bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume
Authors: Vadera Sumeet , Chan Alvin Y. , Mnatsankanyan Lilit , Sazgar Mona , Sen-Gupta Indranil , Lin Jack , Hsu Frank P. K.
Published: May 2018

OBJECTIVE

Surgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.

METHODS

The authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.

RESULTS

Over the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.

CONCLUSIONS

Partnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.
Analysis of cerebrovascular aneurysm treatment cost: retrospective cohort comparison of clipping, coiling, and flow diversion
Authors: Twitchell Spencer , Abou-Al-Shaar Hussam , Reese Jared , Karsy Michael , Eli Ilyas M. , Guan Jian , Taussky Philipp , Couldwell William T.
Published: May 2018

OBJECTIVE

With the continuous rise of health care costs, hospitals and health care providers must find ways to reduce costs while maintaining high-quality care. Comparing surgical and endovascular treatment of intracranial aneurysms may offer direction in reducing health care costs. The Value-Driven Outcomes (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. In this study, the authors evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system.

METHODS

The authors retrospectively reviewed surgical and endovascular treatment of ruptured and unruptured intracranial aneurysms from July 2011 to January 2017. Total cost (as a percentage of each patient’s cost to the system), subcategory costs, and potential cost drivers were evaluated and analyzed.

RESULTS

A total of 514 aneurysms in 469 patients were treated; 273 aneurysms were surgically clipped, 102 were repaired with coiling, and 139 were addressed with flow diverter placements. Middle cerebral artery aneurysms accounted for the largest portion of cases in the clipping group (29.7%), whereas anterior communicating artery aneurysms were most frequently involved in the coiling group (30.4%) and internal carotid artery aneurysms were the majority in the flow diverter group (63.3%). Coiling (mean total cost 0.25% ± 0.20%) had a higher cost than flow diversion (mean 0.20% ± 0.16%) and clipping (mean 0.17 ± 0.14%; p = 0.0001, 1-way ANOVA). Coiling cases cost 1.5 times as much as clipping and flow diversion costs 1.2 times as much as clipping. Facility costs were the most significant contributor to intracranial clipping costs (60.2%), followed by supplies (18.3%). Supplies were the greatest cost contributor to coiling costs (43.2%), followed by facility (40.0%); similarly, supplies were the greatest portion of costs in flow diversion (57.5%), followed by facility (28.5%). Cost differences for aneurysm location, rupture status, American Society of Anesthesiologists (ASA) grade, and discharge disposition could be identified, with variability depending on surgical procedure. A multivariate analysis showed that rupture status, surgical procedure type, ASA status, discharge disposition, and year of surgery all significantly affected cost (p < 0.0001).

CONCLUSIONS

Facility utilization and supplies constitute the majority of total costs in aneurysm treatment strategies, but significant variation exists depending on surgical approach, rupture status, and patient discharge disposition. Developing and implementing approaches and protocols to improve resource utilization are important in reducing costs while maintaining high-quality patient care.
Propensity-matched comparison of outcomes and cost after macroscopic and microscopic lumbar discectomy using a national longitudinal database
Authors: Pendharkar Arjun Vivek , Rezaii Paymon Garakani , Ho Allen Lin , Sussman Eric Scott , Purger David Arnold , Veeravagu Anand , Ratliff John Kevin , Desai Atman Mukesh
Published: May 2018

OBJECTIVE

There has been considerable debate about the utility of the operating microscope in lumbar discectomy and its effect on outcomes and cost.

METHODS

A commercially available longitudinal database was used to identify patients undergoing discectomy with or without use of a microscope between 2007 and 2015. Propensity matching was performed to normalize differences between demographics and comorbidities in the 2 cohorts. Outcomes, complications, and cost were subsequently analyzed using bivariate analysis.

RESULTS

A total of 42,025 patients were identified for the “macroscopic” group, while 11,172 patients were identified for the “microscopic” group. For the propensity-matched analysis, the 11,172 patients in the microscopic discectomy group were compared with a group of 22,340 matched patients who underwent macroscopic discectomy. There were no significant differences in postoperative complications between the groups other than a higher proportion of deep vein thrombosis (DVT) in the macroscopic discectomy cohort versus the microscopic discectomy group (0.4% vs 0.2%, matched OR 0.48 [95% CI 0.26–0.82], p = 0.0045). Length of stay was significantly longer in the macroscopic group compared to the microscopic group (mean 2.13 vs 1.83 days, p < 0.0001). Macroscopic discectomy patients had a higher rate of revision surgery when compared to microscopic discectomy patients (OR 0.92 [95% CI 0.84–1.00], p = 0.0366). Hospital charges were higher in the macroscopic discectomy group (mean $19,490 vs $14,921, p < 0.0001).

