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Ondrejicka, Vladimir, Michal Hajduk, Lubomir Jamecny, Milan Husar, and Matej Jasso. "Positive Energy District Replication - Case Study of the City of Trencin, Slovakia." IOP Conference Series: Materials Science and Engineering 1203, no. 2 (2021): 022087. http://dx.doi.org/10.1088/1757-899x/1203/2/022087.
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Abstract Energy efficiency has been of the key topics for urban planning for the past few years in relation to sustainable development, resilience as well as climate change. There are many technological approaches aiming at efficient use of energy, innovative technologies and renewable sources of energy, but what is often missing is its relation to spatial planning and planning system and documentation. Horizon 2020 project Making City is striving to promote Positive Energy District (PED) planning and methodology aiming at development of new integrated strategies to address the urban energy system transformation towards low carbon cities, with the PED approach as the core of the urban energy transition pathway. It is implemented on the level of cities and city districts, having two types of areas – two lighthouse cities and six follower cities. The city of Trencin (Slovakia) is one of the follower cities where multiple urban areas have been selected to replicate the PED concept developed by the project consortium. Trencin is the eight largest city is Slovakia with a rich manufacturing history in textile and arms industry. It is currently focusing on diversified its economic activities in the sectors of tourism, innovation, culture and industry. The PED replication will involve a broader city centre area including multiple municipal buildings (schools and sports infrastructures) and residential buildings (individual housing and apartments). The following paper describes the key notions from the PED concept providing a holistic approach on harmonizing energy and urban planning for energy. It evolved from single, unintegrated, simple “building” based interventions into PED concepts looking forward to reaching energy and climate targets which will lead to an integrated energy planning. The paper further explores this PED approach in the city of Trencin, including the challenges it had to overcome during the implementation, as well as perspectives for its future development. The aim of the project further on is to create a standardized concept ready to be the core of specific urban energy transitions planning processes.
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Gomes, Ana, Cristina Saraiva, Alexandra Esteves, and Carla Gonçalves. "Evaluation of Hospital Food Waste—A Case Study in Portugal." Sustainability 12, no. 15 (2020): 6157. http://dx.doi.org/10.3390/su12156157.
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Food waste (FW) has been linked with nutrient intake, menu performance, food acceptability, costs and environmental impacts. This study aims to evaluate the FW in the wards of a Portuguese public hospital. The evaluation of the FW of lunch meals was performed during 21 days, to all new hospitalized patients (n = 105) admitted in four hospital wards (Medicine (Med), Paediatrics (Ped), Oncology (Onc) and Orthopaedics (Ort)). For each patient, the type of diet and FW were evaluated during the length of hospital stay (covering 321 meals). The FW of the dish was calculated by the physical method by weighing and the soup by the method of visual estimation, evaluating before and after distribution. The patients have a mean 3.1 ± 2.2 day length of hospital stay. In relation to the FW of the dish per ward, that in the Ped ward it was 72.6%, Med 47.5%, Onc 46.9% and Ort 58.4% (ρ = 0.027). The FW for Ped soup was 67.1%, Med 30.9%, Onc 29.4% and Ort 35.2% (ρ = 0.018). The FW values are high, especially in the paediatric ward. The institutions are unaware of the FW produced and given the magnitude of the problem it is necessary to implement effective measures.
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Doan, Quynh, Emerson D. Genuis, and Alvis Yu. "Trends in use in a Canadian pediatric emergency department." CJEM 16, no. 05 (2014): 405–10. http://dx.doi.org/10.2310/8000.2013.131280.
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ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.
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Razak, Adni Abdul, I. Made Alit Gunawan, and R. Dwi Budiningsari. "Pola asuh ibu sebagai faktor risiko kejadian kurang energi protein (KEP) pada anak balita." Jurnal Gizi Klinik Indonesia 6, no. 2 (2009): 95. http://dx.doi.org/10.22146/ijcn.17717.
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Background: Protein energy deficiency (PED) is one of nutrition disorders which happen to children under-five years. According to data of nutritional status examination result 2005 and 2006, the prevalence of PED at the Province of Sulawesi Tengah was 30.61% and 30.84%, whereas at District of Morowali was 11% and 11.6%. Lots of factors cause malnutrition among children under five, among others is imbalanced nutrient intake, infection, and rearing pattern of mothers comprising care and food supply.Objective: To identify rearing pattern of mothers as risk factor for the prevalence of PED in children under five. Method: This was an observational study with case control study design. Population and samples of the study were children under five suffering from PED as indicated from anthropometric standard weight for age according to standard of WHO National Child Health Standard (NCHS), i.e. < -2 elementary school to ≥ -3 elementary school. The controls were children under five who did not suffer from PED. Respondents consisted of mothers of children who had PED and did not have PED that fulfilled inclusion and exclusion criteria. The variables observed were rearing pattern, infection as confounding variable and nutritional status. Nutritional status of children with PED and without PED was processed using index of weight for age against standard of WHO-NCHS. Chi-square and odds ratio were used to identify rearing pattern as risk factor for PED.Results: The result of the study showed that there were 23 mothers (57.5%) practicing poor rearing pattern in children with PED and there were 35 mothers (87.5%) practicing good rearing pattern in children without PED. The result of statistical test showed p < 0.05, i.e. p = 0.001, so there was significant difference in rearing pattern of mothers which consisted of knowledge, attitude and practice in the care and food supply of children under five.Conclusion: Poor rearing pattern of mothers brought greater risk for children with PED than good rearing pattern in the care and food supply of children under-five.
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Rueda Castellanos, Sofia, and Xabat Oregi. "Positive Energy District (PED) Selected Projects Assessment, Study towards the Development of Further PEDs." Environmental and Climate Technologies 25, no. 1 (2021): 281–94. http://dx.doi.org/10.2478/rtuect-2021-0020.
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Abstract Positive Energy District (PED) is a relatively new concept from which many projects are planned, however, only a few cases are currently close to be materialized, therefore, in this study the PED projects in operation and in implementation process in existing districts are gathered in order to serve as a base for future PEDs. In this sense, certain points of each selected project are highlighted due to their relevance within the project development and their replicability potential. Furthermore, intending to learn from the experience of the assessed case-studies, this paper aims to understand the current situation regarding PED implementation to simplify the development of further PEDs.
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Trivelato, Felipe Padovani, Eduardo Wajnberg, Marco Túlio Salles Rezende, et al. "Safety and Effectiveness of the Pipeline Flex Embolization Device With Shield Technology for the Treatment of Intracranial Aneurysms: Midterm Results From a Multicenter Study." Neurosurgery 87, no. 1 (2019): 104–11. http://dx.doi.org/10.1093/neuros/nyz356.
