ≤80bpm. This review suggests that ETR may have limited benefit in these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Variable gene dispersal conditions and spatial deforestation patterns can interact to affect tropical tree conservation outcomes.

    Directory of Open Access Journals (Sweden)

    Yamini Kashimshetty

    dispersal regimens will be a likely outcome of fragmentation. Conservation implications include possible manual interventions (manual manipulations of offspring dispersers and/or pollinators in forest fragments to increase population recovery and genetic diversity retention.

  19. Variable gene dispersal conditions and spatial deforestation patterns can interact to affect tropical tree conservation outcomes.

    Science.gov (United States)

    Kashimshetty, Yamini; Pelikan, Stephan; Rogstad, Steven H

    2015-01-01

    regimens will be a likely outcome of fragmentation. Conservation implications include possible manual interventions (manual manipulations of offspring dispersers and/or pollinators) in forest fragments to increase population recovery and genetic diversity retention.

  20. Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

    International Nuclear Information System (INIS)

    Kajtazi, Naim I; Arulneyam, Jayanthi C; AlSenani, Fahmi M; Zimmerman, Valerie A; AlShami, Sadiq Y

    2009-01-01

    To investigate cerebral venous thrombosis (CVTR) clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Farad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVTR. Hyper coagulable work-up and neuroimaging were performed. Sixteen patients were female (72.7%), and the median age was 35 years. Clinical presentations included: headache (77.3%), seizures (54.5%), focal neurological signs (54.5%), and decreased level of consciousness (50%). Over two-thirds (n=11; 69%) of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency (n=3), anti phospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n=1), rhinocerebral mucormycosis (n=1), leukemia (n=1), non-Hodgkin's lymphoma (n=1), sepsis (n=1), and unknown (n=6) were causes. Affected areas included superior sagittal (n=13), transverse (n=16), sigmoid (n=14), straight (n=6), and cavernous sinus (n=1); internal cerebral vein (n=2); vein of Galen (n=3); cortical veins (n=10); and internal jugular vein (n=12). Two patients had quadriparesis, and 2 patients died. The remainder (n=18, 81.8%) improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common. Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients. (author)

  1. Associations between frequency of food shopping at different store types and diet and weight outcomes: findings from the NEWPATH study.

    Science.gov (United States)

    Minaker, Leia M; Olstad, Dana L; Thompson, Mary E; Raine, Kim D; Fisher, Pat; Frank, Lawrence D

    2016-08-01

    The present study aimed to: (i) examine associations between food store patronage and diet and weight-related outcomes; and (ii) explore consumer motivations for visiting different types of food store. A stratified probability sample of residents completed household and individual-level surveys in 2009/2010 on food purchasing patterns and motivations, dietary intake, waist circumference (WC), weight and height. Diet quality was calculated using the Healthy Eating Index for Canada from a subset of participants (n 1362). Generalized estimating equations were created in 2015 to examine how frequency of patronizing different types of food store was associated with diet quality, intake of fruits and vegetable, mean intake of energy (kcal) sodium and saturated fat, WC and BMI. Three mid-sized urban municipalities in Ontario, Canada. A representative sample of residents (n 4574). Participants who shopped frequently at food co-ops had significantly better diet quality (β=5·3; 99 % CI 0·3, 10·2) than those who did not. BMI and WC were significantly lower among those who frequently shopped at specialty shops (BMI, β=-2·1; 99 % CI -3·0, -1·1; WC, β=-4·8; 99 % CI -7·0, -2·5) and farmers' markets (BMI, β=-1·4; 99 % CI -2·3, -0·5; WC, β=-3·8; 99 % CI -6·0, -1·6) compared with those who did not. Relative importance of reasons for food outlet selection differed by large (price, food quality) v. small (proximity, convenient hours) shopping trip and by outlet type. Findings contribute to our understanding of food store selection and have implications for potentially relevant retail food intervention settings.

  2. Puzzling Findings in Studying the Outcome of “Real World” Adolescent Mental Health Services: The TRAILS Study

    Science.gov (United States)

    Jörg, Frederike; Ormel, Johan; Reijneveld, Sijmen A.; Jansen, Daniëlle E. M. C.; Verhulst, Frank C.; Oldehinkel, Albertine J.

    2012-01-01

    Background The increased use and costs of specialist child and adolescent mental health services (MHS) urge us to assess the effectiveness of these services. The aim of this paper is to compare the course of emotional and behavioural problems in adolescents with and without MHS use in a naturalistic setting. Method and Findings Participants are 2230 (pre)adolescents that enrolled in a prospective cohort study, the TRacking Adolescents' Individual Lives Survey (TRAILS). Response rate was 76%, mean age at baseline 11.09 (SD 0.56), 50.8% girls. We used data from the first three assessment waves, covering a six year period. Multiple linear regression analysis, propensity score matching, and data validation were used to compare the course of emotional and behavioural problems of adolescents with and without MHS use. The association between MHS and follow-up problem score (β 0.20, SE 0.03, p-value<0.001) was not confounded by baseline severity, markers of adolescent vulnerability or resilience nor stressful life events. The propensity score matching strategy revealed that follow-up problem scores of non-MHS-users decreased while the problem scores of MHS users remained high. When taking into account future MHS (non)use, it appeared that problem scores decreased with limited MHS use, albeit not as much as without any MHS use, and that problem scores with continuous MHS use remained high. Data validation showed that using a different outcome measure, multiple assessment waves and multiple imputation of missing values did not alter the results. A limitation of the study is that, although we know what type of MHS participants used, and during which period, we lack information on the duration of the treatment. Conclusions The benefits of MHS are questionable. Replication studies should reveal whether a critical examination of everyday care is necessary or an artefact is responsible for these results. PMID:23028584

  3. Outcomes of renal replacement therapy in boys with prune belly syndrome: findings from the ESPN/ERA-EDTA Registry

    NARCIS (Netherlands)

    Yalcinkaya, Fatos; Bonthuis, Marjolein; Erdogan, Beyza Doganay; van Stralen, Karlijn J.; Baiko, Sergey; Chehade, Hassib; Maxwell, Heather; Montini, Giovanni; Rönnholm, Kai; Sørensen, Søren Schwartz; Ulinski, Tim; Verrina, Enrico; Weber, Stefanie; Harambat, Jérôme; Schaefer, Franz; Jager, Kitty J.; Groothoff, Jaap W.

    2018-01-01

    As outcome data for prune belly syndrome (PBS) complicated by end-stage renal disease are scarce, we analyzed characteristics and outcomes of children with PBS using the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA)

  4. The Effects of Choice on Intrinsic Motivation and Related Outcomes: A Meta-Analysis of Research Findings

    Science.gov (United States)

    Patall, Erika A.; Cooper, Harris; Robinson, Jorgianne Civey

    2008-01-01

    A meta-analysis of 41 studies examined the effect of choice on intrinsic motivation and related outcomes in a variety of settings with both child and adult samples. Results indicated that providing choice enhanced intrinsic motivation, effort, task performance, and perceived competence, among other outcomes. Moderator tests revealed the effect…

  5. Finding stability regions for preserving efficiency classification of variable returns to scale technology in data envelopment analysis

    Science.gov (United States)

    Zamani, P.; Borzouei, M.

    2016-12-01

    This paper addresses issue of sensitivity of efficiency classification of variable returns to scale (VRS) technology for enhancing the credibility of data envelopment analysis (DEA) results in practical applications when an additional decision making unit (DMU) needs to be added to the set being considered. It also develops a structured approach to assisting practitioners in making an appropriate selection of variation range for inputs and outputs of additional DMU so that this DMU be efficient and the efficiency classification of VRS technology remains unchanged. This stability region is simply specified by the concept of defining hyperplanes of production possibility set of VRS technology and the corresponding halfspaces. Furthermore, this study determines a stability region for the additional DMU within which, in addition to efficiency classification, the efficiency score of a specific inefficient DMU is preserved and also using a simulation method, a region in which some specific efficient DMUs become inefficient is provided.

  6. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings.

    Science.gov (United States)

    Radanov, B P; Sturzenegger, M; Di Stefano, G

    1995-09-01

    With the increased incidence of whiplash injury following the introduction of compulsory car seat belts, a large number of reports have dealt with the aftermath of this condition. Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. the present investigation was designed to assess these combined factors. According to a strict definition of whiplash injury, we assessed a consecutive nonselected sample of 117 patients with recent injury who had similar sociocultural and educational backgrounds. The patients had been in automobile crashes and were all equally covered by accident insurance according to the country-wide scheme. Initial examination was performed 7.2 +/- 4.2 days after trauma, and follow-up examinations 3, 6, 12, and 24 months later. At baseline, features of injury mechanism, subjective complaints, and different aspects of patient history were documented and cervical spine X rays performed. At all examinations patients underwent neurologic examination and cognitive and psychosocial factor assessment. At 2 years, patients were divided into symptomatic and asymptomatic groups and then compared with regard to the initial findings. In addition, symptomatic patients who were disabled at the 2-year follow-up examination and symptomatic patients not disabled (that is, they were able to work at the pretraumatic level) were compared regarding initial and 2-year findings. At 2 years, 18% of patients still had injury-related symptoms. With regard to baseline findings the following significant differences were found: Symptomatic

  7. Measuring the Impact of Gastrointestinal Variables on the Systemic Outcome of Two Suspensions of Posaconazole by a PBPK Model.

    Science.gov (United States)

    Hens, Bart; Talattof, Arjang; Paixão, Paulo; Bermejo, Marival; Tsume, Yasuhiro; Löbenberg, Raimar; Amidon, Gordon L

    2018-03-29

    For the last two decades, the application of physiologically based pharmacokinetic (PBPK) models has grown exponentially in the field of oral absorption and in a regulatory context. Although these models are widely used, their predictive power should be validated and optimized in order to rely on these models and to know exactly what is going on "under the hood". In this study, an automated sensitivity analysis (ASA) was performed for 11 gastrointestinal (GI) variables that are integrated into the PBPK software program Simcyp®. The model of interest was a previously validated workspace that was able to predict the intraluminal and systemic behavior of two different suspensions of posaconazole in the Simcyp® Simulator. The sensitivity of the following GI parameters was evaluated in this model: gastric and duodenal pH, gastric and duodenal bicarbonate concentrations (reflecting buffer capacity), duodenal bile salts concentration, gastric emptying, the interdigestive migrating motor complex (IMMC), small intestinal transit time (SITT), gastric and jejunal volumes, and permeability. The most sensitive parameters were gastric/duodenal pH and gastric emptying, for both suspensions. The outcome of the sensitivity analyses highlights the important GI variables that must be integrated into an in vivo predictive dissolution test to help and create a rational and scientific framework/design for product development of novel and generic drug products.

  8. Revisiting the Heidenhain Variant of Creutzfeldt-Jakob Disease: Evidence for Prion Type Variability Influencing Clinical Course and Laboratory Findings.

    Science.gov (United States)

    Baiardi, Simone; Capellari, Sabina; Ladogana, Anna; Strumia, Silvia; Santangelo, Mario; Pocchiari, Maurizio; Parchi, Piero

    2016-01-01

    The Heidenhain variant defines a peculiar clinical presentation of sporadic Creutzfeldt-Jakob disease (sCJD) characterized by isolated visual disturbances at disease onset and reflecting the early targeting of prions to the occipital cortex. Molecular and histopathological typing, thus far performed in 23 cases, has linked the Heidenhain variant to the MM1 sCJD type. To contribute a comprehensive characterization of cases with the Heidenhain variant, we reviewed a series of 370 definite sCJD cases. Eighteen patients (4.9%) fulfilled the selection criteria. Fourteen of them belonging to sCJD types MM1 or MM1+2C had a short duration of isolated visual symptoms and overall clinical disease, a high prevalence of periodic sharp-wave complexes in EEG, and a marked increase of cerebrospinal fluid proteins t-tau and 14-3-3 levels. In contrast, three cases of the MM 2C or MM 2+1C types showed a longer duration of isolated visual symptoms and overall clinical disease, non-specific EEG findings, and cerebrospinal fluid concentration below threshold for the diagnosis of "probable" CJD of both 14-3-3 and t-tau. However, a brain DWI-MRI disclosed an occipital cortical hyperintensity in the majority of examined cases of both groups. While confirming the strong linkage with the methionine genotype at the polymorphic codon 129 of the prion protein gene, our results definitely establish that the Heidenhain variant can also be associated with the MM 2C sCJD type in addition to the more common MM1 type. Likewise, our results highlight the significant differences in clinical evolution and laboratory findings between cases according to the dominant PrPSc type (type 1 versus type 2).

  9. Differential Responding by Rhesus Monkeys (Macaca mulatta and Humans (Homo sapiens to Variable Outcomes in the Assurance Game

    Directory of Open Access Journals (Sweden)

    Audrey E. Parrish

    2014-08-01

    Full Text Available Behavioral flexibility in how one responds to variable partner play can be examined using economic coordination games in which subjects play against a variety of partners and therefore may need to alter their behavior to produce the highest payoff. But how do we study this behavioral flexibility once players have settled on a response? Here, we investigated how responding by rhesus monkeys (Macaca mulatta and humans (Homo sapiens playing a computerized single-player version of a coordination game, the Assurance game, changed as a function of the variable responses (Stag/Hare generated by multiple simulations (SIMs. We were interested in whether individuals could track and differentially respond to changing frequencies of Stag and Hare play by the SIMs, especially with regard to the payoff dominant (Stag-Stag outcome, something that could not be done with real partners as they quickly settled on the Stag response. For both monkeys and humans, there was a linear relationship between proportion of Stag play by the subject and the likelihood of the Stag choice by the SIM such that both species increased their use of Stag as the SIM increased its use of the Stag response. However, humans more closely matched their proportion of Stag responses to that of the SIM, whereas monkeys adopted a different, but equally effective, strategy of exploiting the higher-paying Stag alternative. These results suggest that monkeys and humans demonstrate sensitivity to a dynamic game environment in which they encounter variable contingencies for the same response options, although they may employ different strategies to maximize reward.

  10. What Variables Are Associated With the Outcome of Arthroscopic Lysis and Lavage Surgery for Internal Derangement of the Temporomandibular Joint?

    Science.gov (United States)

    Haeffs, Tyler H; D'Amato, Lindsay N; Khawaja, Shehryar N; Keith, David A; Scrivani, Steven J

    2018-04-26

    Arthroscopic lysis and lavage surgery (AS) is an effective modality that can decrease pain and increase maximum interincisal opening (MIO) in patients with internal derangement (ID) of the temporomandibular joint (TMJ). However, some patients remain in pain or have limited mandibular range of motion despite AS. The purpose of this study was to determine the effectiveness, prevalence of adverse effects, and predictors of response to TMJ AS in patients with TMJ arthralgia and ID. A retrospective cohort study was conducted using data of patients who had undergone AS by a single surgeon (D.A.K.) from September 2010 to April 2015 in the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital (Boston, MA). Variables, including demographic data, medical history, and clinical presentation, were extracted and analyzed. Criteria for surgical success were defined as a postoperative MIO of at least 35 mm and a postoperative pain level no higher than 3 on an 11-point Likert-type numeric verbal pain rating scale. Appropriate descriptive and analytic statistics were computed and significance was set at a P value less than .05. Of the 247 participants, 226 (91.5%) were women. The mean age of the sample was 38 ± 15.4 years. Successful surgical outcome was achieved in 62.3% of patients. Based on logistic regression analysis, higher initial mean pain score and concurrent use of benzodiazepines were the only variables that predicted an unsuccessful surgical outcome (P < .001; P = .005). Adverse effects were reported by 13.4% of patients, the most common being postoperative increase in pain (13.4%), temporary malocclusion (1.2%), and temporary paresthesia in the preauricular region (0.4%). The results from this study indicate that in patients with ID of the TMJ unresponsive to noninvasive treatments, high initial pain scores and concurrent use of benzodiazepines are correlated with an unsuccessful outcome after AS. Copyright © 2018. Published by

  11. Do Savings Mediate Changes in Adolescents' Future Orientation and Health-Related Outcomes? Findings From Randomized Experiment in Uganda.

    Science.gov (United States)

    Karimli, Leyla; Ssewamala, Fred M

    2015-10-01

    This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset accumulation (in this case, by increasing family savings). Using longitudinal data from the cluster-randomized experiment, we ran generalized estimating equation models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents' future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping-to address the assumption of normal distribution. Results indicate that participation in a matched Child Savings Account (CSA) program improved adolescents' future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents' confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched CSA program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched CSAs, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  12. Systolic blood pressure, routine kidney variables and renal ultrasonographic findings in cats naturally infected with feline immunodeficiency virus.

    Science.gov (United States)

    Taffin, Elien Rl; Paepe, Dominique; Ghys, Liesbeth Fe; De Roover, Katrien; Van de Maele, Isabel; Saunders, Jimmy H; Duchateau, Luc; Daminet, Sylvie

    2017-06-01

    Objectives Hypertension is a common cause of proteinuria in HIV-infected people. In cats, feline immunodeficiency virus (FIV) infection appears to be associated with proteinuria. Therefore, the results from systolic blood pressure (SBP) measurements in naturally infected FIV-positive cats were reviewed to assess whether hypertension contributes to the observed proteinuria in these cats. Ultrasonographic findings in FIV-positive cats were reviewed to complete renal assessment and to extend the scant knowledge on renal ultrasonography in cats. Methods Data from client-owned, naturally infected FIV-positive cats were retrospectively reviewed. To obtain a control group, records were reviewed from age-matched, privately owned, FIV-negative cats. Results Data from 91 FIV-infected and 113 control cats were compared. FIV-infected cats showed a significantly lower SBP ( P 0.4) occurred more frequently in FIV-infected cats ( P <0.001). Renal ultrasonography showed abnormalities in 60/91 FIV-infected cats, with hyperechogenic cortices in 39/91 and enlarged kidneys in 31/91. Conclusions and relevance Hypertension can be excluded as a common cause of renal damage leading to proteinuria in FIV-infected cats. Proteinuria and poorly concentrated urine are common in naturally infected FIV-positive cats, in contrast to azotaemia. Clinicians should cautiously interpret ultrasonographic abnormalities as these occur in over half of FIV-infected cats.

  13. Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand.

    Science.gov (United States)

    Fergusson, David M; McLeod, Geraldine F H; Horwood, L John

    2013-09-01

    Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30. Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30. After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, suicidal ideation (0.395, 0.089, suicide attempt (1.863, 0.403, drug dependence (0.425, 0.113, abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Kahn

    2015-09-01

    Full Text Available Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded “Saving and Empowering Young Lives in Europe” (SEYLE study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE’s two-stage screening program (ProfScreen and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases was set up to detect emergencies in the whole cohort (n = 1007. Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235 were referred to treatment and 2,7% of the emergency cases (27/1007 were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI, and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85, alcohol misuse (OR 2.80, and depressive symptoms (OR 1.13. Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%, anxiety (50%, and suicidal behaviours (50% generated the highest rate of referrals. Qualitative analysis of clinician’s motivations to refer a student to mental health services revealed that depressive symptoms (51%, anxiety (38%, suicidal behaviours (40%, and

  15. Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study

    Science.gov (United States)

    Kahn, Jean-Pierre; Tubiana, Alexandra; Cohen, Renaud F.; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina; Sarchiapone, Marco; Wasserman, Danuta

    2015-01-01

    Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE’s two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician’s motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and

  16. Important Variables When Screening for Students at Suicidal Risk: Findings from the French Cohort of the SEYLE Study.

    Science.gov (United States)

    Kahn, Jean-Pierre; Tubiana, Alexandra; Cohen, Renaud F; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina; Sarchiapone, Marco; Wasserman, Danuta

    2015-09-30

    Due to early detection of mental ill-health being an important suicide preventive strategy, the multi-centre EU funded "Saving and Empowering Young Lives in Europe" (SEYLE) study compared three school-based mental health promotion programs to a control group. In France, 1007 students with a mean age of 15.2 years were recruited from 20 randomly assigned schools. This paper explores the French results of the SEYLE's two-stage screening program (ProfScreen) and of the cross-program suicidal emergency procedure. Two-hundred-thirty-five ProfScreen students were screened using 13 psychopathological and risk behaviour scales. Students considered at risk because of a positive finding on one or more scales were offered a clinical interview and, if necessary, referred for treatment. A procedure for suicidal students (emergency cases) was set up to detect emergencies in the whole cohort (n = 1007). Emergency cases were offered the same clinical interview as the ProfScreen students. The interviewers documented their reasons for referrals in a short report. 16,2% of the ProfScreen students (38/235) were referred to treatment and 2,7% of the emergency cases (27/1007) were also referred to treatment due to high suicidal risk. Frequent symptoms in those students referred for evaluation were depression, alcohol misuse, non-suicidal self-injuries (NSSI), and suicidal behaviours. According to the multivariate regression analysis of ProfScreen, the results show that the best predictors for treatment referral were NSSI (OR 2.85), alcohol misuse (OR 2.80), and depressive symptoms (OR 1.13). Analysis of the proportion for each scale of students referred to treatment showed that poor social relationships (60%), anxiety (50%), and suicidal behaviours (50%) generated the highest rate of referrals. Qualitative analysis of clinician's motivations to refer a student to mental health services revealed that depressive symptoms (51%), anxiety (38%), suicidal behaviours (40%), and negative life

  17. Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year follow-up study

    DEFF Research Database (Denmark)

    Ekelund, Maria; Aalto, Kristiina; Fasth, Anders

    2017-01-01

    BACKGROUND: To study the impact of psoriasis and features associated with psoriasis on classification and outcome in a population-based follow-up cohort of children with juvenile idiopathic arthritis (JIA). METHODS: In all, 440 children with JIA were followed for a median of 8 years...... in a prospective Nordic population-based cohort study. Data for remission was available for 427 of these children. The presence of psoriasis, psoriasis-like rash, dactylitis, nail pitting, enthesitis, tenosynovitis and heredity was assessed in relation to ILAR classification and remission. RESULTS: Clinical...... findings associated with psoriasis developed consecutively during the 8-year period. Six of 14 children with psoriasis were not classified as juvenile psoriatic arthritis according to the ILAR criteria at 8 year follow-up. Dactylitis was more common in children with early onset of JIA. After 8 years we...

  18. Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection

    DEFF Research Database (Denmark)

    Skovgaard, Marlene; Schønheyder, Henrik Carl; Benfield, Thomas

    2013-01-01

    Little is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized...

  19. Do resettlement variables predict psychiatric treatment outcomes in a sample of asylum-seeking survivors of torture?

    Science.gov (United States)

    Whitsett, David; Sherman, Martin F

    2017-12-01

    Mental health clinicians who work with asylum seekers provide services to patients who face stressful everyday living conditions. However, little is known about how these problems potentially impact psychiatric treatment within these populations. The purpose of this study was thus to examine whether resettlement factors predict outcomes of a mental health intervention for a sample of asylum-seeking survivors of torture. The study included data from a US outpatient clinic that specialized in treating asylum-seeking survivors of torture. Patients (primarily from Iraq, Afghanistan and African Countries) were evaluated on demographic factors at intake and psychiatric symptoms throughout the course of treatment. Patients experienced significant reductions in depression, anxiety and trauma symptoms, although symptoms still remained near or above clinical thresholds. Stable, uncrowded housing conditions significantly predicted lower depression, anxiety and trauma symptoms at follow-up. These findings support the hypotheses that individuals seeking asylum within the United States who have survived torture can benefit from psychiatric treatment and emphasize the importance of stable living conditions in improving treatment effectiveness. This suggests the need for further research on social predictors of treatment outcomes, as well as the need for clinicians and policymakers to target improved housing as a potentially important tool to reduce psychiatric problems related to torture and forced migration.

  20. Analysis of over 10,000 Cases finds no association between previously reported candidate polymorphisms and ovarian cancer outcome

    DEFF Research Database (Denmark)

    White, Kristin L; Vierkant, Robert A; Fogarty, Zachary C

    2013-01-01

    Ovarian cancer is a leading cause of cancer-related death among women. In an effort to understand contributors to disease outcome, we evaluated single-nucleotide polymorphisms (SNP) previously associated with ovarian cancer recurrence or survival, specifically in angiogenesis, inflammation, mitosis...

  1. The Interaction of Motivation and Therapist Adherence Predicts Outcome in Cognitive Behavioral Therapy for Panic Disorder: Preliminary Findings

    Science.gov (United States)

    Huppert, Jonathan D.; Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.

    2006-01-01

    This report is a post-hoc, exploratory examination of the relationships among patient motivation, therapist protocol adherence, and panic disorder outcome in patients treated with cognitive behavioral therapy within the context of a randomized clinical trial for the treatment of panic disorder (Barlow, Gorman, Shear, & Woods, 2000). Results…

  2. Infant growth outcomes from birth to 12 months of age: findings from the Delta Healthy Sprouts comparative impact trial

    Science.gov (United States)

    Background: Multicomponent lifestyle interventions designed for both the gestational and early postnatal periods may be key to the prevention of obesity and its consequences in children. This paper’s primary objective was to determine if infant growth outcomes differed between treatment arms of a ...

  3. Sleep quality, the neglected outcome variable in clinical studies focusing on locomotor system; a construct validation study

    Directory of Open Access Journals (Sweden)

    Röder Christoph

    2010-09-01

    Full Text Available Abstract Background In addition to general health and pain, sleep is highly relevant to judging the well-being of an individual. Of these three important outcome variables, however, sleep is neglected in most outcome studies. Sleep is a very important resource for recovery from daily stresses and strains, and any alteration of sleep will likely affect mental and physical health, especially during disease. Sleep assessment therefore should be standard in all population-based or clinical studies focusing on the locomotor system. Yet current sleep assessment tools are either too long or too specific for general use. Methods Based on a literature review and subsequent patient-based rating of items, an expert panel designed a four-item questionnaire about sleep. Construct validation of the questionnaire in a random sample of the German-speaking Swiss population was performed in 2003. Reliability, correlation, and tests for internal consistency and validity were analyzed. Results Overall, 16,634 (70% out of 23,763 eligible individuals participated in the study. Test-retest reliability coefficients ranged from 0.72 to 0.87, and a Cronbach's alpha of 0.83 indicates good internal consistency. Results show a moderate to good correlation between sleep disturbances and health perception, and between sleep disturbances and overall pain. Conclusions The Sleep Standard Evaluation Questionnaire (SEQ-Sleep is a reliable and short tool with confirmed construct validity for sleep assessment in population-based observational studies. It is easy to administer and therefore suitable for postal surveys of the general population. Criterion validity remains to be determined.

  4. Outcomes of renal replacement therapy in boys with prune belly syndrome: findings from the ESPN/ERA-EDTA Registry.

    Science.gov (United States)

    Yalcinkaya, Fatos; Bonthuis, Marjolein; Erdogan, Beyza Doganay; van Stralen, Karlijn J; Baiko, Sergey; Chehade, Hassib; Maxwell, Heather; Montini, Giovanni; Rönnholm, Kai; Sørensen, Søren Schwartz; Ulinski, Tim; Verrina, Enrico; Weber, Stefanie; Harambat, Jérôme; Schaefer, Franz; Jager, Kitty J; Groothoff, Jaap W

    2018-01-01

    As outcome data for prune belly syndrome (PBS) complicated by end-stage renal disease are scarce, we analyzed characteristics and outcomes of children with PBS using the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry data. Data were available for 88 male PBS patients aged <20 years who started renal replacement therapy (RRT) between 1990 and 2013 in 35 European countries. Patient characteristics, survival, and transplantation outcomes were compared with those of male patients requiring RRT due to congenital obstructive uropathy (COU) and renal hypoplasia or dysplasia (RHD). Median age at onset of RRT in PBS was lower [7.0; interquartile range (IQR) 0.9-12.2 years] than in COU (9.6; IQR: 3.0-14.1 years) and RHD (9.4; IQR: 2.7-14.2 years). Unadjusted 10-year patient survival was 85% for PBS, 94% for COU, and 91% for RHD. After adjustment for country, period, and age, PBS mortality was similar to that of RHD but higher compared with COU [hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.03-3.74]. Seventy-four PBS patients (84%) received a first kidney transplant after a median time on dialysis of 8.4 (IQR 0.0-21.1) months. Outcomes with respect to time on dialysis before transplantation, chance of receiving a first transplant within 2 years after commencing RRT, and death-censored, adjusted risk of graft loss were similar for all groups. This study in the largest cohort of male patients with PBS receiving RRT to date demonstrates that outcomes are comparable with other congenital anomalies of the kidney and urinary tract, except for a slightly higher mortality risk compared with patients with COU.

  5. Hierarchy of treatment variables affecting outcome of 131I therapy in thyroid cancer patients with lung metastases.

    Science.gov (United States)

    Kozak, Oksana V; Sukach, Georgiy G; Korchinskaya, Oksana I; Trembach, Alexander M; Turicina, Viktoria L; Voit, Natalia U

    2005-06-01

    To assess the correlations between the first 131I activity value, time interval between the courses of radioiodine treatment and the overall number of courses required for total destruction of lung metastases in patients with differentiated thyroid cancer with metastatic lesions in lungs. 27 patients with differentiated thyroid cancer with metastases in lungs have been treated with radioiodine after surgical intervention. Activities administered amounted from 1600 to 7980 MBq. The number of radioiodine courses before total ablation of all metastatic lesions amounted from 1 to 10. Time interval between the 1st and the 2nd courses amounted from 3.5 to 11.5 months (6 months in average). The regression analysis of the data has been made. The exponential model fits the actual number of courses as a function of the first-second activity value and time interval between the courses. The first activity has a decisive influence on the number of courses required for total metastases ablation. The greater was the first activity value, the lesser was the overall number of courses. Increasing time interval between 1st and 2nd courses to 10 months seems to result in reducing the number of courses. Nevertheless even in the case of high activities the probability to undergone less then 3 courses is low. According to the proposed model in thyroid cancer patients with metastases in lungs the first activity should be not lesser than 6000 MBq, time interval between treatments--approximately 10 months. The results of our study suggest that individual factors such as histology, the number and the size of metastases in lymph nodes could not contribute more to the final outcome than the treatment variables, namely the first-second activity and time interval, nor could they affect the hierarchy of the effects revealed for the treatment variables.

  6. Characterization of the porosity of human dental enamel and shear bond strength in vitro after variable etch times: initial findings using the BET method.

    Science.gov (United States)

    Nguyen, Trang T; Miller, Arthur; Orellana, Maria F

    2011-07-01

    (1) To quantitatively characterize human enamel porosity and surface area in vitro before and after etching for variable etching times; and (2) to evaluate shear bond strength after variable etching times. Specifically, our goal was to identify the presence of any correlation between enamel porosity and shear bond strength. Pore surface area, pore volume, and pore size of enamel from extracted human teeth were analyzed by Brunauer-Emmett-Teller (BET) gas adsorption before and after etching for 15, 30, and 60 seconds with 37% phosphoric acid. Orthodontic brackets were bonded with Transbond to the samples with variable etch times and were subsequently applied to a single-plane lap shear testing system. Pore volume and surface area increased after etching for 15 and 30 seconds. At 60 seconds, this increase was less pronounced. On the contrary, pore size appears to decrease after etching. No correlation was found between variable etching times and shear strength. Samples etched for 15, 30, and 60 seconds all demonstrated clinically viable shear strength values. The BET adsorption method could be a valuable tool in enhancing our understanding of enamel characteristics. Our findings indicate that distinct quantitative changes in enamel pore architecture are evident after etching. Further testing with a larger sample size would have to be carried out for more definitive conclusions to be made.