CONCLUSIONS

The present study suggests that the use of the operating microscope in lumbar discectomy is associated with decreased length of stay, lower DVT rate, lower reoperation rate, and decreased overall hospital costs.
Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores
Authors: Thakar Sumit , Rajagopal Niranjana , Mani Subramaniyan , Shyam Maya , Aryan Saritha , Rao Arun S. , Srinivasa Rakshith , Mohan Dilip , Hegde Alangar S.
Published: May 2018

OBJECTIVE

The utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures.

METHODS

A decision-analytical model was used to assess the cost-effectiveness of TM for elective post–neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change.

RESULTS

The overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy “dominates” that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center.

CONCLUSIONS

TM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post–neurosurgical care population in India. In the authors’ setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.
Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research
Authors: Wali Arvin R. , Brandel Michael G. , Santiago-Dieppa David R. , Rennert Robert C. , Steinberg Jeffrey A. , Hirshman Brian R. , Murphy James D. , Khalessi Alexander A.
Published: May 2018

OBJECTIVE

Markov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research.

METHODS

The PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs.

RESULTS

A total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided.

CONCLUSIONS

As neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.
Ubuntu and Ecofeminism: Value-Building with African and Womanist Voices
Authors: Konik Inge
Published: May 2018

To build a front against neoliberalism, those in the alter-globalisation movement work across perceived divides. Such transversal openness, however, has not been embraced fully within the academic sphere, even though theoretical coalitions are also important for developing a life-affirming societal ethos. Meaningful opportunities for theoretical bridging do exist, particularly where alternative value systems, hitherto isolated, can be drawn into the wider global dialogue on societal futures. In this spirit, this article offers some transversal reflections on materialist ecofeminism, and one such marginalised value system: the African ethic of ubuntu.
Green Faith? The Role of Faith-Based Actors in Global Sustainable Development Discourse
Authors: Glaab Katharina , Fuchs Doris
Published: May 2018

Ethical questions concerning global sustainability governance have been widely discussed with respect to the role of civil society in general. Interestingly, faith-based actors (FBAs) have so far attracted scant attention in this context. Yet FBAs actively participate in international political negotiations and public debates on sustainable development. Secularisation theory differentiates between religious and secular actors. To date, however, it remains unclear whether FBAs contribute a distinct faith-based perspective to global sustainable development discourse and, if so, what this perspective is. The present article aims to identify the relevant norms and ideas in FBAs’ communications and to contrast them with other existing ideas on sustainable development. On the basis of a content analysis of the submissions by FBAs and non-faith based civil society groups in the context of the UN Rio+20 summit, the article first investigates what visions are contained in current articulations of FBAs with respect to sustainable development. Secondly, it explores in what way FBAs’ ideas about sustainable development differ from those of secular civil society. Our analysis establishes a basis for further inquiries into the role of FBAs in global sustainable development discourse.
LPI Based Earthquake Induced Soil Liquefaction Susceptibility Assessment at Probashi Palli Abasan Project Area, Tongi, Gazipur, Bangladesh
Authors: Farazi A. H. , Ferdous N. , Kamal A. S. M. M.
Published: May 2018

This study aims at evaluation of seismic soil liquefaction hazard potential at Probashi Palli Abasan Project area of Tongi, Gazipur, exploiting standard penetration test (SPT) data of 15 boreholes, following Simplified Procedure. Liquefaction potential index (LPI) of each borehole was determined and then cumulative frequency distribution of clustered LPI values of each surface geology unit was determined assuming cumulative frequency at LPI = 5 as the threshold value for liquefaction initiation. By means of geotechnical investigation two surface geological units—Holocene flood plain deposits, and Pleistocene terrace deposits were identified in the study area. We predicted that 14% and 24% area of zones topped by Pleistocene terrace deposits and zones topped by Holocene flood plain deposits, respectively, would exhibit surface manifestation of liquefaction as a result of 7 magnitude earthquake. The engendered hazard map also depicts site specific liquefaction intensity through LPI values of respective boreholes, and color index, which was delineated by mapping with ArcGIS software. Very low to low, and low to high liquefaction potential, respectively, was found in the areas covered by Pleistocene terrace deposits and Holocene flood plain deposits. LPI values of both units are such that sand boils could be generated where LPI > 5.
Variability of Geomagnetic Field with Interplanetary Magnetic Field at Low, Mid and High Latitudes
Authors: Bhardwaj S. , Khan P. A. , Atulkar R. , Purohit P. K.
Published: May 2018