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Abstract BACKGROUND The safety and efficacy of the first generation of the Pipeline Embolization Device (PED; Medtronic Inc) have been proven in large case series. Ischemic events are one of the most common complications following treatment of aneurysms with flow diverters. The new PED Flex with Shield technology (PED Shield; Medtronic Inc) was introduced to minimize the rate of complications. OBJECTIVE To evaluate the outcomes of patients harboring aneurysms treated with the PED Shield. METHODS This was an observational, prospective, single-arm multicenter study of patients treated with the PED Shield. The primary safety endpoint was the absence of major neurological complications and death. The secondary effectiveness endpoint was angiographic occlusion at 6 and 12 mo. Technical complications were also reported. RESULTS Between November 2017 and December 2018, 151 patients from 7 centers with 182 aneurysms were enrolled. The mean aneurysm size was 7.0 mm; 27 (14.8%) aneurysms were large, and 7 (3.8%) were giant. In 141 of 151 patients (93.4%), the primary endpoint was reached. The overall rate of periprocedural complications was 7.3%. Of the aneurysms, 79.7% met the study's secondary endpoint of complete occlusion at 6 mo and 85.3% at 12 mo. CONCLUSION The PED Shield is a safe and effective treatment for intracranial aneurysms. The results regarding total occlusion and ischemic complications did not differ from those obtained in case series using previous versions of the PED. Long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.
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Chabuk, Mohammed Ihsan, Ahmed Mahdi Sharba, and Ali Razzaq Alisalih Alsafar. "Association of Periodontal Disease with Serum Uric Acid and CRP in Patients Treated for Acute Coronary Syndrome: A Comparative Study." NeuroQuantology 19, no. 8 (2021): 07–12. http://dx.doi.org/10.14704/nq.2021.19.8.nq21106.
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Background: Periodontal diseases (PED) are a widespread, complicated, long-lasting inflammation of the gum. In recent years, lots of lines of evidence have confirmed the existence of an interrelated link between PED and systemic illnesses including acute coronary syndrome (ACS). In the pathogenesis of ACS, the persuasive inflammatory role of coronary vessels is well documented. An increasing body of evidence highlights the impact of UA in inflammation. C-reactive protein (CRP) is an acute phase reactant well-known as a nonspecific marker for systemic and vascular inflammation. The study intended to evaluate the associations of PED with SUA and CRP in patients treated for ACS in a comparative study. Methodology: 136-patients registered in this comparative study labeled as ACS besides 74-controls. The blood analysis of creatinine, urea, SUA and CRP had done for the applicants. Oral examination for grades and severity of PED had performed, and the candidates were grouped accordingly. Statistical studies had attained using SPSS software (IBM), with a significance-value calculated at <0.05. Results: There was a significantly higher HSCRP levels with a higher nonsignificant SUA levels among the ACS group. Risk factors in terms of incidence of DM, hypertension, and smoking (except the BMI) were significantly higher among patients. More than 3/4th of the patients' group was suffering from generalized PED (74.3%), while 15.4% had a localized PED and only 9% had healthy periodontium. Meanwhile, about 2/3rd of the controls has normal periodontium. 18.4% vs. 75% had a mild, 25.7% vs. 4% had a moderate, and 21.3% vs. zero had a severe form of PED, in patients and control respectively. There was a significant worsening of PED in terms of severity and grading (p-0.001) with the increase of HSCRP levels, which is not the case for increased SUA. Conclusion: HSCRP levels were significantly higher among patients with ACS compared to healthy control. There was a significant worsening of PED in terms of severity and grading with the increase of HSCRP levels. This is not the case for increased SUA, which is not associated with poor periodontal status.
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Sakamoto, Hugo, Flávia Ronquim, Marcelo Seckler, and Luiz Kulay. "Environmental Performance of Effluent Conditioning Systems for Reuse in Oil Refining Plants: A Case Study in Brazil." Energies 12, no. 2 (2019): 326. http://dx.doi.org/10.3390/en12020326.
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This study aims to evaluate the environmental and energy effects of the reuse of 1.0 m³ of water in a cooling tower obtained from an oil refinery effluent. An arrangement comprising reverse osmosis (RO), evaporation (EV), and crystallization (CR) was created for water desalination. Six process routes were evaluated; for this purpose, each of them was converted into an specific scenario of analysis: S1: pre-treatment with Ethylenediaminetetraacetic acid (EDTA) + RO + EV (multi-effect distillation) + CR; S2: S1 with pre-treatment by BaSO4; S3: with Ca(OH)2/CaCO3/HCl; S4: S3 with waste heat to supply the thermal demand of EV; S5: S3 with steam recompression in EV; and, S6: S3 with HNO3 in place of HCl. The analysis was carried out by attributional LCA for primary energy demand (PED) and global warming (GW) impacts. The comparison was carried out for a reference flow (RF) of: add 1.0 m3 of reused water to a cooling tower with quality to proper functioning of this equipment. S4 presented the best performance among the analyzed possibilities (PED: 11.9 MJ/RF; and GW: 720 gCO2,eq/RF). However, dependence on other refinery sectors makes it inadvisable as a regular treatment option. Thus, S5 appears as the lowest impact scenario in the series (PED: 17.2 MJ/RF; and GW: 1.24 kgCO2,eq/RF), given the pre-treatment technique of RO-fed effluent, and the exclusive use of steam recompression to meet total EV energy demands. Finally, an intrinsic correlation was identified between RO water recovery efficiency and the accumulated PED and GW impacts on the arrangements that operate with heat and electricity.
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Nejat, Farideh, Syed Shuja Kazmi, Zohreh Habibi, Parvin Tajik, and Zahra Shahrivar. "Intelligence quotient in children with meningomyeloceles: a case–control study." Journal of Neurosurgery: Pediatrics 106, no. 2 (2007): 106–10. http://dx.doi.org/10.3171/ped.2007.106.2.106.
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Ondriová, Iveta, Terézia Fertaľová, and Lívia Hadašová. "Case study used communication methods in children suffering from autism." Pediatrie pro praxi 21, no. 6 (2021): 429–31. http://dx.doi.org/10.36290/ped.2020.090.
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Lin, Ning, Adam M. Brouillard, Chandan Krishna, et al. "Use of Coils in Conjunction With the Pipeline Embolization Device for Treatment of Intracranial Aneurysms." Neurosurgery 76, no. 2 (2014): 142–49. http://dx.doi.org/10.1227/neu.0000000000000579.
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ABSTRACT BACKGROUND: Coiling in conjunction with Pipeline embolization device (PED) placement could provide immediate dome protection and an intraaneurysmal scaffold to prevent device prolapse for intracranial aneurysms with high rupture risk and complex anatomy. OBJECTIVE: To report results after treatment of aneurysms with PED with coils (PED+coils group) or without (PED-only group) at a single-institution. METHODS: In this case-controlled study, records of patients who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. RESULTS: Twenty-nine patients were treated with PED+coils and 75 with PED-only. No statistically significant between-group differences were found in terms of age, sex, aneurysm location, medical comorbidities, and length of follow-up. Aneurysms treated by PED+coils were larger (16.3 mm vs 12.4 mm, P = .02) and more likely to be ruptured (20.7% vs 1.3%, P = .001) or dissecting (34.5% vs 9.3%, P = .002). PED deployment was successful in all cases. At the latest follow-up (mean, 7.8 months), complete aneurysm occlusion was achieved in a higher proportion of the PED+coils group (93.1% vs 74.7%, P = .03). Device foreshortening/migration occurred in 4 patients in the PED-only group and none in the PED+coils group. Fewer patients required retreatment in the PED+coils group (3.4% vs 16.0%, P = .71). Rates of neurological complications (10.3% PED+coils vs 8.0% PED-only, P = .7) and favorable outcome (modified Rankin Scale score = 0-2; 93.1% PED+coils vs 94.7% PED-only, P = .6) were similar. CONCLUSION: PED+coils may be a safe and effective treatment for aneurysms with high risk of rupture (or rerupture) and complex anatomy. Coiling in conjunction with PED placement provided a higher aneurysm occlusion rate and reduced the need for retreatment.