  7. Assessing the variability of outcome for patients treated with localized prostate irradiation using different definitions of biochemical control

    International Nuclear Information System (INIS)

    Horwitz, Eric; Ziaja, Ellen; Vicini, Frank; Dmuchowski, Carl; Gonzalez, Jose; Stromberg, Jannifer; Brabbins, Donald; Hollander, Jay; Chen, Peter; Martinez, Alvaro

    1995-01-01

    Purpose: Biochemical control is rapidly becoming the standard to assess treatment outcome of clinically localized prostate cancer. However, no standardized definition of biochemical control has been established. We reviewed our experience treating patients with localized prostate cancer and applied 3 different commonly used definitions to estimate the variability in rates of biochemical control. Materials and Methods: Between (1(87)) and (12(91)), 480 patients with clinically localized prostate cancer received uniform treatment with external beam irradiation (RT) using localized prostate fields at William Beaumont Hospital. The median dose to the prostate was 66.6 Gy (range 58 to 70.4 Gy) through a 4 field technique. A total of 14 patients received pelvic nodal RT (median dose 45 Gy). Four hundred seventy patients had post-treatment (posttx) PSA values and 414 patients had pre-treatment (pretx) PSA values. Three different definitions of biochemical control were used: 1) Biochemical control was defined as posttx PSA nadir < 1 ng/ml within 1 year. After achieving nadir, if there were 2 consecutive increases, the patient was scored a failure at the time of the first increase; 2) Biochemical control was defined as posttx PSA nadir < 1.5 ng/ml within 1 year. After achieving nadir, if there were 2 consecutive increases, the patient was scored a failure at the time of the first increase; 3) Posttx PSA nadir < 4 ng/ml without a time limit. Once the nadir was achieved, and it did not rise above normal, the patient was considered controlled. Clinical local control was defined as no palpable prostate nodularity beyond 18 months, no new prostate nodularity, or a negative biopsy. If hormonal therapy was started, the patient was censored for biochemical failure at that time. Results: Median follow-up is 48 months (range 3 to 112 months). Pre-treatment PSA values were correlated with biochemical response using the 3 definitions of biochemical control as well as clinical local

  8. Dysglycemia, Glycemic Variability, and Outcome After Cardiac Arrest and Temperature Management at 33°C and 36°C

    DEFF Research Database (Denmark)

    Borgquist, Ola; Wise, Matt P; Nielsen, Niklas

    2017-01-01

    OBJECTIVES: Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes...... of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. DESIGN: Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." SETTING: Thirty-six sites in Europe...... and Australia. PATIENTS: All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. INTERVENTIONS: Targeted temperature management at 33°C or 36°C. MEASUREMENTS AND MAIN RESULTS: Nonparametric tests as well as multiple logistic regression and mixed...

  9. Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm.

    Science.gov (United States)

    Vilkki, J; Holst, P; Ohman, J; Servo, A; Heiskanen, O

    1990-04-01

    A series of 83 patients was examined with a battery of cognitive tests, a clinical interview, and computed tomography 1 year after surgery for a ruptured intracranial aneurysm. Disability on the Glasgow Outcome Scale (33%), failure to return to work (25%), impaired social relations (25%), and subjective or clinical mental impairment (56%) were found to be related to each other and to poor performance on cognitive tests, especially to verbal impairments in patients with left lateral infarctions and to memory deficits and cognitive inflexibility in patients with frontal medial infarctions. Furthermore, cognitive deficits and poor outcome were associated with diffuse brain damage. Depression and anxiety were unrelated to test performances, but were frequently reported by patients with right lateral infarctions.

  10. Longitudinal observation of treatment patterns and outcomes for patients with fibromyalgia: 12-month findings from the reflections study.

    Science.gov (United States)

    Robinson, Rebecca L; Kroenke, Kurt; Williams, David A; Mease, Philip; Chen, Yi; Faries, Douglas; Peng, Xiaomei; Hann, Danette; Wohlreich, Madelaine; McCarberg, Bill

    2013-09-01

    To describe 12-month treatment patterns and outcomes for patients starting a new medication for fibromyalgia in routine clinical practice. Data from 1,700 patients were collected at baseline and 1, 3, 6, and 12 months. Repeated measures and Poisson regression models controlling for demographic, clinical, and baseline outcomes were used to assess changes in health outcomes (Brief Pain Inventory severity and interference, Sheehan Disability Scale, Fibromyalgia Impact Questionnaire), satisfaction, and economic factors for patients who initiated on pregabalin (214, 12.6%), duloxetine (264, 15.5%), milnacipran (134, 7.9%), or tricyclic antidepressants (66, 3.9%). Sensitivity analyses were run using propensity-matched cohorts. Patients started on 145 unique drugs for fibromyalgia, and over 75% of patients took two or more medications concurrently for fibromyalgia at each time point assessed. Overall, patients showed improvement on the four health outcomes, with few differences across medication cohorts. At baseline, patients reported annual averages of 20.3 visits for outpatient care, 27.7 missed days of work, and 32.6 days of care by an unpaid caregiver. The duloxetine and milnacipran (vs pregabalin or tricyclic antidepressant) cohorts had fewer outpatient visits during the 12-month study. Patients reported satisfaction with overall treatment and their fibromyalgia medication (46.0% and 42.8%, respectively). In this real-world setting, patients with fibromyalgia reported modest improvements, high resource, and medication use, and were satisfied with the care they received. Cohort differences were difficult to discern because of the high rates of drug discontinuation and concomitant medication use over the 12-month study period. Wiley Periodicals, Inc.

  11. High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes.

    Science.gov (United States)

    Rayar, Michel; Tron, Camille; Jézéquel, Caroline; Beaurepaire, Jean Marie; Petitcollin, Antoine; Houssel-Debry, Pauline; Camus, Christophe; Verdier, Marie Clémence; Dehlawi, Ammar; Lakéhal, Mohamed; Desfourneaux, Véronique; Meunier, Bernard; Sulpice, Laurent; Bellissant, Eric; Boudjema, Karim; Lemaitre, Florian

    2018-03-01

    Tacrolimus (TAC) is the cornerstone of immunosuppressive regimen in liver transplantation (LT). Its pharmacokinetics is characterized by a high interpatient and intrapatient variability (IPV) leading to an unpredictable dose-response relationship. The aim of our study was to evaluate the impact of TAC IPV (IPV) on graft and patient outcomes after LT. We retrospectively analyzed 812 LT recipients treated with TAC. The IPV of TAC concentrations was estimated by calculating the coefficient of variation (CV) of whole blood trough concentrations. Patients were categorized in 2 groups: low IPV (CV < 40%) and high IPV (CV ≥ 40%). There were significantly more neurologic complications (31.2% vs 16.6%, P < 0.001), cardiovascular complications (19.7% vs 9.7%, P < 0.001), and acute renal failure requiring dialysis (8.5% vs 2.2%, P < 0.001) in the high CV group than in the low CV group. Moreover, graft survival was significantly poorer in the high CV group (hazard ratio, 1.42; 95% confidence interval, 1.04-1.95; P = 0.03). A pretransplantation elevated Model for End-Stage Liver Disease score (P < 0.001) and Child-Pugh grade (P < 0.001) were identified as risk factors for presenting a high CV. A high CV of TAC concentrations was found to be predictive of TAC-related toxicity and poorer survival.

  12. Characteristics of patients in routine psycho-oncological care, and changes in outcome variables during and after their treatment.

    Science.gov (United States)

    Garssen, Bert; Van der Lee, Marije; Van der Poll, Amber; Ranchor, Adelita V; Sanderman, Robbert; Schroevers, Maya J

    2016-10-01

    The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions. During a period of nine months, all clients who sought help in one of the seven psycho-oncological care institutes in the Netherlands were approached to participate in the present study (N = 483). Information was gathered with respect to demographic and medical characteristics, and type and duration of the interventions. In addition, depression, anxiety, well-being, quality of life, fatigue and daily function were determined before interventions and three and nine months later. Compared to the Dutch cancer population, patients in psycho-oncological care were more often young and female. Compared to the general Dutch population, they were highly educated and were more likely to have a partner. Clinical levels of depression, anxiety and/or fatigue were found among 83% of the patients. After three months, only 23% had completed their intervention; this figure was 62% after nine months. Symptoms decreased significantly for all outcome variables. An importance difference with randomised controlled trials is the low session frequency and the long intervention time of patients in clinical care.

  13. Infarction of Uterine Fibroids After Embolization: Relationship Between Postprocedural Enhanced MRI Findings and Long-Term Clinical Outcomes

    International Nuclear Information System (INIS)

    Katsumori, Tetsuya; Kasahara, Toshiyuki; Kin, Yoko; Nozaki, Taiki

    2008-01-01

    Purpose. To retrospectively evaluate the relationship between the degree of infarction of uterine fibroids on enhanced MRI after embolization and long-term clinical outcomes. Methods. During 92 months, 290 consecutive patients with symptomatic uterine fibroids were treated with embolization; 221 who underwent enhanced MRI before embolization and 1 week after embolization were included in this study. The infarction rates of all fibroid tissue were assessed using enhanced MRI after embolization. Patients were divided into three groups according to the infarction rates: group A (100% infarction, n 142), group B (90-99% infarction, n = 74), group C (<90% infarction, n = 5). The cumulative rates of clinical outcomes were compared among groups using the Kaplan-Meier limited method. Results. Group A had a significantly higher rate of symptom control than groups B and C. The cumulative rates of symptom control at 5 years were 93%, 71%, and 60% in groups A, B, and C, respectively. Group A had a significantly lower rate of gynecologic intervention after embolization than groups B and C. The cumulative rates of additional gynecologic intervention at 5 years were 3%, 15%, and 20% in groups A, B, and C, respectively. Conclusions. The degree of infarction of uterine fibroids after embolization on enhanced MRI was related to long-term clinical outcomes. Complete infarction of all fibroid tissue can induce a higher rate of symptom control, with a lower rate of additional gynecologic intervention in the long term compared with incomplete infarction of fibroid tissue

  14. Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.

    Science.gov (United States)

    Rose, Danielle E; Tisnado, Diana M; Tao, May L; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

    2012-06-01

    Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411). After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). © Health Research and Educational Trust.

  15. Leadership and management influences the outcome of wildlife reintroduction programs: findings from the Sea Eagle Recovery Project

    Directory of Open Access Journals (Sweden)

    Alexandra E. Sutton

    2015-06-01

    Full Text Available Wildlife reintroductions and translocations are statistically unlikely to succeed. Nevertheless, they remain a critical part of conservation because they are the only way to actively restore a species into a habitat from which it has been extirpated. Past efforts to improve these practices have attributed the low success rate to failures in the biological knowledge (e.g., ignorance of social behavior, poor release site selection, or to the inherent challenges of reinstating a species into an area where threats have already driven it to local extinction. Such research presumes that the only way to improve reintroduction outcomes is through improved biological knowledge. This emphasis on biological solutions may have caused researchers to overlook the potential influence of other factors on reintroduction outcomes. I employed a grounded theory approach to study the leadership and management of a successful reintroduction program (the Sea Eagle Recovery Project in Scotland, UK and identify four critical managerial elements that I theorize may have contributed to the successful outcome of this 50-year reintroduction. These elements are: 1. Leadership & Management: Small, dedicated team of accessible experts who provide strong political and scientific advocacy (“champions” for the project. 2. Hierarchy & Autonomy: Hierarchical management structure that nevertheless permits high individual autonomy. 3. Goals & Evaluation: Formalized goal-setting and regular, critical evaluation of the project’s progress toward those goals. 4. Adaptive Public Relations: Adaptive outreach campaigns that are open, transparent, inclusive (esp. linguistically, and culturally relevant.

  16. Leadership and management influences the outcome of wildlife reintroduction programs: findings from the Sea Eagle Recovery Project.

    Science.gov (United States)

    Sutton, Alexandra E

    2015-01-01

    Wildlife reintroductions and translocations are statistically unlikely to succeed. Nevertheless, they remain a critical part of conservation because they are the only way to actively restore a species into a habitat from which it has been extirpated. Past efforts to improve these practices have attributed the low success rate to failures in the biological knowledge (e.g., ignorance of social behavior, poor release site selection), or to the inherent challenges of reinstating a species into an area where threats have already driven it to local extinction. Such research presumes that the only way to improve reintroduction outcomes is through improved biological knowledge. This emphasis on biological solutions may have caused researchers to overlook the potential influence of other factors on reintroduction outcomes. I employed a grounded theory approach to study the leadership and management of a successful reintroduction program (the Sea Eagle Recovery Project in Scotland, UK) and identify four critical managerial elements that I theorize may have contributed to the successful outcome of this 50-year reintroduction. These elements are: 1. Leadership & Management: Small, dedicated team of accessible experts who provide strong political and scientific advocacy ("champions") for the project. 2. Hierarchy & Autonomy: Hierarchical management structure that nevertheless permits high individual autonomy. 3. Goals & Evaluation: Formalized goal-setting and regular, critical evaluation of the project's progress toward those goals. 4. Adaptive Public Relations: Adaptive outreach campaigns that are open, transparent, inclusive (esp. linguistically), and culturally relevant.

  17. Risk prediction in the community: A systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adults.

    LENUS (Irish Health Repository)

    O'Caoimh, Rónán

    2015-09-01

    Few case-finding instruments are available to community healthcare professionals. This review aims to identify short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death. Data sources included PubMed and the Cochrane library. Data on outcome measures, patient and instrument characteristics, and trial quality (using the Quality In Prognosis Studies [QUIPS] tool), were double-extracted for derivation-validation studies in community-dwelling older adults (>50 years). Forty-six publications, representing 23 unique instruments, were included. Only five were externally validated. Mean patient age range was 64.2-84.6 years. Most instruments n=18, (78%) were derived in North America from secondary analysis of survey data. The majority n=12, (52%), measured more than one outcome with hospitalisation and the Probability of Repeated Admission score the most studied outcome and instrument respectively. All instruments incorporated multiple predictors. Activities of daily living n=16, (70%), was included most often. Accuracy varied according to instruments and outcomes; area under the curve of 0.60-0.73 for hospitalisation, 0.63-0.78 for functional decline, 0.70-0.74 for institutionalisation and 0.56-0.82 for death. The QUIPS tool showed that 5\\/23 instruments had low potential for bias across all domains. This review highlights the present need to develop short, reliable, valid instruments to case-find older adults at risk in the community.

  18. Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes.

    Science.gov (United States)

    Soyupek, Feray; Yesildag, Ahmet; Kutluhan, Suleyman; Askin, Ayhan; Ozden, Ahmet; Uslusoy, Gokcen Ay; Demirci, Seden

    2012-10-01

    Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen's and Tinel's signs. We could find reduction in CSA of MN in PCS group (P 0.05) and also between ultrasonographic parameters and BQ scores (P > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.

  19. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease: findings from the DANREHAB trial.

    Science.gov (United States)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-10-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far. The study sample consisted of 536 patients admitted to hospital for CVD and followed in a rehabilitation trial. Symptoms were assessed using the Hospital Anxiety and Depression Scale at baseline and after 1 year. Cox proportional hazards model was used to describe the association between anxiety and depression and adverse outcome (myocardial infarction (MI), heart failure (HF), stroke, death and a combined endpoint) after 5 years. Prevalence of anxiety and depression at baseline was 32% and 13%, respectively. There were 303 combined events; 140 deaths, 60 patients had MI, 177 patients were admitted to hospital with HF and 60 patients had a stroke. Neither anxiety nor depression at any time was associated with mortality or the combined endpoint. Anxiety in IHD patients at baseline and at 1 year was associated with increased risk of MI (HR 2.74; 95% CI: 1.10-6.83) but was attenuated after adjusting for other risk factors (HR 1.18; 95% CI: 0.39-3.55). Both anxiety and depression at 1 year were associated with increased risk of stroke: HR 2.25 (95% CI: 1.05-4.82) and 2.34 (95% CI: 0.99-5.50), respectively, but risk associated with anxiety was attenuated after adjustment. There were no gender differences. Contrary to conclusions from recent meta-analyses, anxiety and depression measured at baseline and after 1 year were not associated with adverse outcome in CVD patients after multivariable adjustment. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study.

    Science.gov (United States)

    Buxbaum, James; Quezada, Michael; Chong, Bradford; Gupta, Nikhil; Yu, Chung Yao; Lane, Christianne; Da, Ben; Leung, Kenneth; Shulman, Ira; Pandol, Stephen; Wu, Bechien

    2018-03-15

    The Pancreatitis Activity Scoring System (PASS) has been derived by an international group of experts via a modified Delphi process. Our aim was to perform an external validation study to assess for concordance of the PASS score with high face validity clinical outcomes and determine specific meaningful thresholds to assist in application of this scoring system in a large prospectively ascertained cohort. We analyzed data from a prospective cohort study of consecutive patients admitted to the Los Angeles County Hospital between March 2015 and March 2017. Patients were identified using an emergency department paging system and electronic alert system. Comprehensive characterization included substance use history, pancreatitis etiology, biochemical profile, and detailed clinical course. We calculated the PASS score at admission, discharge, and at 12 h increments during the hospitalization. We performed several analyses to assess the relationship between the PASS score and outcomes at various points during hospitalization as well as following discharge. Using multivariable logistic regression analysis, we assessed the relationship between admission PASS score and risk of severe pancreatitis. PASS score performance was compared to established systems used to predict severe pancreatitis. Additional inpatient outcomes assessed included local complications, length of stay, development of systemic inflammatory response syndrome (SIRS), and intensive care unit (ICU) admission. We also assessed whether the PASS score at discharge was associated with early readmission (re-hospitalization for pancreatitis symptoms and complications within 30 days of discharge). A total of 439 patients were enrolled, their mean age was 42 (±15) years, and 53% were male. Admission PASS score >140 was associated with moderately severe and severe pancreatitis (OR 3.5 [95% CI 2.0, 6.3]), ICU admission (OR 4.9 [2.5, 9.4]), local complications (3.0 [1.6, 5.7]), and development of SIRS (OR 2.9 [1

  1. Oral Therapy, Microbiological Findings, and Comorbidity Influence the Outcome of Prosthetic Joint Infections Undergoing 2-Stage Exchange.

    Science.gov (United States)

    Ascione, Tiziana; Pagliano, Pasquale; Balato, Giovanni; Mariconda, Massimo; Rotondo, Renato; Esposito, Silvano

    2017-07-01

    The aim of the present study was to investigate potential predictive factors of an unfavorable outcome in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. Patients with PJI undergoing 2-stage exchange and observed over a 5-year period (2009-2013) were included. Cure was defined by the disappearance of infection after a 96-week follow-up period. Statistical analysis was performed using the Mann-Whitney U test, the Fisher exact test, and the multivariate analysis. One-hundred twenty-two patients with PJI were included (median age, 69 years [range, 36-80 years]; 48% males, 47 hip PJI, and 75 knee PJI). Known comorbidities related to an increased risk of infection were reported in 43 patients (35%). Microbiological definition was obtained in 101 (83%) patients, and Staphylococcus aureus was isolated in 44 (36%) patients. Coagulase-negative staphylococci were isolated in 41 (34%) patients. A favorable outcome was obtained in 102 of 122 patients (84%). After univariate analysis, bacterial growth from operative specimens (P = .007), growth of Gram-positive bacteria (P rate can be reduced with appropriate treatment choices. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection : A cohort analysis to define a case-mix variable

    NARCIS (Netherlands)

    Sandberg, Evelien M.; Driessen, Sara R C; Bak, Evelien A.T.; van Geloven, Nan; Berger, Judith P.; Smeets, Mathilde J.G.H.; Rhemrev, Johann P T; Jansen, F.W.

    2018-01-01

    Background: Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis

  3. Executive Summary of the NHLBI Workshop Report: Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes.

    Science.gov (United States)

    Maier, Lisa A; Crouser, Elliott D; Martin, William J; Eu, Jerry

    2017-12-01

    Sarcoidosis is a systemic granulomatous disease that primarily affects the lung; it is associated with significant disparities, more commonly impacting those in the prime of their lives (age 20-50 yr, with a second peak after age 60 yr), black individuals, and women. However, the burden of disease, the ability to diagnose and prognose organ involvement and course, as well as specific treatment options, management options, and disease pathogenesis remain poorly understood. As a result, the National Heart, Lung, and Blood Institute undertook a sarcoidosis workshop, "Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes," to help address these issues by defining the scientific and clinical priorities to improve sarcoidosis care. The overarching recommendations from this workshop are outlined in the following summary and detailed in the accompanying articles. The recommendations included establishing collaborations and networks to conduct research based on consensus definitions of disease phenotypes and standards of care, and to provide clinical outreach to areas with a burden of disease to improve care. These collaborative networks would also serve as the hub to conduct clinical trials of devastating phenotypes (e.g., cardiac, neurologic, and fibrotic disease) not only for treatment but to enhance our understanding of the burden of disease. In addition, the networks would be used to leverage state-of-the-art "omics" and systems biology research, as well as other studies to advance understanding of disease pathogenesis, and development of biomarkers and therapeutic targets, with a goal to translate this information to improve care of individuals with sarcoidosis.

  4. Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population.

    Science.gov (United States)

    Sumithran, P; Purcell, K; Kuyruk, S; Proietto, J; Prendergast, L A

    2018-02-01

    Consistent, strong predictors of obesity treatment outcomes have not been identified. It has been suggested that broadening the range of predictor variables examined may be valuable. We explored methods to predict outcomes of a very-low-energy diet (VLED)-based programme in a clinically comparable setting, using a wide array of pre-intervention biological and psychosocial participant data. A total of 61 women and 39 men (mean ± standard deviation [SD] body mass index: 39.8 ± 7.3 kg/m 2 ) underwent an 8-week VLED and 12-month follow-up. At baseline, participants underwent a blood test and assessment of psychological, social and behavioural factors previously associated with treatment outcomes. Logistic regression, linear discriminant analysis, decision trees and random forests were used to model outcomes from baseline variables. Of the 100 participants, 88 completed the VLED and 42 attended the Week 60 visit. Overall prediction rates for weight loss of ≥10% at weeks 8 and 60, and attrition at Week 60, using combined data were between 77.8 and 87.6% for logistic regression, and lower for other methods. When logistic regression analyses included only baseline demographic and anthropometric variables, prediction rates were 76.2-86.1%. In this population, considering a wide range of biological and psychosocial data did not improve outcome prediction compared to simply-obtained baseline characteristics. © 2017 World Obesity Federation.

  5. Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment

    DEFF Research Database (Denmark)

    Jensen, Tue Secher; Albert, Hanne B; Sorensen, Joan S

    2007-01-01

    OBJECTIVE: The aims of this study were to investigate the possible prognostic value of disk-related magnetic resonance imaging (MRI) findings in relation to recovery at 14 months in patients with severe sciatica, and whether improvement of disk herniation and/or nerve root compromise is concurrent...... with recovery. METHODS: All patients included in this prospective observational study of patients with sciatica receiving active conservative treatment were scanned at baseline and at 14 months' follow-up. Definite recovery at follow-up was defined as an absence of sciatic leg pain and a Roland Morris...... in that the prevalence of disk-related MRI findings was different for men and women, and they had different recovery rates. Improvement of disk herniations and nerve root compromise over time did not coincide with definite recovery. CONCLUSIONS: In patients with sciatica receiving active conservative treatment, broad...

  6. Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable.

    Science.gov (United States)

    Sandberg, Evelien M; Driessen, Sara R C; Bak, Evelien A T; van Geloven, Nan; Berger, Judith P; Smeets, Mathilde J G H; Rhemrev, Johann P T; Jansen, Frank Willem

    2018-01-01

    Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable. A total of 2655 LH's were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I ( n  = 106) and II ( n  = 103) endometriosis compared to LH without endometriosis. LH with stages III ( n  = 93) and IV ( n  = 95) endometriosis were associated with more intra-operative blood loss ( p  = case-mix variables in future quality measurement tools.

  7. Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

    International Nuclear Information System (INIS)

    Gierada, David S.; Pinsky, Paul F.; Duan, Fenghai; Garg, Kavita; Hart, Eric M.; Kazerooni, Ella A.; Nath, Hrudaya; Watts, Jubal R.; Aberle, Denise R.

    2017-01-01

    This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. (orig.)

  8. Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

    Energy Technology Data Exchange (ETDEWEB)

    Gierada, David S. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Box 8131, St. Louis, MO (United States); Pinsky, Paul F. [National Cancer Institute, Bethesda, MD (United States); Duan, Fenghai [Brown University School of Public Health, Department of Biostatistics and Center for Statistical Sciences, Providence, RI (United States); Garg, Kavita [University of Colorado School of Medicine, Mail Stop F726, Box 6510, Aurora, CO (United States); Hart, Eric M. [Northwestern University, Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Kazerooni, Ella A. [University of Michigan Health System, Department of Radiology, Ann Arbor, MI (United States); Nath, Hrudaya; Watts, Jubal R. [University of Alabama at Birmingham School of Medicine, Department of Radiology-JTN370, Birmingham, AL (United States); Aberle, Denise R. [David Geffen School of Medicine at UCLA, Department of Radiological Sciences, Los Angeles, CA (United States)

    2017-08-15

    This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. (orig.)

  9. The developmental origin of adolescent alcohol use: findings from the Mater University Study of Pregnancy and its outcomes.

    Science.gov (United States)

    Alati, Rosa; Clavarino, Alexandra; Najman, Jake M; O'Callaghan, Michael; Bor, William; Mamun, Abdullah Al; Williams, Gail M

    2008-11-01

    It is unclear whether fetal alcohol exposure contributes to alcohol use in adolescence. In this study, we examine the association between maternal alcohol use in pregnancy and adolescents' drinking patterns at age 14. The association of maternal alcohol exposure with early drinking was examined in 4363 adolescents taking part to the Mater University Study of Pregnancy (MUSP) and its outcomes, a population based birth cohort study commenced in Brisbane (Australia) in 1981. Mothers and children were followed up at birth, 5 and 14 years after the initial interview. Maternal alcohol use was assessed before and during pregnancy and at the 5 years follow-up. Adolescents' alcohol use was assessed at child age 14. In multivariable analysis those born of mothers who consumed 3+ glasses during pregnancy were at increased risk to report drinking 3+ glasses compared with those whose mothers reported no drinking or drinking up to 2 glasses. Comparisons controlling for drinking before pregnancy and at age 5 found the averaged odds ratio of maternal drinking in pregnancy on risk of reporting alcohol consumption of 3 and more glasses at age 14 was 2.74 (CI 1.70, 4.22). Our study suggests that they maybe a biological origin of early drinking. Further studies are needed to better disentangle the nature of the association and the role of other possible confounding factors.

  10. Referral Patterns for Chronic Groin Pain and Athletic Pubalgia/Sports Hernia: Magnetic Resonance Imaging Findings, Treatment, and Outcomes.

    Science.gov (United States)

    Zoland, Mark P; Maeder, Matthew E; Iraci, Joseph C; Klein, Devon A

    Chronic groin pain is a common problem and has been well-described in high-performance athletes. Its presentation in the recreational athlete has been less frequently described. We present the experience of a tertiary group of physicians specializing in groin pain and athletic pubalgia. Dynamic magnetic resonance imaging (MRI) protocol was employed. Surgery was performed in patients failing non-surgical management. A retrospective review was performed. Of 117 mostly non-professional athletes, there were 79 MRI-positive cases of athletic pubalgia (68%). Other common findings were acetabular labral tear (57%) and inguinal hernia (35%). Employment of a dynamic MRI protocol increased sensitivity for certain pathologies. Of positive athletic pubalgia cases, 49% went on to have surgical repair. The satisfaction rate in the surgical group was 90% at follow up. Advances in MRI have increased our ability to characterize and diagnose specific injuries causing groin pain. We present our diagnostic algorithm, including an MRI protocol that not only evaluates the groin, but has increased sensitivity for additional findings such as inguinal hernia and abdominal wall deficiencies. A targeted work-up and subsequent surgical treatment in the appropriate patient, even in the recreational athletic population, has yielded a 90% satisfaction rate.

  11. Finding benefits from acculturative stress among Asian Americans: Self-reflection moderating the mediating effects of ethnocultural empathy on positive outcomes.

    Science.gov (United States)

    Wei, Meifen; Li, Chun-I; Wang, Cixin; Ko, Stacy Y

    2016-11-01

    This study examined a moderated mediation model to see whether self-reflection moderated (a) the association between acculturative stress and ethnocultural empathy and (b) the indirect effects of acculturative stress on 2 positive outcomes (i.e., bicultural competence and making positive sense of adversity) through ethnocultural empathy. A total of 330 Asian American college students from a West coast university participated in an online survey. Results from PROCESS supported hypotheses. First, self-reflection significantly moderated the effects of acculturative stress on ethnocultural empathy. Specifically, the effect of acculturative stress on ethnocultural empathy was significantly positive for those with lower self-reflection. Conversely, this effect was not significant for those with higher self-reflection, but ethnocultural empathy was consistently high across all levels of acculturative stress for those with higher self-reflection. Post hoc exploratory analyses examined the moderated mediation model using each of the 5 domains of acculturative stress as predictors; results supported the moderated mediation hypotheses for 2 domains, discrimination and cultural isolation. Second, self-reflection significantly moderated the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy. Results from conditional indirect effects suggested that the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy were significantly positive for those with lower self-reflection. Conversely, the indirect effects were not significant for those with higher self-reflection, but the 2 positive outcomes stayed high at all levels of acculturative stress. Post hoc analyses found that 5 of 6 components of bicultural competence used as outcome variables supported the moderation mediation hypotheses. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. Associations between objectively measured physical activity and later mental health outcomes in children: findings from the UK Millennium Cohort Study.

    Science.gov (United States)

    Ahn, Jane V; Sera, Francesco; Cummins, Steven; Flouri, Eirini

    2018-02-01

    The beneficial effect of physical activity (PA) on mental health in adults is well established, but less is known about this relationship in children. We examine associations between objectively measured sedentary time, PA and mental health in 11-year-olds from the UK Millennium Cohort Study (MCS). Longitudinal data from MCS sweeps 4 (age 7) and 5 (age 11) were used (n=6153). Accelerometer data were collected at MCS4, and mental health was measured at MCS4 and MCS5 using subscales (peer, emotional, conduct, hyperactivity) of the Strengths and Difficulties Questionnaire (SDQ). Associations between mean daily PA minutes at different intensities (sedentary, light, moderate-to-vigorous) at MCS4 and SDQ outcomes at MCS5 (score range 0-10) were estimated using multiple linear regression models, adjusting for SDQ at MCS4 and individual and family characteristics, and stratified by gender. In fully adjusted models, increased PA at MCS4 was associated with fewer peer problems in boys and girls at MCS5. For each additional 15 min in moderate-to-vigorous physical activity (MVPA), peer problems decreased -0.077 points (95% CI -0.133 to -0.022) in boys. For girls, light PA was associated with decreased peer problems (-0.071 points/30 min, 95% CI -0.130 to -0.013). Greater sedentary time was associated with more peer problems and fewer hyperactivity symptoms in boys and girls. Increased MVPA was associated with more conduct and hyperactivity problems in boys and more hyperactivity in girls. Increased sedentary time is associated with more peer problems in children, and PA, generally, is beneficial for peer relations in children aged 11. © 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.

  13. Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: an aggregate study of single-case research with individuals with ASD.

    Science.gov (United States)

    Ganz, Jennifer B; Rispoli, Mandy J; Mason, Rose Ann; Hong, Ee Rea

    2014-06-01

    The purpose of this meta-analysis was to evaluate the potential moderating effects of intervention setting and type of aided augmentative and alternative communication (AAC) on outcome variables for students with autism spectrum disorders. Improvement rate difference, an effect size measure, was used to calculate aggregate effects across 35 single-case research studies. Results indicated that the largest effects for aided AAC were observed in general education settings. With respect to communication outcomes, both speech generating devices (SGDs) and the Picture Exchange Communication System (PECS) were associated with larger effects than other picture-based systems. With respect to challenging behaviour outcomes, SGDs produced larger effects than PECS. This aggregate study highlights the importance of considering intervention setting, choice of AAC system and target outcomes when designing and planning an aided AAC intervention.