The fluctuations in the Interplanetary Magnetic Field significantly affect the state of geomagnetic field particularly during the Coronal Mass Ejection (CME) events. In the present investigation we have studied the influence of Interplanetary Magnetic Field changes on the geomagnetic field components at high, low and mid latitudes. To carry out this investigation we have selected three stations viz. Alibag (18.6°N, 72.7°E), Beijing MT (40.3°N, 116.2°E) and Casey (66.2°S, 110.5°E) one each in the low, mid and high latitude regions. Then we selected geomagnetic storm events of three types namely weak (-50≤Dst≤-20), moderate (100≤Dst≤-50) and intense (Dst≤-100nT). In each storm category 10 events were considered. From our study we conclude that geomagnetic field components are significantly affected by the changes in the IMF at all the three latitudinal regions during all the storm events. At the same time we also found that the magnitude of change in geomagnetic field components is highest at the high latitudes during all types of storm events while at low and mid latitude stations the magnitude of effect is approximately the same.
In Vivo Evaluation of Jatropha curcas L (Euphorbiaceae) Leaves Acute and Subacute Toxicity in Mice
Authors: Sawadogo S. , Sanou S. D. , Dabiré A. P. , Belemtougri G. R. , Sawadogo L. , Leiris J. de , Tanguy S. , Boucher F.
Published: May 2018

Jatropha curcas is a medicinal plant whose dead leaves are particularly used in arterial hypertension and diabetes treatment. The purpose of this study is to conduct an acute and subacute toxicity study of Jatropha curcas leaves aqueous extract (JCLAE) using OECD method. For acute toxicity, dose limits of 2000 and 5000 mg/kg were used. In subacute toxicity study 4 batches were constituted including a control batch that received distilled water for 28 days and the other 3 batches, JCLAE doses of respectively 200, 400, 800 mg/kg for the same duration. The LD50 was determined and the hematological, biochemical and histological parameters were analyzed in mice. The LD50 is greater than 5000 mg/kg. HDL-C is the only biochemical parameter that has experienced significant rise variation. Hematological analysis showed a decrease in mean platelet volume and Platelets number. The histological study revealed cases of hepatic cellular apoptosis and kidneys tubular necrosis among animals treated with highest dose. JCLAE is less toxic than Jatropha curcas leaves aqueous extract and high-dose JCLAE also has a moderate toxic effect on thrombocyte line and a protective effect on cardiovascular system.
Antibiofilm Activity of Crude Cell Free Extract from Bacillus subtilis S01 against E. coli
Authors: Sayem S. M. A. , Chowdhury A. J. M. T. , Alam M. Z. , Sarker P. K.
Published: May 2018

Antibiofilm phenomenon has become a novel area of research for removing deleterious biofilm. In the present study, strains from different environmental sources were tested for screening antibiofilm compounds. Crude extracts from various microorganisms were evaluated for antibiofilm phenomenon through crystal violet assay and growth curve analysis. Characterization of antibiofilm compound was performed by pre-coating microtiter plate and Cell Surface Hydrophobicity experiment. Among the organisms, cell free extracts (5% v/v) from Bacillus subtilis S01 inhibited the development of E. coli PHL628 biofilm by 63%. The cell free extracts possessed no amylase activity and had no effect on the planktonic growth of biofilm forming bacteria. Moreover, no competition with quorum sensing analogues was found with the extract. Biofilm formation was more inhibited (76%) in the B. subtilis S01 extract pre-coated wells than uncoated wells (62%). However, no effect on preformed biofilm was observed with the extracts of B. subtilis S01. The extract also reduced the cell surface hydrophobicity (69%) of the biofilm forming bacteria. The present study indicated that the crude extracts of B. subtilis S01 from soil origin has anti-adherence properties towards biotic and abiotic surfaces and thus can be a potential candidate in preventing the development of biofilm.
Virological and Immunological Responses to Raltegravir and Dolutegravir in the Gut-Associated Lymphoid Tissue of HIV-Infected Men and Women
Authors: Weber Michael D , Andrews Elizabeth , Prince Heather A , Sykes Craig , Rosen Elias P , Bay Camden , Shaheen Nicholas J , Madanick Ryan D , Dellon Evan S , Paris Kristina De , Nelson Julie AE , Gay Cynthia L , Kashuba Angela DM
Published: May 2018

Background

Raltegravir (RTG) and dolutegravir (DTG) have different pharmacokinetic patterns in the gastrointestinal tract. To determine if this results in pharmacodynamic differences, we compared HIV RNA, HIV DNA and immunological markers in gut-associated lymphoid tissue (GALT) of HIV-infected participants receiving RTG or DTG with tenofovir+emtricitabine (TDF/FTC).

