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1
Galster, George C. "Nonlinear and Threshold Effects Related to Neighborhood: Implications for Planning and Policy." Journal of Planning Literature 33, no. 4 (August 14, 2018): 492–508. http://dx.doi.org/10.1177/0885412218793693.
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Nonlinear and threshold relationships are commonly manifested in neighborhoods, both relating to effects of neighborhoods on residents and causes of neighborhood changes arising from individual mobility and housing investment decisions. These relationships are generated by amalgam of often reinforcing processes related to socialization, gaming, tolerance, contagion, and tolerance. The existence of nonlinear and threshold effects holds powerful implications for planners. Scarce public investment resources must be spatially concentrated, so that they exceed property owners’ reinvestment thresholds. Poverty deconcentration strategies must seek to replace neighborhoods exceeding 40 percent poverty rates with those that have low (less than 15 percent) poverty rates.
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Weltman, A., J. Y. Weltman, R. Schurrer, W. S. Evans, J. D. Veldhuis, and A. D. Rogol. "Endurance training amplifies the pulsatile release of growth hormone: effects of training intensity." Journal of Applied Physiology 72, no. 6 (June 1, 1992): 2188–96. http://dx.doi.org/10.1152/jappl.1992.72.6.2188.
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The effects of intensity of run training on the pulsatile release of growth hormone (GH) were investigated in 21 eumenorrheic untrained women. The O2 consumption (VO2) at the lactate threshold (LT); fixed blood lactate concentrations (FBLC) of 2.0, 2.5, and 4.0 mM; peak VO2; maximal VO2; body composition; and pulsatile release of GH were measured. Subjects in both the at-lactate threshold (/LT, n = 9) and above-lactate threshold (greater than LT, n = 7) training groups increased VO2 at LT and FBLC of 2.0, 2.5, and 4.0 mM and VO2max after 1 yr of run training. However, the increase observed in the greater than LT group was greater than that in the /LT group (P less than 0.05). No change was observed for the control group (n = 5). No among- or within-group differences were observed for body weight, although trends for reductions in percent body fat (P less than 0.06) and fat weight (P less than 0.15) were observed in the greater than LT group, and both training groups significantly increased fat-free weight (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ali, M. Shaukat. "Poverty Assessment: Pakistan's Case." Pakistan Development Review 34, no. 1 (March 1, 1995): 43–54. http://dx.doi.org/10.30541/v34i1pp.43-54.
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This study is an attempt to determine the poverty-line and the incidence of poverty in Pakistan by using data of the latest Household Integrated Economic Survey: 1990-91. The study uses a different approach. and methodology in respect of earlier studies of the subject. The approach is that of the "Basic Needs", which defines the poverty-line in terms of minimum expenditure on all needs, food as well as non-food. The methodology used in estimating the minimum expenditure on various needs is based on the "Extended Linear Expenditure System (ELES)". For the year under review, the total poverty-line was estimated at Rs 374 per capita per month, with the food poverty-line at Rs 191. A comparison with the income levels reported in the Survey revealed that roughly 47 percent population had an income less than this threshold level expenditure on all needs, the shortfall or gap being almost 25 percent. The proportion of population with an income less than the threshold expenditure on food alone was found to be 10 percent. In certain respects, the results were quite different, quantitatively as well as qualitatively, from those of the earlier studies.
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Howard, Kirsten, Sarah J. Lord, Anthony Speer, Robert N. Gibson, Robert Padbury, and Brendon Kearney. "Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: A probabilistic cost-effectiveness analysis of diagnostic strategies." International Journal of Technology Assessment in Health Care 22, no. 1 (January 2006): 109–18. http://dx.doi.org/10.1017/s0266462306050902.
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Background:Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for imaging of the biliary tract but is associated with complications. Less invasive imaging techniques, such as magnetic resonance cholangiopancreatography (MRCP), have a much lower complication rate. The accuracy of MRCP is comparable to that of ERCP, and MRCP may be more effective and cost-effective, particularly in cases for which the suspected prevalence of disease is low and further intervention can be avoided. A model was constructed to compare the effectiveness and cost-effectiveness of MRCP and ERCP in patients with a previous history of cholecystectomy, presenting with abdominal pain and/or abnormal liver function tests.Methods:Diagnostic accuracy estimates came from a systematic review of MRCP. A decision analytic model was constructed to represent the diagnostic and treatment pathway of this patient group. The model compared the following two diagnostic strategies: (i) MRCP followed with ERCP if positive, and then management based on ERCP; and (ii) ERCP only. Deterministic and probabilistic analyses were used to assess the likelihood of MRCP being cost-effective. Sensitivity analyses examined the impact of prior probabilities of common bile duct stones (CBDS) and test performance characteristics. The outcomes considered were costs, quality-adjusted life years (QALYs), and cost per additional QALY.Results:The deterministic analysis indicated that MRCP was dominant over ERCP. At prior probabilities of CBDS, less than 60 percent MRCP was the less costly initial diagnostic test; above this threshold, ERCP was less costly. Similarly, at probabilities of CBDS less than 68 percent, MRCP was also the more effective strategy (generated more QALYs). Above this threshold, ERCP became the more effective strategy. Probabilistic sensitivity analyses indicated that, in this patient group for which there is a low to moderate probability of CBDS, there was a 59 percent likelihood that MRCP was cost-saving, an 83 percent chance that MRCP was more effective with a higher quality adjusted survival, and an 83 percent chance that MRCP had a cost-effectiveness ratio more favorable than $50,000 per QALY gained.Conclusions:Costs and cost-effectiveness are dependent upon the prior probability of CBDS. However, probabilistic analysis indicated that, with a high degree of certainty, MRCP was the more effective and cost-effective initial test in postcholecystectomy patients with a low to moderate probability of CBDS.
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Xie, Xuanqian, Lindsey Falk, James M. Brophy, Hong Anh Tu, Jennifer Guo, Olga Gajic-Veljanoski, Nancy Sikich, Irfan A. Dhalla, and Vivian Ng. "A Non-inferiority Framework for Cost-Effectiveness Analysis." International Journal of Technology Assessment in Health Care 35, no. 4 (2019): 291–97. http://dx.doi.org/10.1017/s0266462319000576.
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AbstractBackgroundTraditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression.MethodsWe modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP).ResultsrTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively.ConclusionsThis new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.
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Niedermayer, Oskar. "Die brandenburgische Landtagswahl vom 1. September 2019: Die SPD schlägt die AfD auf den letzten Metern." Zeitschrift für Parlamentsfragen 51, no. 2 (2020): 285–303. http://dx.doi.org/10.5771/0340-1758-2020-2-285.
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After a slow beginning, Brandenburg’s election campaign became dominated by the SPD’s and AfD’s struggle to come in first . This contributed considerably to an increase in turnout to 61 .3 percent . Although the SPD won the election with 26 .2 percent, it sustained substantial losses because its front runner Dietmar Woidke was less popular than in 2014, and the voters attributed less competences to the party in all relevant policy areas . The CDU could not benefit from this weakness, lost considerably and dropped back to the third place with 15 .6 percent . The AfD, which attracted ideologically convicted voters as well as economically, culturally, or socio-politically deprived protest-voters, moved forward to the second place with 23 .5 percent . The Greens won 10 .8 percent, the Left Party 10 .7 percent . The BVB/Freie Wähler remained at exactly 5 .0 percent, whereas the FDP failed to overcome the five percent threshold . The exploratory talks to form a new three-party coalition at first were overshadowed by an internal rebellion in the CDU but ended with a coalition of SPD, CDU, and the Greens .
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Petrou, Stavros, Angela Boland, Kamran Khan, Colin Powell, Ruwanthi Kolamunnage-Dona, John Lowe, Iolo Doull, Kerry Hood, and Paula Williamson. "ECONOMIC EVALUATION OF NEBULIZED MAGNESIUM SULPHATE IN ACUTE SEVERE ASTHMA IN CHILDREN." International Journal of Technology Assessment in Health Care 30, no. 4 (October 2014): 354–60. http://dx.doi.org/10.1017/s0266462314000440.
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Objectives: The aim of this study was to estimate the cost-effectiveness of nebulized magnesium sulphate (MgSO4) in acute asthma in children from the perspective of the UK National Health Service and personal social services.Methods: An economic evaluation was conducted based on evidence from a randomized placebo controlled multi-center trial of nebulized MgSO4 in severe acute asthma in children. Participants comprised 508 children aged 2–16 years presenting to an emergency department or a children's assessment unit with severe acute asthma across thirty hospitals in the United Kingdom. Children were randomly allocated to receive nebulized salbutamol and ipratropium bromide mixed with either 2.5 ml of isotonic MgSO4 or 2.5 ml of isotonic saline on three occasions at 20-min intervals. Cost-effectiveness outcomes were constructed around the Yung Asthma Severity Score (ASS) after 60 min of treatment; whilst cost-utility outcomes were constructed around the quality-adjusted life-year (QALY) metric. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves at alternative cost-effectiveness thresholds for either: (i) a unit reduction in ASS; or (ii) an additional QALY.Results: MgSO4 had a 75.1 percent probability of being cost-effective at a GBP 1,000 (EUR 1,148) per unit decrement in ASS threshold, an 88.0 percent probability of being more effective (in terms of reducing the ASS) and a 36.6 percent probability of being less costly. MgSO4 also had a 67.6 percent probability of being cost-effective at a GBP 20,000 (EUR 22,957) per QALY gained threshold, an 8.5 percent probability of being more effective (in terms of generating increased QALYs) and a 69.1 percent probability of being less costly. Sensitivity analyses showed that the results of the economic evaluation were particularly sensitive to the methods used for QALY estimation.Conclusions: The probability of cost-effectiveness of nebulized isotonic MgSO4, given as an adjuvant to standard treatment of severe acute asthma in children, is less than 70 percent across accepted cost-effectiveness thresholds for an additional QALY.