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Schiro, Jessica, Sylvia Pelayo, Alain Martinot, François Dubos, Marie-Catherine Beuscart-Zéphir, and Romaric Marcilly. "Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations." JMIR Human Factors 7, no. 3 (2020): e18427. http://dx.doi.org/10.2196/18427.
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Background Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients’ waiting time. However, electronic patient triage systems are not developed so that they comply with clinicians’ workflow. Objective This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED), relying on a human-centered design process. Methods We followed a human-centered design process, wherein we (1) performed a work system analysis through observations and interviews in an academic hospital’s PED; (2) deduced design specifications; (3) designed a mock PPT and the related PPA; and (4) performed user testing to assess the intuitiveness of the icons, the effectiveness in communicating patient priority, the fit between the prioritization model implemented and the participants’ prioritization rules, and the participants’ satisfaction. Results The workflow analysis identified that the PPT interface should meet the needs of physicians and nurses, represent the stages of patient care, and contain patient information such as waiting time, test status (eg, prescribed, in progress), age, and a suggestion for prioritization. The mock-up developed gives the status of patients progressing through the PED; a strip represents the patient and the patient’s characteristics, including a delay indicator that compares the patient’s waiting time to the average waiting time of patients with a comparable reason for emergency. User tests revealed issues with icon intuitiveness, information gaps, and possible refinements in the prioritization algorithm. Conclusions The results of the user tests have led to modifications to improve the usability and usefulness of the PPT and its PPA. We discuss the value of integrating human factors into the design process for a PPT for PED. The PPT/PPA has been developed and installed in Lille University Hospital's PED. Studies are carried out to evaluate the use and impact of this tool on clinicians’ situation awareness and prioritization-related cognitive load, prioritization of patients, waiting time, and patients’ experience.
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Malhotra, Ajay, Xiao Wu, Waleed Brinjikji, et al. "Pipeline Endovascular Device vs Stent-Assisted Coiling in Small Unruptured Aneurysms: A Cost-Effectiveness Analysis." Neurosurgery 85, no. 6 (2019): E1010—E1019. http://dx.doi.org/10.1093/neuros/nyz130.
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AbstractBACKGROUNDBoth stent-assisted coiling (SAC) and flow diversion with the Pipeline Embolization device (PED; Medtronic Inc) have been shown to be safe and clinically effective for treatment of small (<10 mm) unruptured aneurysms. However, the economic impact of these different techniques has not been established.OBJECTIVETo analyze the cost-effectiveness between stent-assisted coiling and flow diversion using PED, including procedural costs, long-term outcomes, and aneurysm recurrence.METHODSA decision-analytical study was performed with Markov modeling methods to simulate patients undergoing SAC or PED for treatment for unruptured aneurysms of sizes 5 and 7 mm. Input probabilities were derived from prior literature, and 1-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed.RESULTSIn base case calculation and PSA, PED was the dominant strategy for both the size groups, with and without consideration of indirect costs. One-way sensitivity analyses show that the conclusion remained robust when varying the retreatment rate of SAC from 0% to 50%, and only changes when the retreatment rate of PED > 49%. PED remained the more cost-effective strategy when the morbidity and mortality of PED increased by <55% and when those of SAC decreased by <37%. SAC only became cost-effective when the total cost of PED is >$73000 more expensive than the total cost of SAC.CONCLUSIONWith increasing use of PED for treatment of small unruptured anterior circulation aneurysms, our study indicates that PED is cost-effective relative to stent coiling irrespective of aneurysm size. This is due to lower aneurysm recurrence rate, as well as better health outcomes.
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Xiang, Jianping, Robert J. Damiano, Ning Lin, et al. "High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex intracranial aneurysms." Journal of Neurosurgery 123, no. 4 (2015): 832–40. http://dx.doi.org/10.3171/2014.11.jns14497.
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OBJECT Flow diversion via Pipeline Embolization Device (PED) represents the most recent advancement in endovascular therapy of intracranial aneurysms. This exploratory study aims at a proof of concept for an advanced device-modeling tool in conjunction with computational fluid dynamics (CFD) to evaluate flow modification effects by PED in actual, treated cases. METHODS The authors performed computational modeling of 3 PED-treated complex aneurysm cases. The patient in Case 1 had a fusiform vertebral aneurysm treated with a single PED. In Case 2 the patient had a giant internal carotid artery (ICA) aneurysm treated with 2 PEDs. Case 3 consisted of tandem ICA aneurysms (III-a and III-b) treated by a single PED. The authors’ recently developed high-fidelity virtual stenting (HiFiVS) technique was used to recapitulate the clinical deployment process of PEDs in silico for these 3 cases. Pretreatment and posttreatment aneurysmal hemodynamics studies performed using CFD simulation were analyzed. Changes in aneurysmal flow velocity, inflow rate, wall shear stress (WSS), and turnover time were calculated and compared with the clinical outcome. RESULTS In Case 1 (occluded within the first 3 months), the aneurysm had the most drastic flow reduction after PED placement; the aneurysmal average velocity, inflow rate, and average WSS were decreased by 76.3%, 82.5%, and 74.0%, respectively, whereas the turnover time was increased to 572.1% of its pretreatment value. In Case 2 (occluded at 6 months), aneurysmal average velocity, inflow rate, and average WSS were decreased by 39.4%, 38.6%, and 59.1%, respectively, and turnover time increased to 163.0%. In Case 3, Aneurysm III-a (occluded at 6 months) had a decrease by 38.0%, 28.4%, and 50.9% in average velocity, inflow rate, and average WSS, respectively, and turnover time increased to 139.6%, which was quite similar to Aneurysm II. Surprisingly, the adjacent Aneurysm III-b had more substantial flow reduction (a decrease by 77.7%, 53.0%, and 84.4% in average velocity, inflow rate, and average WSS, respectively, and an increase to 213.0% in turnover time) than Aneurysm III-a, which qualitatively agreed with angiographic observation at 3-month follow-up. However, Aneurysm III-b remained patent at both 6 months and 9 months. A closer examination of the vascular anatomy in Case 3 revealed blood draining to the ophthalmic artery off Aneurysm III-b, which may have prevented its complete thrombosis. CONCLUSIONS This proof-of-concept study demonstrates that HiFiVS modeling of flow diverter deployment enables detailed characterization of hemodynamic alteration by PED placement. Posttreatment aneurysmal flow reduction may be correlated with aneurysm occlusion outcome. However, predicting aneurysm treatment outcome by flow diverters also requires consideration of other factors, including vascular anatomy.
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Baer, Daniela, Bradley Loewen, Caroline Cheng, et al. "Approaches to Social Innovation in Positive Energy Districts (PEDs)—A Comparison of Norwegian Projects." Sustainability 13, no. 13 (2021): 7362. http://dx.doi.org/10.3390/su13137362.