Methods

GALT specimens from the terminal ileum, splenic flexure and rectum were obtained by colonoscopy at a single time point in 20 adults treated with RTG ( n=10) or DTG ( n=10) with HIV RNA <50 copies/ml. Flow cytometry, drug concentrations, and HIV RNA and DNA were analysed in tissue. CD4/8+ T-cells were tested for γδ TCR, and markers of T-cell activation and exhaustion. Data are reported as median (Q1–Q3).

Results

A total of 15 men and 5 women were enrolled. There was no difference in time since HIV diagnosis for those on RTG (9.5 [4–22] years) and DTG (17 [1–24] years; P=0.6), although time on RTG (5.4 [2.3–6.7] years) was greater than DTG (1.0 [0.1–1.5] years; P<0.001). Concentrations of RTG and DTG in rectal tissue were similar to previous reports: median tissue:plasma ratio was 11.25 for RTG and 0.44 for DTG. RNA:DNA ratios were 1.14 (0.18–5.10) for the RTG group and 0.90 (0.30–18.87) for the DTG group ( P=0.95). No differences ( P≥0.1) between CD4+ and CD8+ T-cell markers were found.

Conclusions

RTG produced higher tissue exposures than DTG, but no significant differences in GALT HIV RNA, DNA or most immunological markers were observed. ClinicalTrials.gov NCT02218320.
PGA×BSA: A Measure of Psoriasis Severity Tested in Patients with Active Psoriatic Arthritis and Treated with Certolizumab Pegol
Authors: Walsh Jessica A. , Arledge Terri , Nurminen Tommi , Peterson Luke , Stark Jeffrey
Published: May 2018

Objective.

The product of physician’s global assessment and body surface area (PGA×BSA) to assess psoriasis severity has previously been investigated in patients with psoriasis, with the aim of assessing PGA×BSA as an alternative to the time-consuming Psoriasis Area and Severity Index (PASI). Here, we investigate PGA×BSA as an alternative to PASI in patients with psoriatic arthritis (PsA).

Methods.

Analyses used data from the double-blind, placebo-controlled, RAPID-PsA trial (NCT01087788) that investigated the efficacy of certolizumab pegol (CZP) in patients with PsA. Outcomes assessed whether the PGA×BSA and PASI results were comparable, and whether these outcomes correlated with one another or with the Dermatology Life Quality Index (DLQI).

Results.

For CZP-treated patients, both PGA×BSA and PASI demonstrated similar sensitivities to treatment between baseline and Week 24, with mean improvements of 77.4% and 69.0%, respectively. Similar improvements were also seen with placebo (PGA×BSA: 3.2%, PASI: 6.1%). Achievement of 75% response criterion in PGA×BSA and PASI was attained by similar proportions of patients with CZP (PGA×BSA75: 59.0%, PASI75: 61.4%) and placebo (PGA × BSA75: 15.1%, PASI75: 15.1%). Cross tabulations showed high concordance between achievement of response outcomes in PGA×BSA and PASI (79.6–95.2%). Spearman correlations revealed strong correlations between PGA×BSA and PASI at baseline (r = 0.78; n = 225) and percentage improvement to Week 24 (r = 0.85; n = 186). Both outcomes were only moderately correlated with DLQI (r = 0.41–0.50; n = 179–249).

Conclusion.

PGA×BSA is sensitive to changes in skin manifestations in patients with PsA treated with CZP. Further, PGA×BSA correlates strongly with PASI, and achievement of 75% improvement was similar for PGA×BSA and PASI.
De l’enfant rêvé à l’adolescent sans rêve
Authors: Fourez Bernard
Published: May 2018

À partir de la notion d’enfant du désir, l’auteur analyse la vision de l’enfant dans notre culture occidentale actuelle comme condition de positionnements éducatifs et de développement psychique selon les traits de l’individualisme contemporain. Il analyse ensuite certains modes relationnels et sociaux émergeant de ce creuset. Enfin, ce prisme opérant de l’enfant du désir permet de mieux saisir les importants et nombreux tableaux cliniques de l’extinction chez l’adolescent.
L’animal dit « de compagnie »
Authors: de Mijolla-Mellor Sophie
Published: May 2018

Ce texte ne porte pas sur la psyché animale et moins encore sur les modèles animaux qui régissent aussi la nôtre mais il tente d’analyser à partir de la pratique clinique et des confidences des auteurs de la littérature le désir humain d’être en compagnie d’un animal privilégié. Son objet est donc de tenter de cerner ce qui fait compagnie dans l’animal et quel type d’attente s’adresse aux animaux de compagnie auxquels nous accordons une part importante de nos investissements alors même qu’ils ne sont d’aucune utilité pratique et s’avèrent souvent source de divers tracas.
Mon cothérapeute chat
Authors: Brousselle André
Published: May 2018