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Deale, O. C., R. C. Wesley, D. Morgan, and B. B. Lerman. "Nature of defibrillation: determinism versus probabilism." American Journal of Physiology-Heart and Circulatory Physiology 259, no. 5 (November 1, 1990): H1544—H1550. http://dx.doi.org/10.1152/ajpheart.1990.259.5.h1544.
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The gradual transitions that are found between unsuccessful and successful shock strengths in percent success or dose-response curves suggest that defibrillation is a probabilistic phenomenon. This concept appears to be reinforced by the fact that a frequency distribution is observed in defibrillation threshold data and that a dose-response relationship is also obtained by integration of the frequency distribution. The purpose of this study was to investigate whether a deterministic threshold model (based on experimental results) could produce 1) gradual transitions in dose-response curves, and 2) a threshold frequency distribution for individual subjects. In the experimental phase of the study, a linear deterministic relationship was found between transthoracic threshold current and defibrillation episode number (other variables held constant) in pentobarbital-anesthetized dogs. The correlation coefficient for each dog was between 0.77 and 0.98 (P less than 0.01), and both positive and negative slopes were found. Based on these results, threshold current was modeled for computer simulation as a linear function of episode number. The model was thus purely deterministic with no random variability. For each simulated experiment, several parameters were varied: order of shocks (increment, decrement, random order), slope of threshold function, and percent error of the initial threshold. Several hundred computer simulations were performed to determine the effect of varying these parameters. In all cases, threshold-frequency distributions and sigmoidal dose-response curves with gradual transitions were produced. The results of this investigation demonstrate that the apparent probabilistic behavior of defibrillation can be produced by a deterministic relationship.
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Niebur, G. L., J. C. Yuen, A. C. Hsia, and T. M. Keaveny. "Convergence Behavior of High-Resolution Finite Element Models of Trabecular Bone." Journal of Biomechanical Engineering 121, no. 6 (December 1, 1999): 629–35. http://dx.doi.org/10.1115/1.2800865.
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The convergence behavior of finite element models depends on the size of elements used, the element polynomial order, and on the complexity of the applied loads. For high-resolution models of trabecular bone, changes in architecture and density may also be important. The goal of this study was to investigate the influence of these factors on the convergence behavior of high-resolution models of trabecular bone. Two human vertebral and two bovine tibial trabecular bone specimens were modeled at four resolutions ranging from 20 to 80 μm and subjected to both compressive and shear loading. Results indicated that convergence behavior depended on both loading mode (axial versus shear) and volume fraction of the specimen. Compared to the 20 μm resolution, the differences in apparent Young’s modulus at 40 μm resolution were less than 5 percent for all specimens, and for apparent shear modulus were less than 7 percent. By contrast, differences at 80 μm resolution in apparent modulus were up to 41 percent, depending on the specimen tested and loading mode. Overall, differences in apparent properties were always less than 10 percent when the ratio of mean trabecular thickness to element size was greater than four. Use of higher order elements did not improve the results. Tissue level parameters such as maximum principal strain did not converge. Tissue level strains converged when considered relative to a threshold value, but only if the strains were evaluated at Gauss points rather than element centroids. These findings indicate that good convergence can be obtained with this modeling technique, although element size should be chosen based on factors such as loading mode, mean trabecular thickness, and the particular output parameter of interest.
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Palmer, Katharina, Harold L. Drake, and Marcus A. Horn. "Genome-Derived Criteria for Assigning Environmental narG and nosZ Sequences to Operational Taxonomic Units of Nitrate Reducers." Applied and Environmental Microbiology 75, no. 15 (June 5, 2009): 5170–74. http://dx.doi.org/10.1128/aem.00254-09.
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ABSTRACT Ninety percent of cultured bacterial nitrate reducers with a 16S rRNA gene similarity of ≥97% had a narG or nosZ similarity of ≥67% or ≥80%, respectively, suggesting that 67% and 80% could be used as standardized, conservative threshold similarity values for narG and nosZ, respectively (i.e., any two sequences that are less similar than the threshold similarity value have a very high probability of belonging to different species), for estimating species-level operational taxonomic units. Genus-level tree topologies of narG and nosZ were generally similar to those of the corresponding 16S rRNA genes. Although some genomes contained multiple copies of narG, recent horizontal gene transfer of narG was not apparent.
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Stahl, James E., Joseph P. Vacanti, and Scott Gazelle. "Assessing emerging technologies—The case of organ replacement technologies: Volume, durability, cost." International Journal of Technology Assessment in Health Care 23, no. 3 (June 19, 2007): 331–36. http://dx.doi.org/10.1017/s0266462307070535.
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Objectives:The aim of this study was to estimate thresholds for production volume, durability, and cost of care for the cost-effective adoption of liver organ replacement technologies (ORTs).Methods:We constructed a discrete-event simulation model of the liver allocation system in the United States. The model was calibrated against UNOS data (1994–2000). Into this model, we introduced ORTs with varying durability (time to failure), cost of care, and production volume. Primary outputs of interest were time to 5 percent reduction in the waiting list and time to 5 percent increase in expected transplant volume.Results:Model output for both calibration and validation phases closely matched published data: waiting list length (±2 percent), number of transplants (±2 percent), deaths while waiting (±5 percent), and time to transplant (±11 percent). Reducing the waiting list was dependent on both ORT durability and production volume. The longer the durability, the less production volume needed to reduce the waiting list and vice versa. However, below 250 ORT/year, durability needed to be >2 years for any significant change to be seen in the waiting list. For base-case costs, all ORT production volume and durability scenarios result in more transplants per year at less total cost of care/patient than the current system. ORTs remain cost saving until manufacturing costs are >5 times base-case costs, production is less 500 ORT/year, and durability <6 months.Conclusions:Although there remain many technical challenges to overcome, as long as ORTs can meet these threshold criteria, they have the potential of transforming the world of end-stage liver disease.
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Kern, Mark K., Safwan Jaradeh, Ronald C. Arndorfer, Andrzej Jesmanowicz, James Hyde, and Reza Shaker. "Gender differences in cortical representation of rectal distension in healthy humans." American Journal of Physiology-Gastrointestinal and Liver Physiology 281, no. 6 (December 1, 2001): G1512—G1523. http://dx.doi.org/10.1152/ajpgi.2001.281.6.g1512.
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Cerebral cortical processing of information relayed via visceral afferents is poorly understood. We determined and compared cortical activity caused by various levels of rectal distension in healthy male and female subjects. Twenty-eight healthy, young (20–44 yr) volunteer subjects (13 male, 15 female) were studied with a paradigm-driven functional magnetic resonance imaging (fMRI) technique during barostat-controlled rectal distension at perception threshold and 10 mmHg below and above perception threshold. Male subjects showed localized clusters of fMRI activity primarily in the sensory and parietooccipital regions, whereas female subjects also showed activity in the anterior cingulate and insular regions. A progressive increase in maximum percent fMRI signal change and total volume of cortical activity was associated with the intensity of rectal distension pressure in both genders. Regions of cortical activity for below-threshold stimuli showed less substantial signal intensity and volume than responses for threshold and above-threshold stimuli. Volume of cortical activity during rectal distension in women was significantly higher than that for men for all distensions. We conclude that 1) there are substantial differences in female cortical activation topography during rectal distension compared with males; 2) intensity and volume of registered cortical activity due to rectal stimulation are directly related to stimulus strength; and 3) rectal stimulation below perception level is registered in the cerebral cortex.
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Lewin, G. R., and S. B. McMahon. "Physiological properties of primary sensory neurons appropriately and inappropriately innervating skin in the adult rat." Journal of Neurophysiology 66, no. 4 (October 1, 1991): 1205–17. http://dx.doi.org/10.1152/jn.1991.66.4.1205.