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The Positive Energy District (PED) concept is a localized city and district level response to the challenges of greenhouse gas emission reduction and energy transition. With the Strategic Energy Transition (SET) Plan aiming to establish 100 PEDs by 2025 in Europe, a number of PED projects are emerging in the EU member states. While the energy transition is mainly focusing on technical innovations, social innovation is crucial to guarantee the uptake and deployment of PEDs in the built environment. We set the spotlight on Norway, which, to date, has three PED projects encompassing 12 PED demo sites in planning and early implementation stages, from which we extract approaches for social innovations and discuss how these learnings can contribute to further PED planning and implementation. We describe the respective approaches and learnings for social innovation of the three PED projects, ZEN, +CityxChange and syn.ikia, in a multiple case study approach. Through the comparison of these projects, we start to identify social innovation approaches with different scopes regarding citizen involvement, stakeholder interaction and capacity building. These insights are also expected to contribute to further planning and design of PED projects within local and regional networks (PEDs in Nordic countries) and contribute to international PED concept development.
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Watanabe, Yoshitaka, Yoshifusa Abe, Katsufumi Otsuki, and Katsumi Mizuno. "Case study: Nonsexual transmission of Neisseria gonorrhea in a prepubescent female patient." Pediatrics International 63, no. 4 (2021): 477–78. http://dx.doi.org/10.1111/ped.14438.
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Tanrıverdi, Mehmet Halis, Yılmaz Palancı, Ahmet Yılmaz, Necmettin Penbegül, Yasin Bez, and Mansur Dağgülli. "Effects of enuresis nocturna on parents of affected children: Case-control study." Pediatrics International 56, no. 2 (2014): 254–57. http://dx.doi.org/10.1111/ped.12242.
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Okuyama, Hiroomi, Satoko Ohfuji, Masahiro Hayakawa, et al. "Risk factors for surgical intestinal disorders in VLBW infants: Case-control study." Pediatrics International 58, no. 1 (2015): 34–39. http://dx.doi.org/10.1111/ped.12815.
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Malhotra, Ajay, Xiao Wu, Timothy Miller, Charles C. Matouk, Pina Sanelli, and Dheeraj Gandhi. "Comparative effectiveness analysis of Pipeline device versus coiling in unruptured aneurysms smaller than 10 mm." Journal of Neurosurgery 132, no. 1 (2020): 42–50. http://dx.doi.org/10.3171/2018.8.jns181080.
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OBJECTIVEBoth endovascular coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for treatment of small (< 10 mm) aneurysms. The authors conducted a comparative effectiveness analysis to compare the utility of these treatment methods in terms of health benefits.METHODSA decision-analytical study was performed with Markov modeling methods to simulate patients with small unruptured aneurysms undergoing endovascular coiling, stent-assisted coiling (SAC), or PED placement for treatment. Input probabilities were derived from prior literature, and 1-way, 2-way, and probabilistic sensitivity analyses were performed to assess model and input parameter uncertainty.RESULTSThe base case calculation for a 50-year-old man reveals PED to have a higher health benefit (17.48 quality-adjusted life years [QALYs]) than coiling (17.44 QALYs) or SAC (17.36 QALYs). PED is the better option in 6020 of the 10,000 iterations in probabilistic sensitivity analysis. When the retreatment rate of PED is lower than 9.53%, and the coiling retreatment is higher than 15.6%, PED is the better strategy. In the 2-way sensitivity analysis varying the retreatment rates from both treatment modalities, when the retreatment rate of PED is approximately 14% lower than the retreatment rate of coiling, PED is the more favorable treatment strategy. Otherwise, coiling is more effective. SAC may be better than PED when the unfavorable outcome risk of SAC is lower than 70% of its reported current value.CONCLUSIONSWith the increasing use of PEDs for treatment of small unruptured aneurysms, the current study indicates that these devices may have higher health benefits due to lower rates of retreatment compared to both simple coiling and stent-assisted techniques. Longer follow-up studies are needed to document the rates of recurrence and retreatment after coiling and PED to assess the cost-effectiveness of these strategies.
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Kilic, Mehmet, Sema Ecin, Erdal Taskin, Askin Sen, and Murat Kara. "The Vitamin D Receptor Gene Polymorphisms in Asthmatic Children: A Case-Control Study." Pediatric Allergy, Immunology, and Pulmonology 32, no. 2 (2019): 63–69. http://dx.doi.org/10.1089/ped.2018.0948.
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Rankinen, Juha-Antti, Sara Lakkala, Harri Haapasalo, and Sari Hirvonen-Kantola. "Stakeholder management in PED projects: challenges and management model." International Journal of Sustainable Energy Planning and Management 34 (May 25, 2022): 91–106. http://dx.doi.org/10.54337/ijsepm.6979.
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The importance of stakeholder analysis and stakeholder management is magnified as project complexity increases. Complex projects can be characterized by uncertainties arising from emerging technologies and the involvement of various types of stakeholders and their interests. Positive Energy District (PED) projects are an example of such undertaking, coupling novel energy solutions with distinct stakeholders and their diverse positions, claims, and requirements pertaining to the project. In this study, our objective is to provide a stakeholder management framework for future PED projects. The qualitative case study follows the theory elaboration methodology and aims to formulate a conceptual stakeholder management framework for PED projects. Thus, our contribution focuses on expanding the domain of project stakeholder management by characterizing and validating it in a new, time-relevant project context.
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Zschocke, Juergen, Carolina Alonzo, Ding Ding, et al. "PP131 Health Technology Assessment Agencies’ Expectations Regarding Patient Experience Data in Europe." International Journal of Technology Assessment in Health Care 39, S1 (2023): S87. http://dx.doi.org/10.1017/s026646232300243x.
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IntroductionHealth technology assessment (HTA) agencies are increasingly embracing patient experience data (PED) to support reimbursement decisions. This study aimed to describe the European Network for HTA (EUnetHTA) and HTA agencies expectations regarding PED to support reimbursement in France, Germany, Italy, Spain and the UK.MethodsPublished HTA guidance documents were reviewed to identify recommendations related to clinical outcomes assessment (COA) (including disease-specificity, validation, analyses, endpoints and interpretation) and other forms of PED (e.g., patient preference information) in HTA decision-making. Insights from guidance documents were supplemented with a review of literature and published HTA cases and interviews with key opinion leaders (KOLs) focused on current and future states.ResultsThe German and French guidance documents include PED recommendations focused on relevant COA and health-related quality of life data, without detailing preferred COA measures. However, key differences were noted between these two countries in the methodological approaches regarding responder definitions, acceptable missing data threshold and multiplicity analyses. These differences were reinforced by the case studies and the KOLs. UK’s sources also focused on COA, in general proposing specific use of the EQ-5D to derive utility values for modelling, but included limited details on other PED-related elements. The Italian and Spanish guidance documents do not detail COA or other PED expectations, but the Italian KOL described that COA is considered if submitted. The currently developed EUnetHTA21 guidelines include PED-related information that bear the signature of certain individual HTA bodies. Globally, there is limited interest in PED beyond COA across the agencies.ConclusionsThe level of expectations with regards to PED varies across EUnetHTA and several European HTA agencies. Interest in PED derived from non-COA sources is limited across the countries. Knowing each agency’s expectations with regards to PED is key when submitting HTA evidence dossiers and should be considered early in clinical trial design to integrate market access perspectives and optimize drug development. Global harmonization would help advancing PED measurement standards.
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Ruzzini, Laura, Sergio De Salvatore, Daniela Lamberti, et al. "COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department." International Journal of Environmental Research and Public Health 18, no. 12 (2021): 6573. http://dx.doi.org/10.3390/ijerph18126573.