  14. Unintended outcomes of farmers' adaptation to climate variability: deforestation and conservation in Calakmul and Maya biosphere reserves

    Directory of Open Access Journals (Sweden)

    Claudia Rodriguez-Solorzano

    2014-06-01

    Full Text Available Minimizing the impact of climate change on farmer livelihoods is crucial, but adaptation efforts may have unintended consequences for ecosystems, with potential impacts on farmers' welfare. Unintended outcomes of climate adaptation strategies have been widely discussed, however, empirical exploration has been neglected. Grounded in scholarship on climate adaptation, environmental governance, social-ecological systems, and land-use change, this paper studies whether farmers' climate adaptation contributes to deforestation or forest conservation. The paper draws on interviews with 353 farmers from 46 communities in Calakmul Biosphere Reserve in Mexico and Maya Biosphere Reserve in Guatemala. Farmers in the area of study have implemented adaptation strategies that people around the world have used for centuries, including migration, diversification, savings, and pooling. The findings show that climate adaptation can increase deforestation or support forest conservation depending on the type of adaptation strategy farmers implement. Saving, based on cattle ranching, is a deforestation-driving strategy. The choice of this strategy is influenced by distance to the commercial and administrative center and cash benefits from the forest. Deforestation can have a negative impact on farmers' welfare, as well as harm biodiversity and contribute to increased climate change. Thus, deforestation-driving adaptation strategies may be ineffective. However, diversification, based on off-farm jobs and operating provision shops, is a conservation-driving strategy influenced by distance as well as by family size. Farmers who choose diversification to adapt may contribute to a virtuous circle in which livelihood improvement in the short term leads to enhanced social-ecological resilience in the longer term. The need for farmers to implement adaptation strategies thus represents great risk but also opportunities.

  15. Patient-reported outcomes and therapeutic affordances of social media: findings from a global online survey of people with chronic pain.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando; Lopez-Campos, Guillermo

    2015-01-22

    Patient-reported outcomes (PROs) from social media use in chronic disease management continue to emerge. While many published articles suggest the potential for social media is positive, there is a lack of robust examination into mediating mechanisms that might help explain social media's therapeutic value. This study presents findings from a global online survey of people with chronic pain (PWCP) to better understand how they use social media as part of self-management. Our aim is to improve understanding of the various health outcomes reported by PWCP by paying close attention to therapeutic affordances of social media. We wish to examine if demographics of participants underpin health outcomes and whether the concept of therapeutic affordances explains links between social media use and PROs. The goal is for this to help tailor future recommendations for use of social media to meet individuals' health needs and improve clinical practice of social media use. A total of 231 PWCP took part in a global online survey investigating PROs from social media use. Recruited through various chronic disease entities and social networks, participants provided information on demographics, health/pain status, social media use, therapeutic affordances, and PROs from use. Quantitative analysis was performed on the data using descriptive statistics, cross-tabulation, and cluster analysis. The total dataset represented 218 completed surveys. The majority of participants were university educated (67.0%, 146/218) and female (83.9%, 183/218). More than half (58.7%, 128/218) were married/partnered and not working for pay (75.9%, 88/116 of these due to ill health). Fibromyalgia (46.6%, 55/118) and arthritis (27.1%, 32/118) were the most commonly reported conditions causing pain. Participants showed a clear affinity for social network site use (90.0%, 189/210), followed by discussion forums and blogs. PROs were consistent, suggesting that social media positively impact psychological

  16. Patient-Reported Outcomes and Therapeutic Affordances of Social Media: Findings From a Global Online Survey of People With Chronic Pain

    Science.gov (United States)

    Gray, Kathleen; Martin-Sanchez, Fernando; Lopez-Campos, Guillermo

    2015-01-01

    Background Patient-reported outcomes (PROs) from social media use in chronic disease management continue to emerge. While many published articles suggest the potential for social media is positive, there is a lack of robust examination into mediating mechanisms that might help explain social media’s therapeutic value. This study presents findings from a global online survey of people with chronic pain (PWCP) to better understand how they use social media as part of self-management. Objective Our aim is to improve understanding of the various health outcomes reported by PWCP by paying close attention to therapeutic affordances of social media. We wish to examine if demographics of participants underpin health outcomes and whether the concept of therapeutic affordances explains links between social media use and PROs. The goal is for this to help tailor future recommendations for use of social media to meet individuals’ health needs and improve clinical practice of social media use. Methods A total of 231 PWCP took part in a global online survey investigating PROs from social media use. Recruited through various chronic disease entities and social networks, participants provided information on demographics, health/pain status, social media use, therapeutic affordances, and PROs from use. Quantitative analysis was performed on the data using descriptive statistics, cross-tabulation, and cluster analysis. Results The total dataset represented 218 completed surveys. The majority of participants were university educated (67.0%, 146/218) and female (83.9%, 183/218). More than half (58.7%, 128/218) were married/partnered and not working for pay (75.9%, 88/116 of these due to ill health). Fibromyalgia (46.6%, 55/118) and arthritis (27.1%, 32/118) were the most commonly reported conditions causing pain. Participants showed a clear affinity for social network site use (90.0%, 189/210), followed by discussion forums and blogs. PROs were consistent, suggesting that social

  17. Association of Haematological and Radiological Findings with Clinical Outcome in Hospitalized Children 2-36 Months Old with Severe Lower Respiratory Tract Infection

    International Nuclear Information System (INIS)

    Waris, R.; Bhatti, N.; Nisar, Y. B.

    2016-01-01

    Background: Despite reduction in ld mortality during last decade, lower respiratory tract infection (LRTI) remained number one killer of under-five. The current study aimed to assess the association of haematological and radiological findings with clinical outcome in hospitalized children 2-36 months old with severe LRTI. Methods: In the current cross sectional study, 581 children 2-36 months old with severe LRTI were enrolled and followed at the Children Hospital, Islamabad, between 2011 and 2014. At the time of enrolment, complete history of present illness, anthropometric measurements, blood sample and chest radiograph were obtained. The primary outcome was either early clinical response (within 72 hours) or delayed clinical response (>72 hours). Multivariable logistic regression was performed to examine the association between haematological and radiological findings with clinical outcome, adjusted for potential confounding factors. Results: Of 581 enrolled children, 292 (50.3 percent) children had early, and 289 (49.7 percent) had delayed clinical response. The multivariable logistic regression showed that leucocytosis (OR 1.79, 95 percent CI 1.15-2.79), neutrophilia (OR 1.91, 95 percent CI 1.29-2.84), radiological interstitial pneumonia (OR 2.49, 95 percent CI 1.70-3.64), and lobar consolidation (OR 6.00, 95 percent CI 2.41-14.96) were significantly associated with delayed clinical response, after adjusted for potential confounding factors. Conclusions: Delayed clinical response was significantly associated with abnormal haematological and radiological findings at the time of admission in children 2-36 months old with severe LRTI. Haematological and radiological findings at the time of presentation are useful for predicting delayed clinical response in children 2-36 months old with severe LRTI. (author)

  18. Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Inga; Frank, Matthias; Hinz, Peter; Ekkernkamp, Axel [Ernst-Moritz-Arndt-University Greifswald, Department of Trauma and Orthopedic Surgery, Emergency Department, Greifswald (Germany); Kuehn, Jens Peter; Hosten, Norbert; Langner, Soenke [Ernst-Moritz-Arndt-University Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Greifswald (Germany)

    2011-04-15

    Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome. During a 6-month period, 38 patients were prospectively included. MRI was performed within 48 h of trauma and clinical examination using a protocol consisting of axial T2-weighted and coronal and sagittal T1-weighted images and a sagittal proton density (PDw) sequence. Each ligament injury was graded on a three-point scale. Functional outcome was evaluated using the AOFAS ankle-hindfoot scale. In 24/38 patients (63.12%), ligament injury was observed. In 22/24 cases, this was an injury of the lateral ligaments and in 2/24 cases of the medial ligaments. Injury of the syndesmosis occurred in three patients, a bone bruise in four, and an osteochondral lesion in three cases. Patients with an injury of two or more ligaments or a bone bruise had a lower AOFAS score and returned to sports activities and full weight-bearing later (P < 0.01). MR imaging at 3 Tesla is an independent predictor for clinical outcome. Therefore MRI may be beneficial in those cases where the findings influence further treatment. (orig.)

  19. Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome

    International Nuclear Information System (INIS)

    Langner, Inga; Frank, Matthias; Hinz, Peter; Ekkernkamp, Axel; Kuehn, Jens Peter; Hosten, Norbert; Langner, Soenke

    2011-01-01

    Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome. During a 6-month period, 38 patients were prospectively included. MRI was performed within 48 h of trauma and clinical examination using a protocol consisting of axial T2-weighted and coronal and sagittal T1-weighted images and a sagittal proton density (PDw) sequence. Each ligament injury was graded on a three-point scale. Functional outcome was evaluated using the AOFAS ankle-hindfoot scale. In 24/38 patients (63.12%), ligament injury was observed. In 22/24 cases, this was an injury of the lateral ligaments and in 2/24 cases of the medial ligaments. Injury of the syndesmosis occurred in three patients, a bone bruise in four, and an osteochondral lesion in three cases. Patients with an injury of two or more ligaments or a bone bruise had a lower AOFAS score and returned to sports activities and full weight-bearing later (P < 0.01). MR imaging at 3 Tesla is an independent predictor for clinical outcome. Therefore MRI may be beneficial in those cases where the findings influence further treatment. (orig.)

  20. Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities.

    NARCIS (Netherlands)

    Jacobs, B.; Beems, T.; Stulemeijer, M.; Vugt, A.B. van; Vliet, A.M. van der; Borm, G.F.; Vos, P.E.

    2010-01-01

    Mild traumatic brain injury (mTBI) is a common heterogeneous neurological disorder with a wide range of possible clinical outcomes. Accurate prediction of outcome is desirable for optimal treatment. This study aimed both to identify the demographic, clinical, and computed tomographic (CT)

  1. Favorable cardio-metabolic outcomes following high carbohydrate intake in accordance with the Daniel Fast: A review of available findings

    Directory of Open Access Journals (Sweden)

    Richard Bloomer

    2017-03-01

    Full Text Available The Daniel Fast is a biblically inspired dietary program rich in carbohydrate, most closely resembling a vegan diet but with additional restrictions, including the elimination of processed foods, white flour products, preservatives, additives, sweeteners, caffeine, and alcohol. While no specific requirements are placed on the ingestion of specific percentages of macronutrients, the mean daily carbohydrate intake is by default approximately 60%, while protein and fat intake are 15% and 25%, respectively. Despite a relatively high carbohydrate intake, multiple favorable cardio-metabolic effects are noted when following the plan, in as few as three weeks. This includes improvements in HOMA-IR, which may be at least in part due to the lower glycemic load and high dietary fiber content of the foods consumed. Other notable changes include reductions in systemic inflammation, total and LDL-cholesterol, oxidative stress, blood pressure, and body weight/body fat. Short and moderate-term compliance to the program is excellent-better than most dietary programs, perhaps due to the ad libitum nature of this plan. This paper presents an overview of the Daniel Fast, a carbohydrate-rich dietary program, including relevant findings from both human and animal investigations using this dietary model.

  2. Significance of performing CT after radiofrequency ablation of hepatocellular carcinoma. Relationship between CT findings in areas other than the tumor site and post therapeutic outcome

    International Nuclear Information System (INIS)

    Shimokoube, Kouichi; Saito, Kazuhiro; Kotake, Fumio; Nakamura, Hiroshi; Mizokami, Yuji; Mikami, Ryuji; Matsuoka, Takeshi

    2004-01-01

    The relationships between the CT findings following radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and the clinical symptoms and laboratory data were examined. The subjects consisted of 31 cases (41 nodules) of HCC that were treated by RFA. The CT findings before and after RFA, particularly the findings in areas other than the treatment site (henceforth, secondary findings), were evaluated by a physician and a radiologist. In addition, the relationships between the CT findings and post-RFA clinical symptoms (fever/pain) and laboratory data were examined. Secondary findings were found in 90.3% (28/31). These findings were broadly classified into changes in the needle tract 51.6% (16/31), retention of effusion 41.9% (13/31), thickening of the gallbladder wall 12.9% (4/31), changes in the retroperitoneal space 9.7% (3/31), and dilatation of the intrahepatic bile duct 3.2% (1/31), in the order of frequency. A relationship was found between changes in the retroperitoneal space and the clinical symptoms (fever: p=0.0366, pain: p=0.0012). Relationships were also found between changes in the needle tract and retention of effusion and aspartate aminotransferase (AST) (p<0.0001), as well as between changes in the needle tract and alanine aminotransferase (ALT) (p=0.0149). The size of the treatment area did not correlate with the presence of clinical symptoms and changes in laboratory data. Diverse classification of CT findings was observed after RFA, and a relationship with clinical symptoms was noted. A relationship was also found between classification of the CT findings following RFA and the post-therapeutic outcome. (authors)

  3. Denver Developmental Test Findings and their Relationship with Sociodemographic Variables in a Large Community Sample of 0-4-Year-Old Children.

    Science.gov (United States)

    Çelikkiran, Seyhan; Bozkurt, Hasan; Coşkun, Murat

    2015-06-01

    The aim of this study was to investigate the prevalence of developmental problems and relationship with sociodemographic variables in a community sample of young children. Participants included 1000 children (558 males, 442 females, age range 1-48 months, mean 18.4 months, SD 7.8 months). Children were referred generally by their parents for developmental evaluation and consultation in response to a public announcement in a district area in Istanbul, Turkey. An interview form and the Denver Developmental Screening Test II (DDST) were used for sociodemographic data and developmental evaluation. The χ 2 test and Pearson's correlation test were used for data analysis. Seven hundred forty-one out of 1000 children (74.1%) had normal, 140 (14%) had risky, and 119 (11.9%) had abnormal findings on the DDST results. The probability of abnormal findings on the DDST results was significantly higher in males (p=0.003), the 2-4-year-old group (pone child (p=0.001), consanguineous marriages (p0.05). Sociodemographic factors have a noteworthy impact on development. Determining these factors is important especially during the first years of life.

  4. Exit site and tunnel infections in children on chronic peritoneal dialysis: findings from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative.

    Science.gov (United States)

    Swartz, Sarah J; Neu, Alicia; Skversky Mason, Amy; Richardson, Troy; Rodean, Jonathan; Lawlor, John; Warady, Bradley; Somers, Michael J G

    2018-06-01

    The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a quality improvement initiative to reduce dialysis-associated infections. The frequency of peritoneal dialysis (PD) catheter exit site infection (ESI) and variables influencing its development and end result are unclear. We sought to determine ESI rates, to elucidate the epidemiology, risk factors, and outcomes for ESI, and to assess for association between provider compliance with care bundles and ESI risk. We reviewed demographic, dialysis and ESI data, and care bundle adherence and outcomes for SCOPE enrollees from October 2011 to September 2014. ESI involved only the exit site, only the subcutaneous catheter tunnel, or both. A total of 857 catheter insertions occurred in 734 children over 10,110 cumulative months of PD provided to these children. During this period 207 ESIs arose in 124 children or 0.25 ESIs per dialysis year. Median time to ESI was 392 days, with 69% of ESIs involving exit site only, 23% involving the tunnel only, and 8% involving both sites. Peritonitis developed in 6%. ESI incidence was associated with age (p = 0.003), being the lowest in children aged  0 at prior month's visit (p treatment, 24% required hospitalization, and 9% required catheter removal, generally secondary to tunnel infection. Exit site infections occur at an annualized rate of 0.25, typically well into the dialysis course. Younger patient age and documented review of site care are associated with lower ESI rates. Although most ESIs resolve, hospitalization is frequent, and tunnel involvement/catheter loss complicate outcomes.

  5. Computerized tomography(CT) in patients with head injuries, assessment of outcome based upon initial clinical findings and initial CT scans

    International Nuclear Information System (INIS)

    Espersen, J.O.; Petersen, O.F.

    1982-01-01

    In this study, which comprises 144 consecutive head injuries, the initial clinical assessment and the findings of the initial CT scan are relatd to the outcome. The mortality is related to the patient's level of consiousness and pupillary light reflex on admission. The disability rate (= number of disabled/number of survivors) was independent of the level of consiousness but closely related to pupillary light reaction. Diminished and obliterated basal cisterns were bad prognostic signs, with a mortality rate of 66% in the latter group. Both disability and mortality increase with the number of different lesion types. (Author)

  6. Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury.

    Science.gov (United States)

    Stephens, Jaclyn A; Salorio, Cynthia F; Barber, Anita D; Risen, Sarah R; Mostofsky, Stewart H; Suskauer, Stacy J

    2017-07-10

    This study examined functional connectivity of the default mode network (DMN) and examined brain-behavior relationships in a pilot cohort of children with chronic mild to moderate traumatic brain injury (TBI). Compared to uninjured peers, children with TBI demonstrated less anti-correlated functional connectivity between DMN and right Brodmann Area 40 (BA 40). In children with TBI, more anomalous less anti-correlated) connectivity between DMN and right BA 40 was linked to poorer performance on response inhibition tasks. Collectively, these preliminary findings suggest that functional connectivity between DMN and BA 40 may relate to longterm functional outcomes in chronic pediatric TBI.

  7. Monitoring the quality of cardiac surgery based on three or more surgical outcomes using a new variable life-adjusted display.

    Science.gov (United States)

    Gan, Fah Fatt; Tang, Xu; Zhu, Yexin; Lim, Puay Weng

    2017-06-01

    The traditional variable life-adjusted display (VLAD) is a graphical display of the difference between expected and actual cumulative deaths. The VLAD assumes binary outcomes: death within 30 days of an operation or survival beyond 30 days. Full recovery and bedridden for life, for example, are considered the same outcome. This binary classification results in a great loss of information. Although there are many grades of survival, the binary outcomes are commonly used to classify surgical outcomes. Consequently, quality monitoring procedures are developed based on binary outcomes. With a more refined set of outcomes, the sensitivities of these procedures can be expected to improve. A likelihood ratio method is used to define a penalty-reward scoring system based on three or more surgical outcomes for the new VLAD. The likelihood ratio statistic W is based on testing the odds ratio of cumulative probabilities of recovery R. Two methods of implementing the new VLAD are proposed. We accumulate the statistic W-W¯R to estimate the performance of a surgeon where W¯R is the average of the W's of a historical data set. The accumulated sum will be zero based on the historical data set. This ensures that if a new VLAD is plotted for a future surgeon of performance similar to this average performance, the plot will exhibit a horizontal trend. For illustration of the new VLAD, we consider 3-outcome surgical results: death within 30 days, partial and full recoveries. In our first illustration, we show the effect of partial recoveries on surgical results of a surgeon. In our second and third illustrations, the surgical results of two surgeons are compared using both the traditional VLAD based on binary-outcome data and the new VLAD based on 3-outcome data. A reversal in relative performance of surgeons is observed when the new VLAD is used. In our final illustration, we display the surgical results of four surgeons using the new VLAD based completely on 3-outcome data. Full

  8. Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy

    OpenAIRE

    Biary, Nora; Wrotniak, Brian; Islam, Shamim

    2017-01-01

    Abstract Background To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital. Methods Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12...

  9. The role of arthroscopy in the dysplastic hip—a systematic review of the intra-articular findings, and the outcomes utilizing hip arthroscopic surgery

    Science.gov (United States)

    Jo, Suenghwan; Lee, Sang Hong; Wang, Sung Il; Smith, Bjorn; O’Donnell, John

    2016-01-01

    Acetabular dysplasia is one of the most common sources of hip arthritis. With the recent innovation in hip arthroscopy, the question has been raised whether arthroscopy can be used to treat dysplastic hip conditions. The purposes of this systematic review are (i) describe the prevalence of intra-articular pathologies and (ii) report the outcomes of dysplastic hip treatment with hip arthroscopy as a sole treatment. Medical databases were searched for articles including arthroscopic findings and treatment of dysplastic hip with predetermined criteria. PubMed, Ovid database and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched up until 7 January 2015. Two reviewers independently assess the eligibility of retrieved studies using titles, abstracts and full-text articles. Thirteen studies were eligible to be included for the systematic review. Overall, labral tear was the most common pathology with a prevalence rate of 77.3%. All of the four studies describing arthroscopic treatment for only borderline dysplasia reported favorable outcome. With regard to more severely dysplastic hips, two out of three studies reported acceptable outcomes while one study reported negative results. This review indicates that intra-articular pathology is commonly observed in symptomatic dysplastic hips with a labral tear being the most common pathology. Arthroscopic treatment of borderline dysplasia could provide benefits whereas treatment of more dysplastic hips is controversial. Nevertheless, there is a lack of evidence for using arthroscopy alone in hips with a center edge angle <20°. Level IV, systematic review of Level IV studies. PMID:27583155

  10. The Effect of Latent Binary Variables on the Uncertainty of the Prediction of a Dichotomous Outcome Using Logistic Regression Based Propensity Score Matching.

    Science.gov (United States)

    Szekér, Szabolcs; Vathy-Fogarassy, Ágnes

    2018-01-01

    Logistic regression based propensity score matching is a widely used method in case-control studies to select the individuals of the control group. This method creates a suitable control group if all factors affecting the output variable are known. However, if relevant latent variables exist as well, which are not taken into account during the calculations, the quality of the control group is uncertain. In this paper, we present a statistics-based research in which we try to determine the relationship between the accuracy of the logistic regression model and the uncertainty of the dependent variable of the control group defined by propensity score matching. Our analyses show that there is a linear correlation between the fit of the logistic regression model and the uncertainty of the output variable. In certain cases, a latent binary explanatory variable can result in a relative error of up to 70% in the prediction of the outcome variable. The observed phenomenon calls the attention of analysts to an important point, which must be taken into account when deducting conclusions.

  11. Ensemble survival tree models to reveal pairwise interactions of variables with time-to-events outcomes in low-dimensional setting

    Science.gov (United States)

    Dazard, Jean-Eudes; Ishwaran, Hemant; Mehlotra, Rajeev; Weinberg, Aaron; Zimmerman, Peter

    2018-01-01

    Unraveling interactions among variables such as genetic, clinical, demographic and environmental factors is essential to understand the development of common and complex diseases. To increase the power to detect such variables interactions associated with clinical time-to-events outcomes, we borrowed established concepts from random survival forest (RSF) models. We introduce a novel RSF-based pairwise interaction estimator and derive a randomization method with bootstrap confidence intervals for inferring interaction significance. Using various linear and nonlinear time-to-events survival models in simulation studies, we first show the efficiency of our approach: true pairwise interaction-effects between variables are uncovered, while they may not be accompanied with their corresponding main-effects, and may not be detected by standard semi-parametric regression modeling and test statistics used in survival analysis. Moreover, using a RSF-based cross-validation scheme for generating prediction estimators, we show that informative predictors may be inferred. We applied our approach to an HIV cohort study recording key host gene polymorphisms and their association with HIV change of tropism or AIDS progression. Altogether, this shows how linear or nonlinear pairwise statistical interactions of variables may be efficiently detected with a predictive value in observational studies with time-to-event outcomes. PMID:29453930

  12. Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.

    Science.gov (United States)

    Nishino, Masami; Lee, Yasuharu; Nakamura, Daisuke; Yoshimura, Takahiro; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio

    2012-10-01

    In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA). Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis. MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%). OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.

  13. Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

    Science.gov (United States)

    Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

  14. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years

    International Nuclear Information System (INIS)

    Marlovits, Stefan; Singer, Philipp; Zeller, Philip; Mandl, Irena; Haller, Joerg; Trattnig, Siegfried

    2006-01-01

    In an observational study, the validity and reliability of magnetic resonance imaging (MRI) for the assessment of autologous chondrocyte transplantation (ACT) in the knee joint was determined. Two years after implantation, high-resolution MRI was used to analyze the repair tissue with nine pertinent variables. A complete filling of the defect was found in 61.5%, and a complete integration of the border zone to the adjacent cartilage in 76.9%. An intact subchondral lamina was present in 84.6% and an intact subchondral bone was present in 61.5%. Isointense signal intensities of the repair tissue compared to the adjacent native cartilage were seen in 92.3%. To evaluate interobserver variability, a reliability analysis with the determination of the intraclass correlation coefficient (ICC) was calculated. An 'almost perfect' agreement, with an ICC value >0.81, was calculated in 8 of 9 variables. The clinical outcome after 2 years showed the visual analog score (VAS) at 2.62 (S.D. ±0.65). The values for the knee injury and osteoarthritis outcome score (KOOS) subgroups were 68.29 (±23.90) for pain, 62.09 (±14.62) for symptoms, 75.45 (±21.91) for ADL function, 52.69 (±28.77) for sport and 70.19 (±22.41) for knee-related quality of life. The clinical scores were correlated with the MRI variables. A statistically significant correlation was found for the variables 'filling of the defect,' 'structure of the repair tissue,' 'changes in the subchondral bone,' and 'signal intensities of the repair issue'. High resolution MRI and well-defined MRI variables are a reliable, reproducible and accurate tool for assessing cartilage repair tissue

  15. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years

    Energy Technology Data Exchange (ETDEWEB)

    Marlovits, Stefan [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)]. E-mail: stefan.marlovits@meduniwien.ac.at; Singer, Philipp [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Zeller, Philip [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Mandl, Irena [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich-Collin-Strasse, A-1140 Vienna (Austria); Trattnig, Siegfried [Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2006-01-15

    In an observational study, the validity and reliability of magnetic resonance imaging (MRI) for the assessment of autologous chondrocyte transplantation (ACT) in the knee joint was determined. Two years after implantation, high-resolution MRI was used to analyze the repair tissue with nine pertinent variables. A complete filling of the defect was found in 61.5%, and a complete integration of the border zone to the adjacent cartilage in 76.9%. An intact subchondral lamina was present in 84.6% and an intact subchondral bone was present in 61.5%. Isointense signal intensities of the repair tissue compared to the adjacent native cartilage were seen in 92.3%. To evaluate interobserver variability, a reliability analysis with the determination of the intraclass correlation coefficient (ICC) was calculated. An 'almost perfect' agreement, with an ICC value >0.81, was calculated in 8 of 9 variables. The clinical outcome after 2 years showed the visual analog score (VAS) at 2.62 (S.D. {+-}0.65). The values for the knee injury and osteoarthritis outcome score (KOOS) subgroups were 68.29 ({+-}23.90) for pain, 62.09 ({+-}14.62) for symptoms, 75.45 ({+-}21.91) for ADL function, 52.69 ({+-}28.77) for sport and 70.19 ({+-}22.41) for knee-related quality of life. The clinical scores were correlated with the MRI variables. A statistically significant correlation was found for the variables 'filling of the defect,' 'structure of the repair tissue,' 'changes in the subchondral bone,' and 'signal intensities of the repair issue'. High resolution MRI and well-defined MRI variables are a reliable, reproducible and accurate tool for assessing cartilage repair tissue.

  16. Perfiles de organizaciones positivas. Análisis de características percibidas según variables individuales, organizacionales y de resultado (Positive organization profiles. Analysis of perceived characteristics according to individual, organizational, and outcome variables

    Directory of Open Access Journals (Sweden)

    María Laura Lupano Perugini

    2016-08-01

    Full Text Available This study analysed the profiles of organizations based on employee perceptions of their workplace. The sample consisted of 459 Argentinian employees (232 men; average age, 36.3 years (SD = 11.7. The participants worked for public companies (17.2%, n = 79 or private companies (82.6%, n = 379. Most of them lived in Buenos Aires and surrounding areas (96.5%, n = 443. A protocol was used for data collection, in which the participants were asked to report positive and negative characteristics associated with their organization. A content analysis of the answers given by the participants was performed, from which different categories of characteristics were derived (e.g., work climate, commitment, values. Several multiple correspondence analyses were conducted to generate profiles according to individual variables (i.e., gender, age, and position, organizational variables (i.e., size, typology, and type, and outcome variables (i.e., performance and job satisfaction. One of the most significant profiles showed associations between the perception of positive characteristics, such as values and outcomes, and high levels of satisfaction and individual/organizational performance.

  17. Identifying the independent effect of HbA1c variability on adverse health outcomes in patients with Type 2 diabetes.

    Science.gov (United States)

    Prentice, J C; Pizer, S D; Conlin, P R

    2016-12-01

    To characterize the relationship between HbA 1c variability and adverse health outcomes among US military veterans with Type 2 diabetes. This retrospective cohort study used Veterans Affairs and Medicare claims for veterans with Type 2 diabetes taking metformin who initiated a second diabetes medication (n = 50 861). The main exposure of interest was HbA 1c variability during a 3-year baseline period. HbA 1c variability, categorized into quartiles, was defined as standard deviation, coefficient of variation and adjusted standard deviation, which accounted for the number and mean number of days between HbA 1c tests. Cox proportional hazard models predicted mortality, hospitalization for ambulatory care-sensitive conditions, and myocardial infarction or stroke and were controlled for mean HbA 1c levels and the direction of change in HbA 1c levels during the baseline period. Over a mean 3.3 years of follow-up, all HbA 1c variability measures significantly predicted each outcome. Using the adjusted standard deviation measure for HbA 1c variability, the hazard ratios for the third and fourth quartile predicting mortality were 1.14 (95% CI 1.04, 1.25) and 1.42 (95% CI 1.28, 1.58), for myocardial infarction and stroke they were 1.25 (95% CI 1.10, 1.41) and 1.23 (95% CI 1.07, 1.42) and for ambulatory-care sensitive condition hospitalization they were 1.10 (95% CI 1.03, 1.18) and 1.11 (95% CI 1.03, 1.20). Higher baseline HbA 1c levels independently predicted the likelihood of each outcome. In veterans with Type 2 diabetes, greater HbA 1c variability was associated with an increased risk of adverse long-term outcomes, independently of HbA 1c levels and direction of change. Limiting HbA 1c fluctuations over time may reduce complications. © 2016 Diabetes UK.

  18. The validity of the variable "NICU admission" as an outcome measure for neonatal morbidity: a retrospective study

    NARCIS (Netherlands)

    Wiegerinck, Melanie M. J.; Danhof, Nora A.; van Kaam, Anton H.; Tamminga, Pieter; Mol, Ben Willem J.

    2014-01-01

    To determine whether "neonatal intensive care unit (NICU) admission" is a valid surrogate outcome measure to assess neonatal condition in clinical studies. Retrospective study. Tertiary hospital in the Netherlands. Neonates admitted to NICU during a 10-year period. Inclusion was restricted to

  19. Evaluation of plasma lactate concentration and base excess at the time of hospital admission as predictors of gastric necrosis and outcome and correlation between those variables in dogs with gastric dilatation-volvulus: 78 cases (2004-2009).

    Science.gov (United States)

    Beer, Kari A Santoro; Syring, Rebecca S; Drobatz, Kenneth J

    2013-01-01

    To determine the correlation between plasma lactate concentration and base excess at the time of hospital admission and evaluate each variable as a predictor of gastric necrosis or outcome in dogs with gastric dilatation-volvulus (GDV). Retrospective case series. 78 dogs. For each dog, various data, including plasma lactate concentration and base excess at the time of hospital admission, surgical or necropsy findings, and outcome, were collected from medical records. Gastric necrosis was identified in 12 dogs at the time of surgery and in 4 dogs at necropsy. Sixty-five (83%) dogs survived to hospital discharge, whereas 13 (17%) dogs died or were euthanized. Of the 65 survivors and 8 nonsurvivors that underwent surgery, gastric necrosis was detected in 8 and 4 dogs, respectively. Via receiver operating characteristic curve analysis, an initial plasma lactate concentration cutoff of 7.4 mmol/L was 82% accurate for predicting gastric necrosis (sensitivity, 50%; specificity, 88%) and 88% accurate for predicting outcome (sensitivity, 75%; specificity, 89%). Among all dogs, the correlation between initial plasma lactate concentration and base excess was significant, although base excess was a poor discriminator for predicting gastric necrosis or outcome (area under the receiver operating characteristic curve, 0.571 and 0.565, respectively). In dogs with GDV, plasma lactate concentration at the time of hospital admission was a good predictor of gastric necrosis and outcome. However, despite the correlation between initial base excess and plasma lactate concentration, base excess should not be used for prediction of gastric necrosis or outcome in those patients.