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1. We have studied the physiology of sensory neurons innervating skin of the rat hindlimb, in three groups of animals: 1) normal animals; 2) animals in which the sural nerve (Sn) had regenerated to its original cutaneous target; and 3) animals in which the gastrocnemius muscle nerve (Gn) had previously been cut and cross anastomosed with the distal stump of the cut Sn so that its axons regenerated to a foreign target, skin. 2. Single-unit recordings were made from 222 afferents in normal, intact animals. They had conduction velocities of 0.5-53.1 m/s. The conduction velocity distribution had distinct peaks at approximately 37.5, 2.5, and 1.25 m/s, presumably corresponding to A alpha beta-, A delta-, and C-fiber populations. Eighty-two percent of the characterized myelinated fibers had low-threshold mechanosensitive receptive fields, whereas 16% were high threshold, and only 2% appeared to have no receptive field. The very large majority of low-threshold mechanosensitive receptive fields (87%) were rapidly adapting hair follicle afferents. 3. In animals with regenerated Sn, 308 afferents were recorded with conduction velocities of 0.4-58.8 m/s. However, the mean conduction velocity was lower than in control animals (P less than 0.05), and only one peak, at 27.5 m/s, was apparent for myelinated fibers. Eighty-six percent of myelinated fibers were low-threshold mechanosensitive afferents, 8.5% were high-threshold mechanoreceptors (HTMRs), and 5.5% appeared to have no receptive fields. Fewer low-threshold mechanoreceptors (LTMRs; compared with controls) were activated by hair movement (63 vs. 87%). Most of the remainder appeared to be field receptors (which were therefore more commonly observed here than in normal animals). 4. In animals in which the Gn had regenerated to skin, 430 afferents were recorded. These had conduction velocities ranging from 0.6 to 71.4 m/s, and again only one peak was apparent in the myelinated conduction velocity histogram, at approximately 17.5 m/s. Of the myelinated fibers, 79% had low-threshold mechanosensitive receptive fields in skin and 10% high-threshold mechanosensitive receptive fields. The remaining 11% apparently had no receptive field (cf. 5.5% in regenerated Sn). In contrast to normal or regrown sural afferents, only 58% of low-threshold gastrocnemius afferents in skin were rapidly adapting. Of the 42% slowly adapting afferents, many surprisingly responded to hair movement. Thus some gastrocnemius afferents seemed to have retained the adaptation properties characteristic of muscle afferents. Also surprisingly, given that the Gn contains fewer fibers than the Sn, receptive-field areas were not significantly different from regrown or normal sural fibers.(ABSTRACT TRUNCATED AT 400 WORDS)
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Wu, Ya, Philippe Escande, and R. Du. "A New Method for Real-Time Tool Condition Monitoring in Transfer Machining Stations1." Journal of Manufacturing Science and Engineering 123, no. 2 (February 1, 2000): 339–47. http://dx.doi.org/10.1115/1.1334859.
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This paper introduces a new method for tool condition monitoring in transfer machining stations. The new method is developed based on a combination of wavelet transform, signal reconstruction, and the probability of threshold crossing. It consists of two parts: training and decision making. Training is aimed at determining the alarm threshold and it is done in six steps: (1) Calculate the wavelet packet transform of the sensor signals (spindle motor current) obtained from normal tool conditions. (2) Select feature wavelet packets that represent the principal components of the signals. (3) Reconstruct the signals from the feature wavelet packets (this removes the unwanted noises). (4) Calculate the statistics of the reconstructed signals. (5) Calculate the alarm thresholds based on the statistics of the reconstructed signals, and (6) Calculate the probability of the threshold crossing (the number of threshold crossing conforms a Poisson distribution). The decision making is done in two steps: (1) Check the threshold crossing, and (2) Calculate the number of threshold crossing to determine whether an alarm shall be given. As demonstrated using a practical example from a drilling transfer station, the new method is effective with a success rate over 90 percent. Also, it is fast (the monitoring decision can be done in milliseconds) and cost-effective (the implementation cost shall be less than $500).
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Kearney, Pamela Reed, Eric A. Mann, Christopher J. Poletto, and Christy L. Ludlow. "Suppression of Thyroarytenoid Muscle Responses during Repeated Air Pressure Stimulation of the Laryngeal Mucosa in Awake Humans." Annals of Otology, Rhinology & Laryngology 114, no. 4 (April 2005): 264–70. http://dx.doi.org/10.1177/000348940511400403.
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Repeated stimulation of the laryngeal mucosa occurs during speech. Single stimuli, however, can elicit the laryngeal adductor response (LAR). Our hypothesis was that the LAR to repeated rapid air pressure stimuli is centrally suppressed in humans. Hookedwire electrodes were inserted into the thyroarytenoid and cricothyroid muscles on both sides and into the posterior cricoarytenoid muscle on one side. Pairs of air puff stimuli were presented to the mucosa over the arytenoids at pressure levels three times threshold with interstimulus intervals from 250 to 5,000 ms. Bilateral thyroarytenoid responses occurred at around 150 ms to more than 70% of the initial stimuli. With repeated presentation at intervals of 2 seconds or less, the percent occurrence decreased to less than 40% and response amplitudes were reduced by 50%. Central suppression of adductor responses to repeated air puff stimuli may allow speakers to produce voice without eliciting reflexive spasms that could disrupt speech.
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Tseng, Chwan-Lu, Chun-Chieh Hsiao, I.-Chi Chou, Chia-Jung Hsu, Yi-Ju Chang, and Ren-Guey Lee. "DESIGN AND IMPLEMENTATION OF ECG COMPRESSION ALGORITHM WITH CONTROLLABLE PERCENT ROOT-MEAN-SQUARE DIFFERENCE." Biomedical Engineering: Applications, Basis and Communications 19, no. 04 (August 2007): 259–68. http://dx.doi.org/10.4015/s1016237207000343.
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In this paper, the orthogonality of coefficient matrices of wavelet filters is utilized to derive the energy equation for the relation between time-domain signal and its corresponding wavelet coefficients. Using the energy equation, the relationship between the wavelet coefficient error and the reconstruction error is obtained. The errors considered in this paper include the truncation error and quantization error. This not only helps to control the reconstruction quality but also brings two advantages: (1) It is not necessary to perform inverse transform to obtain the distortion caused by compression using wavelet transform and can thus reduce computation efforts. (2) By using the energy equation, we can search for a threshold value to attain a better compression ratio within the range of a pre-specified percent root-mean-square difference (PRD) value. A compression algorithm with run length encoding is proposed based on the energy equation. In the end, the Matlab software and MIT-BIH database are adopted to perform simulations for verifying the feasibility of our proposed method. The algorithm is also implemented on a DSP chip to examine the practicality and suitability. The required computation time of an ECG segment is less than 0.0786 ,s which is fast enough to process real-time signals. As a result, the proposed algorithm is applicable for implementation on mobile ECG recording devices.
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Fan, Yun, Sifeng Liu, Jun Liu, Saad Ahmed Javed, and Zhigeng Fang. "Habit or Utility: A Key Choice Point in Promoting the Adoption of Telehealth in China." Complexity 2020 (July 4, 2020): 1–11. http://dx.doi.org/10.1155/2020/5063756.
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Telehealth, as an indispensable means of technical support in the Healthy China Strategy, currently has less than 20 percent adoption rate in China despite a great deal of government policies and investments. In the current study, to analyse the influencing factors behind doctors’ and patients’ adoption of telehealth, an asymmetric dynamic evolutionary game model of doctor-patient behaviour selection was established. Based on the model solution, the evolutionarily stable strategies that emerge in different situations were analysed. The results show that it is difficult for the adoption of telehealth in China to keep pace with coverage due to the “dual low” nature of telehealth: both doctors’ utility from telehealth and patients’ telehealth cost threshold are too low to incentivize adoption. The strategy to promote the adoption of telehealth in China should include providing adequate training for doctors and patients on the use of telehealth technology, rewarding doctors who provide telehealth services and raising the threshold cost of patient’s telehealth adoption.
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Plinsinga, Melanie Louise, Brooke Kaye Coombes, Rebecca Mellor, and Bill Vicenzino. "Individuals with Persistent Greater Trochanteric Pain Syndrome Exhibit Impaired Pain Modulation, as well as Poorer Physical and Psychological Health, Compared with Pain-Free Individuals: A Cross-Sectional Study." Pain Medicine 21, no. 11 (March 31, 2020): 2964–74. http://dx.doi.org/10.1093/pm/pnaa047.
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Abstract Objectives To compare physical, sensory, and psychosocial factors between individuals with greater trochanteric pain syndrome and controls and to explore factors associated with pain and disability. Design Cross-sectional study. Setting General community. Subjects Patients with persistent, clinically diagnosed greater trochanteric pain syndrome and healthy controls. Methods Participants completed tests of thermal and pressure pain threshold, conditioned pain modulation, temporal summation, muscle strength, physical function, physical activity, psychological factors, and health-related quality of life. Standardized mean differences between groups were calculated, and multiple linear regression identified factors associated with pain and disability. Results Forty patients (95% female, average [SD] age = 51 [9] years) and 58 controls (95% female, average [SD] age = 53 [11] years) were included. Heat pain threshold, temporal summation, and pain catastrophizing were not different between groups. Compared with controls, patients displayed significantly poorer quality of life (standardized mean difference = –2.66), lower pressure pain threshold locally (–1.47, remotely = –0.57), poorer health status (–1.22), impaired physical function (range = 0.64–1.20), less conditioned pain modulation (–1.01), weaker hip abductor/extensor strength (–1.01 and –0.59), higher depression (0.72) and anxiety (0.61) levels, lower cold pain threshold locally (–0.47, remotely = –0.39), and less time spent in (vigorous) physical activity (range = –0.43 to –0.39). Twenty-six percent of pain and disability was explained by depression, hip abductor strength, and time to complete stairs. Conclusions Patients with greater trochanteric pain syndrome exhibited poorer health-related quality of life, physical impairments, widespread hyperalgesia, and greater psychological distress than healthy controls. Physical and psychological factors were associated with pain and disability.
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Maguire, Orla, Laura McCullagh, Cara Usher, and Michael Barry. "OP65 Pharmacoeconomic Evaluation Of Orphan Drugs: Impact Of Extra Criteria?" International Journal of Technology Assessment in Health Care 35, S1 (2019): 16. http://dx.doi.org/10.1017/s0266462319001260.