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The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March–4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries’ protocols, could be helpful to solve problems in case of worldwide emergency situations.
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Aoki, Kuraaki, and Kazuhiro Akaba. "Characteristics of nonoliguric hyperkalemia in preterm infants: A case‐control study in a single center." Pediatrics International 62, no. 5 (2020): 576–80. http://dx.doi.org/10.1111/ped.14115.
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Fukazawa, Mitsuharu, Mitsuru Fukazawa, Etsuro Nanishi, Hisanori Nishio, Kiyoshi Ichihara, and Shouichi Ohga. "Previous antibiotic use and the development of Kawasaki disease: a matched pair case‐control study." Pediatrics International 62, no. 9 (2020): 1044–48. http://dx.doi.org/10.1111/ped.14255.
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Wali, Arvin R., Charlie C. Park, David R. Santiago-Dieppa, Florin Vaida, James D. Murphy, and Alexander A. Khalessi. "Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis." Neurosurgical Focus 42, no. 6 (2017): E6. http://dx.doi.org/10.3171/2017.3.focus1749.
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OBJECTIVERupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms.METHODSA Markov model was constructed to simulate a 60-year-old woman with a large or giant intracranial aneurysm considering a PED, endovascular coiling, or no treatment in terms of neurological outcome, angiographic outcome, retreatment rates, procedural and rehabilitation costs, and rupture rates. Transition probabilities were derived from prior literature reporting outcomes and costs of PED, coiling, and no treatment for the management of aneurysms. Cost-effectiveness was defined, with the incremental cost-effectiveness ratios (ICERs) defined as difference in costs divided by the difference in quality-adjusted life years (QALYs). The ICERs < $50,000/QALY gained were considered cost-effective. To study parameter uncertainty, 1-way, 2-way, and probabilistic sensitivity analyses were performed.RESULTSThe base-case model demonstrated lifetime QALYs of 12.72 for patients in the PED cohort, 12.89 for the endovascular coiling cohort, and 9.7 for patients in the no-treatment cohort. Lifetime rehabilitation and treatment costs were $59,837.52 for PED; $79,025.42 for endovascular coiling; and $193,531.29 in the no-treatment cohort. Patients who did not undergo elective treatment were subject to increased rates of aneurysm rupture and high treatment and rehabilitation costs. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about the costs and mortality risks for PED and coiling. Probabilistic sampling demonstrated that PED was the cost-effective strategy in 58.4% of iterations, coiling was the cost-effective strategy in 41.4% of iterations, and the no-treatment option was the cost-effective strategy in only 0.2% of iterations.CONCLUSIONSThe authors’ cost-effective model demonstrated that elective endovascular techniques such as PED and endovascular coiling are cost-effective strategies for improving health outcomes and lifetime quality of life measures in patients with large or giant unruptured intracranial aneurysm.
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Wallace, Adam N., Jonathan A. Grossberg, Josser E. Delgado Almandoz, et al. "Endovascular Treatment of Posterior Cerebral Artery Aneurysms With Flow Diversion: Case Series and Systematic Review." Neurosurgery 83, no. 4 (2018): 790–99. http://dx.doi.org/10.1093/neuros/nyx561.
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Abstract BACKGROUND Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. OBJECTIVE To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. METHODS Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared. RESULTS Ten PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. Complete aneurysm occlusion with parent vessel preservation was achieved in 75% (6/8) of cases at mean follow-up of 16.7 mo. Eleven of 12 (92%) major branch vessels covered by a PED remained patent. Including the present study, systematic review of 15 studies found a complete aneurysm occlusion rate of 88% (30/34) and complication rate of 26% (10/38), including 5 symptomatic ischemic strokes (13%; 5/38). Fusiform aneurysms more frequently completely occluded compared with saccular aneurysms (100% vs 70%; P = .03) but were associated with a higher complication rate (43% vs 9%; P = .06). CONCLUSION The safety and effectiveness profile of flow diverter treatment of PCA aneurysms may be acceptable in select cases.
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Nakamura, Jun-ichiro. "Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5." May 2017 4, no. 20;4 (2017): E507—E512. http://dx.doi.org/10.36076/ppj.2017.e512.
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Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve
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Bender, Matthew T., Robert W. Young, David A. Zarrin, et al. "Twisting: Incidence and Risk Factors of an Intraprocedural Challenge Associated With Pipeline Flow Diversion of Cerebral Aneurysms." Neurosurgery 88, no. 1 (2020): 25–35. http://dx.doi.org/10.1093/neuros/nyaa309.
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Abstract BACKGROUND Pipeline Embolization Device (PED; Medtronic) “twisting” manifests with the appearance of a “figure 8” in perpendicular planes on digital subtraction angiography. This phenomenon has received little attention in the literature, requires technical precision to remediate, and has potential to cause ischemic stroke if not properly remediated. OBJECTIVE To report incidence, risk factors, and sequelae of PED twisting and to discuss techniques to remediate a PED twist. METHODS Case images were reviewed for instances of twisting from a prospectively-maintained, Institutional Review Board-approved cohort of patients undergoing flow diversion for cerebral aneurysm. RESULTS From August 2011 to December 2017, 999 PED flow diverting stents were attempted in 782 cases for 653 patients. A total of 25 PED twists were observed while treating 20 patients (2.50%, 25/999). Multivariate analysis revealed predictors of twisting to be: Large and giant aneurysms (odds ratio (OR) = 9.66, P = .005; OR = 27.47, P &lt; .001), increased PED length (OR = 1.14, P &lt; .001), and advanced patient age (OR = 1.07, P = .002). Twisted PEDs were able to be remediated 75% of the time, and procedural success was achieved in 90% of cases. PED twisting was not found to be a significant cause of major or minor complications. However, at long-term follow-up, there was a trend towards poor occlusion outcomes for the cases that encountered twisting. CONCLUSION Twisting is a rare event during PED deployment that was more likely to occur while treating large aneurysms with long devices in older patients. While twisting did not lead to major complications in this study, remediation can be challenging and may be associated with inferior occlusion outcomes.
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Evans, Alexander R., Jack E. Stanfield, Abigail York, Shyian Jen, and Hakeem J. Shakir. "Emergent salvage of the vertebral artery with flow diverter pipeline stent following vessel laceration: Systematic literature review and illustrative case example." Surgical Neurology International 15 (November 29, 2024): 448. http://dx.doi.org/10.25259/sni_773_2024.
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Background: Iatrogenic injury to neck vasculature is a potentially life-threatening complication of spine surgery. We present an illustrative case describing the use of the PipelineTM Embolization Device (PED) in the emergent reconstruction of the vertebral artery (VA) following vessel laceration. In addition, we document a systematic review concerning the use of the PED in acute to chronic iatrogenic injury of the internal carotid or VAs. Methods: This study was a systematic literature review and illustrative case example. Results: A 73-year-old woman underwent anterior cervical discectomy and fusion (ACDF) surgery complicated by left VA injury. The incision was promptly packed and pressure held while the vessel was salvaged using a PipelineTM stent. At 6 months follow-up, the patient had no residual symptoms. A systematic review identified 11 publications meeting study criteria, in which 16 patients were reported to have an injury to the internal carotid or VAs. Patients were grouped into acute, subacute, and chronic cohorts. In the acute group, the majority of patients experienced injury during transsphenoidal resection or ACDF procedures. All cases in the acute group received immediate intervention with the deployment of a PED device. One patient experienced continued contrast extravasation, necessitating vessel sacrifice through superficial temporal artery-middle cerebral artery bypass. All patients recovered to their neurologic baseline. In the subacute and chronic groups, two patients experienced complications, with the majority going on to recover to their neurologic baseline. Conclusion: PED placement is a viable management strategy for restoring anatomic integrity to head-and-neck vasculature following acute iatrogenic injury.