  20. Variability Bugs:

    DEFF Research Database (Denmark)

    Melo, Jean

    . Although many researchers suggest that preprocessor-based variability amplifies maintenance problems, there is little to no hard evidence on how actually variability affects programs and programmers. Specifically, how does variability affect programmers during maintenance tasks (bug finding in particular......)? How much harder is it to debug a program as variability increases? How do developers debug programs with variability? In what ways does variability affect bugs? In this Ph.D. thesis, I set off to address such issues through different perspectives using empirical research (based on controlled...... experiments) in order to understand quantitatively and qualitatively the impact of variability on programmers at bug finding and on buggy programs. From the program (and bug) perspective, the results show that variability is ubiquitous. There appears to be no specific nature of variability bugs that could...

  1. Language and speech outcomes of children with hearing loss and additional disabilities: Identifying the variables that influence performance at 5 years of age

    Science.gov (United States)

    Cupples, Linda; Ching, Teresa Y.C.; Button, Laura; Leigh, Greg; Marnane, Vivienne; Whitfield, Jessica; Gunnourie, Miriam; Martin, Louise

    2016-01-01

    Objective This study examined language and speech outcomes in young children with hearing loss and additional disabilities. Design Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs). Study sample A population-based cohort of 146 5-year-old children with hearing loss and additional disabilities took part. Results Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes. Conclusions The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data. PMID:27630013

  2. Assessing the variability of outcome for patients treated with localized prostate irradiation using different definitions of biochemical control

    International Nuclear Information System (INIS)

    Horwitz, Eric M.; Vicini, Frank A.; Ziaja, Ellen L.; Gonzalez, Jose; Dmuchowski, Carl F.; Stromberg, Jannifer S.; Brabbins, Donald S.; Hollander, Jay; Chen, Peter Y.; Martinez, Alvaro A.

    1996-01-01

    Purpose: Biochemical control using serial posttreatment serum prostate specific antigen (PSA) levels is being increasingly used to assess treatment efficacy for localized prostate cancer. However, no standardized definition of biochemical control has been established. We reviewed our experience treating patients with localized prostate cancer and applied three different commonly used definitions of biochemical control to determine if differences in therapeutic outcome would be observed. Methods and Materials: Between January 1987 and December 1991, 480 patients with clinically localized prostate cancer received external beam irradiation (RT) using localized prostate fields at William Beaumont Hospital. The median dose to the prostate was 66.6 Gy (range 58-70.4) using a four-field or arc technique. Pretreatment and posttreatment serum PSA levels were recorded. Over 86% (414 of 480) of patients had a pretreatment PSA level available. Three different definitions of biochemical control were used: (a) PSA nadir 20), and 5-year actuarial rates of biochemical control were calculated using the three biochemical control and one clinical local control definitions. For Group 1, 5-year actuarial rates of biochemical control were 84%, 90%, and 96% for Definitions 1-3 and clinical local control, respectively. For Group 2, 5-year actuarial control rates were 45%, 54%, 74%, and 92% for the four definitions, respectively. For Group 3, 5-year actuarial control rates were 26%, 31%, 63%, and 100% for the four definitions, respectively. For Group 4, 5-year actuarial control rates were 24%, 24%, 50%, and 100% for the four definitions, respectively. Finally, for Group 5, 5-year actuarial control rates were 5%, 14%, 15%, and 89% for the four definitions, respectively. Depending on the definition used, statistically significant differences overall in outcome rates were observed. Differences between all four definitions for all pairwise comparisons ranged from 5 to 53% (p < 0

  3. The feasibility of introducing an adult safeguarding measure for inclusion in the Adult Social Care Outcomes Framework (ASCOF): findings from a pilot study.

    Science.gov (United States)

    Norrie, Caroline; Manthorpe, Jill; Cartwright, Cher; Rayat, Pritpal

    2016-06-30

    There are currently no national measures in England reporting the experiences of people who have been involved with adult safeguarding services following concerns that they may be at risk of abuse or neglect. The Health and Social Care Information Centre (HSCIC) aimed to develop a new adult safeguarding outcome measure (survey) for local authorities (LAs) that could be added to the Adult Social Care Outcomes Framework (ASCOF). The ASCOF is a national collection of social care outcomes performance indicators collected from the perspective of people receiving partial or total funding from a LA for care services. An outcome measure (a face-to-face interview based survey consisting of 7 questions) was piloted in 40 LAs with 382 adults at risk (or their representative) who had been the subject of a safeguarding investigation. The aim was to investigate the feasibility of the survey in three domains: i) if a statistically representative sample of adults at risk (or their family, friend, carer or advocate) could be recruited; ii) analysis of survey responses and its acceptability to participants iii) feedback from LAs about the survey's administration. Overall the survey results met statistical confidence; however the individual results for adults at risk did not, due to the high proportion of representatives who responded because adults at risk were unable. Responses to the survey were generally positive; 72 % of participants felt that the help received during the safeguarding investigation had made them or the adult at risk (if reporting as a proxy) feel 'quite a bit' or 'a lot safer'. These results are the most robust data collected in England on the perspectives of adults at risk and their representatives on safeguarding services. Participants reported they appreciated being asked for feedback. LAs suggested survey administration improvements. This survey is one way LAs can meet their new legal requirement under the Care Act 2014 to 'seek feedback' from adults at

  4. A six-month prospective study to find out the treatment outcome, prognosis and offending drugs in toxic epidermal necrolysis from an urban institution in Kolkata

    Directory of Open Access Journals (Sweden)

    Sudip Das

    2013-01-01

    Full Text Available Toxic epidermal necrolysis is the life-threatening dermatological emergency, most often an adverse cutaneous drug reaction with high mortality. A 6-month prospective study was conducted in our institution to find out the offending drugs, to assess the prognosis on admission using SCORTEN: Severity of illness score and to find out the treatment outcome. Anticonvulsants, NSAIDs and sulphonamides are the common offending agents; but in our study, 2 were due to homeopathic medicines. Out of 20 patients, on the date of admission SCORTEN prognostic score was 2 in 11 patients, 3 in 8 patients and 4 in 1 patient. Eighteen patients were treated with dexamethasone intramuscular injection and 2 patients got intravenous immunoglobulin (IVIG. All patients survived without any mortality. Though improvement was slightly faster with IVIG, early administration of corticosteroids was also of encouraging efficacy and should be considered in developing countries due to low cost. No mortality in our study suggests need to validate the SCORTEN index in our country in a large number of patients.

  5. Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

    Science.gov (United States)

    Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

    2014-01-01

    Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

  6. CT Imaging Findings and Their Relevance to the Clinical Outcomes After Stent Graft Repair of Penetrating Aortic Ulcers: Six-year, Single-center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Angle, John F.; Park, Auh Whan; Anderson, Curtis; Sabri, Saher S.; Turba, Ulku C. [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States); Kern, John A.; Cherry, Kenneth J. [University of Virginia Health System, Department of Surgery (United States); Matsumoto, Alan H., E-mail: ahm4d@virginia.edu [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States)

    2012-12-15

    Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8) or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 {+-} 5.6 mm; range 1.5-25.0 mm) and diameter (mean, 13.5 {+-} 9.7 mm; range 2.2-41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.

  7. CT Imaging Findings and Their Relevance to the Clinical Outcomes After Stent Graft Repair of Penetrating Aortic Ulcers: Six-year, Single-center Experience

    International Nuclear Information System (INIS)

    Shin, Ji Hoon; Angle, John F.; Park, Auh Whan; Anderson, Curtis; Sabri, Saher S.; Turba, Ulku C.; Kern, John A.; Cherry, Kenneth J.; Matsumoto, Alan H.

    2012-01-01

    Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8) or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 ± 5.6 mm; range 1.5–25.0 mm) and diameter (mean, 13.5 ± 9.7 mm; range 2.2–41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.

  8. Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: findings from a community based survey in Japan.

    Science.gov (United States)

    Goren, Amir; Montgomery, William; Kahle-Wrobleski, Kristin; Nakamura, Tomomi; Ueda, Kaname

    2016-06-10

    This study assessed how family caregivers for patients with Alzheimer's disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Caregivers were hypothesized to experience significantly poorer outcomes than non-caregivers. Data were combined from the 2012 and 2013 National Health and Wellness Survey in Japan (n = 60000). Caregivers for adult relatives with AD or dementia were compared with non-caregivers on: comorbidities (including Patient Health Questionnaire (PHQ-9) cutoff scores suggesting presence/absence of major depressive disorder (MDD)), Work Productivity and Activity Impairment (WPAI), SF-36v2-based HRQoL, and healthcare resource utilization. Sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores were compared across groups. Propensity matching, based on scores generated from a logistic regression predicting caregiving, was used to match caregivers with non-caregivers with similar likelihood of being caregivers. Bivariate comparisons across matched groups served to estimate outcomes differences due to caregiving. Among 55060 respondents, compared with non-caregivers (n = 53758), caregivers (n = 1302) were older (52.6 vs. 47.5 years), more frequently female (53 % vs. 49 %), married/partnered, frequent alcohol drinkers, current smokers, exercisers, and not employed, and they averaged higher CCI scores (0.37 vs. 0.14), all p marital status, CCI, insured status, education, employment, income, and children in household. A greedy matching algorithm produced 1297 exact matches, excluding 5 non-matched caregivers. Health utilities scores were significantly lower among caregivers (0.724) vs. non-caregivers (0.764), as were SF-36v2 Physical and Mental Component Summary scores. Caregivers vs. non-caregivers had significantly higher absenteeism

  9. Rothmund-Thomson Syndrome: Insights from New Patients on the Genetic Variability Underpinning Clinical Presentation and Cancer Outcome

    Directory of Open Access Journals (Sweden)

    Elisa A. Colombo

    2018-04-01

    Full Text Available Biallelic mutations in RECQL4 gene, a caretaker of the genome, cause Rothmund-Thomson type-II syndrome (RTS-II and confer increased cancer risk if they damage the helicase domain. We describe five families exemplifying clinical and allelic heterogeneity of RTS-II, and report the effect of pathogenic RECQL4 variants by in silico predictions and transcripts analyses. Complete phenotype of patients #39 and #42 whose affected siblings developed osteosarcoma correlates with their c.[1048_1049del], c.[1878+32_1878+55del] and c.[1568G>C;1573delT], c.[3021_3022del] variants which damage the helicase domain. Literature survey highlights enrichment of these variants affecting the helicase domain in patients with cancer outcome raising the issue of strict oncological surveillance. Conversely, patients #29 and #19 have a mild phenotype and carry, respectively, the unreported homozygous c.3265G>T and c.3054A>G variants, both sparing the helicase domain. Finally, despite matching several criteria for RTS clinical diagnosis, patient #38 is heterozygous for c.2412_2414del; no pathogenic CNVs out of those evidenced by high-resolution CGH-array, emerged as contributors to her phenotype.

  10. Treatment outcome and prognostic variables for local control and survival in patients receiving radical radiotherapy for urinary bladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fokdal, Lars; Hoeyer, Morten; Maase, Hans von der [Aarhus Univ. Hospital (Denmark). Dept. of Oncology

    2004-12-01

    The aim of this retrospective study was to analyze the outcome of radical radiotherapy in 292 patients with bladder cancer and to identify prognostic factors for local control and survival. Median age was 72.3 years (range 45-83 years). Median follow up was 66 months (range 18-121 months). All patients were treated by use of a standard 3-field technique with 60 Gy in 30 fractions to the tumor and the bladder. The elective lymph nodes were treated with doses in the range from 46 Gy to 60 Gy. Complete response was obtained in 52% of the patients at 3-month control. However, 41% of all patients with an initial CR developed recurrence during follow-up. The 3-year and 5-year overall survival rate was 31% and 21%, respectively. Performance status, T-stage, macroscopic complete TURB, hydronephrosis, and serum creatinine were independent prognostic factors for overall survival and, thus, important for the selection of patients for curative intended radiotherapy. During radiotherapy acute transient side effects were recorded in 78% of the patients; severe bowel complications were recorded in 9 patients (3%). Following radiotherapy, 10 patients (3%) developed intestinal reactions requiring surgery. Three patients (1%) were cystectomized because of severe radiation reactions in the bladder. At 5-year follow-up, the actuarial risk of complications requiring surgery was 15%. Treatment-related mortality was 2%.

  11. Effects of central nervous system drugs on driving: speed variability versus standard deviation of lateral position as outcome measure of the on-the-road driving test.

    Science.gov (United States)

    Verster, Joris C; Roth, Thomas

    2014-01-01

    The on-the-road driving test in normal traffic is used to examine the impact of drugs on driving performance. This paper compares the sensitivity of standard deviation of lateral position (SDLP) and SD speed in detecting driving impairment. A literature search was conducted to identify studies applying the on-the-road driving test, examining the effects of anxiolytics, antidepressants, antihistamines, and hypnotics. The proportion of comparisons (treatment versus placebo) where a significant impairment was detected with SDLP and SD speed was compared. About 40% of 53 relevant papers did not report data on SD speed and/or SDLP. After placebo administration, the correlation between SDLP and SD speed was significant but did not explain much variance (r = 0.253, p = 0.0001). A significant correlation was found between ΔSDLP and ΔSD speed (treatment-placebo), explaining 48% of variance. When using SDLP as outcome measure, 67 significant treatment-placebo comparisons were found. Only 17 (25.4%) were significant when SD speed was used as outcome measure. Alternatively, for five treatment-placebo comparisons, a significant difference was found for SD speed but not for SDLP. Standard deviation of lateral position is a more sensitive outcome measure to detect driving impairment than speed variability.

  12. A new generalized expansion method and its application in finding explicit exact solutions for a generalized variable coefficients KdV equation

    International Nuclear Information System (INIS)

    Sabry, R.; Zahran, M.A.; Fan Engui

    2004-01-01

    A generalized expansion method is proposed to uniformly construct a series of exact solutions for general variable coefficients non-linear evolution equations. The new approach admits the following types of solutions (a) polynomial solutions, (b) exponential solutions, (c) rational solutions, (d) triangular periodic wave solutions, (e) hyperbolic and solitary wave solutions and (f) Jacobi and Weierstrass doubly periodic wave solutions. The efficiency of the method has been demonstrated by applying it to a generalized variable coefficients KdV equation. Then, new and rich variety of exact explicit solutions have been found

  13. Treatment of malignant gastric outlet obstruction with stents: An evaluation of the reported variables for clinical outcome

    Directory of Open Access Journals (Sweden)

    Medhus Asle W

    2009-06-01

    Full Text Available Abstract Background Malignant gastric outlet obstruction (GOO is commonly seen in patients with advanced gastric-, pancreatic-, duodenal, hepatobiliary or metastatic malignancies. Ten to 25% of patients with pancreatic cancer will develop duodenal obstruction during the course of the disease. Duodenal stenting with self-expandable metal stents is an alternative treatment to surgical bypass procedures. Our aim was to review the published literature regarding treatment of malignant GOO with stents to reveal whether the information provided is sufficient to evaluate the clinical effects of this treatment Methods A literature search from 2000 – 2007 was conducted in Pub Med, Embase, and Cochrane library, combining the following search terms: duodenal stent, malignant duodenal obstruction, gastric outlet obstruction, SEMS, and gastroenteroanastomosis. All publications presenting data with ≥ 15 patients and only articles written in English were included and a review focusing on the following parameters were conducted: 1 The use of graded scoring systems evaluating clinical success; 2 Assessment of Quality of life (QoL before and after treatment; 3 Information on stent-patency; 4 The use of objective criteria to evaluate the stent effect. Results 41 original papers in English were found; no RCT's. 16 out of 41 studies used some sort of graded scoring system. No studies had objectively evaluated QoL before or after stent treatment, using standardized QoL-questionnaires, 32/41 studies reported on stent patency and 9/41 performed an oral contrast examination after stent placement. Objective quantitative tests of gastric emptying had not been performed. Conclusion Available reports do not provide sufficient relevant information of the clinical outcome of duodenal stenting. In future studies, these relevant issues should be addressed to allow improved evaluation of the effect of stent treatment.

  14. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2015-11-15

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  15. Impact of Project P.A.T.H.S. on adolescent developmental outcomes in Hong Kong: findings based on seven waves of data.

    Science.gov (United States)

    Shek, Daniel T L; Ma, Cecilia M S

    2012-01-18

    The present study examined the longitudinal impact of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) on adolescent developmental outcomes in Hong Kong. Using a longitudinal randomized group design, seven waves of data were collected from 24 experimental schools (n=4049 at wave 1) in which students participated in the Tier 1 Program of Project P.A.T.H.S. and 24 control schools (n=3797 at wave 1). Results based on individual growth curve modeling generally showed that, relative to the control participants, participants in the experimental group had: (a) a higher level of positive development; (b) a lower level of substance abuse; and (c) a lower level of delinquent behavior. Participants who regarded the program to be beneficial also showed higher levels of positive development and lower levels of problem behavior than did the control school students. The present findings suggest that Project P.A.T.H.S. is effective in promoting positive development and preventing adolescent problem behavior in Chinese adolescents in Hong Kong.

  16. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    International Nuclear Information System (INIS)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K.

    2015-01-01

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  17. Assessment of leg muscles mechanical capacities: Which jump, loading, and variable type provide the most reliable outcomes?

    Science.gov (United States)

    García-Ramos, Amador; Feriche, Belén; Pérez-Castilla, Alejandro; Padial, Paulino; Jaric, Slobodan

    2017-07-01

    This study aimed to explore the strength of the force-velocity (F-V) relationship of lower limb muscles and the reliability of its parameters (maximum force [F 0 ], slope [a], maximum velocity [V 0 ], and maximum power [P 0 ]). Twenty-three men were tested in two different jump types (squat and countermovement jump: SJ and CMJ), performed under two different loading conditions (free weight and Smith machine: Free and Smith) with 0, 17, 30, 45, 60, and 75 kg loads. The maximum and averaged values of F and V were obtained for the F-V relationship modelling. All F-V relationships were strong and linear independently whether observed from the averaged across the participants (r ≥ 0.98) or individual data (r = 0.94-0.98), while their parameters were generally highly reliable (F 0 [CV: 4.85%, ICC: 0.87], V 0 [CV: 6.10%, ICC: 0.82], a [CV: 10.5%, ICC: 0.81], and P 0 [CV: 3.5%, ICC: 0.93]). Both the strength of the F-V relationships and the reliability of their parameters were significantly higher for (1) the CMJ over the SJ, (2) the Free over the Smith loading type, and (3) the maximum over the averaged F and V variables. In conclusion, although the F-V relationships obtained from all the jumps tested were linear and generally highly reliable, the less appropriate choice for testing the F-V relationship could be through the averaged F and V data obtained from the SJ performed either in a Free weight or in a Smith machine. Insubstantial differences exist among the other combinations tested.

  18. Mineral bone disorder and its management among hemodialysis patients in the Gulf Cooperation Council: Initial findings from the dialysis outcomes and practice patterns study (2012-2015).

    Science.gov (United States)

    Al Salmi, Issa; AlRukhaimi, Mona; AlSahow, Ali; Shaheen, Faisal A M; Al-Ghamdi, Saeed M G; AlAli, Fadwa; AlGhareeb, Sumaya; Al Maimani, Yacoub; AlGhonaim, Mohammed; Bieber, Brian; Tentori, Francesca; Pisoni, Ronald L

    2016-11-01

    DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24%) and phosphorus binder use (81%), whereas intravenous Vitamin D use (24%) was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43%) versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variability was seen across countries and facilities in the GCC. Mean serum calcium was lower in the GCC despite the much greater use of dialysate Ca of ~3.5 mEq/L which may be due to the relatively low use of vitamin D and higher cinacalcet use, meriting further study. Future work will focus on GCC facility HD practices and patient characteristics most strongly related to the achievement of MBD target levels and associated outcomes.

  19. Mineral bone disorder and its management among hemodialysis patients in the Gulf Cooperation Council: Initial findings from the dialysis outcomes and practice patterns study (2012-2015

    Directory of Open Access Journals (Sweden)

    Issa Al Salmi

    2016-01-01

    other DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P <0.001 for each. History of parathyroidectomy was lower in the GCC countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24% and phosphorus binder use (81%, whereas intravenous Vitamin D use (24% was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43% versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variability was seen across countries and facilities in the GCC. Mean serum calcium was lower in the GCC despite the much greater use of dialysate Ca of ~3.5 mEq/L which may be due to the relatively low use of vitamin D and higher cinacalcet use, meriting further study. Future work will focus on GCC facility HD practices and patient characteristics most strongly related to the achievement of MBD target levels and associated outcomes.

  20. Experience by children and adolescents of more than one type of maltreatment: Association of different classes of maltreatment profiles with clinical outcome variables.

    Science.gov (United States)

    Witt, Andreas; Münzer, Annika; Ganser, Helene G; Fegert, Jörg M; Goldbeck, Lutz; Plener, Paul L

    2016-07-01

    Most victims of child abuse have experienced more than one type of maltreatment, yet there is a lack of understanding of the impact of specific combinations of types of maltreatment. This study aimed to identify meaningful classes of maltreatment profiles and to associate them with short-term clinical outcomes. A total of 358 German children and adolescents aged 4-17 with a known history of child maltreatment were included in the study. Through interviews and questionnaires, information was obtained from participants and their primary caregivers on history of maltreatment, sociodemographics, psychopathology, level of psychosocial functioning, and health-related quality of life. Types of abuse were categorized into six major groups: sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic violence. A latent class analysis (LCA) was performed to determine distinct multi-type maltreatment profiles, which were then assessed for their associations with the sociodemographic and clinical outcome variables. The LCA revealed that participants could be categorized into three meaningful classes according to history of maltreatment: (1) experience of multiple types of maltreatment excluding sexual abuse (63.1%), (2) experience of multiple types of maltreatment including sexual abuse (26.5%), and (3) experience of predominantly sexual abuse (10.3%). Members of Class 2 showed significantly worse short-term outcomes on psychopathology, level of functioning, and quality of life compared to the other classes. Three distinct profiles of multiple types of maltreatment were empirically identified in this sample. Exposure to multiple types of abuse was associated with poorer outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement.

    Science.gov (United States)

    Maximiano, Constanza; López, Iker; Martín, Cristina; Zugazabeitia, Luis; Martí-Ciriquián, Juan L; Núñez, Miguel A; Contreras, Jorge; Herdman, Michael; Traseira, Susana; Provencio, Mariano

    2018-01-01

    There have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL. Large, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores. 1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (pbreast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL. In the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.

  2. Surgeons and suture zones: Hybridization among four surgeonfish species in the Indo-Pacific with variable evolutionary outcomes

    KAUST Repository

    DiBattista, Joseph; Whitney, Jonathan; Craig, Matthew T.; Hobbs, Jean-Paul A.; Rocha, Luiz A.; Feldheim, Kevin A.; Berumen, Michael L.; Bowen, Brian W.

    2016-01-01

    DNA lineage and species identification based on external morphology, indicating that species integrity may not be eroding. The A. nigricans complex demonstrates a range of outcomes from incomplete speciation to secondary contact to decreasing hybridization with increasing evolutionary depth.

  3. Surgeons and suture zones: Hybridization among four surgeonfish species in the Indo-Pacific with variable evolutionary outcomes.

    Science.gov (United States)

    DiBattista, Joseph D; Whitney, Jonathan; Craig, Matthew T; Hobbs, Jean-Paul A; Rocha, Luiz A; Feldheim, Kevin A; Berumen, Michael L; Bowen, Brian W

    2016-08-01

    species identification based on external morphology, indicating that species integrity may not be eroding. The A. nigricans complex demonstrates a range of outcomes from incomplete speciation to secondary contact to decreasing hybridization with increasing evolutionary depth. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Surgeons and suture zones: Hybridization among four surgeonfish species in the Indo-Pacific with variable evolutionary outcomes

    KAUST Repository

    DiBattista, Joseph

    2016-04-30

    DNA lineage and species identification based on external morphology, indicating that species integrity may not be eroding. The A. nigricans complex demonstrates a range of outcomes from incomplete speciation to secondary contact to decreasing hybridization with increasing evolutionary depth.

  5. 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

  6. Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up.

    Science.gov (United States)

    Gressot, Loyola V; Vadivelu, Sudhakar; Hwang, Steven W; Fulkerson, Daniel H; Luerssen, Thomas G; Jea, Andrew

    2014-02-01

    Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist. The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2-3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded. The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2-3 angulation, displacement, and width of pars defect were measured when available. The mean C2-3 angulation was 9.5° (range 1-34°), the mean C2-3 displacement was 4.78 mm (range 1.1-10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9-7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14-120 months). Based on the literature and the authors' own experience, they conclude that most very young children

  7. Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration.

    Science.gov (United States)

    Jeung, Kyung Woon; Ryu, Hyun Ho; Song, Kyung Hwan; Lee, Byung Kook; Lee, Hyoung Youn; Heo, Tag; Min, Yong Il

    2011-07-01

    Adjustment of adrenaline (epinephrine) dosage according to cardiac arrest (CA) duration, rather than administering the same dose, may theoretically improve resuscitation outcomes. We evaluated variable effects of high-dose adrenaline (HDA) relative to standard-dose adrenaline (SDA) on resuscitation outcomes according to CA duration. Twenty-eight male domestic pigs were randomised to the following 4 groups according to the dosage of adrenaline (SDA 0.02 mg/kg vs. HDA 0.2mg/kg) and duration of CA before beginning cardiopulmonary resuscitation (CPR): 6 min SDA, 6 min HDA, 13 min SDA, or 13 min HDA. After the predetermined duration of untreated ventricular fibrillation, CPR was provided. All animals in the 6 min SDA, 6 min HDA, and 13 min HDA groups were successfully resuscitated, while only 4 of 7 pigs in the 13 min SDA group were successfully resuscitated (p=0.043). HDA groups showed higher right atrial pressure, more frequent ventricular ectopic beats, higher blood glucose, higher troponin-I, and more severe metabolic acidosis than SDA groups. Animals of 13 min groups showed more severe metabolic acidosis and higher troponin-I than animals of 6 min groups. All successfully resuscitated animals, except two animals in the 13 min HDA group, survived for 7 days (p=0.121). Neurologic deficit score was not affected by the dose of adrenaline. HDA showed benefit in achieving restoration of spontaneous circulation in 13 min CA, when compared with 6 min CA. However, this benefit did not translate into improved long-term survival or neurologic outcome. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. 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

  9. Teacher learning and student outcomes in the context of classroom discourse. Findings from a video-based teacher professional development programme

    Directory of Open Access Journals (Sweden)

    Katharina Kiemer

    2014-06-01

    Full Text Available We present an innovative teacher professional development programme (TPD focusing on the re-definition of teachers’ discourse behaviour. We report findings on teacher learning and student outcomes, and reflect on practical implications and directions for future research on the programme. In the “Dialogic Video Cycle” (DVC six teachers participated in a year-long intervention built on effective components of TPD and using videos of teachers’ own practices as tools for reflection and basis for group discussions. We compared the DVC with a traditional TPD programme (n= 4 teachers. Additionally, students (N= 226 were assessed regarding their motivational orientations and individual beliefs. Results show that effective TPD components could successfully be implemented in the DVC and that this new and innovative programme enhances teachers’ performance in classroom discourse and affects students’ interest in the subject, self-efficacy and domain-specific self-concept of ability positively. Thus, the DVC seems a promising tool to foster teacher learning with an impact on perceived student motivation and learning. Presentiamo un programma innovativo per lo sviluppo professionale degli insegnanti (TPD, centrato sulla ridefinizione della conduzione di interazioni verbali in classe. Sono riportati i risultati dell’apprendimento di insegnanti e studenti, e la riflessione sulle implicazioni pratiche per la ricerca futura sul programma. Nel “Dialogic Video Cycle” (DVC sei insegnanti hanno partecipato per un anno a un intervento di TPD mediante videoregistrazioni usate come strumenti di riflessione sulle proprie pratiche e per le discussioni di gruppo. Abbiamo confrontato il DVC con un programma TPD tradizionale (n= 4 insegnanti. Inoltre sono stati valutati gli orientamenti degli studenti (N= 226 in termini di motivazione e fiducia nelle proprie capacità. I risultati mostrano che le componenti efficaci del TPD potrebbero essere attuate con

  10. Clinical and Surgical Findings and Outcome Following Rumenotomy in Adult Dairy Cattle Affected with Recurrent Rumen Tympany Associated with Non-Metallic Foreign Bodies

    OpenAIRE

    Z. Bani Ismail; A. Al-Majali; K. Al-Qudah

    2007-01-01

    Medical records of 31 adult dairy cows suffering from recurrent rumen tympany for at least 1 month duration that underwent exploratory laparotomy and rumenotomy were reviewed and information was obtained on signalment, history, physical examination findings, laboratory findings and surgical findings. Cases were categorized according to surgical findings into 3 groups. Group 1 (n = 10) included cattle with reticuloruminal, metallic foreign bodies and perireticular adhesions/inflammation, group...

  11. Organizational justice is related to heart rate variability in white-collar workers, but not in blue-collar workers-findings from a cross-sectional study.

    Science.gov (United States)

    Herr, Raphael M; Bosch, Jos A; van Vianen, Annelies E M; Jarczok, Marc N; Thayer, Julian F; Li, Jian; Schmidt, Burkhard; Fischer, Joachim E; Loerbroks, Adrian

    2015-06-01

    Perceived injustice at work predicts coronary heart disease. Vagal dysregulation represents a potential psychobiological pathway. We examined associations between organizational justice and heart rate variability (HRV) indicators. Grounded in social exchange and psychological contract theory, we tested predictions that these associations are more pronounced among white-collar than among blue-collar workers. Cross-sectional data from 222 blue-collar and 179 white-collar men were used. Interactional and procedural justice were measured by questionnaire. Ambulatory HRV was assessed across 24 h. Standardized regression coefficients (β) were calculated. Among white-collar workers, interactional justice showed positive relationships with 24-h HRV, which were strongest during sleeping time (adjusted βs≥0.26; p values≤0.01). No associations were found for blue-collar workers. A comparable but attenuated pattern was observed for procedural justice. Both dimensions of organizational injustice were associated with lowered HRV among white-collar workers. The impact of justice and possibly its association with health seems to differ by occupational groups.

  12. [Effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit].

    Science.gov (United States)

    Wu, Jing; Sun, Qiuhong; Yang, Hua

    2015-05-19

    To explore the effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit (ICU). A total of 72 ICU patients with severe acute pancreatitis were recruited and divided randomly into observation and control groups (n = 36 each). Both groups were treated conventionally. And the observation group achieved stable blood glucose at 6.1-8.3 mmol/L with intensive glucose control. The length of ICU and hospital stays, ICU mortality rate, transit operative rate, concurrent infection rate, admission blood glucose, glycosylated hemoglobin, mean insulin dose, mean blood glucose, blood glucose value standard deviation (GLUSD), glycemic liability index (GLUGLI) and mean amplitude of glycemic excursion (GLUMAGE) of two groups were compared. At the same time, the relationship between blood glucose variability, ICU mortality rate and its predictive value were analyzed by correlation analysis and receiver operating characteristic curve (ROC). The lengths of ICU and hospital stays of observation group were all significantly less than those of the control group [(11.7 ± 9.9) vs (15.9 ± 8.02) days, (21.8 ± 10.8) vs (28.2 ± 12.7) days, P blood glucose value and GLUSD of observation group were significantly lower than those of control group [(7.4 ± 1.1) vs (9.6 ± 1.2), (1.8 ± 1.0) vs (2.5 ± 1.3) mmol/L]. The differences were statistically significant (P curve analysis showed that, AUC of GLUGLI was 0.748 and 95% CI 0.551-0.965 (P glucose control in patients with severe acute pancreatitis helps reduce the blood sugar fluctuations, lower the risks of infectious complications and promote the patient rehabilitation. And GLUGLI is positively correlated with ICU mortality rate. It has good predictive values.