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IntroductionThere is ongoing debate as to whether conventional pharmacoeconomic evaluation (PE) methods are appropriate for orphan medicinal products (OMPs). The National Centre for Pharmacoeconomics (NCPE) in Ireland has a well-defined process for conducting pharmacoeconomic evaluations of pharmaceuticals, which is the same for OMPs and non-OMPs. The objective of this study was to identify whether supplementary criteria considered in the pharmacoeconomic evaluation of OMPs would affect final reimbursement recommendations.MethodsA literature search was conducted to identify criteria. Orphan drug pharmacoeconomic evaluations completed by the NCPE between January 2015 and December 2017 were identified and supplementary criteria, where feasible, were applied.ResultsFourteen pharmacoeconomic evaluations were included in the study. Three criteria that could feasibly be applied to the NCPE evaluation process were identified, all three of which essentially broadened the economic perspective of the pharmacoeconomic evaluation. Higher cost-effectiveness threshold: Despite being arbitrarily raised from EUR 45,000/QALY to EUR 100,000/QALY, only one orphan drug demonstrated cost-effectiveness at this higher threshold. Weighted QALY gain: here, a weighted gain of between one and three is applied to drugs demonstrating QALY gains between 10 and 30, respectively. No OMPs included in the study showed a QALY gain of more than 10. Thirteen demonstrated QALY gains less than 10 and one could not be evaluated. Societal perspective: six submissions incorporated societal perspective as a scenario analysis. Despite incremental cost-effectiveness ratios (ICERs) being reduced between 4 percent and 58 percent, only two OMPs demonstrated cost-effectiveness at the higher threshold (EUR 100,000/QALY).ConclusionsApplication of supplementary criteria to the pharmacoeconomic evaluation of OMPs had a minor effect on three products assessed. However, for the majority, the final cost-effectiveness outcomes remained the same. The study highlights that other criteria are being considered in the decision to reimburse.
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Cooper, J. A., H. van der Zee, B. R. Line, and A. B. Malik. "Relationship of end-expiratory pressure, lung volume, and 99mTc-DTPA clearance." Journal of Applied Physiology 63, no. 4 (October 1, 1987): 1586–90. http://dx.doi.org/10.1152/jappl.1987.63.4.1586.
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We investigated the dose-response effect of positive end-expiratory pressure (PEEP) and increased lung volume on the pulmonary clearance rate of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA). Clearance of lung radioactivity was expressed as percent decrease per minute. Base-line clearance was measured while anesthetized sheep (n = 20) were ventilated with 0 cmH2O end-expiratory pressure. Clearance was remeasured during ventilation at 2.5, 5, 10, 15, or 20 cmH2O PEEP. Further studies showed stepwise increases in functional residual capacity (FRC) (P less than 0.05) measured at 0, 2.5, 5, 10, 15, and 20 cmH2O PEEP. At 2.5 cmH2O PEEP, the clearance rate was not different from that at base line (P less than 0.05), although FRC was increased from base line. Clearance rate increased progressively with increasing PEEP at 5, 10, and 15 cmH2O (P less than 0.05). Between 15 and 20 cmH2O PEEP, clearance rate was again unchanged, despite an increase in FRC. The pulmonary clearance of aerosolized 99mTc-DTPA shows a sigmoidal response to increasing FRC and PEEP, having both threshold and maximal effects. This relationship is most consistent with the hypothesis that alveolar epithelial permeability is increased by lung inflation.
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Pescatello, Linda S., Loretta DiPietro, Ann E. Fargo, Adrian M. Ostfeld, and Ethan R. Nadel. "The Impact of Physical Activity and Physical Fitness on Health Indicators among Older Adults." Journal of Aging and Physical Activity 2, no. 1 (January 1994): 2–13. http://dx.doi.org/10.1123/japa.2.1.2.
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The cross-sectional relationship between physical activity, physical fitness, and measures of resting hemodynamic function and adiposity was examined in 11 women and 14 men, all of whom were in good health (Mage = 69.3 yrs). Resting diastolic blood pressure (DBP) differed significantly by quartiles of both weekly energy expenditure and estimated VO2max. Subjects whose energy expenditure was above the 50th percentile had significantly lower DBP than less active subjects, independent of age, gender, and VO2max, whereas those above the 75th percentile of VO2max had lower DBP and mean arterial pressure compared to less fit subjects, independent of age, gender, and weekly energy expenditure. There were no significant differences in the body mass index or percent body fat by quartile of weekly energy expenditure or estimated VO2max in the multivariable analysis. Mean waist-to-hip ratio (WHR) differed by level of weekly energy expenditure, independent of age, gender, and VO2max; individuals who reported a threshold of energy expenditure ≥6,099 kcal/wk had less relative abdominal fat than those reporting less activity. There were no significant independent differences in mean WHR or the central-to-peripheral skinfold ratio between quartiles of VO2max.
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Fennema, Peter, Thomas J. Heyse, and Carin A. Uyl-de Groot. "COST-EFFECTIVENESS AND CLINICAL IMPLICATIONS OF ADVANCED BEARINGS IN TOTAL KNEE ARTHROPLASTY: A LONG-TERM MODELING ANALYSIS." International Journal of Technology Assessment in Health Care 30, no. 2 (April 2014): 218–25. http://dx.doi.org/10.1017/s0266462314000129.
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Background:Polyethylene (PE) wear is a major contributor to implant loosening following total knee arthroplasty (TKA). Advanced bearings are therefore required in TKA to reduce or eliminate wear-related loosening. A recently introduced bearing that combines oxidized zirconium with highly cross-linked PE has been shown to drastically reduce wear inin vitrosettings, due to its improved tribological characteristics in both tibial and femoral components. However, there are no data on its cost-effectiveness.Data and Methods:A Markov model was developed to assess the cost-effectiveness of this low-wear bearing from a German societal perspective. The model population was derived from a registry of 75,000 patients requiring TKA. The model allocated patients to receive either a low-wear or standard articulation, and followed them until death. Revisions and re-revision were included. Input values were derived from registry databases or from published reports in the literature. Threshold analysis and probabilistic sensitivity analysis were conducted to estimate model robustness.Results:The low-wear articulation prevented 24 (2.4 percent) revisions and 8 (0.8 percent) re-revisions. The total incremental cost-effectiveness ratio (ICER) of the low-wear articulation was EUR 16,474 per quality-adjusted life-year (QALY). For patients aged less than 55 years, an ICER of EUR 653 per QALY was observed. For patients aged over 75 years, this value was EUR 83,300. Threshold and probabilistic sensitivity analysis indicated that these findings were reasonably robust.Conclusion:Low-wear articulations may be considered cost-effective, although the cost effectiveness is age-dependent, with the cost per QALY being significantly lower for younger people than for older people.
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Novak, R., G. M. Matuschak, and M. R. Pinsky. "Effect of positive-pressure ventilatory frequency on regional pleural pressure." Journal of Applied Physiology 65, no. 3 (September 1, 1988): 1314–23. http://dx.doi.org/10.1152/jappl.1988.65.3.1314.
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Regional lung ventilation is modulated by the spatiotemporal distribution of alveolar distending forces. During positive-pressure ventilation, regional transmission of airway pressure (Paw) to the pleural surface may vary with ventilatory frequency (f), thus changing interregional airflow distribution. Pendelluft phenomena may result owing to selective regional hyperventilation or phase differences in alveolar distension. To define the effects of f on regional alveolar distension during positive-pressure ventilation, we compared regional pleural pressure (Ppl) swings from expiration to inspiration (delta Ppl) and end-expiratory Ppl over the f range 0-150 min-1 in anesthetized, paralyzed, close-chested dogs with normal lungs. We inserted six pleural balloon catheters to analyze Ppl distribution along three orthogonal axes of the right hemithorax. Increases in regional Ppl were synchronously coupled with inspiratory increases in Paw regardless of f. However, at a constant tidal volume and percent inspiratory time, end-expiratory Paw and Ppl increased in all regions once a f threshold was reached (P less than 0.01). Supradiaphragmatic delta Ppl were less than in other regions (P less than 0.05), but thoracoabdominal binding abolished this difference by decreasing thoracoabdominal compliance. We conclude that the distribution of forces determining dynamic regional alveolar distension are temporally synchronous but spatially asymmetric during positive-pressure ventilation at f less than or equal to 150/min.
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Matherne, G. P., J. P. Headrick, and R. M. Berne. "Ontogeny of adenosine response in guinea pig heart and aorta." American Journal of Physiology-Heart and Circulatory Physiology 259, no. 6 (December 1, 1990): H1637—H1642. http://dx.doi.org/10.1152/ajpheart.1990.259.6.h1637.