Le chat peut-il se faire cothérapeute pendant les séances ? Il peut être envisagé comme faisant partie du cadre, ou d’un environnement winnicottien, ou comme miroir d’un bien-être narcissique. Toutefois, à d’autres moments, il sera objet libidinal, personne ou « jouet érotique ». Risque-t-il alors d’entrer dans le clivage mauvais humains/bons animaux, ce qui retirerait sa valeur bénéfique ? Nos questionnements s’appuieront sur le cas clinique d’une patiente.
Case Study Application for Psychopharmacology With Borderline Personality Disorder
Authors: Limandri Barbara J.
Published: May 2018

Using an evolving case study, the current article demonstrates the principles of working with a client who has borderline personality disorder in relation to medications. The case study poses questions for the reader to consider and answers at the end of the article. [
Journal of Psychosocial Nursing and Mental Health Services, 56
(5), 16–19.]
Early Warning Score Communication Bundle: A Pilot Study
Authors: Gagne Cheryl , Fetzer Susan
Published: May 2018

Background

Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers.

Objective

To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer.

Methods

After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation.

Results

Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002).

Conclusion

Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.
GUT COLONIZATION WITH CARBAPENEM RESISTANT ENTEROBACTERIACEAE ADVERSELY IMPACTS THE OUTCOME IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES: RESULTS OF A PROSPECTIVE SURVEILLANCE STUDY
Authors: CHAKRABARTI SUPARNO
Published: May 2018

Background: Gut colonisation with Carbapenem Resistant Enterobacteriaceae (CRE) is a risk factor for CRE bacteremia and patients with haematological malignancies (HM) are at the highest risk of mortality.Methods: We conducted a prospective surveillance study of gut colonisation with CRE and its impact on the outcome on  225 consecutive patients of HM over 28 months.                                                                                                                                                                                                                                                                                                                   Results: The median age of the cohort was 46 years, majority with Acute Leukemia.  48 (21%) patients were colonized with CRE on admission (CAD). Another 46 patients were colonized with CRE in the hospital (CIH). The risk factors for CAD and CIH were diagnosis of acute leukemia and duration of hospital stay respectively. CRE accounted for 77% of non-relapse mortality (NRM). CRE bacteremia occurred only in colonized patients with 100% mortality. NRM was 35.3% in CIH group compared to 10.5% in the CAD group (p=0.0001). NRM was highest in those with AML and CIH (54.9% p=0.0001). On multivariate analysis, CIH was the most important risk factor for NRM (HR-7.2).Conclusion: Our data demonstrates that a substantial proportion of patients with HM are colonized with CRE without prior hospitalization, but those with nosocomial colonization have the highest risk of mortality, particularly in those with Acute Myeloid Leukemia.
Breastfeeding in patients with chronic myeloid leukaemia: case series with measurements of drug concentrations in maternal milk and review of literature
Authors: Chelysheva Ekaterina , Aleshin Sergey , Polushkina Evgenia , Shmakov Roman , Shokhin Igor , Chilov Ghermes , Turkina Anna
Published: May 2018

Breastfeeding in patients with chronic myeloid leukaemia (CML) who take tyrosine kinase inhibitors (TKIs) is not recommended but interruption of TKI treatment may cause the loss of remission. We observed the kinetics of the leukaemic clone in 3 women with CML in accordance with treatment interruptions for pregnancy and breastfeeding. The concentrations of nilotinib and imatinib in maternal milk were measured when the breastfeeding period was over. Nilotinib transfer into human breast milk was demonstrated for the first time and had a maximum concentration (Cmax) 129 ng/ml after 4 hours of the drug intake at a dose of 400 mg. The Cmax of imatinib in maternal milk ranged from 420 to 1411 ng/ml after 4-8 hours of the drug intake at a dose of 400-600 mg. Breastfeeding without TKI treatment may be safe with molecular monitoring, but preferably in those patients with CML who have durable deep molecular response.
PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW
Authors: Adjepong Kwame Ofori , Otegbeye Folashade , ADJEPONG Yaw Amoateng
Published: May 2018

An estimated 30 million people worldwide have sickle cell disease (SCD).  Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.  Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss.  Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.
LYMPHOPROLIFERATIVE SYNDROMES ASSOCIATED WITH HUMAN HERPESVIRUS-6A AND HUMAN HERPESVIRUS-6B
Authors: Eliassen Eva , Krueger Gerhard R , Luppi Mario , Ablashi Dharam
Published: May 2018