  13. Increased chromosomal breakage in Tourette syndrome predicts the possibility of variable multiple gene involvement in spectrum phenotypes: Preliminary findings and hypothesis

    Energy Technology Data Exchange (ETDEWEB)

    Gericke, G.S.; Simonic, I.; Cloete, E.; Buckle, C. [Univ. of Pretoria (South Africa)] [and others

    1995-10-09

    Increased chromosomal breakage was found in 12 patients with DSM-IV Tourette syndrome (TS) as compared with 10 non-TS control individuals with respect to untreated, modified RPM1-, and BrdU treated lymphocyte cultures (P < 0.001 in each category). A hypothesis is proposed that a major TS gene is probably connected to genetic instability, and associated chromosomal marker sites may be indicative of the localization of secondary genes whose altered expression could be responsible for associated comorbid conditions. This concept implies that genes influencing higher brain functions may be situated at or near highly recombigenic areas allowing enhanced amplification, duplication and recombination following chromosomal strand breakage. Further studies on a larger sample size are required to confirm the findings relating to chromosomal breakage and to analyze the possible implications for a paradigmatic shift in linkage strategy for complex disorders by focusing on areas at or near unstable chromosomal marker sites. 32 refs., 1 tab.

  14. Heart rate variability in major depressive disorder and after antidepressant treatment with agomelatine and paroxetine: Findings from the Taiwan Study of Depression and Anxiety (TAISDA).

    Science.gov (United States)

    Yeh, Ta-Chuan; Kao, Lien-Cheng; Tzeng, Nian-Sheng; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-01-04

    Evidence from previous studies suggests that heart rate variability (HRV) is reduced in major depressive disorder (MDD). However, whether this reduction is attributable to the disorder per se or to medication, since antidepressants may also affect HRV, is still debated. There is a dearth of information regarding the effects of agomelatine, a novel antidepressant, on HRV. Here, we investigated whether HRV is reduced in MDD and compared the effects of agomelatine and paroxetine on HRV. We recruited 618 physically healthy unmedicated patients with MDD and 506 healthy volunteers aged 20-65 years. Frequency-domain measures of resting HRV were obtained at the time of enrollment for all participants. For patients with MDD, these measures were obtained again after 6 weeks of either agomelatine or paroxetine monotherapy. Compared with healthy subjects, unmedicated patients with MDD exhibited significantly lower variance (total HRV), low frequency (LF), and high frequency (HF) HRV, and a higher LF/HF ratio. Depression severity independently contributed to decreased HRV and vagal tone. Fifty-six patients completed the open-label trial (n=29 for agomelatine, n=27 for paroxetine). Between-group analyses showed a significant group-by-time interaction for LF-HRV and HF-HRV, driven by increases in LF-HRV and HF-HRV only after agomelatine treatment. Within the paroxetine-treated group, there were no significant changes in mean R-R intervals or any HRV indices. We therefore concluded that MDD is associated with reduced HRV, which is inversely related to depression severity. Compared with paroxetine, agomelatine has a more vagotonic effect, suggesting greater cardiovascular safety. Clinicians should consider HRV effects while selecting antidepressants especially for depressed patients who already have decreased cardiac vagal tone. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years

    Energy Technology Data Exchange (ETDEWEB)

    Facchetti, Luca [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); University of Brescia, Department of Radiology, Brescia (Italy); Schwaiger, Benedikt J.; Gersing, Alexandra S.; Nardo, Lorenzo; Majumdar, Sharmila; Link, Thomas M.; Li, Xiaojuan [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Guimaraes, Julio Brandao [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Federal University of Sao Paulo (UNIFESP), Department of Radiology, Sao Paulo (Brazil); Ma, Benjamin C. [University of California, Department of Orthopedic Surgery, San Francisco, CA (United States); Collaboration: UCSF-P50-ACL Consortium; AF-ACL Consortium

    2017-08-15

    To assess the impact of cyclops lesions with MRI in patients treated for anterior cruciate ligament (ACL) tears on clinical outcome. In 113 patients (age 29.8 ± 10.5y; 55 females; BMI 24.8 ± 3.7 kg/m{sup 2}) with complete ACL tear, 3 T-MRI scans were obtained before, 6-months, 1-year (n = 75) and 2-years (n = 33) after ACL reconstruction. Presence and volume of cyclops lesions were assessed. Clinical outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS) and differences between time points (∇KOOS) were calculated. Changes of KOOS subscales were compared between patients with and without cyclops lesion. KOOS was also correlated with lesion volume. Cyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively. The lesion volume did not change significantly (P > 0.05) between time points, measuring 0.65 ± 0.59, 0.81 ± 0.70 and 0.72.9 ± 0.96 cm{sup 3}, respectively. Clinical outcomes based on KOOS subscales were not significantly different in patients with cyclops lesions compared to those without cyclops lesions (each comparison P > 0.05), and no significant associations of clinical outcomes with lesion volume were found (P > 0.05). Neither presence nor size of cyclops lesions within the first 2-years after ACL surgery were associated with inferior clinical outcome. (orig.)

  16. Claimed Effects, Outcome Variables and Methods of Measurement for Health Claims on Foods Related to Vision Proposed Under Regulation (EC) 1924/2006

    Science.gov (United States)

    Bedogni, Giorgio; Biasini, Beatrice; Zavaroni, Ivana; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Bonadonna, Riccardo C.; Passeri, Giovanni

    2018-01-01

    Adequate visual function has a strong impact on the quality of life of people. Several foods and food components have been hypothesized to play a role in the maintenance of normal visual function and in the prevention of eye diseases. Some of these foods/food components have been the object of a request of authorization for use of health claims under Articles 13(5) or 14 of the Regulation (EC) 1924/2006. Most of these requests have received a negative opinion from the European Food Safety Authority (EFSA) due to the choice of inappropriate outcome variables (OVs) and/or methods of measurement (MMs) applied in the studies used to substantiate the claims. This manuscript refers to the collection, collation and critical analysis of OVs and MMs related to vision. Guidance document and requests for authorization of health claims were used to collect OVs and MMs related to vision. A literature review was performed to critically analyse OVs and MMs, with the aim of defining their appropriateness in the context of a specific claimed effect related to vision. The results highlight the importance of adequate choices of OVs and MMs for an effective substantiation of claims related to visual function. PMID:29443929

  17. Quality of life as an outcome variable and a risk factor for total mortality and cardiovascular disease: a study of men born in 1913.

    Science.gov (United States)

    Tibblin, G; Svärdsudd, K; Welin, L; Erikson, H; Larsson, B

    1993-06-01

    To construct a simple assessment of the quality of life that can be used to evaluate medical treatment in light of the need to conserve resources and limit costs. The Göteborg Quality of Life Assessment was constructed in 1973 from the responses of men who were 50 years old at the time of the initial survey (1963) and were re-evaluated 10 years later. The assessment covers 15 factors in the World Health Organization definition of health or well-being, and includes a symptom questionnaire of 30 items relating to the most common elements of physical, mental and social well-being. The assessment was validated by determining the variation in these three principle components of well-being as a function of age. The use of this assessment as an outcome variable for subjects with cardiovascular disease indicated significantly lower quality of life scores, especially with regard to the general well-being, fitness and energy of subjects with hypertension and congestive heart failure compared to subjects without these diseases. When the assessment was evaluated as a risk factor for cardiovascular disease and mortality, the results of univariate analysis showed that health, fitness and appetite were significantly correlated with total mortality, while multivariate analysis indicated that only health was a significant factor.

  18. Evaluation of an HIV prevention intervention for African Americans and Hispanics: findings from the VOICES/VOCES Community-based Organization Behavioral Outcomes Project.

    Science.gov (United States)

    Fisher, Holly H; Patel-Larson, A; Green, K; Shapatava, E; Uhl, G; Kalayil, E J; Moore, A; Williams, W; Chen, B

    2011-11-01

    There is limited knowledge about whether the delivery of evidence-based, HIV prevention interventions in 'real world' settings will produce outcomes similar to efficacy trial outcomes. In this study, we describe longitudinal changes in sexual risk outcomes among African American and Hispanic participants in the Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) program at four CDC-funded agencies. VOICES/VOCES was delivered to 922 high-risk individuals in a variety of community settings such as substance abuse treatment centers, housing complex centers, private residences, shelters, clinics, and colleges. Significant risk reductions were consistently observed at 30- and 120-days post-intervention for all outcome measures (e.g., unprotected sex, self-reported STD infection). Risk reductions were strongest for African American participants, although Hispanic participants also reported reducing their risky behaviors. These results suggest that, over a decade after the first diffusion of VOICES/VOCES across the U.S. by CDC, this intervention remains an effective tool for reducing HIV risk behaviors among high-risk African American and Hispanic individuals.

  19. Use of clinical and computed tomography findings to assess long-term unsatisfactory outcome after femoral head and neck ostectomy in four large breed dogs.

    Science.gov (United States)

    Ober, Ciprian; Pestean, Cosmin; Bel, Lucia; Taulescu, Marian; Milgram, Joshua; Todor, Adrian; Ungur, Rodica; Leșu, Mirela; Oana, Liviu

    2018-05-10

    Femoral head and neck ostectomy (FHNO) is a salvage surgical procedure intended to eliminate hip joint laxity associated pain in the immature dog, or pain due to secondary osteoarthritis in the mature dog. The outcome of the procedure is associated with the size of the dog but the cause of a generally poorer outcome in larger breeds has not been determined. The objective of this study was to assess the long-term results of FHNO associated with unsatisfactory functional outcome by means of clinical examination and computed tomography (CT) scanning. Four large mixed breed dogs underwent FHNO in different veterinary clinics. Clinical and CT scanning evaluations were carried out long time after the procedures had been done. Hip pain, muscle atrophy, decreased range of motion and chronic lameness were observed at clinical examination. Extensive remodelling, unacceptable bone-on-bone contact with bony proliferation involving the femoral neck and acetabulum, but also excessive removal with bone lysis were observed by CT scanning. Revision osteotomy was performed in one dog. Deep gluteal muscle interposition was used, but no improvements were observed postoperatively. This is the first report on the evaluation of three-dimensional CT reconstructions of the late bone remodelling associated with poor clinical outcome in large dogs. The study shows that FHNO could lead to severe functional deficits in large breed dogs. An extensive follow-study is necessary to more accurately determine the frequency of such complications.

  20. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

    Science.gov (United States)

    Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-01-01

    Objectives To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD). Design Cross-sectional survey. Setting Outpatient clinics at a tertiary psychiatric hospital in Singapore. Participants 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD. Methods Data were collected in relation to self-stigma, perceived stigma, self-esteem, functioning and quality of life. In order to examine the mediating role of self-stigma on the relationship between perceived stigma and psychosocial outcomes, bootstrapping mediation analyses were used. Results Mediation analyses revealed that the relationship between perceived stigma and psychosocial outcomes was subject to the effects of self-stigma among the overall sample. Separate mediation analyses were conducted by diagnoses and showed differences in the mediating effects of self-stigma. Among the whole sample and the subsample with OCD, self-stigma mediated the relationship between perceived stigma and all psychosocial outcomes. For those with anxiety, depression and schizophrenia, the mediating effects of self-stigma were present in all relationships except (1) perceived stigma with physical health in the anxiety sample, (2) perceived stigma with social relationships in the depression sample and (3) perceived stigma with physical health in the schizophrenia sample. Conclusions The mediating effects of self-stigma on the relationship between perceived stigma and various psychosocial outcomes are evident and differ across diagnoses. Interventions to address and reduce the effects of self-stigma along with targeted treatments and psychoeducation to assist people with mental illness overcome or better manage self-stigma while providing them the skills to counteract public stigma are needed. PMID:28851803

  1. Methods and impact of engagement in research, from theory to practice and back again: early findings from the Patient-Centered Outcomes Research Institute.

    Science.gov (United States)

    Forsythe, Laura; Heckert, Andrea; Margolis, Mary Kay; Schrandt, Suzanne; Frank, Lori

    2018-01-01

    Since 2012, PCORI has been funding patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders in the research, a requirement that is unique among the US funders of clinical research. This paper presents PCORI's evaluation framework for assessing the short- and long-term impacts of engagement; describes engagement in PCORI projects (types of stakeholders engaged, when in the research process they are engaged and how they are engaged, contributions of their engagement); and identifies the effects of engagement on study design, processes, and outcomes selection, as reported by both PCORI-funded investigators and patient and other stakeholder research partners. Detailed quantitative and qualitative information collected annually from investigators and their partners was analyzed via descriptive statistics and cross-sectional qualitative content and thematic analysis, and compared against the outcomes expected from the evaluation framework and its underlying conceptual model. The data support the role of engaged research partners in refinements to the research questions, selection of interventions to compare, choice of study outcomes and how they are measured, contributions to strategies for recruitment, and ensuring studies are patient-centered. The evaluation framework and the underlying conceptual model are supported by results to date. PCORI will continue to assess the effects of engagement as the funded projects progress toward completion, dissemination, and uptake into clinical decision making.

  2. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome.

    Science.gov (United States)

    Skandsen, Toril; Kvistad, Kjell Arne; Solheim, Ole; Strand, Ingrid Haavde; Folvik, Mari; Vik, Anne

    2010-09-01

    In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. One hundred and fifty-nine patients (age range 5-65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3-13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale-Extended (GOSE). Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with "pure DAI" (median GCS Score 9) than in patients without DAI (median GCS Score 12; p GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.

  3. Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

    Science.gov (United States)

    Mentz, Robert J.; Hernandez, Adrian F.; Stebbins, Amanda; Ezekowitz, Justin A.; Felker, G. Michael; Heizer, Gretchen M.; Atar, Dan; Teerlink, John R.; Califf, Robert M.; Massie, Barry M.; Hasselblad, Vic; Starling, Randall C.; O'Connor, Christopher M.; Ponikowski, Piotr

    2013-01-01

    Aims To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes. Methods and results ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68–0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74–0.99), but similar mortality. Conclusion Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes. PMID:23159547

  4. An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

    Science.gov (United States)

    2013-01-01

    Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded

  5. Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey.

    Science.gov (United States)

    Henderson, Jane; Jomeen, Julie; Redshaw, Maggie

    2018-01-01

    mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate. to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period. this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care. England PARTICIPANTS: a random sample of women who had a live birth in January 2014. the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics. the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects. this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems. health care professionals may need additional training to effectively support women with mental health problems during the perinatal period. Copyright © 2017 The Authors

  6. Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome

    Energy Technology Data Exchange (ETDEWEB)

    Aragao, Maria de Fatima Vasco; Law, Meng; Prola Netto, Joao; Naidich, Thomas [Mount Sinai School of Medicine, New York, NY (United States). Dept. of Radiology], e-mail: aragao@truenet.com; Valenca, Marcelo Moraes [Federal University of Pernambuco (UFPE), Recife, PE (Brazil). Dept. of Neuropsychiatry and Behavioral Studies

    2009-03-15

    In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy ({sup 1}H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) {sup 1}H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early {sup 1}H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome. (author)

  7. Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome

    International Nuclear Information System (INIS)

    Aragao, Maria de Fatima Vasco; Law, Meng; Prola Netto, Joao; Naidich, Thomas; Valenca, Marcelo Moraes

    2009-01-01

    In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy ( 1 H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) 1 H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early 1 H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome. (author)

  8. Effect of an interactive E-learning tool for delirium on patient and nursing outcomes in a geriatric hospital setting: findings of a before-after study.

    Science.gov (United States)

    Detroyer, Elke; Dobbels, Fabienne; Teodorczuk, Andrew; Deschodt, Mieke; Depaifve, Yves; Joosten, Etienne; Milisen, Koen

    2018-01-19

    Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium. A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data. No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 ± SD 4.8 days versus 4.9 ± SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate

  9. Negative predictive value of multiparametric MRI for prostate cancer detection: Outcome of 5-year follow-up in men with negative findings on initial MRI studies

    Energy Technology Data Exchange (ETDEWEB)

    Itatani, R., E-mail: banguliao@gmail.com [Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556 (Japan); Department of Radiology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Kumamoto 862-0965 (Japan); Namimoto, T. [Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556 (Japan); Atsuji, S.; Katahira, K.; Morishita, S. [Department of Radiology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Kumamoto 862-0965 (Japan); Kitani, K.; Hamada, Y. [Department of Urology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Kumamoto 862-0965 (Japan); Kitaoka, M. [Department of Pathology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Kumamoto 862-0965 (Japan); Nakaura, T. [Department of Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto 863-0046 (Japan); Yamashita, Y. [Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556 (Japan)

    2014-10-15

    Highlights: • We assess the negative predictive value of multiparametric MRI for prostate cancer. • Patients with positive prostate biopsy findings were defined as false-negative. • Patients with negative initial prostate biopsy findings were followed up for 5 years. • The negative predictive value was 89.6% for significant prostate cancer. • MRI is a useful tool to rule out significant prostate cancer before biopsy. - Abstract: Objective: To assess the clinical negative predictive value (NPV) of multiparametric MRI (mp-MRI) for prostate cancer in a 5-year follow-up. Materials and methods: One hundred ninety-three men suspected of harboring prostate cancer with negative MRI findings were included. Patients with positive transrectal ultrasound (TRUS)-guided biopsy findings were defined as false-negative. Patients with negative initial TRUS-guided biopsy findings were followed up and only patients with negative findings by digital rectal examination, MRI, and repeat biopsy and no increase in PSA at 5-year follow-up were defined as “clinically negative”. The clinical NPV of mp-MRI was calculated. For quantitative analysis, mean signal intensity on T2-weighted images and the mean apparent diffusion coefficient value on ADC maps of the initial MRI studies were compared between peripheral-zone (PZ) cancer and the normal PZ based on pathologic maps of patients who had undergone radical prostatectomy. Results: The clinical NPV of mp-MRI was 89.6% for significant prostate cancer. Small cancers, prostatitis, and benign prostatic hypertrophy masking prostate cancer returned false-negative results. Quantitative analysis showed that there was no significant difference between PZ cancer and the normal PZ. Conclusion: The mp-MRI revealed a high clinical NPV and is a useful tool to rule out clinically significant prostate cancer before biopsy.

  10. Negative predictive value of multiparametric MRI for prostate cancer detection: Outcome of 5-year follow-up in men with negative findings on initial MRI studies

    International Nuclear Information System (INIS)

    Itatani, R.; Namimoto, T.; Atsuji, S.; Katahira, K.; Morishita, S.; Kitani, K.; Hamada, Y.; Kitaoka, M.; Nakaura, T.; Yamashita, Y.

    2014-01-01

    Highlights: • We assess the negative predictive value of multiparametric MRI for prostate cancer. • Patients with positive prostate biopsy findings were defined as false-negative. • Patients with negative initial prostate biopsy findings were followed up for 5 years. • The negative predictive value was 89.6% for significant prostate cancer. • MRI is a useful tool to rule out significant prostate cancer before biopsy. - Abstract: Objective: To assess the clinical negative predictive value (NPV) of multiparametric MRI (mp-MRI) for prostate cancer in a 5-year follow-up. Materials and methods: One hundred ninety-three men suspected of harboring prostate cancer with negative MRI findings were included. Patients with positive transrectal ultrasound (TRUS)-guided biopsy findings were defined as false-negative. Patients with negative initial TRUS-guided biopsy findings were followed up and only patients with negative findings by digital rectal examination, MRI, and repeat biopsy and no increase in PSA at 5-year follow-up were defined as “clinically negative”. The clinical NPV of mp-MRI was calculated. For quantitative analysis, mean signal intensity on T2-weighted images and the mean apparent diffusion coefficient value on ADC maps of the initial MRI studies were compared between peripheral-zone (PZ) cancer and the normal PZ based on pathologic maps of patients who had undergone radical prostatectomy. Results: The clinical NPV of mp-MRI was 89.6% for significant prostate cancer. Small cancers, prostatitis, and benign prostatic hypertrophy masking prostate cancer returned false-negative results. Quantitative analysis showed that there was no significant difference between PZ cancer and the normal PZ. Conclusion: The mp-MRI revealed a high clinical NPV and is a useful tool to rule out clinically significant prostate cancer before biopsy

  11. A prospective investigation of physical health outcomes in abused and neglected children: new findings from a 30-year follow-up.

    Science.gov (United States)

    Widom, Cathy Spatz; Czaja, Sally J; Bentley, Tyrone; Johnson, Mark S

    2012-06-01

    We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood. Using a prospective cohort design, we matched children (aged 0-11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age=41.2 years). After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships. Child abuse and neglect affect long-term health status-increasing risk for diabetes, lung disease, malnutrition, and vision problems-and support the need for early health care prevention.

  12. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.

    Science.gov (United States)

    Medford-Davis, Laura N; Fonarow, Gregg C; Bhatt, Deepak L; Xu, Haolin; Smith, Eric E; Suter, Robert; Peterson, Eric D; Xian, Ying; Matsouaka, Roland A; Schwamm, Lee H

    2016-11-14

    Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (rehab (stroke, time to presentation for acute treatment, access to rehabilitation, and in-hospital mortality differ by patient insurance status. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. Kentucky Preschool Evaluation Project: Differential Effects, Program Characteristics and Child Outcomes, and Longitudinal and Cumulative Findings. Reports 1-4, 1998-1999.

    Science.gov (United States)

    Hemmeter, Mary Louise; Townley, Kim; Wilson, Stephen; Epstein, Ann; Hines, Huyi

    This document is comprised of four reports related to the evaluation of the Kentucky Preschool Program (KPP), serving 4-year-olds who qualify for the free lunch program and 3- and 4-year-olds with disabilities. Report 1 focuses on the differential effects of the preschool program related to race and to gender. Three key findings are reported: (1)…

  14. Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms: a single institutional study of 161 patients

    International Nuclear Information System (INIS)

    Kim, Dong Wook; Kim, Hyoung Jung; Kim, Kyung Won; Byun, Jae Ho; Kim, So Yeon; Song, Ki Byung; Ramaiya, Nikhil H.; Tirumani, Sree Harsha; Hong, Seung-Mo

    2016-01-01

    To evaluate the prognostic value of CT to predict recurrence-free and overall survival in patients with pancreatic neuroendocrine neoplasms (PanNENs). Between January 2004 and December 2012, 161 consecutive patients who underwent preoperative triphasic CT and surgical resection with curative intent for PanNENs were identified. The tumour consistency, margin, presence of calcification, pancreatic duct dilatation, bile duct dilatation, vascular invasion, and hepatic metastases were evaluated. The tumour size, arterial enhancement ratio, and portal enhancement ratio were measured. The Cox proportional hazard model was used to determine the association between CT features and recurrence-free survival and overall survival. By multivariate analysis, tumour size (>3 cm) (hazard ratio, 3.314; p = 0.006), portal enhancement ratio (≤1.1) (hazard ratio, 2.718; p = 0.006), and hepatic metastases (hazard ratio, 4.374; p = 0.003) were independent significant variables for worse recurrence-free survival. Portal enhancement ratio (≤1.1) (hazard ratio, 5.951; p = 0.001) and hepatic metastases (hazard ratio, 4.122; p = 0.021) were independent significant variables for worse overall survival. Portal enhancement ratio (≤1.1) and hepatic metastases assessed on CT were common independent prognostic factors for worse recurrence-free survival and overall survival in patients with PanNENs. (orig.)

  15. Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms: a single institutional study of 161 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Wook; Kim, Hyoung Jung; Kim, Kyung Won; Byun, Jae Ho; Kim, So Yeon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Song, Ki Byung [University of Ulsan College of Medicine, Department of Surgery, Asan Medical Center, Seoul (Korea, Republic of); Ramaiya, Nikhil H.; Tirumani, Sree Harsha [Harvard Medical School, Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, MA (United States); Hong, Seung-Mo [University of Ulsan College of Medicine, Department of Pathology, Asan Medical Center, Seoul (Korea, Republic of)

    2016-05-15

    To evaluate the prognostic value of CT to predict recurrence-free and overall survival in patients with pancreatic neuroendocrine neoplasms (PanNENs). Between January 2004 and December 2012, 161 consecutive patients who underwent preoperative triphasic CT and surgical resection with curative intent for PanNENs were identified. The tumour consistency, margin, presence of calcification, pancreatic duct dilatation, bile duct dilatation, vascular invasion, and hepatic metastases were evaluated. The tumour size, arterial enhancement ratio, and portal enhancement ratio were measured. The Cox proportional hazard model was used to determine the association between CT features and recurrence-free survival and overall survival. By multivariate analysis, tumour size (>3 cm) (hazard ratio, 3.314; p = 0.006), portal enhancement ratio (≤1.1) (hazard ratio, 2.718; p = 0.006), and hepatic metastases (hazard ratio, 4.374; p = 0.003) were independent significant variables for worse recurrence-free survival. Portal enhancement ratio (≤1.1) (hazard ratio, 5.951; p = 0.001) and hepatic metastases (hazard ratio, 4.122; p = 0.021) were independent significant variables for worse overall survival. Portal enhancement ratio (≤1.1) and hepatic metastases assessed on CT were common independent prognostic factors for worse recurrence-free survival and overall survival in patients with PanNENs. (orig.)

  16. Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study.

    Science.gov (United States)

    Caballero, Teresa; Zanichelli, Andrea; Aberer, Werner; Maurer, Marcus; Longhurst, Hilary J; Bouillet, Laurence; Andresen, Irmgard

    2018-01-01

    Icatibant is a bradykinin B2-receptor antagonist used for the treatment of hereditary angioedema attacks resulting from C1-inhibitor deficiency. Treatment is not adjusted by body weight however the impact of body mass index (BMI) on the effectiveness of icatibant is not documented in the literature. We examined disease characteristics and icatibant treatment effectiveness in patients stratified by BMI in the Icatibant Outcome Survey, an ongoing, international, observational study monitoring the real-world safety and effectiveness of icatibant. Attack and treatment characteristics as well as outcomes following treatment with icatibant were compared among patients with underweight, normal, overweight, and obese BMI. Data from 2697 icatibant-treated attacks in 342 patients (3.5, 44.7, 34.8, and 17.0% patients of underweight, normal, overweight, and obese BMI, respectively) were analyzed. There was no significant difference in the frequency and severity of attacks across BMI groups, although obese patients tended to have more attacks of high severity. There was no impact of BMI on the frequency of laryngeal attacks, but patients with normal BMI had fewer cutaneous attacks and more abdominal attacks. Most attacks (71.9-83.8%) were treated with a single icatibant injection without the need for rescue with plasma-derived C1-inhibitor (pdC1-INH), regardless of BMI. Patients with obese BMI used pdC1-INH as rescue treatment more often (P < 0.0001; P = 0.0232 excluding 2 outliers) and treated attacks earlier than patients with normal BMI (P = 0.007). Furthermore, time to resolution and duration of attack were shorter for patients with high BMI (P < 0.001 for overweight and P < 0.05 for obese versus normal). Overall, icatibant was comparatively effective in treating attacks in patients across all BMI groups. Trial registration NCT01034969.

  17. Fertility outcome and information on fertility issues in individuals with different forms of disorders of sex development: findings from the dsd-LIFE study.

    Science.gov (United States)

    Słowikowska-Hilczer, Jolanta; Hirschberg, Angelica Lindén; Claahsen-van der Grinten, Hedi; Reisch, Nicole; Bouvattier, Claire; Thyen, Ute; Cohen Kettenis, Peggy; Roehle, Robert; Köhler, Birgit; Nordenström, Anna

    2017-11-01

    To investigate fertility outcome in individuals with different forms of disorders of sex development (DSD), if assisted reproductive technology (ART) was used, and the patients' satisfaction with the information they had received. A cross-sectional multicenter study, dsd-LIFE. Not applicable. A total of 1,040 patients aged ≥16 years with different DSD diagnoses participated. A web-based questionnaire was filled out by all participants. The participants could chose to take part in somatic investigations including ultrasonography. Information on partner, number of children, ART, adoption and step-children, general health, presence of gonads and uterus, current education and economic situation, received information on fertility issues, and satisfaction with the information, was collected. In the total cohort, mean age 32 years, 33% lived with a partner, but only 14% reported having at least one child including 7% with ART, 4% adopted. Only 3.5% of the total cohort had been able to reproduce without ART, most frequently women with congenital adrenal hyperplasia, and only 0.7% of participants with other diagnoses. Of the participants, 72% had received information on fertility, but 17% were not satisfied with the information. Fertility outcome is significantly reduced in all types of DSD; however, fertility potential should be assessed individually. The satisfaction with how fertility problems have been discussed can be improved. The care of patients with DSD is complex, should be individualized, and new treatment possibilities incorporated. A close collaboration in multidisciplinary teams is therefore essential to improve the situation for individuals with DSD. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program.

    Science.gov (United States)

    Qian, Feng; Ling, Frederick S; Deedwania, Prakash; Hernandez, Adrian F; Fonarow, Gregg C; Cannon, Christopher P; Peterson, Eric D; Peacock, W Frank; Kaltenbach, Lisa A; Laskey, Warren K; Schwamm, Lee H; Bhatt, Deepak L

    2012-01-01

    Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients. We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (PAsian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04). Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.

  19. Astronaut Preflight Cardiovascular Variables Associated with Vascular Compliance are Highly Correlated with Post-Flight Eye Outcome Measures in the Visual Impairment Intracranial Pressure (VIIP) Syndrome Following Long Duration Spaceflight

    Science.gov (United States)

    Otto, Christian; Ploutz-Snyder, R.

    2015-01-01

    The detection of the first VIIP case occurred in 2005, and adequate eye outcome measures were available for 31 (67.4%) of the 46 long duration US crewmembers who had flown on the ISS since its first crewed mission in 2000. Therefore, this analysis is limited to a subgroup (22 males and 9 females). A "cardiovascular profile" for each astronaut was compiled by examining twelve individual parameters; eleven of these were preflight variables: systolic blood pressure, pulse pressure, body mass index, percentage body fat, LDL, HDL, triglycerides, use of anti-lipid medication, fasting serum glucose, and maximal oxygen uptake in ml/kg. Each of these variables was averaged across three preflight annual physical exams. Astronaut age prior to the long duration mission, and inflight salt intake was also included in the analysis. The group of cardiovascular variables for each crew member was compared with seven VIIP eye outcome variables collected during the immediate post-flight period: anterior-posterior axial length of the globe measured by ultrasound and optical biometry; optic nerve sheath diameter, optic nerve diameter, and optic nerve to sheath ratio- each measured by ultrasound and magnetic resonance imaging (MRI), intraocular pressure (IOP), change in manifest refraction, mean retinal nerve fiber layer (RNFL) on optical coherence tomography (OCT), and RNFL of the inferior and superior retinal quadrants. Since most of the VIIP eye outcome measures were added sequentially beginning in 2005, as knowledge of the syndrome improved, data were unavailable for 22.0% of the outcome measurements. To address the missing data, we employed multivariate multiple imputation techniques with predictive mean matching methods to accumulate 200 separate imputed datasets for analysis. We were able to impute data for the 22.0% of missing VIIP eye outcomes. We then applied Rubin's rules for collapsing the statistical results across our 200 multiply imputed data sets to assess the canonical

  20. Magnifying Endoscopic Findings Can Predict Clinical Outcome during Long-Term Follow-Up of More Than 12 Months in Patients with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Hajime Isomoto

    2013-01-01

    Full Text Available Background and Aims. To explore the association of magnifying endoscopic (ME findings with histopathology and relapse in ulcerative colitis (UC. Methods. Forty-six patients with UC underwent ME with narrow band imaging (NBI and crystal violet staining and were followed for more than 12 months. ME findings with vital staining were classified into ME-A, regular arrangement of round to oval pits; ME-B, irregular arrangement with/without enlarged spaces between even pits; ME-C, irregular pits in size and shape with more irregular arrangement of pits; and ME-D, disrupted or disappeared pits. NBI-guided ME features of microvascular pattern (MVP were divided into the MVP-regular and MVP-irregular type. Results. There were 5, 24, 10, and 7 cases of ME-A, ME-B, ME-C, and ME-D grade, respectively, while there were 21 and 25 of MVP-regular and MVP-irregular type, respectively. ME classifications were significantly associated with Matts endoscopic grade. ME classifications and MVP types were significantly associated with each pathognomonic microscopic feature of severe mucosal inflammation, crypt abscess, and goblet cell depletion. There were significant differences in the percentages of remission among ME classifications and between MVP types. Conclusion. ME findings can be predictive of relapse in UC and reliable for in vivo histopathological assessment.