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Effects of maturation on the responses of isolated perfused hearts and aortic rings to adenosine were examined. Dose-response relationships for adenosine were obtained in aortic rings and hearts isolated from immature (5 days) and mature (1-2 mo) guinea pigs. Immature and mature hearts were perfused at constant flows of 9.9 +/- 0.3 and 9.5 +/- 0.4 ml.min-1.g-1, respectively, and displayed basal resistances of 4.8 +/- 0.1 and 6.7 +/- 0.2 mmHg.ml-1.min.g. Immature hearts were more sensitive to exogenous adenosine, displaying a significantly lower 50% effective concentration (EC50, 2.5 x 10(-8) M) than mature hearts (1.1 x 10(-7) M, P less than 0.05). Adenosine induced dilation at a lower threshold dose in immature hearts (3 x 10(-9) M, 6.0 +/- 0.3% relaxation) than in mature hearts (10(-8) M, 3.1 +/- 1.3% relaxation). The time required to elicit 50% of the observed dilation was similar in immature and mature hearts, yet the time required for basal tone to recover by 50% was approximately 100% greater in immature hearts (P less than 0.05). Immature aortic rings, stretched to their optimal resting tensions and contracted with EC85 doses of prostaglandin F2 alpha, displayed a significantly lower EC50 (7.7 x 10(-5) M) than mature rings (1.1 x 10(-4) M, P less than 0.05). The maximum percent response to adenosine was greater in immature vessels (64 +/- 1 vs. 54 +/- 0.4%, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Cunningham, Lee N. "Physiologic Comparison of Adolescent Female and Male Cross-Country Runners." Pediatric Exercise Science 2, no. 4 (November 1990): 313–21. http://dx.doi.org/10.1123/pes.2.4.313.
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To compare the physiologic differences between adolescent male and female cross-country runners, 12 male and 12 female high school nonelite distance runners who had competed successfully at the All State 5-km championship cross-country meet were tested in the laboratory. Data were analyzed in relation to maximal oxygen consumption (VO2max), ventilatory threshold (VT), and running economy (RE). Male runners were taller, heavier, had less body fat, and ran faster by 2 minutes and 18 seconds than female runners. Running economy was similar between gender. VO2 at a 215 m•min−1 pace was 46.7 ml•kg−1•min−1 for male runners and 47.8 ml•kg−1•min−1 for female runners. At the VT, males demonstrated a higher VO2 and treadmill velocity than females. Heart rate, percent HR max, and percent VO2 max at the VT were not different between gender. Males demonstrated a higher VO2 max of 74.6 versus 66.1 ml•kg−1•min−1 than female runners. The fractional utilization of VO2 at race pace was not different between males (90%) and females (91%). In conclusion, the primary physiologic determinant for performance differences between nonelite, competitive male and female adolescent distance runners is associated with VO2 max.
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Wahyudi, Eka, and Novi Indah Pradasari. "Case Based Reasoning untuk Diagnosis Penyakit Jantung Menggunakan Metode Minkowski Distance." INTECOMS: Journal of Information Technology and Computer Science 1, no. 1 (March 23, 2018): 119–23. http://dx.doi.org/10.31539/intecoms.v1i1.170.
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Case Based Reasoning is a computer system that used for reasoning old knowledge to solve new problems. It works by looking at the closest old case to the new case. This research attempts to establish a system of CBR for diagnosing heart disease. The diagnosis process is done by inserting new cases containing symptoms into the system, then the similarity value calculation between cases uses the minkowski distance similarity. Case taken is the case with the highest similarity value. If a case does not succeed in the diagnosis or threshold less than 0.80, the case will be revised by experts. Revised successful cases are stored to add the system knowledge. Method with the best diagnostic result accuracy will be used in building the CBR system for heart disease diagnosis. The test results using medical records data validated by expert indicate that the system is able to recognize diseases heart using minskowski distance similarity correctly of 100 percent. Using minkowski get accuracy of 100 percent.
Keywords : Case Based Reasoning, Minkowski Distance Similarity.
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Zendehdel, Rezvan, Il Je Yu, Behnam Hajipour-Verdom, and Zahra Panjali. "DNA effects of low level occupational exposure to extremely low frequency electromagnetic fields (50/60 Hz)." Toxicology and Industrial Health 35, no. 6 (May 28, 2019): 424–30. http://dx.doi.org/10.1177/0748233719851697.
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Aims: Exposure to extremely low frequency magnetic fields (ELF-MF) occurs from natural and artificial sources. Although ELF-MF has been classified as a suspected humans carcinogen agent by the International Agency for Research on Cancer, little is known of the effects of ELF-MF at lower exposure levels of the recommended range. In the present study, DNA damage in the peripheral blood cells of power line workers was investigated. Materials and Methods: Occupational exposure to ELF-MF in a power plant was measured using the National Institute for Occupational Safety and Health (NIOSH) manual. Single-strand breaks (SSBs) in DNA were evaluated in 29 male utility workers as the exposed population and 28 male support personnel as the control subjects using the comet assay. Effects of ELF-MF on subjects were evaluated using DNA percent in tails, tail length, olive length, and tail moment. Results: Occupational exposure levels to ELF-MF in the utility workers were less than the threshold limit values (TLV) recommended by the American Conference of Government Industrial Hygienist (ACGIH). The median value of the magnetic field at the working sites was 0.85 µT. Induction of DNA damage was observed for the exposed workers compared with the controls. Olive length, tail moment, and tail DNA percent increased significantly ( p < 0.05) in the utility workers. Conclusions: Exposure to ELF-MF at levels less than the ACGIH exposure limit can produce DNA strand breaks.
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Krenzer, Joseph, Alyson Nelson, Trisha Robakowski, Kevin Grant, Kornelia Galior, and Sarah A. Hackenmueller. "Lipemic Interference in Basic Metabolic Panels: Increasing the Lipemia Index Threshold in Order to Decrease the Frequency of Ultracentrifugation." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S15. http://dx.doi.org/10.1093/ajcp/aqaa137.027.
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Abstract Introduction Lipemia in clinical chemistry samples is a problematic form of interference. Clearing these samples for routine testing can be time consuming and increases the turn-around time for these specimens. In our laboratory, samples with a lipemia index >50 (L-index) are manually inspected and visibly lipemic specimens are cleared by ultracentrifugation. Objective The objective of this study was to determine at what L-index ultracentrifugation of lipemic BMP specimens is necessary prior to sample testing to ensure accurate results. Methods Specimens consisted of routinely ordered basic metabolic panels (BMP) that met current criteria for ultracentrifugation, which included an L-index >50 as measured on the Abbott Architect c8000 and visual lipemia. Specimens meeting these criteria were ultracentrifuged and retested. The difference of the pre-ultracentrifuged and post-ultracentrifuged result was evaluated and put into a percent to find the ‘percent difference’ and evaluated against the total allowable error (TEa) for each analyte. If the difference observed following ultracentrifugation was less than or equal to 50% of the TEa, clearance of lipemia by ultracentrifugation was considered unnecessary. Values from all BMP component tests were analyzed in order to find an L-index threshold at which samples need to be ultracentrifuged which could be applied to the entire panel. The report of lipemic indices for BMPs for the month of January 2020 were extracted from the laboratory information system to evaluate the potential impact of altering the L-index threshold for ultracentrifugation. Results Based on the acceptance criteria of ≤50% of TEa, L-index thresholds for Na, K, Cl, calcium, glucose, creatinine, CO2 and BUN were <203, <410, <287, <387, <410, <285, < 153 and <285, respectively. All the calculated differences or percent differences for each analyte did not exceed 50% of the TEa for a given analyte when the L-index was 150 or less. Adjusting the L-index to 150 and applying it to the 195 lipemic BMP samples in January 2020, would have potentially decreased the number of samples requiring ultracentrifugation to 24 lipemic BMPs (88% reduction). Conclusion These data suggest that an L-index greater than 150 can be used for all analytes within a BMP as the threshold for requiring ultracentrifugation. The BMP is one of the most frequently ordered tests in our laboratory and consistently accounts for a substantial portion of the lipemic samples that require ultracentrifugation. Increasing the L-index at which samples will be ultracentrifuged from 50 to 150 would potentially result in an 88% reduction in one month of BMP samples requiring ultracentrifugation.
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Gray, William A., Thathya V. Ariyaratne, Robert I. Griffiths, Peter W. M. Elroy, Stacey L. Amorosi, Ronald L. Akehurst, Alysha M. McGovern, and Stefan Müller-Hülsbeck. "PP329 An Australian Cost-Effectiveness Analysis Of The EluviaTM Drug-Eluting Stent For Treatment Of Symptomatic Lower-Limb Peripheral Artery Disease." International Journal of Technology Assessment in Health Care 36, S1 (December 2020): 28–29. http://dx.doi.org/10.1017/s0266462320001592.
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IntroductionDespite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.MethodsA state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.ResultsAt 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.ConclusionsIn the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.
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Vold Pepper, Patricia, and Douglas K. Owens. "Cost-Effectiveness of the Pneumococcal Vaccine in Healthy Younger Adults." Medical Decision Making 22, no. 1_suppl (September 2002): 45–57. http://dx.doi.org/10.1177/027298902237705.
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Objectives Routine vaccination for Streptococcus pneumoniae has been recommended as a cost-effective measure for elderly and immunocompromised patients, yet no analysis has been performed for healthy younger adults in America. The authors evaluated the cost-effectiveness of the pneumococcal vaccine and determined the net health benefits conferred for the healthy young adult population. Methods The authors developed a decision model to compare the health and economic outcomes of vaccinate versus do not vaccinate for S. pneumoniae. Results Vaccinating patients for S. pneumoniae generates benefits that are dependent on incidence rates and the efficacy of the vaccine. In the 22-year-old patient with a pneumonia incidence of 0.3/1000, the vaccine would need to be >71 percent effective for the vaccination strategy to cost less than $50,000/QALY gained. At an incidence of 0.4/1000, the threshold efficacy is 53 percent, whereas at 0.5/1000 it is 43 percent. In the 35-year-old patient where the incidence of pneumococcal pneumonia is higher (0.85/1000), the vaccine would be cost-effective with an efficacy as low as 30 percent. Conclusions Use of the S. pneumoniae vaccine in young adults would provide modest reductions in pneumonia-associated morbidity and mortality. Vaccination of young adults is moderately expensive unless vaccine efficacy is above 50% to 60%. In 35-year-old adults, use of the vaccine is cost-effective even with moderate efficacy.