Human herpesvirus 6A and 6B (HHV-6A and HHV-6B) have been noted since their discovery for their T-lymphotropism. Although it has proven difficult to determine the extent to which HHV-6A and HHV-6B are involved in the pathogenesis of many diseases, evidence suggests that primary infection and reactivation of both viruses may induce or contribute to the progression of several lymphoproliferative disorders, ranging from benign to malignant and including infectious mononucleosis-like illness, drug induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), and nodular sclerosis Hodgkin’s lymphoma. Herein, we discuss the conditions associated with the lymphoproliferative capacity of HHV-6, as well as the potential mechanisms behind them. Continued exploration on this topic may add to our understanding of the interactions between HHV-6 and the immune system and may open the doors to more accurate diagnosis and treatment of certain lymphoproliferative disorders.
Case Report: Atypical Cutaneous Manifestations of Tularemia after Horsefly Bite
Authors: Drago Francesco , Javor Sanja , Parodi Aurora
Published: May 2018

Tularemia is an infectious zoonosis caused by Francisella tularensis, an aerobic, noncapsulated, Gram-negative coccobacillus. It is more common in the northern hemisphere, and there are sporadic reports in non-endemic areas. The bacterium is usually transmitted by the bite or feces of a tick or other arthropods such as mosquitoes and horseflies. We report a case of an Italian patient with tularemia after a horsefly bite.
Factors Associated with Wuchereria bancrofti Microfilaremia in an Endemic Area of Mali
Authors: Dolo Housseini , Coulibaly Yaya Ibrahim , Kelly-Hope Louise , Konate Siaka , Dembele Benoit , Coulibaly Siaka Yamoussa , Sanogo Dramane , Soumaoro Lamine , Coulibaly Michel Emmanuel , Doumbia Salif Seriba , Diallo Abdallah Amadou , Traore Sekou Fantamady , Colebunders Robert , Nutman Thomas B. , Klion Amy D.
Published: May 2018

Although Wuchereria bancrofti (Wb), the causative agent of lymphatic filariasis, is endemic throughout Mali, the prevalence of Wb microfilaremia (Mf) can vary widely between villages despite similar prevalence of infection as assessed by circulating antigen. To examine this variation, cross-sectional data obtained during screening prior to an interventional study in two neighboring villages in Mali were analyzed. The overall prevalence of Wb, as assessed by Wb CAg (circulating antigen), was 50.3% among 373 participants, aged 14-65. Wuchereria bancrofti Mf-positive and negative individuals appeared randomly distributed across the two villages (Moran’s I spatial statistic = -0.01, Z score =0.1, P>0.05). Among the 187 subjects positive for Wb CAg, 117 (62.5%) had detectable Mansonella perstans microfilaremia (Mp Mf) and 64 (34.2%) had detectable Wb microfilaremia. The prevalence of Mp microfilaremia was 73.4% in the Wb Mf-positive group (as compared to 56.9% in the Wb Mf-negative group; p=0.01), and median Wb Mf load was increased in co-infected subjects (267Mf/ml vs 100 Mf/ml; p<0.001). In multivariate analysis, village of residence, Mp Mf positivity and gender were significantly associated with Wb Mf positivity. After controlling for age, gender, and village of residence, the odds of being Wb Mf positive was 2.67 times higher in Mp positive individuals (95% confidence interval [1.42–5.01]). Given the geographical overlap between Mp and Wb in Africa, a better understanding of the distribution and prevalence of Mp could assist national lymphatic filariasis control programs in predicting areas of high Wb Mf prevalence that may require closer surveillance.
Increased Human Incidence of West Nile Virus Disease near Rice Fields in California but Not in Southern United States
Authors: Kovach Tony J. , Kilpatrick A. Marm
Published: May 2018

Anthropogenic land use change, including agriculture, can alter mosquito larval habitat quality, increase mosquito abundance, and increase incidence of vector-borne disease. Rice is a staple food crop for more than half of the world’s population, with ∼1% of global production occurring within the United States (US). Flooded rice fields provide enormous areas of larval habitat for mosquito species and may be hotspots for mosquito-borne pathogens, including West Nile virus (WNV). West Nile virus was introduced into the Americas in 1999 and causes yearly epidemics in the US with an average of approximately 1,400 neuroinvasive cases and 130 deaths per year. We examined correlations between rice cultivation and WNV disease incidence in rice-growing regions within the US. Incidence of WNV disease increased with the fraction of each county under rice cultivation in California but not in the southern US. We show that this is likely due to regional variation in the mosquitoes transmitting WNV. Culex tarsalis was an important vector of WNV in California, and its abundance increased with rice cultivation, whereas in rice-growing areas of the southern US, the dominant WNV vector was Culex quinquefasciatus, which rarely breeds in rice fields. These results illustrate how cultivation of particular crops can increase disease risk and how spatial variation in vector ecology can alter the relationship between land cover and disease.
Analogy and Exemplary Reasoning in Legal Discourse
Authors: Kaptein Hendrik , Velden Bastiaan
Published: May 2018