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Plut, Jan, Ivan Toplak, and Marina Štukelj. "Variations in the detection of anti-PEDV antibodies in serum samples using three diagnostic tests – short communication." Acta Veterinaria Hungarica 66, no. 2 (2018): 337–42. http://dx.doi.org/10.1556/004.2018.030.
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Over the last few years several porcine epidemic diarrhoea (PED) outbreaks have been discovered in Europe including the first PED case in Slovenia in January 2015. The aim of this study was to determine when PED virus (PEDV) infection started in Slovenia. Serum samples collected between 2012 and 2016 were tested. Three hundred and seventy-five serum samples were collected from 132 Slovenian small, one-site pig farms. Samples were tested for PEDV antibodies utilising three different serological methods: commercially-available indirect ELISA, in-house blocking ELISA test and Immunoperoxidase Monolayer Assay (IPMA) test. One hundred and seventy (45.33%) tested samples were found positive by the commercially-available ELISA test kit, and 10 (5.68%) of these 170 samples found positive were positive by the in-house blocking ELISA. Only these 10 samples were collected from a farm where clinical signs of PED infection had been observed and PEDV was confirmed by RT-PCR methodology; the other 160 samples were collected randomly. Thirty-two samples with the highest S/P value obtained with the commercial ELISA were all negative with IPMA. Reasons for the high variance in the results obtained remain unclear; more research is required to ensure higher sensitivity and specificity in terms of PEDV antibody tests and other PED diagnostic methods.
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Colby, Geoffrey P., Li-Mei Lin, Justin M. Caplan, et al. "Immediate procedural outcomes in 44 consecutive Pipeline Flex cases: the first North American single-center series." Journal of NeuroInterventional Surgery 8, no. 7 (2015): 702–9. http://dx.doi.org/10.1136/neurintsurg-2015-011894.
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BackgroundFlow diversion is an established technique for treatment of cerebral aneurysms. The Pipeline embolization device (PED) is the only FDA-approved flow diverting stent in the USA. A second-generation device, PED Flex, has recently been released with modifications to the delivery system. Published reports of experience with this new device are limited.ObjectiveTo describe the initial outcomes from the first North American series using the PED Flex—a single-center experience of 44 cases.MethodsAll patients consecutively treated with the PED Flex embolization device from February 2015 through April 2015 were included in the study. Data were collected for patient demographics, aneurysm characteristics, technical procedural details, and early outcomes.ResultsPED Flex treatment was attempted in 42 patients (mean 56.6±2.0 years) with 44 aneurysms (mean size 6.5±0.6 mm), 41/44 (93%) of which were anterior circulation and 3/44 (7%) were posterior circulation. PED Flex was successfully implanted in 43/44 cases (98%). A single device was used in 41/43 cases (95%), with a mean of 1.07±0.05 devices implanted per case. Resheathing was performed in 4/44 cases (9%). Mean postprocedure hospital length of stay was 1.3±0.2 days. One significant neurological complication (2.3%) occurred, which was a stroke in a patient non-compliant with the prescribed antiplatelet regimen.ConclusionsPipeline Flex is a second-generation flow diverter with enhanced features compared with the first-generation PED. These modifications allow for more reliable deployment with continued improvements in procedural safety.
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Velichová, Kateřina, and Karel Medek. "An unlucky souvenir from the tropics - a case study of fevers occuring after returning from the tropics." Pediatrie pro praxi 25, no. 4 (2024): 236–40. http://dx.doi.org/10.36290/ped.2024.046.
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Rathore, Saima, Gaurav Shukla, Hamed Akbari, et al. "TMOD-34. A RADIOMIC SIGNATURE OF INFILTRATION IN PERITUMORAL EDEMA PREDICTS SUBSEQUENT RECURRENCE IN GLIOBLASTOMA." Neuro-Oncology 21, Supplement_6 (2019): vi270. http://dx.doi.org/10.1093/neuonc/noz175.1133.
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Abstract BACKGROUND The malignant parenchyma in glioblastoma extends beyond the enhancing borders of tumor on postcontrast T1-weighted magnetic resonance imaging (MRI), which is the primary target of treatment. Such non-enhancing tumor invasion into the peri-tumoral edema (PED) is, however, not usually distinguishable on conventional MRI. The aim of this study was to evaluate pre-operative MRI in the PED to assess whether areas of tumor infiltration and early recurrence can be detected. METHODS A cohort of 90 de novo glioblastoma patients from a single institution (Penn) was selected. All included patients had preoperative multi-parametric MRI (mpMRI;T1,T1Gd,T2,T2-FLAIR,ADC), underwent initial gross-total-resection followed by standard chemoradiation, and had pathologically-confirmed recurrence. An extensive panel of handcrafted features, including shape, volume, intensity distributions, texture, was extracted from mpMRI scans. Predictive modeling for estimation of PED infiltration was performed using sequential feature selection approach designed with a support vector machine classifier and through a Leave-one-out cross-validation approach in the Penn cohort. Generalizability of the model was evaluated by applying it on a cohort of 20 patients from a second institution (Case), and predicted probability distributions in PED were compared in both the cohorts. RESULTS Spatial probability maps, representing the likelihood of tumor infiltration and eventual recurrence, were binarized at 50% cutoff, and compared with actual recurrence on post-recurrence scans. The cross-validated accuracy of our model within Penn cohort was 81.35% (odds-ratio=3.62, sensitivity/specificity=78.26/81.35). The model trained on the Penn cohort, when applied on the Case cohort, produced almost similar intensity distribution in the PED, suggesting that the method has potential for robust performance across institutions. The comparison of intensity distributions revealed higher ADC and T2-FLAIR in non-recurrent regions compared to recurrent ones. CONCLUSION Multi-parametric pattern analysis of mpMRI across multiple institutions generates similar, accurate estimates of spatial extent and patterns of recurrence in PED, which may guide strategies for treatment intensification in glioblastoma.
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Bae, Woori, Arum Choi, Seonjeong Byun, Kyunghoon Kim, and Sukil Kim. "Impact of COVID-19 Pandemic on Children Visiting Emergency Department for Mental Illness: A Multicenter Database Analysis from Korea." Children 9, no. 8 (2022): 1208. http://dx.doi.org/10.3390/children9081208.
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We aimed to identify changes in the proportion of pediatric emergency department (PED) visits due to mental illness during the coronavirus disease 2019 (COVID-19) pandemic. This was a retrospective observational study of visits to the PED at six university hospitals from January 2017 to December 2020. We included children aged 5–17 years who were diagnosed with a mental illness. We used segmented regression analysis to identify the change in the proportion of patients with mental illness. A total of 845 patients were included in the analysis. After the first case of COVID-19 was reported in Korea, the number of PED visits significantly decreased by 560.8 patients per week (95% confidence interval (CI): −665.3 to −456.3, p < 0.001). However, the proportion of patients with mental illness increased significantly, by 0.37% per week (95% CI: 0.04% to 0.70%, p = 0.03), at this time point. Subgroup analyses revealed that emotional disorders significantly increased by 0.06% per month (95% CI: 0.02% to 0.09%, p < 0.001) during the pandemic. Our study revealed that an increased proportion of patients with mental illness visited the PED during the COVID-19 pandemic. Specifically, we identified that the proportion of emotional disorders continues to rise during this pandemic.