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Downham, Gemma, Joseph Reilly, Manish Trivedi, Justin Baptist, Susan Delfino, and Shana Szymborski. "55. Ertapenem for surgical prophylaxis: the impact of antimicrobial stewardship interventions on inappropriate carbapenem utilization at a community teaching hospital." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S49. http://dx.doi.org/10.1093/ofid/ofaa439.100.
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Abstract Background Internal analysis of ertapenem utilization revealed overuse for surgical prophylaxis in intra-abdominal (IA) procedures. Our Antimicrobial Management Team (AMT) initiated a multimodal intervention to promote the appropriate use of ertapenem. The primary objective of this study is to describe and evaluate the impact of our interventions targeting ertapenem utilization for IA surgical prophylaxis. Methods From March to October 2019, a pre-post study was performed to evaluate ertapenem utilization for surgical prophylaxis. Our AMT interventions which were formally implemented in June 2019 included the following: targeted provider feedback, review and update of our surgical prophylactic antibiotic protocol (SPAP), policy, and order set addition of Cefoxitin to formulary, extensive provider education, and monitoring of SPAP compliance. Data was abstracted from the electronic medical record for IA cases and included antibiotics prescribed, procedure type, and prescriber information. In addition, surgical site infection (SSI) rates and Clostridium difficile infection rates were monitored throughout the study period. Results In total, 1,080 IA surgical cases were reviewed. The set quality measure of less than 5 percent ertapenem utilization was achieved each month after AMT interventions in June 2019, as demonstrated by monthly ertapenem use for surgical prophylaxis: 13.7 percent in March, 13.4 percent in April, 4.9 percent in May, 8.9 percent in June, 3.1 percent in July, 2.2 percent in August, 4.5 percent in September, and 3.4 percent in October. Overall, the number of ertapenem cases was 58 pre-study (March to June) versus 16 post-study (July to October), accounting for a 72.4 percent reduction in ertapenem utilization for IA surgical prophylaxis. The rate of SSI among IA surgeries and Clostridium difficile infection did not increase as a consequence of our interventions Conclusion Carbapenem use for surgical prophylaxis was consistently within threshold limits following the stewardship interventions. Incidence of surgical site infections and Clostridium difficile infection did not increase during the interventions suggesting that alternate antimicrobial agents in the SPAP are safe and effective for IA surgeries in our patient population. Disclosures All Authors: No reported disclosures
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Siddiqui, Muhammad Danish, Arjumand Z. Zaidi, and Muhammad Abdullah. "Performance Evaluation of Newly Proposed Seaweed Enhancing Index (SEI)." Remote Sensing 11, no. 12 (June 17, 2019): 1434. http://dx.doi.org/10.3390/rs11121434.
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Seaweed is a valuable coastal resource for its use in food, cosmetics, and other items. This study proposed new remote sensing based seaweed enhancing index (SEI) using spectral bands of near-infrared (NIR) and shortwave-infrared (SWIR) of Landsat 8 satellite data. Nine Landsat 8 satellite images of years 2014, 2016, and 2018 for the January, February, and March months were utilized to test the performance of SEI. The seaweed patches in the coastal waters of Karachi, Pakistan were mapped using the SEI, normalized difference vegetation index (NDVI), and floating algae index (FAI). Seaweed locations recorded during a field survey on February 26, 2014, were used to determine threshold values for all three indices. The accuracy of SEI was compared with NDVI while placing FAI as the reference index. The accuracy of NDVI and SEI were assessed by matching their spatial extent of seaweed cover with FAI enhanced seaweed area. SEI images of January 2016, February 2018, and March 2018 enhanced less than 50 percent of the corresponding FAI total seaweed areas. However, on these dates the NDVI performed very well, matching more than 95 percent of FAI seaweed coverage. Except for these three times, the performance of SEI in the remaining six images was either similar to NDVI or even better than NDVI. SEI enhanced 99 percent of FAI seaweed cover on January 2018 image. Overall, seaweed area not covered by FAI was greater in SEI than NDVI in almost all images, which needs to be further explored in future studies by collecting extensive field information to validate SEI mapped additional area beyond the extent of FAI seaweed cover. Based on these results, in the majority of the satellite temporal images selected for this study, the performance of the newly proposed index—SEI, was found either better than or similar to NDVI.
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Van Dun, Bram, Harvey Dillon, and Mark Seeto. "Estimating Hearing Thresholds in Hearing-Impaired Adults through Objective Detection of Cortical Auditory Evoked Potentials." Journal of the American Academy of Audiology 26, no. 04 (April 2015): 370–83. http://dx.doi.org/10.3766/jaaa.26.4.5.
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Background: Hearing threshold estimation based on cortical auditory evoked potentials (CAEPs) has been applied for some decades. However, available research is scarce evaluating the accuracy of this technique with an automated paradigm for the objective detection of CAEPs. Purpose: To determine the difference between behavioral and CAEP thresholds detected using an objective paradigm based on the Hotelling’s T 2 statistic. To propose a decision tree to choose the next stimulus level in a sample of hearing-impaired adults. This knowledge potentially could increase the efficiency of clinical hearing threshold testing. Research Design: Correlational cohort study. Thresholds obtained behaviorally were compared with thresholds obtained through cortical testing. Study Sample: Thirty-four adults with hearing loss participated in this study. Data Collection and Analysis: For each audiometric frequency and each ear, behavioral thresholds were collected with both pure-tone and 40-msec tone-burst stimuli. Then, corresponding cortical hearing thresholds were determined. An objective cortical-response detection algorithm based on the Hotelling’s T 2 statistic was applied to determine response presence. A decision tree was used to select the next stimulus level. In total, 241 behavioral-cortical threshold pairs were available for analysis. The differences between CAEP and behavioral thresholds (and their standard deviations [SDs]) were determined for each audiometric frequency. Cortical amplitudes and electroencephalogram noise levels were extracted. The practical applicability of the decision tree was evaluated and compared to a Hughson-Westlake paradigm. Results: It was shown that, when collapsed over all audiometric frequencies, behavioral pure-tone thresholds were on average 10 dB lower than 40-msec cortical tone-burst thresholds, with an SD of 10 dB. Four percent of CAEP thresholds, all obtained from just three individual participants, were more than 30 dB higher than their behavioral counterparts. The use of a decision tree instead of a Hughson-Westlake procedure to obtain a CAEP threshold did not seem to reduce test time, but there was significantly less variation in the number of CAEP trials needed to determine a threshold. Conclusions: Behavioral hearing thresholds in hearing-impaired adults can be determined with an acceptable degree of accuracy (mean threshold correction and SD of both 10 dB) using an objective statistical cortical-response detection algorithm in combination with a decision tree to determine the test levels.
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Miller, Gary W., Aaron T. Graves, Kurt W. Gottschalk, and John E. Baumgras. "Accuracy of Tree Grade Projections for Five Appalachian Hardwood Species." Northern Journal of Applied Forestry 25, no. 1 (March 1, 2008): 45–51. http://dx.doi.org/10.1093/njaf/25.1.45.
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Abstract The potential value increase of individual trees is an important factor in planning effective forest management strategies. Similar to other investments, trees with high potential value increase are retained and allowed to grow, and those with relatively low potential value increaseare harvested so that the proceeds may earn a higher rate of return elsewhere. Tree grade is used to assess the quality and value of wood within a tree; thus, projecting tree grade is an integral part of estimating potential value increase. This study measured the accuracy of projected treegrades over a period of 12–15 years for 588 black cherry, 404 northern red oak, 167 red maple, 191 white and chestnut oaks, and 450 yellow-poplar sawtimber trees in both thinned and unthinned stands. Projected grade was based on surface defects and percent volume deductions for sweep,crook, and rot at the time of the projection with the assumption that the threshold dbh for the highest possible grade would be reached in the future. This approach allows the forest manager to make grade projections based on what is visible and measurable on the tree, even if the tree iscurrently too small to qualify for higher grades. In general, grade projections were somewhat accurate, with 9% of trees higher than the projected grade, 80% projected correctly, and 11% lower than the projected grade. Trees that had a lower-than-projected grade usuallyexhibited additional deductions for percent cull volume and/or new epicormic branches. Grade projections were less accurate for larger, higher-quality trees because requirements for the top grade are more constraining and sensitive to changes in butt log characteristics than lower grades.For black cherry and northern red oak, grade projections in thinned stands were less accurate compared with unthinned stands because of resulting logging wounds or new epicormic branches.
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Joseph, Josepha, Johan Svartberg, Inger Njølstad, and Henrik Schirmer. "Change in cardiovascular risk factors in relation to diabetes status: the Tromsø Study." European Journal of Preventive Cardiology 19, no. 3 (April 19, 2011): 551–57. http://dx.doi.org/10.1177/1741826711408147.