  1. Influence of dose, age at the onset of disease and ultrasonographic findings of the thyroid gland on the early outcome of the radioiodine treatment of hyperthyroidism

    International Nuclear Information System (INIS)

    Ugrinska, A.; Pop Gjorceva, D.; Muratovska, L.; Crcareva, B.; Stojanovski, S.

    2007-01-01

    Full text: Aim of the study: Estimation of the early effects of the treatment of hyperthyroidism with radioactive iodine in correlation with the radioiodine dose, the age at the onset of disease and ultrasonographic (US) findings of the thyroid. Material and methods: Retrospective analysis of the files of 80 patients that underwent a radioactive iodine treatment from the period of 1987 till 2006 because of a diffuse hyperthyroid goiter was performed. The patients were divided in two groups. Group C consisted of patients who were treated with calculated doses from 60-100μC/ml gland volume and group NC who received higher, non-calculated doses. According to age at the onset of disease patients were divided in two groups- group A younger than 40 years and group B older than 40 years. According to the US findings of the thyroid prior to radioiodine therapy patients were divided in two groups group N with predominantly normal US findings and group H with predominantly hypoechoic structure. Results: One year after the application of radioactive iodine 58% of the patients from the group C still remained hyperthyroid, 29% became euthyroid and only 13% developed early hypothyroidism. In the NC group only 7% remained hyperthyroid, 40% were euthyroid, while 54% of the patients developed early hypothyroidism. The occurrence of early hypothyroidism was significantly more frequent in NC than in C group (58% vs. 32%, p<0.05). The age was predictor for the probability of development of early hypothyroidism in C group: only 13% younger in group A, but 46% older patients from group B developed an early hypothyroidism. In the NC group the age was not a predictive factor. In 44 patients there were available records on the US findings prior to radioiodine therapy. In the N group patients that received calculated dose of radioiodine therapy remained euthyroid in 86%, while the patients that received non-calculated dose achieved euthyroidism only in 30%.In the H group there was no

  2. Real-world variability in ranibizumab treatment and associated clinical, quality of life, and safety outcomes over 24 months in patients with neovascular age-related macular degeneration: the HELIOS study

    Directory of Open Access Journals (Sweden)

    Rakic JM

    2013-09-01

    < 0.0001. The mean visual acuity increase over baseline at 12 months was not significant (P = 0.08; the decline over baseline at 24 months statistically significant (P = 0.02. Overall, 94.3% of patients showed stable or improved disease at 6 months and 81.5% of patients showed stable or improved disease at 24 months. At 6 months, improvements over baseline were significant for VFQ-25 (P = 0.03 and HUI3 (P = 0.02, but not at 12 months and 24 months. Improvements in VFQ-25 and HUI3 were maintained at 24 months in 38% and 34% of patients, respectively. In total 78 serious adverse events were reported in 40 patients and 77 nonserious adverse events in 34 patients. Nine serious adverse events and nine nonserious adverse events in 14 patients were suspected to be related to ranibizumab treatment. Conclusion: The "real-world" clinical effectiveness of ranibizumab was evidenced by the initial improvements over baseline in visual acuity and quality of life, as well as the maintenance of these outcomes at baseline levels at 24 months, and this was observed under variable treatment conditions. The findings underscore the need for individualized treatment with regular monitoring to achieve optimal vision and quality of life outcomes. Keywords: ranibizumab, age-related macular degeneration, neovascular macular degeneration, visual acuity, visual function, quality of life

  3. Impact of First Aid on Treatment Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and Demographic Census.

    Science.gov (United States)

    Hoque, Dewan Md Emdadul; Islam, Md Irteja; Sharmin Salam, Shumona; Rahman, Qazi Sadeq-Ur; Agrawal, Priyanka; Rahman, Aminur; Rahman, Fazlur; El-Arifeen, Shams; Hyder, Adnan A; Alonge, Olakunle

    2017-07-12

    Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

  4. Implicit and explicit memory outcome in children who have sustained severe traumatic brain injury: impact of age at injury (preliminary findings).

    Science.gov (United States)

    Lah, Suncica; Epps, Adrienne; Levick, Wayne; Parry, Louise

    2011-01-01

    To examine implicit and explicit memory outcome in children who had sustained severe traumatic brain injury (TBI) through childhood. Opposite patterns of impairments were expected: (i) impaired implicit memory in children with early TBI (TBI-EC, explicit memory in children with late TBI (TBI-LC, ≥ 6 years). Children who had sustained severe TBI more then 1 year ago were assessed. Fourteen children who had sustained severe TBI (TBI-EC, n = 10 and TBI-LC, n = 4) between 8 months and 13 years 7 months of age and 13 non-injured control subjects (NC) participated. Implicit (repetition priming and skill learning) and explicit verbal memory were examined. The TBI group performed worse on implicit (repetition priming) and explicit memory tasks compared to the NC group. Moreover, impairments were found in implicit and explicit memory in the TBI-EC, but not in the TBI-LC group. This study has shown, for the first time, that severe childhood TBI may compromise not only explicit, but also implicit memory. Nevertheless, instead of a selective implicit memory impairment, it was found that children who sustained injuries in early childhood present with impairments in both memory systems.

  5. Subcentimeter hypervascular nodules with typical imaging findings of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: Outcomes of early treatment and watchful waiting

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Jung Han; Song, Kyoung Doo; Kim, Seong Hyun [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, 81 Irwon-Ro, Gangnam-Gu, Seoul (Korea, Republic of)

    2017-10-15

    To compare treatment outcomes of subcentimeter hypervascular nodules at high risk for developing into hepatocellular carcinomas (SHNHR) between early treatment and watchful waiting until progression to overt hepatocellular carcinoma (HCC) groups. SHNHRs were defined as subcentimeter hypervascular nodules with the usual imaging features of HCC on gadoxetic acid-enhanced magnetic resonance imaging (MRI). Among 63 patients with 74 SHNHRs, 27 (37 SHNHRs) received early treatment (treatment of < 1 cm nodules), and 36 (37 SHNHRs) underwent watchful waiting until progression to overt HCC. Risk factor analysis was performed for recurrence-free and local recurrence-free survival. Among the 36 patients who adopted watchful waiting, 33 eventually underwent treatment because their SHNHRs progressed to overt HCC. For recurrence-free survival, significant risk factors included number of previous treatments (HR, 1.181; p < 0.001), tumour number (HR, 1.943; p = 0.009), and α-feto protein level (HR, 1.005; p = 0.037) in the multivariate analyses. Treatment strategy was not a significant risk factor for recurrence-free survival. For local recurrence-free survival from the date of treatment, only treatment modality (transarterial chemoembolization) (HR, 6.879; p = 0.002) was a significant risk factor. Recurrence-free survival was not significantly different between early treatment and watchful waiting for SHNHRs. (orig.)

  6. Brain responses to biological motion predict treatment outcome in young adults with autism receiving Virtual Reality Social Cognition Training: Preliminary findings.

    Science.gov (United States)

    Yang, Y J Daniel; Allen, Tandra; Abdullahi, Sebiha M; Pelphrey, Kevin A; Volkmar, Fred R; Chapman, Sandra B

    2017-06-01

    Autism Spectrum Disorder (ASD) is characterized by remarkable heterogeneity in social, communication, and behavioral deficits, creating a major barrier in identifying effective treatments for a given individual with ASD. To facilitate precision medicine in ASD, we utilized a well-validated biological motion neuroimaging task to identify pretreatment biomarkers that can accurately forecast the response to an evidence-based behavioral treatment, Virtual Reality-Social Cognition Training (VR-SCT). In a preliminary sample of 17 young adults with high-functioning ASD, we identified neural predictors of change in emotion recognition after VR-SCT. The predictors were characterized by the pretreatment brain activations to biological vs. scrambled motion in the neural circuits that support (a) language comprehension and interpretation of incongruent auditory emotions and prosody, and (b) processing socio-emotional experience and interpersonal affective information, as well as emotional regulation. The predictive value of the findings for individual adults with ASD was supported by regression-based multivariate pattern analyses with cross validation. To our knowledge, this is the first pilot study that shows neuroimaging-based predictive biomarkers for treatment effectiveness in adults with ASD. The findings have potentially far-reaching implications for developing more precise and effective treatments for ASD. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

    Directory of Open Access Journals (Sweden)

    Giorgio Cioni

    2016-11-01

    Full Text Available Abstract Background Clostridium difficile (CD is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI in Internal Medicine (IM wards in Italy. Methods PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results Among the 10,780 patients observed, 103 (0.96 % showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis. In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001, whereas median length of hospital stay was 16 (IQR = 13 vs 8 (IQR = 8 days (p < 0.001 among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay. The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2–3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.

  8. Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis.

    Science.gov (United States)

    Thorneloe, R J; Bundy, C; Griffiths, C E M; Ashcroft, D M; Cordingley, L

    2017-03-01

    Medication nonadherence is known to limit the effectiveness of available therapies; however, little is known specifically about medication adherence in people with psoriasis. Medicines self-management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing nonadherence to medication as an outcome of limited personal coping resources and conflicting goals may help to explain medication nonadherence. To explore individuals' perspectives of their psoriasis, medication and its management. Twenty people with psoriasis were recruited from community samples in England and interviewed in-depth about their perceptions of their psoriasis, medication, and adherence to medication and self-management advice. Data were analysed using Framework Analysis. Participants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self-reported adherence, which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants' self-management difficulties was viewed as an additional source of stress and distress. Adhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of nonadherence to psoriasis medication as rational attempts by individuals to minimize distress and to gain control over their life. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

  9. A CBPR partnership increases HIV testing among men who have sex with men (MSM): outcome findings from a pilot test of the CyBER/testing internet intervention.

    Science.gov (United States)

    Rhodes, Scott D; Vissman, Aaron T; Stowers, Jason; Miller, Cindy; McCoy, Thomas P; Hergenrather, Kenneth C; Wilkin, Aimee M; Reece, Michael; Bachmann, Laura H; Ore, Addison; Ross, Michael W; Hendrix, Ellen; Eng, Eugenia

    2011-06-01

    The Internet has emerged as an important tool for the delivery of health promotion and disease prevention interventions. Our community-based participatory research (CBPR) partnership developed and piloted CyBER/testing, a culturally congruent intervention designed to promote HIV testing among men who have sex with men (MSM) within existing Internet chat rooms. Using a quasi-experimental, single-group study design, cross-sectional data were collected from chat room participants, known as "chatters," at pretest (n = 346) and posttest (n = 315). Extant profile data also were collected to describe the demographics of the online population. The intervention significantly increased self-reported HIV testing among chatters overall, increasing rates from 44.5% at pretest to nearly 60% at posttest (p testing at posttest. Findings suggest that chat room-based HIV testing intervention may increase testing among MSM who may be difficult to reach in traditional physical spaces.

  10. Surgical Findings and Outcomes in Premenopausal Breast Cancer Patients Undergoing Oophorectomy: A Multicenter Review From the Society of Gynecologic Surgeons Fellows Pelvic Research Network.

    Science.gov (United States)

    Harvey, Lara F B; Abramson, Vandana G; Alvarez, Jimena; DeStephano, Christopher; Hur, Hye-Chun; Lee, Katherine; Mattingly, Patricia; Park, Beau; Piszczek, Carolyn; Seifi, Farinaz; Stuparich, Mallory; Yunker, Amanda

    2018-01-01

    To describe the procedures performed, intra-abdominal findings, and surgical pathology in a cohort of women with premenopausal breast cancer who underwent oopherectomy. Multicenter retrospective chart review (Canadian Task Force classification II-3). Nine US academic medical centers participating in the Fellows' Pelvic Research Network (FPRN). One hundred twenty-seven women with premenopausal breast cancer undergoing oophorectomy between January 2013 and March 2016. Surgical castration. The mean patient age was 45.8 years. Fourteen patients (11%) carried a BRCA mutations, and 22 (17%) carried another germline or acquired mutation, including multiple variants of uncertain significance. There was wide variation in surgical approach. Sixty-five patients (51%) underwent pelvic washings, and 43 (35%) underwent concurrent hysterectomy. Other concomitant procedures included midurethral sling placement, appendectomy, and hysteroscopy. Three patients experienced complications (transfusion, wound cellulitis, and vaginal cuff dehiscence). Thirteen patients (10%) had ovarian pathology detected on analysis of the surgical specimen, including metastatic tumor, serous cystadenomas, endometriomas, and Brenner tumor. Eight patients (6%) had Fallopian tube pathology, including 3 serous tubal intraepithelial cancers. Among the 44 uterine specimens, 1 endometrial adenocarcinoma and 1 multifocal endometrial intraepithelial neoplasia were noted. Regarding the entire study population, the number of patients meeting our study criteria and seen by gynecologic surgeons in the FPRN for oophorectomy increased by nearly 400% from 2013 to 2015. Since publication of the Suppression of Ovarian Function Trial data, bilateral oophorectomy has been recommended for some women with premenopausal breast cancer to facilitate breast cancer treatment with aromatase inhibitors. These women may be at elevated risk for occult abdominal pathology compared with the general population. Gynecologic surgeons

  11. Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash.

    Science.gov (United States)

    Radanov, B P; Sturzenegger, M; De Stefano, G; Schnidrig, A

    1994-05-01

    To analyse the significance of the interplay between somatic and psychosocial factors in influencing the course of recovery a non-selected well defined group of 117 whiplash patients was investigated. Initial examination was performed, on average, 7.2 +/- 4.2 days after trauma and follow-ups were carried out at 3, 6 and 12 months. At the initial investigation all patients were given a neurological examination, cognitive and psychosocial factor assessment and cervical spine X-rays. At each follow-up stepwise regression was performed to evaluate the relationship between initial findings and the course of recovery. Fifty-one (44%), 36 (31%) and 28 (24%) patients were symptomatic at 3, 6 and 12 months respectively. Poor improvement at all examinations was significantly correlated with factors associated with severity of injury such as initial symptoms of radicular irritation and intensity of neck pain. Moreover, results indicate that poor recovery is related to severity of injury in addition to some pre-traumatic factors (previous history of head trauma and headache) and initial injury-related reaction (i.e. sleep disturbances, reduced speed of information processing and nervousness). However, psychosocial factors did not prove predictive at any follow-up examination. These results indicate that symptoms suggesting a more severe neck injury appear to be particularly related to delayed recovery from common whiplash. Moreover these results may be of value in the objective evaluation of potentially difficult claims for compensation, which may in some cases be falsely based.

  12. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)

    DEFF Research Database (Denmark)

    Poulter, Neil R; Wedel, Hans; Dahlöf, Björn

    2005-01-01

    Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen (HR...... 0.86 and 0.77, respectively). Our aim was to assess to what extent these differences were due to significant differences in blood pressures and in other variables noted after randomisation....

  13. How Are Students' Attitudes Related to Learning Outcomes?

    Science.gov (United States)

    Metsärinne, Mika; Kallio, Manne

    2016-01-01

    This article is a part of a research project aimed to find out how different background variables are related to learning outcomes in technology education related to the school subject Sloyd (craft). The research question of this article is: "How are ninth grade students' attitudes towards the subject related to their learning outcomes?"…

  14. Scientific imperatives, clinical implications, and theoretical underpinnings for the investigation of the relationship between genetic variables and patient-reported quality-of-life outcomes

    NARCIS (Netherlands)

    Sprangers, Mirjam A. G.; Sloan, Jeff A.; Barsevick, Andrea; Chauhan, Cynthia; Dueck, Amylou C.; Raat, Hein; Shi, Quiling; van Noorden, Cornelis J. F.; Abernethy, Amy P.; Baas, Frank; Barsevick, Andrea M.; Bartels, Meike; Boomsma, Dorret I.; Bottomley, Andrew; Brundage, Michael; Cella, David; Cleeland, Charles S.; Coens, Corneel; Frost, Marlene H.; Hall, Per; Halyard, Michele Y.; Klepstad, Pål; Martin, Nicholas G.; Miaskowski, Christine; Mosing, Miriam; Movsas, Benjamin; Oliveira, Joao R.; Ordoñana, Juan; Patrick, Donald L.; Pedersen, Nancy L.; Reeve, Bryce; Ropka, Mary E.; Shinozaki, Gen; Singh, Jasvinder A.; Swaab, Dick; Veenhoven, Ruut; Wagner, Gert; Yang, Ping; Zwinderman, Ailko H.

    2010-01-01

    Objectives There is emerging evidence for a genetic basis of patient-reported quality-of-life (QOL) outcomes that can ultimately be incorporated into clinical research and practice. Objectives are (1) to provide arguments for the timeliness of investigating the genetic basis of QOL given the

  15. Reduction in camera-specific variability in [(123)I]FP-CIT SPECT outcome measures by image reconstruction optimized for multisite settings

    DEFF Research Database (Denmark)

    Buchert, Ralph; Kluge, Andreas; Tossici-Bolt, Livia

    2016-01-01

    the Southampton method with binding in the whole brain, occipital cortex or cerebellum as the reference. The correlation between SBR and age was used as the primary quality measure. RESULTS: The fraction of SBR variability explained by age was highest (1) with QSPECT, independently of the reference region, and (2...... as the reference provides more stable quantitative estimates than occipital or cerebellar binding....

  16. Maternal nutrition and birth outcomes.

    Science.gov (United States)

    Abu-Saad, Kathleen; Fraser, Drora

    2010-01-01

    In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

  17. Reinforcing Saccadic Amplitude Variability

    Science.gov (United States)

    Paeye, Celine; Madelain, Laurent

    2011-01-01

    Saccadic endpoint variability is often viewed as the outcome of neural noise occurring during sensorimotor processing. However, part of this variability might result from operant learning. We tested this hypothesis by reinforcing dispersions of saccadic amplitude distributions, while maintaining constant their medians. In a first experiment we…

  18. Psychosocial determinants of outcomes in knee replacement.

    Science.gov (United States)

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

    2011-10-01

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

  19. Genetic polymorphisms of antioxidant enzymes CAT and SOD affect the outcome of clinical, biochemical, and anthropometric variables in people with obesity under a dietary intervention.

    Science.gov (United States)

    Hernández-Guerrero, César; Parra-Carriedo, Alicia; Ruiz-de-Santiago, Diana; Galicia-Castillo, Oscar; Buenrostro-Jáuregui, Mario; Díaz-Gutiérrez, Carmen

    2018-01-01

    Genetic polymorphisms of antioxidant enzymes CAT, GPX, and SOD are involved in the etiology of obesity and its principal comorbidities. The aim of the present study was to analyze the effect of aforementioned SNPs over the output of several variables in people with obesity after a nutritional intervention. The study included 92 Mexican women, which received a dietary intervention by 3 months. Participants were genotyped and stratified into two groups: (1) carriers; mutated homozygous plus heterozygous (CR) and (2) homozygous wild type (WT). A comparison between CR and WT was done in clinical (CV), biochemical (BV), and anthropometric variables (AV), at the beginning and at the end of the intervention. Participants ( n  = 92) showed statistically significant differences ( p  T GPX1 (rs1050450), - 251A>G SOD1 (rs2070424), and - 262C>T CAT (rs1001179). (B) Only CR showed statistically changes ( p  T CAT (rs7943316) and 47C>T SOD2 (rs4880). The dietary intervention effect was statistically significantly between the polymorphisms of 47C>T SOD2 and BMI, SBP, TBARS, total cholesterol, and C-LCL ( p  T CAT (rs7943316) and SBP, DBP, total cholesterol, and atherogenic index ( p  CAT enzymes.

  20. Positron Emission Tomography/Computed Tomography Findings During Therapy Predict Outcome in Patients With Diffuse Large B-Cell Lymphoma Treated With Chemotherapy Alone but Not in Those Who Receive Consolidation Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Dabaja, Bouthaina S., E-mail: bdabaja@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hess, Kenneth [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Shihadeh, Ferial [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Podoloff, Donald A. [Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Medeiros, L. Jeffrey [Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mawlawi, Osama [Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Arzu, Isidora [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Oki, Yasuhiro; Hagemeister, Fredrick B.; Fayad, Luis E. [Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Reed, Valerie K.; Kedir, Aziza; Wogan, Christine F. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez, Alma [Office of the Executive Vice President and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-06-01

    Purpose: To assess the value of mid-therapy positron emission tomography (PET) findings for predicting survival and disease progression in patients with diffuse large B-cell lymphoma, considering type of therapy (chemotherapy with or without radiation therapy). Methods and Materials: We retrospectively evaluated 294 patients with histologically confirmed diffuse large B-cell lymphoma with respect to age, sex, disease stage, International Prognostic Index score, mid-therapy PET findings (positive or negative), and disease status after therapy and at last follow-up. Overall survival (OS) and progression-free survival (PFS) were compared according to mid-therapy PET findings. Results: Of the 294 patients, 163 (55%) were male, 144 (49%) were age >61 years, 110 (37%) had stage I or II disease, 219 (74%) had International Prognostic Index score ≤2, 216 (73%) received ≥6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, and 88 (30%) received consolidation radiation therapy. Five-year PFS and OS rates were associated with mid-therapy PET status: PFS was 78% for those with PET-negative (PET−) disease versus 63% for PET-positive (PET+) disease (P=.024), and OS was 82% for PET− versus 62% for PET+ (P<.002). These associations held true for patients who received chemotherapy only (PFS 71% for PET− vs 52% PET+ [P=.012], OS 78% for PET− and 51% for PET+ [P=.0055]) but not for those who received consolidation radiation therapy (PFS 84% PET− vs 81% PET+ [P=.88]; OS 90% PET− vs 81% PET+ [P=.39]). Conclusion: Mid-therapy PET can predict patient outcome, but the use of consolidation radiation therapy may negate the significance of mid-therapy findings.

  1. Variables influencing wearable sensor outcome estimates in individuals with stroke and incomplete spinal cord injury: a pilot investigation validating two research grade sensors.

    Science.gov (United States)

    Jayaraman, Chandrasekaran; Mummidisetty, Chaithanya Krishna; Mannix-Slobig, Alannah; McGee Koch, Lori; Jayaraman, Arun

    2018-03-13

    Monitoring physical activity and leveraging wearable sensor technologies to facilitate active living in individuals with neurological impairment has been shown to yield benefits in terms of health and quality of living. In this context, accurate measurement of physical activity estimates from these sensors are vital. However, wearable sensor manufacturers generally only provide standard proprietary algorithms based off of healthy individuals to estimate physical activity metrics which may lead to inaccurate estimates in population with neurological impairment like stroke and incomplete spinal cord injury (iSCI). The main objective of this cross-sectional investigation was to evaluate the validity of physical activity estimates provided by standard proprietary algorithms for individuals with stroke and iSCI. Two research grade wearable sensors used in clinical settings were chosen and the outcome metrics estimated using standard proprietary algorithms were validated against designated golden standard measures (Cosmed K4B2 for energy expenditure and metabolic equivalent and manual tallying for step counts). The influence of sensor location, sensor type and activity characteristics were also studied. 28 participants (Healthy (n = 10); incomplete SCI (n = 8); stroke (n = 10)) performed a spectrum of activities in a laboratory setting using two wearable sensors (ActiGraph and Metria-IH1) at different body locations. Manufacturer provided standard proprietary algorithms estimated the step count, energy expenditure (EE) and metabolic equivalent (MET). These estimates were compared with the estimates from gold standard measures. For verifying validity, a series of Kruskal Wallis ANOVA tests (Games-Howell multiple comparison for post-hoc analyses) were conducted to compare the mean rank and absolute agreement of outcome metrics estimated by each of the devices in comparison with the designated gold standard measurements. The sensor type, sensor location

  2. Finding Sliesthorp?

    DEFF Research Database (Denmark)

    Dobat, Andres S.

    2016-01-01

    In 2003, a hitherto unknown Viking age settlement was discovered at Füsing in Northern Germany close to Hedeby/Schleswig, the largest of the early Scandinavian towns. Finds and building features suggest a high status residence and a seat of some chiefly elite that flourished from around 700 to th...... and the transformation of socio‐political structures in Northern Europe as it transitioned from prehistory into the middle Ages....

  3. Twelve-Month Prostate-Specific Antigen Values and Perineural Invasion as Strong Independent Prognostic Variables of Long-Term Biochemical Outcome After Prostate Seed Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ding, William, E-mail: billyding888@gmail.com [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Lee, John [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Chamberlain, David [Department of Radiation Oncology, St. Mary' s Regional Medical Center, Reno, Nevada (United States); Cunningham, James [Carson Urology, Carson City, Nevada (United States); Yang Lixi [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Tay, Jonathan [Department of Radiation Oncology, St. Mary' s Regional Medical Center, Reno, Nevada (United States)

    2012-11-15

    Purpose: To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy. Methods and Materials: Records of 204 hormone-naieve patients with localized adenocarcinoma of the prostate treated at St. Mary's Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml. Results: Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of {<=}1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p = 0.009). Conclusions: Presence of PNI and ptPSA values at 12 months are strong prognostic

  4. Twelve-Month Prostate-Specific Antigen Values and Perineural Invasion as Strong Independent Prognostic Variables of Long-Term Biochemical Outcome After Prostate Seed Brachytherapy

    International Nuclear Information System (INIS)

    Ding, William; Lee, John; Chamberlain, David; Cunningham, James; Yang Lixi; Tay, Jonathan

    2012-01-01

    Purpose: To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy. Methods and Materials: Records of 204 hormone-naïve patients with localized adenocarcinoma of the prostate treated at St. Mary’s Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml. Results: Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of ≤1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p = 0.009). Conclusions: Presence of PNI and ptPSA values at 12 months are strong prognostic variables for

  5. Variable mechanical ventilation.

    Science.gov (United States)

    Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini, Luiz Alberto; Friedman, Gilberto

    2017-01-01

    To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE®, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". A total of 36 studies were selected. Of these, 24 were original studies, including 21 experimental studies and three clinical studies. Several experimental studies reported the beneficial effects of distinct variable ventilation strategies on lung function using different models of lung injury and healthy lungs. Variable ventilation seems to be a viable strategy for improving gas exchange and respiratory mechanics and preventing lung injury associated with mechanical ventilation. However, further clinical studies are necessary to assess the potential of variable ventilation strategies for the clinical improvement of patients undergoing mechanical ventilation.

  6. Impact of pretreatment variables on the outcome of 131I therapy with a standardized dose of 150 Gray in Graves' disease

    International Nuclear Information System (INIS)

    Pfeilschifter, J.; Elser, H.; Haufe, S.; Ziegler, R.; Georgi, P.

    1997-01-01

    Aim: We examined the impact of several pretreatment variables on thyroid size and function in 61 patients with Graves' disease one year after a standardized [131[I treatment with 150 Gray. Methods: FT3, FT4, and TSH serum concentrations were determined before and 1.5, 3, 6, and 12 months after therapy. Thyroid size was measured by ultrasound and scintigraphy before and one year after therapy. Results: One year after therapy, 30% of the patients had latent or manifest hyperthyroidism, 24% were euthyroid, and 46% had developed latent or manifest hypothyroidism. Age and initial thyroid volume were major predictors of posttherapeutical thyroid function. Thus, persistent hyperthyroidism was observed in 70% of the patients age 50 years and older with a thyroid size of more than 50 ml. With few exception, thyroid size markedly decreased after therapy. Initial thyroid size and age were also major predictors of posttherapeutical thyroid volume. Thyroid size normalized in all patients younger than 50 years of age, independent from initial thyroid size. Conclusion: Radioiodine treatment with 150 Gray causes a considerable decrease in thyroid size in most patients with Graves' disease. Age and initial thyroid volume are important determinants of thyroid function and size after therapy and should be considered in dose calculation. (orig.) [de

  7. Claimed effects, outcome variables and methods of measurement for health claims on foods proposed under European Community Regulation 1924/2006 in the area of appetite ratings and weight management.

    Science.gov (United States)

    Martini, Daniela; Biasini, Beatrice; Rossi, Stefano; Zavaroni, Ivana; Bedogni, Giorgio; Musci, Marilena; Pruneti, Carlo; Passeri, Giovanni; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Dei Cas, Alessandra; Bonadonna, Riccardo C; Del Rio, Daniele

    2018-06-01

    All the requests for authorisation to bear health claims under Articles 13(5) and 14 in the context of appetite ratings and weight management have received a negative opinion by the European Food Safety Authority (EFSA), mainly because of the insufficient substantiation of the claimed effects (CEs). This manuscript results from an investigation aimed to collect, collate and critically analyse the information related to outcome variables (OVs) and methods of measurement (MMs) in the context of appetite ratings and weight management compliant with Regulation 1924/2006. Based on the literature review, the appropriateness of OVs and MMs was evaluated for specific CEs. This work might help EFSA in the development of updated guidance addressed to stakeholders interested in bearing health claims in the area of weight management. Moreover, it could drive the applicants during the design of randomised controlled trials aimed to substantiate such claims.

  8. Initial findings from a mixed-methods evaluation of computer-assisted therapy for substance misuse in prisoners: Development, implementation and clinical outcomes from the ‘Breaking Free Health & Justice’ treatment and recovery programme

    Directory of Open Access Journals (Sweden)

    Sarah Elison

    2015-08-01

    transfer between different prisons and upon release from prison into the community, given prisoners can access their BFHJ programme account regardless of their location. In terms of clinical outcomes, changes in psychometric scores from baseline to follow-up indicated significant reductions in dependence to drugs and alcohol, alongside improvements to quality of life and other aspects of psychosocial functioning relevant to substance misuse and recovery progression. Linear regression were conducted for each psychometric outcome to examine whether time periods in weeks between baseline and follow-up assessment acted as predictors of change in psychometric scores. Time elapsed between assessments did not predict change in scores for severity of dependence to drugs and alcohol or quality of life. However, time between baseline and follow-up assessment did significantly predict change in psychosocial aspects of recovery progression. In addition, degree of improvement on the outcomes measured appeared to be associated with prisoner age, with older prisoners demonstrating greater improvements than younger prisoners. Conclusions: Findings from this study support the use of BFHJ within prisons settings in terms of acceptability of this technology-enhanced approach to treatment, despite the complexities around implementing an online treatment programme in the highly digitally secure setting of the prison estate. Additionally, clinical outcomes appear to replicate the outcomes from studies of the programme in community-based substance misuse treatment settings. Further work is now underway, including a randomised controlled trial (RCT and longer-term follow-up of substance use and offending outcomes, which is being conducted in collaboration with the MoJ Justice Data Lab.

  9. Short timescale variability in the faint sky variability survey

    NARCIS (Netherlands)

    Morales-Rueda, L.; Groot, P.J.; Augusteijn, T.; Nelemans, G.A.; Vreeswijk, P.M.; Besselaar, E.J.M. van den

    2006-01-01

    We present the V-band variability analysis of the Faint Sky Variability Survey (FSVS). The FSVS combines colour and time variability information, from timescales of 24 minutes to tens of days, down to V = 24. We find that �1% of all point sources are variable along the main sequence reaching �3.5%

  10. Retrospective evaluation of the prevalence, risk factors, management, outcome, and necropsy findings of acute lung injury and acute respiratory distress syndrome in dogs and cats: 29 cases (2011-2013).