This book brings together contributions from leading figures in legal studies on analogy and related forms of reasoning in the law. Analogical reasoning-which relies on the concept of two different things being in some way like each other-is hugely important not just in the practice of law, but it is nonetheless strongly contested. This volume raises key questions like: What is the logical, argumentative, rhetorical, or just heuristic force of analogy in law? Is analogy really different from extensive interpretation, reasoning by precedent and appeal to paradigm?
ESTIMATING GROSS PRIMARY PRODUCTION IN CROPLAND WITH HIGH SPATIAL AND TEMPORAL SCALE REMOTE SENSING DATA
Authors: Lin S. , Li J. , Liu Q.
Published: May 2018

Abstract. Satellite remote sensing data provide spatially continuous and temporally repetitive observations of land surfaces, and they have become increasingly important for monitoring large region of vegetation photosynthetic dynamic. But remote sensing data have their limitation on spatial and temporal scale, for example, higher spatial resolution data as Landsat data have 30-m spatial resolution but 16 days revisit period, while high temporal scale data such as geostationary data have 30-minute imaging period, which has lower spatial resolution (> 1 km). The objective of this study is to investigate whether combining high spatial and temporal resolution remote sensing data can improve the gross primary production (GPP) estimation accuracy in cropland. For this analysis we used three years (from 2010 to 2012) Landsat based NDVI data, MOD13 vegetation index product and Geostationary Operational Environmental Satellite (GOES) geostationary data as input parameters to estimate GPP in a small region cropland of Nebraska, US. Then we validated the remote sensing based GPP with the in-situ measurement carbon flux data. Results showed that: 1) the overall correlation between GOES visible band and in-situ measurement photosynthesis active radiation (PAR) is about 50 % (R2 = 0.52) and the European Center for Medium-Range Weather Forecasts ERA-Interim reanalysis data can explain 64 % of PAR variance (R2 = 0.64); 2) estimating GPP with Landsat 30-m spatial resolution data and ERA daily meteorology data has the highest accuracy(R2 = 0.85, RMSE < 3 gC/m2/day), which has better performance than using MODIS 1-km NDVI/EVI product import; 3) using daily meteorology data as input for GPP estimation in high spatial resolution data would have higher relevance than 8-day and 16-day input. Generally speaking, using the high spatial resolution and high frequency satellite based remote sensing data can improve GPP estimation accuracy in cropland.
INTERSEISMIC DEFORMATION ACROSS THE EASTERN ALTYN TAGH FAULT FROM INSAR MEASUREMENTS
Authors: Liu C. J. , Zhao C. Y. , Ji L. Y. , Zhang Z. R. , Sun H.
Published: May 2018

Abstract. As a new type of earth observation technique, InSAR has a lot of advantages, such as all-weather, all-time, high precision, high density, wide coverage and low cost. It has been widely used in deformation monitoring. Taking the eastern segment of Altyn Tagh fault (ATF) as the object of the research, this paper discussed the application of multi-temporal InSAR technology in the field of interseismic deformation monitoring. We measured the interseismic deformation along the eastern section of ATF using three neighboring descending tracks SAR data from the ERS and Envisat missions. The results show that, first, the validation of InSAR results is better than 2.5 mm/yr, the calibration of InSAR results is about 1.06 mm/yr. Second, the fault slip rate in this segment is about 4–7 mm/yr, and is in the locked condition. Third, The InSAR velocity profile across the fault is the clear asymmetry with respect to ATF, it may be the combined effect of northern (NATF) and southern (SATF) branches of ATF.
THE RESEARCH ON DRYLAND CROP CLASSIFICATION BASED ON THE FUSION OF SENTINEL-1A SAR AND OPTICAL IMAGES
Authors: Liu F. , Chen T. , He J. , Wen Q. , Yu F. , Gu X. , Wang Z.
Published: May 2018