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Aims: To investigate changes in cardiovascular risk factors over 14 years in relation to diabetes status. Methods: The study is based on 10,327 subjects who attended the Tromsø Study in 1994 and were screened again in 2007–8. At baseline there were 79 prevalent cases, and 397 incident cases of type 2 diabetes mellitus (DM2) were diagnosed between 1994 and 2008. Results: Cases with DM2 had decreasing levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol and blood pressure (BP) and increasing levels of triglycerides, body mass index (BMI), and anti-hypertensive treatment during 14 years of follow-up. Despite decreasing BP, more than 75% of the treated cases had BP above 135/80 at the end of follow-up. Similarly, less than 35% of incident cases using statins had low-density lipoprotein cholesterol (LDL-C) below the recommended threshold value of 2.6 mmol/l. Conclusions: Despite greater relative reduction in cardiovascular risk factors among people with DM2 compared to those without, treatment targets were met in less than 50% of subjects with DM2. Thirteen percent reached the combined targets for glucose, BP and LDL-C control. This indicates a need for more effective strategies to control cardiovascular risk factors especially among individuals with DM2.
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Weimann-Sandig, Nina. "Everyday struggle - Gender Equal Working Conditions for Females in Cambodia?" Malaysian Journal of Social Sciences and Humanities (MJSSH) 6, no. 1 (January 6, 2021): 245–54. http://dx.doi.org/10.47405/mjssh.v6i1.587.
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Compared to other East Asian countries, Cambodia has relatively high female labor force participation rates. More than 75 percent of women are working, compared to the regional average of 60% (World Bank 2018). However, the educational background of many people, especially females coming from rural areas, is still poor in Cambodia, Therefore, the garment industry and the construction sector offer low-threshold job possibilities for less educated females in order to gain a stable income. Whereas the garment industry is defined as dominated by females, the construction sector is still characterized as typical male sector. The study aims to ask to what extend less educated females, coming from poor areas of Cambodia can enjoy and benefit from their work lives. In addition, gender stereotypes and gender inequality concerning the female workforce in garment and construction are presented. As previous research has focused on quantitative analysis, this study tried to explore perceptions of females working in the garment and construction sector by using the qualitative method of focus group discussions.
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Hout, Michael. "Money and Morale." ANNALS of the American Academy of Political and Social Science 663, no. 1 (December 10, 2015): 204–28. http://dx.doi.org/10.1177/0002716215596973.
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Dozens of past studies document how affluent people feel somewhat better about life than middle-class people feel and much better than poor people do. New analyses of the General Social Surveys from 1974 to 2012 address questions in the literature regarding aggregate responses to hard times, whether the income-class relationship is linear or not, and whether inequality affects happiness. General happiness dropped significantly during the Great Recession, suggesting that the income-happiness relationship might also exist at the macro level. People with extremely low incomes are not as unhappy as a linear model expects, but there is no evidence of a threshold beyond which personal happiness stops increasing. Comparing happiness over the long term, the affluent were about as happy in 2012 as they were in the 1970s, but the poor were much less happy. Consequently, the gross happiness gap by income was about 30 percent bigger in 2012 than it was in the 1970s. A multivariate model shows that the net effect of income on happiness also increased significantly over time.
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Al-Husban, Naser. "H1N1 INFECTION IN PREGNANCY; A RETROSPECTIVE STUDY OF FETO-MATERNAL OUTCOME AND IMPACT OF THE TIMING OF ANTIVIRAL THERAPY." Mediterranean Journal of Hematology and Infectious Diseases 11, no. 1 (February 26, 2019): e2019020. http://dx.doi.org/10.4084/mjhid.2019.020.
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Background and Objective: H1N1 infection carries an increased risk in pregnancy. Our aim was to study the fetomaternal outcome and the effect of early initiation of therapy.
Methods: This is a retrospective descriptive study. Confirmed infected cases were included. Maternal age, parity, gestational age at diagnosis, presenting symptoms, time between presentation and starting therapy, ICU admission, and maternal and perinatal outcome were evaluated.
Results: Nineteen confirmed patients were included. Most patients are 31 years old or more. Multiparous patients were 73.68% and 57.89% were in the third trimester. Most of our patients presented with cough, fever, and chills. Two patients were admitted to the ICU. One of them was a case of maternal mortality. 42.10% of patients were started on therapy only one day after clinical onset of symptoms. 26.31% delivered before 37 completed weeks. 73.68% delivered beyond term. Around one third delivered vaginally. 45% of babies weighed more than 3 kg. Four babies weighed less than 2 kg. Ninety percent had APGAR scores more than 8 at 1 and 5 minutes after delivery. Twenty five percent were admitted to the NICU with no neonatal mortalities.
Conclusions: H1N1 influenza A infection in pregnancy is associated with adverse maternal and perinatal outcomes. Medical and public awareness, low threshold for testing suspected pregnant patients, very early initiation of antiviral therapy, and multidisciplinary approach in our series decreased the overall adverse effects of this infection.
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Custódio, Pedro, André Santos, and Cristina Ruas. "PD33 Incorporation Of New Medicines In Brazil: A Descriptive Analysis." International Journal of Technology Assessment in Health Care 34, S1 (2018): 141. http://dx.doi.org/10.1017/s0266462318003057.
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Introduction:Health Technology Assessment (HTA) is important to the rational decision in healthcare systems. In Brazil, HTA is carried out by the national commission for the incorporation of technologies in the public system (Conitec), which issues reports with recommendations. This work aims to describe these recommendations and the factors influencing them.Methods:A descriptive analysis was conducted on Conitec's reports of incorporation of medicines between 2012 and 2016. The medicines were classified according to the Anatomical Therapeutic Chemical system (ATC).Results:One hundred and twenty-eight reports were assessed. Most requests were issued by the pharmaceutical industry (n=72; 47 percent), followed by the Ministry of Health (n=63; 41 percent). More reports issued by the Ministry of Health had positive recommendations compared to manufacturers (n=22 vs. n=50; χ2=30.231, df=1, p<0.001). Other antivirals were the most common class with requisitions (n=16), followed by TNF-α inhibitors (n=14) and selective immunosuppressants (n=12). Other antivirals had the most positive recommendations (n=12; 75 percent), followed by TNF-α inhibitors (n=7; 50 percent) and selective immunosuppressants (n=7; 58 percent). The difference was significant (χ2=88.65, df=63, p=0.02). TNF-α inhibitors was the class with the most negative recommendations (n=7; 50 percent), followed by monoclonal antibodies (n=6; 67 percent). Sixty-two reports contained economic assessments. Fifty-four presented incremental cost-effectiveness ratio (ICER) data and 57 presented the budget impact. Twenty-three reports showed data indicating dominance of the medicine, but only five of these were recommended for incorporation. Drugs for cancer have been recommended despite high ICER values. Decision makers accepted all the recommendations issued by Conitec.Conclusions:Data suggest that the economic evaluation is secondary to the decision of incorporation. The pharmaceutical industry is the largest applicant for the incorporation of medicines, but these requests are significantly less accepted than those made by the Ministry of Health. Conitec's recommendations are well-accepted by policy-makers. It was not possible to determine an implicit cost-effectiveness threshold.
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Lang, E., A. Novak, P. W. Reeh, and H. O. Handwerker. "Chemosensitivity of fine afferents from rat skin in vitro." Journal of Neurophysiology 63, no. 4 (April 1, 1990): 887–901. http://dx.doi.org/10.1152/jn.1990.63.4.887.
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1. Properties of sensory receptors with slowly conducting nerve fibers (less than 10 m/s) were studied using a rat skin-saphenous nerve in vitro preparation where receptive fields of identified single units can be isolated and superfused at the corium side with defined chemical solutions. 2. With mechanical search stimuli, 150 slowly adapting units were identified, 88% C-fibers, and the remainder, A delta-fibers. The majority of these units (65%) were categorized as mechano-heat sensitive ("polymodal") with controlled radiant heat stimulation. The remaining units were classified as low- or high-threshold mechanoreceptors according to their von Frey thresholds. 3. Bradykinin (BK), in concentrations of 10(-8) to 10(-4) M, was repeatedly applied for 1 min at 10-min intervals. Fifty-six percent of the polymodal C-fibers responded to BK (up to 10(-5) M), in contrast to 17% of the heat-insensitive units (P less than 0.01). No correlation between BK sensitivity and conduction velocity or von Frey threshold was found. 4. The BK "threshold concentrations" to excite C- and A delta-fibers were about equally distributed over a range from 10(-8) to 10(-5) M. 5. There was a large interindividual variability in pattern and magnitude of the response to BK. Intraindividually, a marked tachyphylaxis upon repeated BK stimulation was observed. 6. In fibers with a slow development of tachyphylaxis, the effects of conditioning application of different chemicals on BK responsiveness were studied. Norepinephrine in 10(-7) M concentration did not produce a significant effect, whereas 10(-5) M and 10(-4) M seemed to increase the BK responses. 7. Prostaglandin E2 (10(-6) M) caused a weak sensitization to BK on average (n.s.), but serotonin (10(-6) M) was clearly effective (P less than 0.05). 8. The strongest sensitization to BK (P = 0.01) resulted from conditioning heat stimulation, which also uncovered a responsiveness in some units initially insensitive to BK. 9. In some experiments the calcium concentration in the superfusate of receptive fields was lowered to 0.3 mM, which induced ongoing activity in C-fibers and markedly increased the BK responses in two polymodal units tested. Increasing the calcium concentration to 3.0 mM reversed these effects. 10. After completing the BK test protocol, polymodal C-fibers were exposed to other chemicals.(ABSTRACT TRUNCATED AT 400 WORDS)
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Maxwell, D. L., R. W. Fuller, K. B. Nolop, C. M. Dixon, and J. M. Hughes. "Effects of adenosine on ventilatory responses to hypoxia and hypercapnia in humans." Journal of Applied Physiology 61, no. 5 (November 1, 1986): 1762–66. http://dx.doi.org/10.1152/jappl.1986.61.5.1762.