    Science.gov (United States)

    Balakrishnan, Anusha; Drobatz, Kenneth J; Silverstein, Deborah C

    2017-11-01

    To determine the prevalence and risk factors for veterinary acute lung injury (VetALI) and veterinary acute respiratory distress syndrome (VetARDS), assess mechanical ventilation settings and patient outcomes, and to evaluate the relationship of clinical diagnoses with necropsy findings. Retrospective study. University teaching hospital. Twenty-four dogs and 5 cats with a clinical diagnosis of VetALI or VetARDS. Control population includes 24 dogs and 5 cats with a clinical diagnosis of respiratory disease other than VetALI or VetARDS. None. VetALI and VetARDS were diagnosed in 3.2% of dogs and 1.3% of cats presenting to the ICU. Systemic inflammatory response syndrome was the most common inciting condition (16/24 dogs, 2/5 cats), followed by vomiting and subsequent aspiration of gastric contents (9/24 dogs), sepsis (5/24 dogs, 3/5 cats), multiple transfusions (4/24 dogs), trauma (3/24 dogs), and adverse drug reactions (1/24 dogs, 1/5 cats).  None of these conditions were found to be significantly associated with a risk of development of VetALI or VetARDS when compared to controls. Twelve dogs (50%) and 4 cats (80%) underwent mechanical ventilation for a median duration of 18 hours in dogs (range: 6-174 h) and 15.5 hours in cats (range: 6-91 h). Overall, 3/29 patients survived to discharge including 2/24 dogs and 1/5 cats. Necropsy results were available for 8/22 dogs and 3/4 cats. A total of 6/8 dogs (75%) dogs and 3/3 (100%) cats met the histopathologic criteria for diagnosis of VetALI or VetARDS. VetALI and VetARDS can cause life-threatening respiratory distress in dogs and cats necessitating mechanical ventilation in 50% of dogs and 80% of cats in this study. These diseases are associated with a poor clinical outcome and a high rate of humane euthanasia. © Veterinary Emergency and Critical Care Society 2017.

  11. Prognostic Predictors of Outcome in an Operative Series in Traumatic Brain Injury Patients

    Directory of Open Access Journals (Sweden)

    Jinn-Rung Kuo

    2011-04-01

    Conclusion: In our preliminary findings, five variables to predict poor outcomes 6 months after TBI were useful. These sensitive variables can be used as a referential guideline in our daily practice to decide whether or not to perform advanced management or avoid decompressive craniectomy.

  12. Rapidly variable relatvistic absorption

    Science.gov (United States)

    Parker, M.; Pinto, C.; Fabian, A.; Lohfink, A.; Buisson, D.; Alston, W.; Jiang, J.

    2017-10-01

    I will present results from the 1.5Ms XMM-Newton observing campaign on the most X-ray variable AGN, IRAS 13224-3809. We find a series of nine absorption lines with a velocity of 0.24c from an ultra-fast outflow. For the first time, we are able to see extremely rapid variability of the UFO features, and can link this to the X-ray variability from the inner accretion disk. We find a clear flux dependence of the outflow features, suggesting that the wind is ionized by increasing X-ray emission.

  13. A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults.

    Science.gov (United States)

    Crews, W David; Harrison, David W; Wright, James W

    2008-04-01

    In recent years, there has been increased interest in the potential health-related benefits of antioxidant- and phytochemical-rich dark chocolate and cocoa. The objective of the study was to examine the short-term (6 wk) effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health in healthy older adults. A double-blind, placebo-controlled, fixed-dose, parallel-group clinical trial was used. Participants (n = 101) were randomly assigned to receive a 37-g dark chocolate bar and 8 ounces (237 mL) of an artificially sweetened cocoa beverage or similar placebo products each day for 6 wk. No significant group (dark chocolate and cocoa or placebo)-by-trial (baseline, midpoint, and end-of-treatment assessments) interactions were found for the neuropsychological, hematological, or blood pressure variables examined. In contrast, the midpoint and end-of-treatment mean pulse rate assessments in the dark chocolate and cocoa group were significantly higher than those at baseline and significantly higher than the midpoint and end-of-treatment rates in the control group. Results of a follow-up questionnaire item on the treatment products that participants believed they had consumed during the trial showed that more than half of the participants in both groups correctly identified the products that they had ingested during the experiment. This investigation failed to support the predicted beneficial effects of short-term dark chocolate and cocoa consumption on any of the neuropsychological or cardiovascular health-related variables included in this research. Consumption of dark chocolate and cocoa was, however, associated with significantly higher pulse rates at 3- and 6-wk treatment assessments.

  14. Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses. Findings from the national DenHeart survey."

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Thorup, Charlotte Brun; Borregaard, Britt

    2018-01-01

    -reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design: A cross-sectional survey with register follow-up. Methods: Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes: Patient-reported outcomes......Aims: Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient...

  15. Childhood Maltreatment and Educational Outcomes.

    Science.gov (United States)

    Romano, Elisa; Babchishin, Lyzon; Marquis, Robyn; Fréchette, Sabrina

    2015-10-01

    Children (0-18 years) with maltreatment histories are vulnerable to experiencing difficulties across multiple domains of functioning, including educational outcomes that encompass not only academic achievement but also mental well-being. The current literature review adopted Slade and Wissow's model to examine (1) the link between childhood maltreatment and academic achievement, (2) the link between childhood maltreatment and mental health outcomes (i.e., emotional and behavioral difficulties), and (3) the bidirectional relationship between childhood academic achievement and mental health. In addition, we reviewed variables that might influence or help explain the link between childhood maltreatment and educational outcomes, drawing on developmental perspectives and Bronfenbrenner's ecological model. Finally, whenever possible, we presented findings specific to maltreated children in out-of-home care to highlight the unique challenges experienced by this population. Results indicated that children with maltreatment histories often experience impairments in both their academic performance (e.g., special education, grade retention, lower grades) and mental well-being (e.g., anxiety, low mood, aggression, social skills deficits, poor interpersonal relationships). These impairments appeared to be particularly pronounced among maltreated children in out-of-home care. Findings, albeit sparse, also indicated that mental health difficulties are negatively associated with children's academic achievement and, similarly, that academic achievement deficits are linked with mental health problems. The link between childhood maltreatment and educational outcomes may be partly explained through the disruption of key developmental processes in children, such as attachment, emotion regulation, and sense of agency. As well, maltreatment characteristics and the functioning of various systems in which children are embedded (e.g., family, school, child welfare) can serve to positively

  16. Understanding Brown Dwarf Variability

    Science.gov (United States)

    Marley, Mark S.

    2013-01-01

    Surveys of brown dwarf variability continue to find that roughly half of all brown dwarfs are variable. While variability is observed amongst all types of brown dwarfs, amplitudes are typically greatest for L-T transition objects. In my talk I will discuss the possible physical mechanisms that are responsible for the observed variability. I will particularly focus on comparing and contrasting the effects of changes in atmospheric thermal profile and cloud opacity. The two different mechanisms will produce different variability signatures and I will discuss the extent to which the current datasets constrain both mechanisms. By combining constraints from studies of variability with existing spectral and photometric datasets we can begin to construct and test self-consistent models of brown dwarf atmospheres. These models not only aid in the interpretation of existing objects but also inform studies of directly imaged giant planets.

  17. Instrumental variables I: instrumental variables exploit natural variation in nonexperimental data to estimate causal relationships.

    Science.gov (United States)

    Rassen, Jeremy A; Brookhart, M Alan; Glynn, Robert J; Mittleman, Murray A; Schneeweiss, Sebastian

    2009-12-01

    The gold standard of study design for treatment evaluation is widely acknowledged to be the randomized controlled trial (RCT). Trials allow for the estimation of causal effect by randomly assigning participants either to an intervention or comparison group; through the assumption of "exchangeability" between groups, comparing the outcomes will yield an estimate of causal effect. In the many cases where RCTs are impractical or unethical, instrumental variable (IV) analysis offers a nonexperimental alternative based on many of the same principles. IV analysis relies on finding a naturally varying phenomenon, related to treatment but not to outcome except through the effect of treatment itself, and then using this phenomenon as a proxy for the confounded treatment variable. This article demonstrates how IV analysis arises from an analogous but potentially impossible RCT design, and outlines the assumptions necessary for valid estimation. It gives examples of instruments used in clinical epidemiology and concludes with an outline on estimation of effects.

  18. Pulsating variables

    International Nuclear Information System (INIS)

    1989-01-01

    The study of stellar pulsations is a major route to the understanding of stellar structure and evolution. At the South African Astronomical Observatory (SAAO) the following stellar pulsation studies were undertaken: rapidly oscillating Ap stars; solar-like oscillations in stars; 8-Scuti type variability in a classical Am star; Beta Cephei variables; a pulsating white dwarf and its companion; RR Lyrae variables and galactic Cepheids. 4 figs

  19. Understanding the Influence of Race/Ethnicity, Gender, and Class on Inequalities in Academic and Non-Academic Outcomes among Eighth-Grade Students: Findings from an Intersectionality Approach

    Science.gov (United States)

    Bécares, Laia; Priest, Naomi

    2015-01-01

    Socioeconomic, racial/ethnic, and gender inequalities in academic achievement have been widely reported in the US, but how these three axes of inequality intersect to determine academic and non-academic outcomes among school-aged children is not well understood. Using data from the US Early Childhood Longitudinal Study—Kindergarten (ECLS-K; N = 10,115), we apply an intersectionality approach to examine inequalities across eighth-grade outcomes at the intersection of six racial/ethnic and gender groups (Latino girls and boys, Black girls and boys, and White girls and boys) and four classes of socioeconomic advantage/disadvantage. Results of mixture models show large inequalities in socioemotional outcomes (internalizing behavior, locus of control, and self-concept) across classes of advantage/disadvantage. Within classes of advantage/disadvantage, racial/ethnic and gender inequalities are predominantly found in the most advantaged class, where Black boys and girls, and Latina girls, underperform White boys in academic assessments, but not in socioemotional outcomes. In these latter outcomes, Black boys and girls perform better than White boys. Latino boys show small differences as compared to White boys, mainly in science assessments. The contrasting outcomes between racial/ethnic and gender minorities in self-assessment and socioemotional outcomes, as compared to standardized assessments, highlight the detrimental effect that intersecting racial/ethnic and gender discrimination have in patterning academic outcomes that predict success in adult life. Interventions to eliminate achievement gaps cannot fully succeed as long as social stratification caused by gender and racial discrimination is not addressed. PMID:26505623

  20. Understanding the Influence of Race/Ethnicity, Gender, and Class on Inequalities in Academic and Non-Academic Outcomes among Eighth-Grade Students: Findings from an Intersectionality Approach.

    Science.gov (United States)

    Bécares, Laia; Priest, Naomi

    2015-01-01

    Socioeconomic, racial/ethnic, and gender inequalities in academic achievement have been widely reported in the US, but how these three axes of inequality intersect to determine academic and non-academic outcomes among school-aged children is not well understood. Using data from the US Early Childhood Longitudinal Study-Kindergarten (ECLS-K; N = 10,115), we apply an intersectionality approach to examine inequalities across eighth-grade outcomes at the intersection of six racial/ethnic and gender groups (Latino girls and boys, Black girls and boys, and White girls and boys) and four classes of socioeconomic advantage/disadvantage. Results of mixture models show large inequalities in socioemotional outcomes (internalizing behavior, locus of control, and self-concept) across classes of advantage/disadvantage. Within classes of advantage/disadvantage, racial/ethnic and gender inequalities are predominantly found in the most advantaged class, where Black boys and girls, and Latina girls, underperform White boys in academic assessments, but not in socioemotional outcomes. In these latter outcomes, Black boys and girls perform better than White boys. Latino boys show small differences as compared to White boys, mainly in science assessments. The contrasting outcomes between racial/ethnic and gender minorities in self-assessment and socioemotional outcomes, as compared to standardized assessments, highlight the detrimental effect that intersecting racial/ethnic and gender discrimination have in patterning academic outcomes that predict success in adult life. Interventions to eliminate achievement gaps cannot fully succeed as long as social stratification caused by gender and racial discrimination is not addressed.

  1. Understanding the Influence of Race/Ethnicity, Gender, and Class on Inequalities in Academic and Non-Academic Outcomes among Eighth-Grade Students: Findings from an Intersectionality Approach.

    Directory of Open Access Journals (Sweden)

    Laia Bécares

    Full Text Available Socioeconomic, racial/ethnic, and gender inequalities in academic achievement have been widely reported in the US, but how these three axes of inequality intersect to determine academic and non-academic outcomes among school-aged children is not well understood. Using data from the US Early Childhood Longitudinal Study-Kindergarten (ECLS-K; N = 10,115, we apply an intersectionality approach to examine inequalities across eighth-grade outcomes at the intersection of six racial/ethnic and gender groups (Latino girls and boys, Black girls and boys, and White girls and boys and four classes of socioeconomic advantage/disadvantage. Results of mixture models show large inequalities in socioemotional outcomes (internalizing behavior, locus of control, and self-concept across classes of advantage/disadvantage. Within classes of advantage/disadvantage, racial/ethnic and gender inequalities are predominantly found in the most advantaged class, where Black boys and girls, and Latina girls, underperform White boys in academic assessments, but not in socioemotional outcomes. In these latter outcomes, Black boys and girls perform better than White boys. Latino boys show small differences as compared to White boys, mainly in science assessments. The contrasting outcomes between racial/ethnic and gender minorities in self-assessment and socioemotional outcomes, as compared to standardized assessments, highlight the detrimental effect that intersecting racial/ethnic and gender discrimination have in patterning academic outcomes that predict success in adult life. Interventions to eliminate achievement gaps cannot fully succeed as long as social stratification caused by gender and racial discrimination is not addressed.

  2. Cognitive Variability

    Science.gov (United States)

    Siegler, Robert S.

    2007-01-01

    Children's thinking is highly variable at every level of analysis, from neural and associative levels to the level of strategies, theories, and other aspects of high-level cognition. This variability exists within people as well as between them; individual children often rely on different strategies or representations on closely related problems…

  3. MR findings of craniopharyngioma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Moon; Woo, Young Hoon; Joo, Yang Goo; Suh, Soo Jhi [College of Medicine, Keimyung University, Daegu (Korea, Republic of)

    1992-11-15

    Craniopharyngioma is a benign, slow-growing tumor that constitues 3-9% of all intracranial tumors, and arises from epithelial remnants of the Rathke's pouch. We analyzed MR (2.0T) findings of ten cases with surgically proved craniopharyngioma retrospectively. CT was available in five cases, and Gd-DTPA was used in six cases. Characteristic findings of craniopharyngioma in MRI included multilocularity and variable signal intensities within each loculus that were more prominent in T1WI. Detection rate of calcification in MR was 60%. Six cases with Gd-DTPA enhancement revealed irregular or rim-like enhancement. MRI provides useful information regarding the location, extent and biochemical characteristics of the oraniopharyngioma as well as its relationship to the neighboring structures which will be valuable in planning surgical resection.

  4. MR findings of craniopharyngioma

    International Nuclear Information System (INIS)

    Lee, Sung Moon; Woo, Young Hoon; Joo, Yang Goo; Suh, Soo Jhi

    1992-01-01

    Craniopharyngioma is a benign, slow-growing tumor that constitues 3-9% of all intracranial tumors, and arises from epithelial remnants of the Rathke's pouch. We analyzed MR (2.0T) findings of ten cases with surgically proved craniopharyngioma retrospectively. CT was available in five cases, and Gd-DTPA was used in six cases. Characteristic findings of craniopharyngioma in MRI included multilocularity and variable signal intensities within each loculus that were more prominent in T1WI. Detection rate of calcification in MR was 60%. Six cases with Gd-DTPA enhancement revealed irregular or rim-like enhancement. MRI provides useful information regarding the location, extent and biochemical characteristics of the oraniopharyngioma as well as its relationship to the neighboring structures which will be valuable in planning surgical resection

  5. Suspended graphene variable capacitor

    OpenAIRE

    AbdelGhany, M.; Mahvash, F.; Mukhopadhyay, M.; Favron, A.; Martel, R.; Siaj, M.; Szkopek, T.

    2016-01-01

    The tuning of electrical circuit resonance with a variable capacitor, or varactor, finds wide application with the most important being wireless telecommunication. We demonstrate an electromechanical graphene varactor, a variable capacitor wherein the capacitance is tuned by voltage controlled deflection of a dense array of suspended graphene membranes. The low flexural rigidity of graphene monolayers is exploited to achieve low actuation voltage in an ultra-thin structure. Large arrays compr...

  6. Association of Implementation of Practice Standards for Electrocardiographic Monitoring with Nurses’ Knowledge, Quality of Care, and Patient Outcomes: Findings from the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial

    Science.gov (United States)

    Funk, Marjorie; Fennie, Kristopher P.; Stephens, Kimberly E.; May, Jeanine L.; Winkler, Catherine G.; Drew, Barbara J.

    2017-01-01

    Background Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods and Results The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, Time 2 after Group 1 hospitals received the intervention, and Time 3 after Group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses’ knowledge (N=3,013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4,587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest) (N=95,884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses’ knowledge improved significantly immediately following the intervention in both groups, but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention, and was sustained. Conclusions Online ECG monitoring education and strategies to change practice can lead to improved nurses’ knowledge, quality of care, and patient outcomes. PMID:28174175

  7. When is affect variability bad for health? The association between affect variability and immune response to the influenza vaccination.

    Science.gov (United States)

    Jenkins, Brooke N; Hunter, John F; Cross, Marie P; Acevedo, Amanda M; Pressman, Sarah D

    2018-01-01

    This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination. Participants (N=83) received the vaccination and completed daily diary measures of affect four times a day for 13days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels. Findings indicate that affect variability and its interaction with mean levels of affect predict an individual's immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response. Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Clinical variability in dystrophic epidermolysis bullosa and findings with scanning electron microscopy Variabilidade clínica em epidermólise bolhosa distrófica e achados de microscopia eletrônica de varredura

    Directory of Open Access Journals (Sweden)

    Hiram Larangeira de Almeida Jr

    2012-02-01

    Full Text Available In dystrophic epidermolysis bullosa, the genetic defect of anchoring fibrils leads to cleavage beneath the basement membrane and its consequent loss. A 46 year-old female patient presented blisters with a pretibial distribution associated with nail dystrophy. Her two children had hyponychia and anonychia, which affected all toe nails and the thumb, forefinger and middle finger. DNA sequencing identified in exon 75 of COL7A1 gene a pathologic mutation: c.6235G>A (p.Gly2079Arg. Immunomapping of a blister demonstrated collagen IV (basal membrane in the blister roof and collagen VII in its floor, confirming dystrophic epidermolysis bullosa. Scanning electron microscopy of an inverted blister showed net-forming collagen attached to the blister roof . The variability found in this family has already been reported and confirms, on a clinical basis, the nail subtype as a dystrophic variant.Na epidermólise bolhosa distrófica, o defeito genético das fibrilas de ancoragem leva à clivagem abaixo da membrana basal com sua consequente perda. Uma paciente de 46 anos apresentava bolhas pré-tibiais associadas à distrofia ungueal. Seus dois filhos apresentavam hipo e anoníquia, afetando todas as unhas dos pododáctilos e dos primeiros, segundos e terceiros quirodáctilos. O sequenciamento de DNA identificou no exon 75 do gene COL7A1 uma mutação patológica: c.6235G>A (p.Gly2079Arg. O imunomapeamento identificou o colágeno IV no teto e colágeno VII no assoalho de uma bolha , confirmando o diagnóstico de epidermólise bolhosa distrófica. A microscopia eletrônica de varredura de um teto invertido de bolha demonstrou rede de colágeno aderida ao mesmo. A variabilidade clínica encontrada nessa família já foi escrita e confirma, que o subtipo ungueal das epidermólises bolhosas é uma forma distrófica.

  9. Finding The Baseline--Putting Recent Eutrophication Of Two South Texas Coastal Water Bodies Into Perspective By Using Sedimentary Records To Examine The Long-Term, Natural Variability Of The Systems

    Science.gov (United States)

    Besonen, M. R.; Zimba, P.; Hill, E.; Tissot, P.; Mckay, M.; Silliman, J.

    2013-12-01

    reservoirs along the Nueces River, the primary inflow for the system. The lack of long-term environmental monitoring records makes it difficult to disentangle the complex interrelationships between the natural and anthropogenic factors that have contributed to eutrophication. To address this issue, we are examining proxy evidence from sediment cores to look back in time, and understand the true baseline conditions and natural variability of these systems long before they were affected by anthropogenic impacts. We are using a suite of geological, chemical, and biological indicators including color spectral reflectance (for total chlorophyll content), organic carbon content via loss-on-ignition, Terrigenous/Aquatic Ratio (TARHC), TOC, C/N ratio analysis, pigment analysis via HPLC, and microfossil assemblage analysis. Age control for the stratigraphy will be provided by radiometric age analyses using 137Cs, 210Pb, and 14C. Initial results from spectral reflectance scanning of sediment cores from the Nueces Estuary appear to indicate an increased chlorophyll content up core, which probably reflects a long-term increase of primary productivity in the system.

  10. The Marketplace Variables in Successful and Unsuccessful NPD Projects in Technology Intensive Companies

    OpenAIRE

    Haverila, Matti

    2010-01-01

    We present an exploratory investigation of how managers conceptualize and perceive ‘marketplace’ variables in successful and unsuccessful New Product Development (NPD) projects, and explore the role that marketplace variables play in differentiating between successful and unsuccessful NPD outcomes. Limitations and future research directions are also discussed. Our findings indicate that managers perceive the marketplace in multiple ways during the NPD process and also that differences exis...

  11. Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry.

    Science.gov (United States)

    Joseph, Lee; Bashir, Mohammad; Xiang, Qun; Yerokun, Babatunde A; Matsouaka, Roland Albert; Vemulapalli, Sreekanth; Kapadia, Samir; Cigarroa, Joaquin E; Zahr, Firas

    2018-04-09

    This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure-related hospitalization, and mitral valve intervention at 1 year. MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure-related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Client Predictors of Short-term Psychotherapy Outcomes among Asian and White American Outpatients

    Science.gov (United States)

    Kim, Jin E.; Zane, Nolan W.; Blozis, Shelley A.

    2015-01-01

    Purpose To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients. Method Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pre-treatment, and outcomes were measured post-fourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators. Results Higher levels of somatic symptoms predicted lower psychosocial functioning at post-treatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style. Conclusions Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes. PMID:22836681

  13. Complex variables

    CERN Document Server

    Fisher, Stephen D

    1999-01-01

    The most important topics in the theory and application of complex variables receive a thorough, coherent treatment in this introductory text. Intended for undergraduates or graduate students in science, mathematics, and engineering, this volume features hundreds of solved examples, exercises, and applications designed to foster a complete understanding of complex variables as well as an appreciation of their mathematical beauty and elegance. Prerequisites are minimal; a three-semester course in calculus will suffice to prepare students for discussions of these topics: the complex plane, basic

  14. Variable stars

    International Nuclear Information System (INIS)

    Feast, M.W.; Wenzel, W.; Fernie, J.D.; Percy, J.R.; Smak, J.; Gascoigne, S.C.B.; Grindley, J.E.; Lovell, B.; Sawyer Hogg, H.B.; Baker, N.; Fitch, W.S.; Rosino, L.; Gursky, H.

    1976-01-01

    A critical review of variable stars is presented. A fairly complete summary of major developments and discoveries during the period 1973-1975 is given. The broad developments and new trends are outlined. Essential problems for future research are identified. (B.R.H. )

  15. Visit-to-visit blood pressure variation is associated with outcomes in a U-shaped fashion in patients with myocardial infarction complicated with systolic dysfunction and/or heart failure: findings from the EPHESUS and OPTIMAAL trials.

    Science.gov (United States)

    Ferreira, João Pedro; Duarte, Kévin; Pitt, Bertram; Dickstein, Kenneth; McMurray, John J V; Zannad, Faiez; Rossignol, Patrick

    2018-04-21

    Visit-to-visit office blood pressure variation (BPV) has prognostic implications independent from mean BP across several populations in the cardiovascular field. The association of BPV with outcomes in patients with myocardial infarction (MI) with systolic dysfunction and/or heart failure is yet to be determined. Two independent cohorts were assessed: the EPHESUS and the OPTIMAAL trials with a total of more than 12 000 patients. The primary outcome was all-cause death. BPV was calculated as a coefficient of variation, that is, the ratio of the SD to the mean BP along the postbaseline follow-up. Cox regression models were used to determine the associations between BPV and events. Compared with the middle and lower BPV tertiles, patients in the upper BPV tertile were older, more often women, hypertensive, diabetic, with peripheral artery disease, and had more frequent use of loop diuretics and ACEi/ARBs. They also had lower LVEF, hemoglobin, and eGFR (all P < 0.001). BPV was independently associated with worse prognosis in a U-shaped manner. In the EPHESUS trial, both low and high BPV were associated with higher rates of death (and also cardiovascular death and the composite of cardiovascular death/ cardiovascular hospitalization): adjusted hazard ratio (95% CI) for the outcome of death is 1.99 (1.68-2.36) for high BPV and is 1.60 (1.35-1.90) for low BPV. Similar results were observed in the OPTIMAAL trial population. In two independent cohorts of MI patients with systolic dysfunction and/or heart failure, BPV was associated with worse prognosis in a U-shaped manner independently of the mean BP.

  16. Abdominal aspergillosis: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Suk Keu, E-mail: pagoda20@hanmail.net [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: kimhyejin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: jhbyun@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: aykim@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: mglee@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: hkha@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)

    2011-03-15

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  17. Pharmacogenetics and outcome with antipsychotic drugs.

    Science.gov (United States)

    Pouget, Jennie G; Shams, Tahireh A; Tiwari, Arun K; Müller, Daniel J

    2014-12-01

    Antipsychotic medications are the gold-standard treatment for schizophrenia, and are often prescribed for other mental conditions. However, the efficacy and side-effect profiles of these drugs are heterogeneous, with large interindividual variability. As a result, treatment selection remains a largely trial-and-error process, with many failed treatment regimens endured before finding a tolerable balance between symptom management and side effects. Much of the interindividual variability in response and side effects is due to genetic factors (heritability, h(2)~ 0.60-0.80). Pharmacogenetics is an emerging field that holds the potential to facilitate the selection of the best medication for a particular patient, based on his or her genetic information. In this review we discuss the most promising genetic markers of antipsychotic treatment outcomes, and present current translational research efforts that aim to bring these pharmacogenetic findings to the clinic in the near future.

  18. ASSOCIATION OF A LYMPHOTOXIN-α VARIABLE SITE rs1041981 WITH DEVELOPMENT OF LONG-TERM UNFAVORABLE OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST-SEGMENT ELEVATION

    Directory of Open Access Journals (Sweden)

    E. A. Shmidt

    2018-01-01

    Full Text Available Lymphotoxin-α (LTA is a major pro-inflammatory cytokine produced at the early stages of vascular inflammation, taking part in the formation of arterial atherosclerosis and development of coronary heart disease. Functional changes in the gene encoding LTA production may influence the development of coronary heart disease with unfavorable progression. However, studies for associations between rs1041981 (C-804A LTA gene variant and development of acute cerebrovascular accidents, myocardial infarction, and severity of coronary atherosclerosis have yielded contradictory results. The purpose of our study was to investigate an association of rs1041981 gene LTA with risk of adverse events within five years of follow-up in the patients with acute coronary syndrome without ST elevation ST (nonST-ACS. 178 patients with nonST-ACS from the Kemerovo Cardiology Center Registry were included into the study. Genotyping of rs1041981 site variable LTA gene was performed by TaqMan technique using an “iCycler iQ” device (BIO-RAD, USA. Results: we have found that the A allele and A/A genotype polymorphism in LTA gene (rs1041981 have been associated with development of adverse cardiovascular events over five years of observation (respective p levels were 0.02 and 0.036. In patients with A/A genotype, the rs1041981 polymorphism in LTA gene was associated with 3.8-fold increase in adverse cardiovascular events, compared to patients having A/C or C/C genotype. Carriage of A allele in LTA gene (rs1041981 doubles the risk of adverse cardiovascular events in patients with nonST-ACS at long observation terms. By means of Kaplan-Meier method, we have determined that survival to the first endpoint occurred more often in carriers of the genotype A/A of LTA gene (rs1041981. The A/A genotype of LTA gene (rs1041981 proved to be more significant (p = 0.016 for development of adverse outcomes, when combining the patients with A/C and C/C genotypes. One may draw a conclusion

  19. Individual Movement Variability Magnitudes Are Explained by Cortical Neural Variability.

    Science.gov (United States)

    Haar, Shlomi; Donchin, Opher; Dinstein, Ilan

    2017-09-13

    Humans exhibit considerable motor variability even across trivial reaching movements. This variability can be separated into specific kinematic components such as extent and direction that are thought to be governed by distinct neural processes. Here, we report that individual subjects (males and females) exhibit different magnitudes of kinematic variability, which are consistent (within individual) across movements to different targets and regardless of which arm (right or left) was used to perform the movements. Simultaneous fMRI recordings revealed that the same subjects also exhibited different magnitudes of fMRI variability across movements in a variety of motor system areas. These fMRI variability magnitudes were also consistent across movements to different targets when performed with either arm. Cortical fMRI variability in the posterior-parietal cortex of individual subjects explained their movement-extent variability. This relationship was apparent only in posterior-parietal cortex and not in other motor system areas, thereby suggesting that individuals with more variable movement preparation exhibit larger kinematic variability. We therefore propose that neural and kinematic variability are reliable and interrelated individual characteristics that may predispose individual subjects to exhibit distinct motor capabilities. SIGNIFICANCE STATEMENT Neural activity and movement kinematics are remarkably variable. Although intertrial variability is rarely studied, here, we demonstrate that individual human subjects exhibit distinct magnitudes of neural and kinematic variability that are reproducible across movements to different targets and when performing these movements with either arm. Furthermore, when examining the relationship between cortical variability and movement variability, we find that cortical fMRI variability in parietal cortex of individual subjects explained their movement extent variability. This enabled us to explain why some subjects

  20. Prevalent digoxin use and subsequent risk of death or hospitalization in ambulatory heart failure patients with a reduced ejection fraction-Findings from the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized controlled trial.

    Science.gov (United States)

    Ambrosy, Andrew P; Bhatt, Ankeet S; Stebbins, Amanda L; Wruck, Lisa M; Fudim, Marat; Greene, Stephen J; Kraus, William E; O'Connor, Christopher M; Piña, Ileana L; Whellan, David J; Mentz, Robert J

    2018-05-01

    Despite more than 200 years of clinical experience and a pivotal trial, recently published research has called into question the safety and efficacy of digoxin therapy in heart failure (HF). HF-ACTION (ClinicalTrials.gov Number: NCT00047437) enrolled 2331 outpatients with HF and an EF ≤35% between April 2003 and February 2007 and randomized them to aerobic exercise training versus usual care. Patients were grouped according to prevalent digoxin status at baseline. The association between digoxin therapy and outcomes was assessed using Cox proportional hazard and inverse-probability weighted (IPW) regression models adjusted for demographics, medical history, medications, laboratory values, quality of life, and exercise parameters. The prevalence of digoxin therapy decreased from 52% during the first 6 months of enrollment to 35% at the end of the HF-ACTION trial (P <0.0001). Study participants were 59± 13 years of age, 72% were male, and approximately half had an ischemic etiology of HF. Patients receiving digoxin at baseline tended to be younger and were more likely to report New York Heart Association functional class III/IV symptoms (rather than class II) compared to those not receiving digoxin. Patients taking digoxin had worse baseline exercise capacity as measured by peak VO 2 and 6-min walk test and greater impairments in health status as reflected by the Kansas City Cardiomyopathy Questionnaire. The association between digoxin and the risk of death or hospitalization differed depending on whether Cox proportional hazard (Hazard Ratio 1.03, 95% Confidence Interval 0.92-1.16; P = .62) or IPW regression models (HR 1.08, 95% CI 1.00-1.17; P = .057) were used to adjust for potential confounders. Although digoxin use was associated with high-risk clinical features, the association between digoxin therapy and outcomes was dependent on the statistical methods used for multivariable adjustment. Clinical equipoise exists and additional prospective research is

  1. Imaging findings of sternal abnormalities

    International Nuclear Information System (INIS)

    Franquet, T.; Gimenez, A.; Alegret, X.; Sanchis, E.; Rivas, A.