Abstract. In recent years, the quick upgrading and improvement of SAR sensors provide beneficial complements for the traditional optical remote sensing in the aspects of theory, technology and data. In this paper, Sentinel-1A SAR data and GF-1 optical data were selected for image fusion, and more emphases were put on the dryland crop classification under a complex crop planting structure, regarding corn and cotton as the research objects. Considering the differences among various data fusion methods, the principal component analysis (PCA), Gram-Schmidt (GS), Brovey and wavelet transform (WT) methods were compared with each other, and the GS and Brovey methods were proved to be more applicable in the study area. Then, the classification was conducted based on the object-oriented technique process. And for the GS, Brovey fusion images and GF-1 optical image, the nearest neighbour algorithm was adopted to realize the supervised classification with the same training samples. Based on the sample plots in the study area, the accuracy assessment was conducted subsequently. The values of overall accuracy and kappa coefficient of fusion images were all higher than those of GF-1 optical image, and GS method performed better than Brovey method. In particular, the overall accuracy of GS fusion image was 79.8 %, and the Kappa coefficient was 0.644. Thus, the results showed that GS and Brovey fusion images were superior to optical images for dryland crop classification. This study suggests that the fusion of SAR and optical images is reliable for dryland crop classification under a complex crop planting structure.
THE SPATIAL-TEMPORAL ANALYSIS OF ECOLOGICAL ENVIRONMENT OF RED BED HILLS IN EAST SICHUAN - TAKING LU COUNTY AS A CASE
Authors: Liu H. , Liu Y. , Wang X. , Liu J.
Published: May 2018

Abstract. Good ecological environment is the foundation of human existence and development, the development of society and economy must be based on the premise of maintaining the stability and balance of the ecological environment. RS and GIS technology are used in this paper while the red-bed hills of Sichuan Province-Lu County have been taken as an example. According to the ecological environment characteristics of the study areas and the principle of choosing evaluation index, this paper selected six evaluation indicators (elevation, slope, aspect, vegetation cover, land use, gully density) to establish evaluation index system of ecological environment of Lu County. This paper determine the weight of each evaluation index by AHP (Analytic Hierarchy Process) and establishes a comprehensive evaluation model by the weighted comprehensive evaluation method. This model is used to divide the ecological environment quality of Lu County into excellent, good, middle, poor and worse, and to analyze the ecological environment change in Lu County in recent ten years.
A REVIEW OF DIGITAL WATERMARKING AND COPYRIGHT CONTROL TECHNOLOGY FOR CULTURAL RELICS
Authors: Liu H. , Hou M. , Hu Y.
Published: May 2018

Abstract. With the rapid growth of the application and sharing of the 3-D model data in the protection of cultural relics, the problem of Shared security and copyright control of the three-dimensional model of cultural relics is becoming increasingly prominent. Followed by a digital watermarking copyright control has become the frontier technology of 3-D model security protection of cultural relics and effective means, related technology research and application in recent years also got further development. 3-D model based on cultural relics digital watermarking and copyright control technology, introduces the research background and demand, its unique characteristics were described, and its development and application of the algorithm are discussed, and the prospects of the future development trend and some problems and the solution.
EXTRACTING 3-D DEFORMATION FIELDS FROM LEFT- AND RIGHT-LOOKING INSAR WITH SM-VCE METHOD: A CASE STUDY OF OCTOBER 21, 2016 CENTRAL TOTTORI EARTHQUAKE
Authors: Liu J. H. , Hu J. , Li Z. W.
Published: May 2018

Abstract. Three-dimensional (3-D) deformation fields with respect to the October 2016’s Central Tottori earthquake are extracted in this paper from ALOS-2 conducted Interferometric Synthetic Aperture Radar (InSAR) observations with four different incline angles, i.e., ascending/descending and left-/right-looking. In particular, the Strain Model and Variance Component Estimation (SM-VCE) method is developed to integrate the heterogeneous InSAR observations without being affected by the coverage inconformity of SAR images associated with the earthquake focal area. Compare with classical weighted least squares (WLS) method, SM-VCE method is capable for the retrieval of more accurate and complete deformation field of Central Tottori earthquake, as indicated by the comparison with the GNSS observations. In addition, accuracies of heterogeneous InSAR observations and 3-D deformations on each point are quantitatively provided by the SM-VCE method.
THIN CLOUD DETECTION METHOD BY LINEAR COMBINATION MODEL OF CLOUD IMAGE
Authors: Liu L. , Li J. , Wang Y. , Xiao Y. , Zhang W. , Zhang S.
Published: May 2018

Abstract. The existing cloud detection methods in photogrammetry often extract the image features from remote sensing images directly, and then use them to classify images into cloud or other things. But when the cloud is thin and small, these methods will be inaccurate. In this paper, a linear combination model of cloud images is proposed, by using this model, the underlying surface information of remote sensing images can be removed. So the cloud detection result can become more accurate. Firstly, the automatic cloud detection program in this paper uses the linear combination model to split the cloud information and surface information in the transparent cloud images, then uses different image features to recognize the cloud parts. In consideration of the computational efficiency, AdaBoost Classifier was introduced to combine the different features to establish a cloud classifier. AdaBoost Classifier can select the most effective features from many normal features, so the calculation time is largely reduced. Finally, we selected a cloud detection method based on tree structure and a multiple feature detection method using SVM classifier to compare with the proposed method, the experimental data shows that the proposed cloud detection program in this paper has high accuracy and fast calculation speed.