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Wang, Guangxuan, Olivier Gilmont, and Julien Blondeau. "Pathways to Positive Energy Districts: A Comprehensive Techno-Economic and Environmental Analysis Using Multi-Objective Optimization." Energies 18, no. 5 (2025): 1134. https://doi.org/10.3390/en18051134.
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Transitioning to Positive Energy Districts (PEDs) is essential for achieving carbon neutrality in urban areas by 2050. This study presents a multi-objective optimization framework that balances energy, environmental, and economic performance, addressing the diverse priorities of multiple stakeholders. The framework enhances PED design by systematically evaluating technical solutions, including renewable-based electrification, demand-side management (DSM), energy storage, and retrofitting. The framework is applied to the Usquare district in Brussels, Belgium, as a case study. The results indicate that expanding photovoltaic (PV) capacity is crucial for achieving PED targets, with renewable-based electrification potentially reducing carbon emissions by up to 79%. The incorporation of demand-side management (DSM) and battery storage improves system flexibility, reduces grid dependency, and enhances cost-effectiveness. Although slightly more costly, retrofitting existing buildings provides the most balanced approach, offering the lowest CO2 emissions and the highest self-consumption ratio. This study presents a comprehensive decision-making support framework for optimizing PED design and operation, offering practical guidance for urban energy planning and contributing to global efforts toward carbon neutrality.
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Michnová, Zuzana, Zuzana Havlíčeková, Marek Pršo, Michaela Matiščáková, Jaroslav Fábry, and Peter Bánovčin. "Exocrine pancreatic insufficiency as a first sign in toddler with cystic fibrosis with negative newborn screening - a case study." Pediatrie pro praxi 25, no. 2 (2024): 105–8. http://dx.doi.org/10.36290/ped.2024.022.
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Henmi, Tatsuhiko, Tomoya Terai, Akihiro Nagamachi, and Koichi Sairyo. "Morphometric Changes of the Lumbar Intervertebral Foramen after Percutaneous Endoscopic Foraminoplasty under Local Anesthesia." Journal of Neurological Surgery Part A: Central European Neurosurgery 79, no. 01 (2017): 019–24. http://dx.doi.org/10.1055/s-0037-1599059.
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Abstract Background Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal. Methods In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery-related complications were reviewed. Results There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4–L5, one case at L3–L4, and one case at L5–S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm2 before surgery to 88.4 mm2 after surgery (p < 0.05 by paired t test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ∼ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED. Conclusion Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.
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Leone, Federica, Francesco Reda, Ala Hasan, et al. "Lessons Learned from Positive Energy District (PED) Projects: Cataloguing and Analysing Technology Solutions in Different Geographical Areas in Europe." Energies 16, no. 1 (2022): 356. http://dx.doi.org/10.3390/en16010356.
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A Positive Energy District (PED) is a portion of urban area with defined boundaries that can produce energy in excess of its own consumption. The aim of this study is to analyse design variations among the six projects (12 case studies) of PED belonging to the European Smart Cities and Communities programme. Thus, it will be possible to identify the reasons behind the energy choices related to generation, storage and distribution that appear in the different geographical areas. To achieve this, different data were collected by consulting official documents and creating questionnaires that were communicated with the project representatives. Thus, the result of this study is a catalogue of the energy system solutions adopted in the studied PEDs with a critical analysis of the different motivations behind them in order to outline general trends in the geographical areas with similar characteristics. In conclusion, this study defined which technological choices are the most common in territories with similar profiles and how divergent those with different profiles are. Furthermore, applied to a large catalogue of PED, the methodology identified would make it possible to create different operating models for different territorial types and urban settlements.
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Dell’Unto, Martina, Louise-Nour Sassenou, Lorenzo Olivieri, and Francesca Olivieri. "Technical Feasibility for the Boosting of Positive Energy Districts (PEDs) in Existing Mediterranean Districts: A Methodology and Case Study in Alcorcón, Spain." Sustainability 15, no. 19 (2023): 14134. http://dx.doi.org/10.3390/su151914134.
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The deployment of Positive Energy Districts (PEDs) is currently facing a set of diverse and complex challenges, mainly arising from their novelty and the lack of practical experience. In that sense, there is a clear need for translating concepts and strategies into instruments that support the design, planning and operation of PEDs. The present research aims to address this gap by introducing a methodology to assess the potential of an existing district to be converted into a PED in the specific context of Mediterranean cities, which, in addition to presenting similar climatic characteristics, share a common urban pattern and culture. The first step consists of analyzing the initial state of the district through the study of its bioclimatic and urban characteristics and estimation of its energy demand. Then, the second step allows for selecting and designing a set of passive and active strategies for the district. Finally, the technical feasibility of the scenario is evaluated by calculating its annual energy balance. The methodology is applied to a district of Alcorcón, Spain. Results show that the selected district could achieve an annual surplus of 4 GWh and, therefore, has the technical potential to be converted into a PED.
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Gu, Yan-Hong, and Akira Matsui. "Long-term native liver survival in infants with biliary atresia and use of a stool color card: Case-control study." Pediatrics International 59, no. 11 (2017): 1189–93. http://dx.doi.org/10.1111/ped.13360.
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Šurková, Silvie. "Why Vašek couldn't smile: a case study - facial nerve palsy as the initial symptom of hematologic malignancy in a pediatric patient." Pediatrie pro praxi 25, no. 3 (2024): 180–82. http://dx.doi.org/10.36290/ped.2024.037.
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Verwaaijen, Emma J., Patrick van der Torre, Josef Vormoor, et al. "Novel Adaption of the SARC-F Score to Classify Pediatric Hemato-Oncology Patients with Functional Sarcopenia." Cancers 15, no. 1 (2023): 320. http://dx.doi.org/10.3390/cancers15010320.