    1997-01-01

    Radiographic findings in the sternal abnormalities are often nonspecific, showing appearances from a localized benign lesion to an aggressive lesion as seen with infections and malignant neoplasms. A specific diagnosis of sternal abnormalities can be suggested on the basis of CT and MR characteristics. Familiarity with the presentation and variable appearance of sternal abnormalities may aid the radiologist is suggesting a specific diagnosis. We present among others characteristic radiographic findings of hemangioma, chondrosarcoma, hydatid disease, and SAPHO syndrome. In those cases in which findings are not specific, cross-sectional imaging modalities may help the clinician in their management. (orig.)

  2. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

    Science.gov (United States)

    Qian, Feng; Fonarow, Gregg C; Krim, Selim R; Vivo, Rey P; Cox, Margueritte; Hannan, Edward L; Shaw, Benjamin A; Hernandez, Adrian F; Eapen, Zubin J; Yancy, Clyde W; Bhatt, Deepak L

    2015-01-01

    Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Impact of hospital atmosphere on perceived health care outcome.

    Science.gov (United States)

    Narang, Ritu; Polsa, Pia; Soneye, Alabi; Fuxiang, Wei

    2015-01-01

    Healthcare service quality studies primarily examine the relationships between patients' perceived quality and satisfaction with healthcare services, clinical effectiveness, service use, recommendations and value for money. These studies suggest that patient-independent quality dimensions (structure, process and outcome) are antecedents to quality. The purpose of this paper is to propose an alternative by looking at the relationship between hospital atmosphere and healthcare quality with perceived outcome. Data were collected from Finland, India, Nigeria and the People's Republic of China. Regression analysis used perceived outcome as the dependent variable and atmosphere and healthcare service quality as independent variables. Findings - Results showed that atmosphere and healthcare service quality have a statistically significant relationship with patient perceived outcomes. The sample size was small and the sampling units were selected on convenience; thus, caution must be exercised in generalizing the findings. The study determined that service quality and atmosphere are considered significant for developing and developed nations. This result could have significant implications for policy makers and service providers developing healthcare quality and hospital atmosphere. Studies concentrate on healthcare outcome primarily regarding population health status, mortality, morbidity, customer satisfaction, loyalty, quality of life, customer behavior and consumption. However, the study exposes how patients perceive their health after treatment. Furthermore, the authors develop the healthcare service literature by considering atmosphere and perceived outcome.

  4. An automated approach for finding variable-constant pairing bugs

    DEFF Research Database (Denmark)

    Lawall, Julia; Lo, David

    2010-01-01

    program-analysis and data-mining based approach to identify the uses of named constants and to identify anomalies in these uses.  We have applied our approach to a recent version of the Linux kernel and have found a number of bugs affecting both correctness and software maintenance.  Many of these bugs...... have been validated by the Linux developers....

  5. Fraser syndrome: Phenotypic variability and unusual findings in four ...

    African Journals Online (AJOL)

    Ebtesam M. Abdalla

    2015-11-25

    Nov 25, 2015 ... a Department of Human Genetics, Medical Research Institute, Alexandria University, Egypt .... centin1 (HMCN1), Furin, and Fibulin 1, that interact in base- ... The first child of this couple [case 2-1], who was born at term and ...

  6. Complex variables

    CERN Document Server

    Flanigan, Francis J

    2010-01-01

    A caution to mathematics professors: Complex Variables does not follow conventional outlines of course material. One reviewer noting its originality wrote: ""A standard text is often preferred [to a superior text like this] because the professor knows the order of topics and the problems, and doesn't really have to pay attention to the text. He can go to class without preparation."" Not so here-Dr. Flanigan treats this most important field of contemporary mathematics in a most unusual way. While all the material for an advanced undergraduate or first-year graduate course is covered, discussion

  7. Early Adolescent Affect Predicts Later Life Outcomes.

    Science.gov (United States)

    Kansky, Jessica; Allen, Joseph P; Diener, Ed

    2016-07-01

    Subjective well-being as a predictor for later behavior and health has highlighted its relationship to health, work performance, and social relationships. However, the majority of such studies neglect the developmental nature of well-being in contributing to important changes across the transition to adulthood. To examine the potential role of subjective well-being as a long-term predictor of critical life outcomes, we examined indicators of positive and negative affect at age 14 as predictors of relationship, adjustment, self-worth, and career outcomes a decade later at ages 23 to 25, controlling for family income and gender. We utilised multi-informant methods including reports from the target participant, close friends, and romantic partners in a demographically diverse community sample of 184 participants. Early adolescent positive affect predicted fewer relationship problems (less self-reported and partner-reported conflict, and greater friendship attachment as rated by close peers) and healthy adjustment to adulthood (lower levels of depression, anxiety, and loneliness). It also predicted positive work functioning (higher levels of career satisfaction and job competence) and increased self-worth. Negative affect did not significantly predict any of these important life outcomes. In addition to predicting desirable mean levels of later outcomes, early positive affect predicted beneficial changes across time in many outcomes. The findings extend early research on the beneficial outcomes of subjective well-being by having an earlier assessment of well-being, including informant reports in measuring a large variety of outcome variables, and by extending the findings to a lower socioeconomic group of a diverse and younger sample. The results highlight the importance of considering positive affect as an important component of subjective well-being distinct from negative affect. © 2016 The International Association of Applied Psychology.

  8. Photometric Variability in the Faint Sky Variability Survey

    NARCIS (Netherlands)

    Morales-Rueda, L.; Groot, P.J.; Augusteijn, T.; Nelemans, G.A.; Vreeswijk, P.M.; Besselaar, E.J.M. van den

    2005-01-01

    The Faint Sky Variability Survey (FSVS) is aimed at finding photometric and/or astrometric variable objects between 16th and 24th mag on time-scales between tens of minutes and years with photometric precisions ranging from 3 millimag to 0.2 mag. An area of ~23 deg2, located at mid and

  9. Do Infant Birth Outcomes Vary Among Mothers With and Without Health Insurance Coverage in Sub-Saharan Africa? Findings from the National Health Insurance and Cash and Carry Eras in Ghana, West Africa

    Directory of Open Access Journals (Sweden)

    Abdallah Ibrahim, DrPH

    2014-06-01

    Full Text Available Background: Beginning in the late 1960’s, and accelerating after 1985, a system known as “Cash and Carry” required the people of Ghana to pay for health services out-of-pocket before receiving them. In 2003, Ghana enacted a National Health Insurance Scheme (NHIS (fully implemented by 2005 that allowed pregnant women to access antenatal care and hospital delivery services for low annual premiums tied to income. The objective of this study was to compare trends in low birth weight (LBW among infants born under the NHIS with infants born during the Cash and Carry system when patients paid out-of-pocket for maternal and child health services. Methods: Sampled birth records abstracted from birth folders at the Tamale Teaching Hospital (TTH were examined. Chi-squared tests were performed to determine differences in the prevalence of LBW. A p-value of ≤ 0.05 was considered statistically significant. Analyses were conducted for selected variables in each year from 2000 to 2003 (Cash and Carry and 2008 to 2011(NHIS. Results: Higher birth weights were not observed for deliveries under NHIS compared to those under Cash and Carry. More than one-third of infants in both eras were born to first-time mothers, and they had a significantly higher prevalence of LBW compared to infants born to multiparous mothers. Conclusion and Global Health Implications: Understanding the factors that affect the prevalence of LBW is crucial to public health policy makers in Ghana. LBW is a powerful predictor of infant survival, and therefore, an important factor in determining the country’s progress toward meeting the United Nations Millennium Development Goal of reducing under-five child mortality rates (MDG4 by the end of 2015.

  10. Assessment of Scientific Reasoning as an Institutional Outcome

    Science.gov (United States)

    2016-04-01

    expertise in the outcome domain. Student achievement of the Scientific Reasoning and Principles of Science was assessed in the 2012-13 academic year by...scientific reasoning assessment. Overall, students were weakest when answering questions related to (a) proportional reasoning , (b) isolation of...variables, and (c) if-then reasoning . These findings are being incorporates into redesign of the core curriculum to enhance continuity among science courses

  11. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life.

    Science.gov (United States)

    Rod, Kevin

    2016-01-01

    , with a reduction of severe pain from 40% before treatment to 25% after treatment (p value 0.0184). Conclusion. Self-management support interventions, such as Internet-based educational tools, can be considered to help patients manage their chronic pain, depression, and anxiety and may be helpful to improve the treatment outcome in patients who could not otherwise afford noninsured services.

  12. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life

    Directory of Open Access Journals (Sweden)

    Kevin Rod

    2016-01-01

    after treatment, with a reduction of severe pain from 40% before treatment to 25% after treatment (p value 0.0184. Conclusion. Self-management support interventions, such as Internet-based educational tools, can be considered to help patients manage their chronic pain, depression, and anxiety and may be helpful to improve the treatment outcome in patients who could not otherwise afford noninsured services.

  13. The Brugada syndrome. Outcome of one case

    Directory of Open Access Journals (Sweden)

    Maia Ivan G.

    2000-01-01

    Full Text Available The Brugada syndrome is a rare condition, and due to its mutating manner of presentation it may be difficult to diagnose. We report one case and discuss the diagnostic aspects and the clinical outcome of one patient with characteristic findings of this syndrome. These findings are especially defined by J-ST elevation in the right leads of serial electrocardiographic records, wide oscillations of J points and ST segments during 24-hour Holter monitoring, and nocturnal sudden death. We stress the importance of the Holter monitor findings for diagnostic complementation. Through this method it is possible to establish a correlation between vigil activities and sleep and the variability of the degree of impairment in ventricular repolarization.

  14. Radiographic findings in immunodeficiency

    International Nuclear Information System (INIS)

    Obregon, R.; Lynch, D.A.; Cink, T.M.; Newell, J.D.; Kirkpatrick, C.

    1991-01-01

    This paper reviews the chest radiographs and high-resolution CT (HRCT) scans in patients with immunodeficiency disorders and define the role of HRCT. Thirty-three cases were retrospectively graded according to the consensus of two radiologists. Patients with HIV seropositivity and asthma were excluded. HRCT was performed in 12 cases with standard techniques. Diagnoses included common variable hypogammaglobulinemia (n = 19), X-linked agammaglobulinemia (n = 4), chronic mucocutaneous candidiasis (n = 4), and selective immunoglobulin g deficiencies (n = 2). Chest radiographs showed bronchiectasis in 11 of 33 cases with a predominant lower lobe distribution (82%). Nodules were present in six cases and mucus plugs in four cases. HRCT showed bronchiectasis in nine of 12 cases; in five of these nine cases, bronchiectasis was not apparent on chest radiographs. Other HRCT findings included segmental air trapping (four of 12), mucus plugs (three of 12), hazy consolidation (four of 12), nodules (five of 12), and bronchiolectasis (two of 12). Therapy was altered in seven of 12 cases in which HRCT was performed. Most pertinent to clinical management were the presence of a thymoma (n = 1) and severe focal of diffuse bronchiectasis

  15. Who benefits? Outcome following a coping skills group intervention for traumatically brain injured individuals.

    Science.gov (United States)

    Anson, Katie; Ponsford, Jennie

    2006-01-01

    To investigate the variables associated with positive psychological outcome following a group intervention for 33 individuals with traumatic brain injury. Evaluation study which used multiple regression analysis to examine the variables associated with change in psychological adjustment following a 10-session cognitive behaviour therapy-based group. The predictor variables were age at injury, time since injury, injury severity, self-awareness, pre-morbid intellectual function, memory function, executive function and level of depression and anxiety prior to intervention. The predictor variables contributed a significant proportion of the variance in percentage change in depression. The major finding was that better outcomes following intervention were associated with greater self-awareness of injury-related deficits. The present study identified a number of variables that were associated with improvement in depression following psychological intervention and may assist future treatment resources to be directed most effectively.

  16. Does the Early Bird Catch the Worm? Instrumental Variable Estimates of Educational Effects of Age of School Entry in Germany

    OpenAIRE

    Puhani, Patrick A.; Weber, Andrea M.

    2006-01-01

    We estimate the effect of age of school entry on educational outcomes using two different data sets for Germany, sampling pupils at the end of primary school and in the middle of secondary school. Results are obtained based on instrumental variable estimation exploiting the exogenous variation in month of birth. We find robust and significant positive effects on educational outcomes for pupils who enter school at seven instead of six years of age: Test scores at the end of primary school incr...

  17. Variability through the Eyes of the Programmer

    DEFF Research Database (Denmark)

    Melo, Jean; Batista Narcizo, Fabricio; Hansen, Dan Witzner

    2017-01-01

    Preprocessor directives (#ifdefs) are often used to implement compile-time variability, despite the critique that they increase complexity, hamper maintainability, and impair code comprehensibility. Previous studies have shown that the time of bug finding increases linearly with variability. Howe...

  18. Extraction Methods, Variability Encountered in

    NARCIS (Netherlands)

    Bodelier, P.L.E.; Nelson, K.E.

    2014-01-01

    Synonyms Bias in DNA extractions methods; Variation in DNA extraction methods Definition The variability in extraction methods is defined as differences in quality and quantity of DNA observed using various extraction protocols, leading to differences in outcome of microbial community composition

  19. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)

    DEFF Research Database (Denmark)

    Poulter, Neil R; Wedel, Hans; Dahlöf, Björn

    2005-01-01

    Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen (HR...

  20. Variable collimator

    International Nuclear Information System (INIS)

    Richey, J.B.; McBride, T.R.; Covic, J.

    1979-01-01

    This invention describes an automatic variable collimator which controls the width and thickness of X-ray beams in X-ray diagnostic medical equipment, and which is particularly adapted for use with computerized axial tomographic scanners. A two-part collimator is provided which shapes an X-ray beam both prior to its entering an object subject to radiographic analysis and after the attenuated beam has passed through the object. Interposed between a source of radiation and the object subject to radiographic analysis is a first or source collimator. The source collimator causes the X-ray beam emitted by the source of radiation to be split into a plurality of generally rectangular shaped beams. Disposed within the source collimator is a movable aperture plate which may be used to selectively vary the thickness of the plurality of generally rectangular shaped beams transmitted through the source collimator. A second or receiver collimator is interposed between the object subject to radiographic analysis and a series of radiation detectors. The receiver collimator is disposed to receive the attenuated X-ray beams passing through the object subject to radiographic analysis. Located within the receiver collimator are a plurality of movable aperture plates adapted to be displaced relative to a plurality of fixed aperture plates for the purpose of varying the width and thickness of the attenuated X-ray beams transmitted through the object subject to radiographic analysis. The movable aperture plates of the source and receiver collimators are automatically controlled by circuitry which is provided to allow remote operation of the movable aperture plates

  1. Find a Podiatrist

    Science.gov (United States)

    ... RSS Home » Learn About Feet » Find a Podiatrist Find a Podiatrist Search Criteria: First Name: Last Name: ... first 3 digits of your zip code to find the closest doctor. Country: Australia Canada Guam Israel ...

  2. Find a Therapist

    Science.gov (United States)

    ... My ADAA Blog Home / Find Help Print | Email Find a Therapist Zip Code: Radius: 5 Miles 10 ... personal referrals. We supply information to help you find local mental health services and resources that allow ...

  3. Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography?

    Science.gov (United States)

    Nanavati, Tania; Seemaladinne, Nirupama; Regier, Michael; Yossuck, Panitan; Pergami, Paola

    2015-01-01

    Background Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity, and long-term neurological deficits. Despite the availability of neuroimaging and neurophysiological testing, tools for accurate early diagnosis and prediction of developmental outcome are still lacking. The goal of this study was to determine if combined use of magnetic resonance imaging (MRI) and electroencephalography (EEG) findings could support outcome prediction. Methods We retrospectively reviewed records of 17 HIE neonates, classified brain MRI and EEG findings based on severity, and assessed clinical outcome up to 48 months. We determined the relation between MRI/EEG findings and clinical outcome. Results We demonstrated a significant relationship between MRI findings and clinical outcome (Fisher’s exact test, p = 0.017). EEG provided no additional information about the outcome beyond that contained in the MRI score. The statistical model for outcome prediction based on random forests suggested that EEG readings at 24 hours and 72 hours could be important variables for outcome prediction, but this needs to be investigated further. Conclusion Caution should be used when discussing prognosis for neonates with mild-to-moderate HIE based on early MR imaging and EEG findings. A robust, quantitative marker of HIE severity that allows for accurate prediction of long-term outcome, particularly for mild-to-moderate cases, is still needed. PMID:25862075

  4. Technological Capability's Predictor Variables

    Directory of Open Access Journals (Sweden)

    Fernanda Maciel Reichert

    2011-03-01

    Full Text Available The aim of this study was to identify the factors that influence in configuration of the technological capability of companies in sectors with medium-low technological intensity. To achieve the goal proposed in this article a survey was carried out. Based on the framework developed by Lall (1992 which classifies firms in basic, intermediate and advanced level of technological capability; it was found that the predominant technological capability is intermediate, with 83.7% of respondent companies (plastics companies in Brazil. It is believed that the main contribution of this study is the finding that the dependent variable named “Technological Capability” can be explained at a rate of 65% by six variables: development of new processes; selection of the best equipment supplier; sales of internally developed new technology to third parties; design and manufacture of equipment; study of the work methods and perform inventory control; and improvement of product quality.

  5. Farmer Health and Adaptive Capacity in the Face of Climate Change and Variability. Part 1: Health as a Contributor to Adaptive Capacity and as an Outcome from Pressures Coping with Climate Related Adversities

    Directory of Open Access Journals (Sweden)

    Anne Parkinson

    2011-10-01

    Full Text Available This paper examines the role farmers’ health plays as an element of adaptive capacity. The study examines which of twenty aspects of adaptation may be related to overall health outcomes, controlling for demographic and on-farm-factors in health problems. The analysis is based on 3,993 farmers’ responses to a national survey of climate risk and adaptation. Hierarchical linear regression modelling was used examine the extent to which, in a multivariate analysis, the use of adaptive practices was predictively associated with self-assessed health, taking into account the farmer’s rating of whether their health was a barrier to undertaking farm work. We present two models, one excluding pre-existing health (model 1 and one including pre-existing health (model 2. The first model accounted for 21% of the variance. In this model better health was most strongly predicted by an absence of on-farm risk, greater financial viability, greater debt pressures, younger age and a desire to continue farming. Social capital (trust and reciprocity was moderately associated with health as was the intention to adopt more sustainable practices. The second model (including the farmers’ health as a barrier to undertaking farm work accounted for 43% of the variance. Better health outcomes were most strongly explained, in order of magnitude, by the absence of pre-existing health problems, greater access to social support, greater financial viability, greater debt pressures, a desire to continue farming and the condition of on-farm resources. Model 2 was a more parsimonious model (only nine predictors, compared with 15 in model 1, and explained twice as much variance in health outcomes. These results suggest that (i pre-existing health problems are a very important factor to consider when designing adaptation programs and policies and (ii these problems may mediate or modify the relationship between adaptation and health.

  6. Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.

    Science.gov (United States)

    Hudson, Jennifer L; Kendall, Philip C; Chu, Brian C; Gosch, Elizabeth; Martin, Erin; Taylor, Alan; Knight, Ashleigh

    2014-01-01

    This study examined the relations between treatment process variables and child anxiety outcomes. Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Genetics and intelligence differences: five special findings

    Science.gov (United States)

    Plomin, R; Deary, I J

    2015-01-01

    Intelligence is a core construct in differential psychology and behavioural genetics, and should be so in cognitive neuroscience. It is one of the best predictors of important life outcomes such as education, occupation, mental and physical health and illness, and mortality. Intelligence is one of the most heritable behavioural traits. Here, we highlight five genetic findings that are special to intelligence differences and that have important implications for its genetic architecture and for gene-hunting expeditions. (i) The heritability of intelligence increases from about 20% in infancy to perhaps 80% in later adulthood. (ii) Intelligence captures genetic effects on diverse cognitive and learning abilities, which correlate phenotypically about 0.30 on average but correlate genetically about 0.60 or higher. (iii) Assortative mating is greater for intelligence (spouse correlations ~0.40) than for other behavioural traits such as personality and psychopathology (~0.10) or physical traits such as height and weight (~0.20). Assortative mating pumps additive genetic variance into the population every generation, contributing to the high narrow heritability (additive genetic variance) of intelligence. (iv) Unlike psychiatric disorders, intelligence is normally distributed with a positive end of exceptional performance that is a model for ‘positive genetics'. (v) Intelligence is associated with education and social class and broadens the causal perspectives on how these three inter-correlated variables contribute to social mobility, and health, illness and mortality differences. These five findings arose primarily from twin studies. They are being confirmed by the first new quantitative genetic technique in a century—Genome-wide Complex Trait Analysis (GCTA)—which estimates genetic influence using genome-wide genotypes in large samples of unrelated individuals. Comparing GCTA results to the results of twin studies reveals important insights into the genetic

  8. Determinants of Network Outcomes

    DEFF Research Database (Denmark)

    Ysa, Tamyko; Sierra, Vicenta; Esteve, Marc

    2014-01-01

    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization...... networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network...... outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more...

  9. Finding a Neurosurgeon

    Science.gov (United States)

    Tip: Finding A Neurosurgeon The first step in getting proper treatment for Chiari is to find the right doctor. While many patients are ... surgical, Conquer Chiari recommends that patients see a neurosurgeon for evaluation. As a policy, Conquer Chiari does ...

  10. Finding optimal exact reducts

    KAUST Repository

    AbouEisha, Hassan M.

    2014-01-01

    The problem of attribute reduction is an important problem related to feature selection and knowledge discovery. The problem of finding reducts with minimum cardinality is NP-hard. This paper suggests a new algorithm for finding exact reducts

  11. Find a Dermatologist

    Science.gov (United States)

    ... Practice Tools Education Meetings & Events Advocacy Public & Patients Find a Dermatologist Why see a dermatologist? Learn more . ... Last Name Search Special Proprietary Notice and Disclaimer "Find a Dermatologist" is produced by the American Academy ...

  12. Find din stemme

    DEFF Research Database (Denmark)

    Hansen, Jette Barnholdt

    2010-01-01

    Anmeldelse af Dorte Kock og Lene Kleinschmidts: Find din stemme. En brugsbog.Hans Reitzels Forlag 2010.......Anmeldelse af Dorte Kock og Lene Kleinschmidts: Find din stemme. En brugsbog.Hans Reitzels Forlag 2010....

  13. Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

    Directory of Open Access Journals (Sweden)

    Volker Kast

    Full Text Available Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers and untrained individuals (novices in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

  14. Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

    Science.gov (United States)

    Kast, Volker; Leukel, Christian

    2016-01-01

    Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers) and untrained individuals (novices) in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

  15. Imaging findings of xanthogranulomatous pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul [School of Medicine, Chungnam National University, Taejon (Korea, Republic of)

    2000-01-01

    To define the imaging patterns of xanthogranulomatous pyelonephritis (XGP). The demographic, clinical, and imaging findings of 21 cases of pathologically proven XGP in 20 patients (bilateral in one) were evaluated. The findings of ultrasonography and CT were retrospectively evaluated with regard to distribution and extent of the disease, kidney size, the presence of calculi, hydronephrosis, and renal function. The findings were assessed by two radiologists, who established a consensus. Imaging and pathologic findings were compared. Sixteen of the 20 patients were female, and 19 were adults. Their age ranged from 3 to 16 (mean, 45) years. In all patients except one, the disease was unilateral (right: left =3D 13 :16). In one patient, XGP was bilateral, and there were thus 21 cases. Seventeen (81%) of these were diffuse, and four (19%) were focal; extrarenal extension occurred in 13 cases (62%), among which ipsilateral pleural effusion was noted in two. The kidney was enlarged diffusely in 12 cases (57%), and focally in three (14%); urinary calculi were present in 16 cases (76%), with staghorn calculi in four of these; and hydronephrosis occurred in 17 (81%). Impairment of ipsilateral renal function was noted in 13 cases (62%). Clinical findings of inflammation such as fever, pyuria, bacteriuria, or leucocytosis were noted in all patients. In addition to nephromegaly, renal function impairment, and urinary obstruction due to calculi, which are typical features of XGP, the condition may also show variable imaging findings. If the images obtained in the case of a middle-aged woman with clinical findings of urinary infection are atypical, we believe that XGP should be included in the differential diagnosis. (author)

  16. Articulatory variability in cluttering.

    Science.gov (United States)

    Hartinger, Mariam; Mooshammer, Christine

    2008-01-01

    In order to investigate the articulatory processes of the hasty and mumbled speech in cluttering, the kinematic variability was analysed by means of electromagnetic midsagittal articulography. In contrast to persons with stuttering, those with cluttering improve their intelligibility by concentrating on their speech task. Variability has always been an important criterion in comparable studies of stuttering and is discussed in terms of the stability of the speech motor system. The aim of the current study was to analyse the spatial and temporal variability in the speech of three persons with cluttering (PWC) and three control speakers. All participants were native speakers of German. The speech material consisted of repetitive CV syllables and loan words such as 'emotionalisieren', because PWC have the severest problems with long words with a complex syllable structure. The results showed a significantly higher coefficient of variation for PWC in loan word production, both in the temporal and in the spatial domain, whereas the means of displacements and durations did not differ between groups. These findings were discussed in terms of the effects of the linguistic complexity, since for the syllable repetition task, no significant differences between PWC and controls were found. Copyright 2008 S. Karger AG, Basel.

  17. MR imaging findings of ring apophyseal fractures in lumbar vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yong Soo; Kwon, Soon Tae; Song, Chang Joon; Lee, Young Hwan; Kim, Hyoung Seob; Lee, Hwan Do; Cho, June Sik; Ahn, Jae Sung; Lee, June Kyu [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1997-07-01

    To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7%. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery.

  18. MR imaging findings of ring apophyseal fractures in lumbar vertebrae

    International Nuclear Information System (INIS)

    Kang, Yong Soo; Kwon, Soon Tae; Song, Chang Joon; Lee, Young Hwan; Kim, Hyoung Seob; Lee, Hwan Do; Cho, June Sik; Ahn, Jae Sung; Lee, June Kyu

    1997-01-01

    To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7%. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery

  19. Incorporating outcome uncertainty and prior outcome beliefs in stated preferences

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  20. Psychologic Outcomes in Implant Prosthodontics

    NARCIS (Netherlands)

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

    2013-01-01

    Consensus regarding outcomes of the treatment of tooth loss, especially the psychologic outcomes, is needed to guide discovery of best practices and enable a better understanding of patient management for this chronic condition. This paper presents the findings of the ORONet Psychological Working

  1. Ultrasonographic findings of cataract

    International Nuclear Information System (INIS)

    Choi, Sun Seob; Kim, Yang Soo; Lee, Kwan Seh; Kim, Kun Sang

    1985-01-01

    Examining the eye with high resolution ultrasonography, authors encountered 34 cases (41 eyeballs) of cataract and found out its characteristic ultrasonographic findings, though cataract is easily recognized by physician on inspection. Ultrasonographic findings of cataract were as follows; 1. Thickening of lens due to edema. 2. Demonstration of lens echo in whole circumference. 3. Multiple internal lens echo

  2. Morel-Lavallée Lesions of the Knee: MRI Findings Compared With Cadaveric Study Findings.

    Science.gov (United States)

    Vassalou, Evangelia E; Zibis, Aristeidis H; Raoulis, Vasileios A; Tsifountoudis, Ioannis P; Karantanas, Apostolos H

    2018-05-01

    The purpose of this study is to describe the MRI findings and treatment decisions and outcome for Morel-Lavallée lesions (MLLs) of the knee and to investigate whether evidence exists to support an increased frequency of such lesions on the medial or lateral side by performing a cadaveric experiment. In a 4-year period, 24 MRI studies of 24 consecutive patients (16 male patients and eight female patients) with knee MLLs were retrospectively reviewed. Patient demographic characteristics, treatment decisions and outcome, and associated injuries were recorded. The location of the MLL was categorized as medial, lateral, or global. Lesions were categorized according to an established MRI classification. During the cadaveric experiment, the compartmental pressures of the medial or lateral aspect of the knee were monitored in 20 cadaveric knees. The chi-square test, t test, and Pearson correlation were used for statistical analysis. MLLs were located medially in 16 patients, laterally in two patients, and globally in six patients. The medial location was significantly more common than a lateral or global location (p < 0.05). MLLs were classified as type I in 14 patients, type II in eight patients, and type III in two patients. MRI type was correlated with the chronicity of injury (r 2 = 0.614; p = 0.0014). Fractures were the most common associated injuries, occurring in seven of 24 patients. In 17 patients, all of whom had conservatively treated type I or type II lesions, complete resolution of the MLL occurred. The maximum compartmental pressures were significantly higher on the lateral side than on the medial side (p < 0.0001). Knee MLLs have a predilection for the medial side, which may be attributed to the lower resistance in this location, and they have variable patterns on MRI, which correlate with chronicity. Conservative treatment of type I and II lesions seems effective.

  3. Motivation as an independent and a dependent variable in medical education: a review of the literature.

    Science.gov (United States)

    Kusurkar, R A; Ten Cate, Th J; van Asperen, M; Croiset, G

    2011-01-01

    Motivation in learning behaviour and education is well-researched in general education, but less in medical education. To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation. A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included. Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT. Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.

  4. Variable Selection via Partial Correlation.

    Science.gov (United States)

    Li, Runze; Liu, Jingyuan; Lou, Lejia

    2017-07-01

    Partial correlation based variable selection method was proposed for normal linear regression models by Bühlmann, Kalisch and Maathuis (2010) as a comparable alternative method to regularization methods for variable selection. This paper addresses two important issues related to partial correlation based variable selection method: (a) whether this method is sensitive to normality assumption, and (b) whether this method is valid when the dimension of predictor increases in an exponential rate of the sample size. To address issue (a), we systematically study this method for elliptical linear regression models. Our finding indicates that the original proposal may lead to inferior performance when the marginal kurtosis of predictor is not close to that of normal distribution. Our simulation results further confirm this finding. To ensure the superior performance of partial correlation based variable selection procedure, we propose a thresholded partial correlation (TPC) approach to select significant variables in linear regression models. We establish the selection consistency of the TPC in the presence of ultrahigh dimensional predictors. Since the TPC procedure includes the original proposal as a special case, our theoretical results address the issue (b) directly. As a by-product, the sure screening property of the first step of TPC was obtained. The numerical examples also illustrate that the TPC is competitively comparable to the commonly-used regularization methods for variable selection.

  5. Supplemental Instruction: The Effect of Demographic and Academic Preparation Variables on Community College Student Academic Achievement in STEM-Related Fields

    Science.gov (United States)

    Rabitoy, Eric R.; Hoffman, John L.; Person, Dawn R.

    2015-01-01

    This study evaluated variables associated with academic preparation and student demographics as predictors of academic achievement through participation in supplemental instruction (SI) programs for community college students in Science, Technology, Engineering, and Math (STEM) fields. The findings suggest a differential impact of SI outcome for…

  6. Radiologic findings of anthracofibrosis

    International Nuclear Information System (INIS)

    Yoon, Mi Jin; Ko, Eun Joo; Yoon, Sook Ja; Tien, Kuang Lung; Yoon, Yong Kyu; Lee, Kyung Soo; Kim, Jin Hwan

    1998-01-01

    To evaluate the CT findings of bronchial anthracofibrosis. Fourteen patients with bronchoscopically confirmed anthracofibrosis were involved in this study. CT findings (n=3D12) were retrospectively analysed; the pattern, distri-bution and extent of bronchial and parenchymal abnormalities and additional findings such as mediastinal lymphadenopathy and pleural effusion were assessed. Age, sex, and occupational and disease history were history were also reviewed. Patients were aged between 63 and 95 (mean, 71.3) years, and ten were female. Only one patient had an occupational history, but four had a history of pulmonary tuberculosis. Frequent radiologic findings were bronchial wall thickening(n=3D6), atelectasis(n=3D8), mediastinal lymphad-enopathy(n=3D7) and mass(n=3D4). Other accompanying findings were