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Sarcopenia in pediatric hemato-oncology patients is undesirable because of the consequences it may have for treatment continuation and outcome, physical abilities and participation in daily life. An easy-to-use screening tool for sarcopenia will facilitate the identification of children at risk who need interventions to prevent serious physical deterioration. In the elderly, the use of the SARC-F score as a case-finding tool for sarcopenia is recommended. The aim of this cross-sectional study was to investigate the accuracy of the pediatric SARC-F (PED-SARC-F) for identifying sarcopenia in pediatric hemato-oncology patients, including the determination of a cut-off point for clinical use. Patients 3–20 years of age, under active treatment or within 12 months after treatment cessation were eligible. Patients had a physiotherapy assessment including a PED-SARC-F (0–10) and measurements of muscle strength (handheld dynamometry), physical performance (various tests) and/or muscle mass (bio-impedance analysis), as part of the standard of care. Spearman’s correlation coefficient (rs) between the PED-SARC-F and physiotherapy outcomes were calculated. Structural sarcopenia was defined as low appendicular skeletal muscle mass (ASMM) in combination with low muscle strength and/or low physical performance. Functional sarcopenia indicated low muscle strength combined with low physical performance. Multiple logistic regression models were estimated to study the associations between the PED-SARC-F and structural/functional sarcopenia. To evaluate which cut-off point provides the most accurate classification, the area under the receiver operating characteristic curve (AUCs), sensitivity and specificity per point were calculated. In total, 215 assessments were included, 62% were performed in boys and the median age was 12.9 years (interquartile range: 8.5–15.8). The PED-SARC-F scores correlated moderately with the measurements of muscle strength (rs = −0.37 to −0.47, p < 0.001) and physical performance (rs = −0.45 to −0.66, p < 0.001), and weakly with ASMM (rs = −0.27, p < 0.001). The PED-SARC-F had an AUC of 0.90 (95% confidence interval (CI) = 0.84–0.95) for functional sarcopenia and 0.79 (95% CI = 0.68–0.90) for structural sarcopenia. A cut-off point of ≥5 had the highest specificity of 96% and a sensitivity of 74%. In conclusion, we adapted the SARC-F to a pediatric version, confirmed its excellent diagnostic accuracy for identifying functional sarcopenia and defined a clinically useful cut-off point in pediatric hemato-oncology patients.
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Tsai, Chih-Min, Chun-Hung Richard Lin, Huan Zhang, et al. "Using Machine Learning to Predict Bacteremia in Febrile Children Presented to the Emergency Department." Diagnostics 10, no. 5 (2020): 307. http://dx.doi.org/10.3390/diagnostics10050307.
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Blood culture is frequently used to detect bacteremia in febrile children. However, a high rate of negative or false-positive blood culture results is common at the pediatric emergency department (PED). The aim of this study was to use machine learning to build a model that could predict bacteremia in febrile children. We conducted a retrospective case-control study of febrile children who presented to the PED from 2008 to 2015. We adopted machine learning methods and cost-sensitive learning to establish a predictive model of bacteremia. We enrolled 16,967 febrile children with blood culture tests during the eight-year study period. Only 146 febrile children had true bacteremia, and more than 99% of febrile children had a contaminant or negative blood culture result. The maximum area under the curve of logistic regression and support vector machines to predict bacteremia were 0.768 and 0.832, respectively. Using the predictive model, we can categorize febrile children by risk value into five classes. Class 5 had the highest probability of having bacteremia, while class 1 had no risk. Obtaining blood cultures in febrile children at the PED rarely identifies a causative pathogen. Prediction models can help physicians determine whether patients have bacteremia and may reduce unnecessary expenses.
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Hamilton Craig, I. "Australian case detection of familial hypercholesterolaemia a collaborative study with the international MED-PED FH project." Atherosclerosis 115 (June 1995): S77. http://dx.doi.org/10.1016/0021-9150(95)96543-2.
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Akinduro, Oluwaseun O., Neethu Gopal, Tasneem F. Hasan, et al. "Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy." Neurosurgery 87, no. 4 (2020): 770–78. http://dx.doi.org/10.1093/neuros/nyz548.
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Abstract BACKGROUND There is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series. OBJECTIVE To evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms. METHODS This is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up. RESULTS A total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n = 25/28), with near-complete occlusion (&gt;90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n = 21/24) and 1 in 12% (n = 3/24) of patients, and mRS was 0 in 83% (n = 20/24) and 1 in 17% (n = 4/24) of patients. CONCLUSION The treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms.
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Sahito, Ambreen, Zafar Fatmi, Muhammad Masood Kadir, and Fehmina Arif. "Indoor Urban Environment and Conventional Risk Factors for Pediatric Tuberculosis Among 1–12 Years Old Children in a Megacity in Pakistan: A Matched Case–Control Study." Pediatric Allergy, Immunology, and Pulmonology 35, no. 4 (2022): 158–65. http://dx.doi.org/10.1089/ped.2021.0094.
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Reche-Frutos, Juan, Cristina Calvo-Gonzalez, Silvia Pérez-Trigo, Cristina Fernandez-Perez, Juan Donate-Lopez, and Julian Garcia-Feijoo. "Ranibizumab in Retinal Angiomatous Proliferation (RAP): Influence of RAP Stage on Visual Outcome." European Journal of Ophthalmology 21, no. 6 (2011): 783–88. http://dx.doi.org/10.5301/ejo.2011.6526.
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Purpose. To evaluate the influence of retinal angiomatous proliferation (RAP) stage on visual and anatomic outcome after ranibizumab (Lucentis®). Methods. This was a prospective study on consecutively diagnosed RAP eyes at the Hospital Clínico San Carlos, Madrid. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) are performed monthly. Indocyanine green angiography (ICG) and fluorescein angiography (FA) are performed at baseline and every 3 months thereafter. A starting dose of a monthly ranibizumab injection in the first 3 months is followed by retreatment in case of intraretinal edema, subretinal fluid, or pigment epithelium detachment (PED) in OCT, increased leakage in FA, or a hot spot in ICG. Results. A total of 53 eyes from 49 patients were included. The mean change in BCVA at 12 months was +7.3, +0.83, and −2.1 letters in stages IIA (21 cases), Il B (18 cases), and III (14 cases), respectively. After adjusting the change in BCVA according to baseline BCVA, β coefficient was −6.012 letters (p=0.025) in stage IIB and −9.762 letters (p=0.003) in stage III vs stage IIA. Four cases had a retinal pigment epithelium tear after injection of ranibizumab. Conclusions. Patients in stage II without PED have a better visual and anatomic evolution than patients in stage II with PED and stage III.
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Daou, Badih, Elias Atallah, Nohra Chalouhi, et al. "Aneurysms with persistent filling after failed treatment with the Pipeline embolization device." Journal of Neurosurgery 130, no. 4 (2019): 1376–82. http://dx.doi.org/10.3171/2017.12.jns163090.
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OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.
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Botelho, Ana Carla Gomes, Luana Valeriano Neri, Marina Queiroz Ferreira da Silva, et al. "Presumed congenital infection by Zika virus: findings on psychomotor development - a case report." Revista Brasileira de Saúde Materno Infantil 16, suppl 1 (2016): 39–44. http://dx.doi.org/10.1590/1806-9304201600s100004.
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Abstract Introduction: the identification of Zika virus (ZikV) in the amniotic fluid, in the placenta and in newborns' brains suggests a neurotropism of this agent in the brain development, resulting in neuro-psycho-motor alterations. Thus, this present study reports the assessment of children diagnosed by a congenital infection, presumably by ZikV, followed-up at the Rehabilitation Center Prof. Ruy Neves Baptist at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). Description: as proposed by the Ministry of Health, the following instruments were used to evaluate the neuro-motor functions of four children with microcephaly aged between three and four months: The Test of Infant Motor Performance (TIMP); the functional vision assessment; the manual function scale development; and the clinical evaluation protocol on pediatric dysphagia (PAD-PED). Discussion: the children evaluated presented atypical motor performance, muscle tone and spontaneous motricity which encompass the symmetry and the motion range of the upper and lower limbs proven to be altered. The functional vision showed alterations which can cause limitations in the performance of functional activities and the learning process. Regarding to the speech articulator's functions observed that the maturation and coordination of sucking, swallowing and breathing did not yet encounter the appropriate age maturity level.