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Adenosine infusion (100 micrograms X kg-1 X min-1) in humans stimulates ventilation but also causes abdominal and chest discomfort. To exclude the effects of symptoms and to differentiate between a central and peripheral site of action, we measured the effect of adenosine infused at a level (70–80 micrograms X kg-1 X min-1) below the threshold for symptoms. Resting ventilation (VE) and progressive ventilatory responses to isocapnic hypoxia and hyperoxic hypercapnia were measured in six normal men. Compared with a control saline infusion given single blind on the same day, adenosine stimulated VE [mean increase: 1.3 +/- 0.8 (SD) l/min; P less than 0.02], lowered resting end-tidal PCO2 (PETCO2) (mean fall: -3.9 +/- 0.9 Torr), and increased heart rate (mean increase: 16.1 +/- 8.1 beats/min) without changing systemic blood pressure. Adenosine increased the hypoxic ventilatory response (control: -0.68 +/- 0.4 l X min-1 X %SaO2-1, where %SaO2 is percent of arterial O2 saturation; adenosine: -2.40 +/- 1.2 l X min-1 X %SaO2-1; P less than 0.01) measured at a mean PETCO2 of 38.3 +/- 0.6 Torr but did not alter the hypercapnic response. This differential effect suggests that adenosine may stimulate ventilation by a peripheral rather than a central action and therefore may be involved in the mechanism of peripheral chemoreception.
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Ioup, Juliette W., Marlin L. Gendron, and Maura C. Lohrenz. "Vector Map Data Compression with Wavelets." Journal of Navigation 53, no. 3 (September 2000): 437–49. http://dx.doi.org/10.1017/s0373463300001089.
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This paper was first presented at a Symposium on ‘Advanced Moving-Map Displays’ held on the 3rd and 4th of August 1999 by the US Naval Research Laboratory Detachment at the NASA Stennis Space Centre, Mississippi, and is reproduced in modified form with the kind permission of the NRL Commanding Officer, Captain Douglas H. Rau USN.Wavelets and wavelet transforms can be used for vector-map data compression. The choice of wavelet, the level of decomposition, the method of thresholding, the height of the threshold, relative CPU times and file sizes, and reconstructed map appearance were investigated using the Wavelet Toolbox of MATLAB. Quantitative error measures were obtained. For two test vector-map data sets consisting of longitude and latitude points, compressions of 35 to 50 percent (1·5[ratio ]1 to 2[ratio ]1) were obtained with root-mean-square errors less than 0·003 to 0·01° longitude/latitude for wavelet packet decompositions using selected wavelets.
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Burstein, R., R. J. Dado, K. D. Cliffer, and G. J. Giesler. "Physiological characterization of spinohypothalamic tract neurons in the lumbar enlargement of rats." Journal of Neurophysiology 66, no. 1 (July 1, 1991): 261–84. http://dx.doi.org/10.1152/jn.1991.66.1.261.
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1. Ninety-six neurons in the lumbar enlargement of urethananesthetized rats were antidromically activated from the contralateral hypothalamus. The antidromic stimulating electrode was moved systematically within the hypothalamus until antidromic activation could be produced with currents of less than or equal to 50 microA (18.6 +/- 10.8 microA; mean +/- SD). The points at which antidromic activation thresholds were lowest were found in several regions of the hypothalamus but were concentrated in the optic tract and the supraoptic decussation. 2. The recording locations of 79 spinohypothalamic tract (SHT) neurons were marked and recovered. Twenty-nine were located in the superficial dorsal horn (SDH), 42 in the deep dorsal horn (DDH), 4 in the intermediate zone, and 2 in the gray matter surrounding the central canal. Two additional marks were located in the dorsal lateral funiculus (DLF). 3. The responses of 46 SHT neurons were examined during innocuous and noxious mechanical stimulation of their receptive fields. Forty-eight percent of recorded SHT neurons responded to both innocuous and noxious stimuli (wide dynamic range, WDR) and 39% responded only to noxious stimuli (high threshold, HT). Therefore 87% of SHT neurons responded preferentially or exclusively to noxious mechanical stimulation. Nine percent of SHT neurons responded exclusively to innocuous manipulation of joints and muscles. Four percent of SHT neurons responded only to innocuous tactile stimul (low threshold, LT). WDR, HT, and LT neurons were recorded widely throughout the dorsal horn; no relationship was found between the locations of recording sites in the dorsal horn and the response types of the neurons. SHT neurons that responded to stimulation of muscle, tendon, or joint were recorded deep in the gray matter. 4. The effects of heating the receptive fields were determined for 25 SHT neurons. Fourteen (56%) responded to thermal stimuli. Six (43%) of the responsive neurons responded at low frequencies to innocuous warming (38-41 degrees C) but more vigorously to noxious (greater than or equal to 45 degrees C) heating. The other eight responded only to noxious heat. Eighteen percent (3/17) of tested SHT neurons were activated by noxious cooling of their receptive fields. 5. Cutaneous receptive fields of most recorded SHT neurons were small, typically involving areas as small as two or three toes on the ipsilateral hindlimb; the largest receptive fields covered the entire paw. These findings indicate that relatively precise information about the location of innocuous and noxious stimuli is conveyed directly to the hypothalamus by SHT neurons.(ABSTRACT TRUNCATED AT 400 WORDS)
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Akagi, Kozo, and John R. G. Challis. "Threshold of hormonal and biophysical responses to acute hypoxemia in fetal sheep at different gestational ages." Canadian Journal of Physiology and Pharmacology 68, no. 5 (May 1, 1990): 549–55. http://dx.doi.org/10.1139/y90-080.
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We examined whether there was a threshold for change in fetal arterial [Formula: see text] to elicit alterations in plasma adrenocorticotropic hormone, arginine vasopressin, or cortisol, or to affect the incidence of fetal breathing movements or eye movements and we determined whether such a threshold changed with gestational age. Fetal sheep were exposed to two levels of hypoxemia, mild (4.6–5.3 mmHg [Formula: see text] drop) and moderate (8.3–8.8 mmHg [Formula: see text] drop) (1 mmHg = 133.322 Pa) for 1 h without pH change at 125–129 or 134–147 days of gestation within 7 days of spontaneous labor. Hypoxemia was induced by altering the inspired percent oxygen of the mother. No significant hormonal and biophysical changes were observed in mild hypoxemia at either age. In moderate hypoxemia at 125–129 days of gestation, there were significant increases of fetal adrenocorticotropic hormone, arginine vasopressin, and cortisol concentrations, and a decreased incidence of fetal breathing movements and eye movements. At 134–147 days of pregnancy, moderate hypoxemia induced a significant increase in adrenocorticotropic hormone, but the response was less than at 125–129 days of gestation. The arginine vasopressin response was similar to that at 125–129 days and there was no significant change in cortisol. There was a significant decrease in fetal breathing movements but not in eye movements. We conclude that a threshold of fetal arterial [Formula: see text] drop exists between 5 and 8 mmHg to elicit endocrine or biophysical responses to hypoxemia in fetal sheep at 125–129 days of gestation. There was a similar threshold for hypoxemia effects at 134–147 days of gestation within 7 days of spontaneous labor on adrenocorticotropic hormone, arginine vasopressin, and fetal breathing movements, but not on cortisol and fetal eye movements.Key words: fetal sheep, hypoxemia, adrenocorticotropic hormone, arginine vasopressin, cortisol, fetal breathing movements, fetal eye movements.
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Rezvani, M. A., and E. J. Hahn. "Limitations of the Short Bearing Approximation in Dynamically Loaded Narrow Hydrodynamic Bearings." Journal of Tribology 115, no. 3 (July 1, 1993): 544–49. http://dx.doi.org/10.1115/1.2921672.
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Transient solutions are still widely used for evaluating the vibrational behavior of rotor bearing systems containing dynamically loaded journal bearings with large unbalance, or noncircular orbit type squeeze film dampers, such as dampers without centralizing springs. For parametric design studies, such transient analyses need rapid means for evaluating the motion dependent fluid film forces and for narrow bearings or dampers (aspect ratios less than 0.5) the short bearing approximation (SBA) to the Reynolds equation has generally been assumed. Comparisons with exact numerical solutions under conditions of static loading and pure squeezing show that the SBA pressure profile predictions are significantly in error for aspect ratios as low as 0.25 at eccentricities around 0.9, whereas the optimal parabolic axial profile approximation (MSBA), while retaining all the rapid calculation features of the SBA, is accurate to within 1 percent under the same conditions and to within 3 percent for aspect ratios around 1.0. Using the MSBA as a yardstick under transient solution conditions, the SBA, while satisfactory for aspect ratios of 0.05, was found to be inadequate in predicting transient and steady state orbits and transmitted forces at aspect ratios of 0.5. At these aspect ratios, jump speeds and instability threshold speeds were also found to be erroneously predicted, with speed overestimates of 30 percent possible for practical unbalance situations. In view of the vastly improved accuracy obtainable by the MSBA, its use is to be preferred to the SBA under dynamic loading conditions for aspect ratios around 0.5, and probably around 0.25 or lower.
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Harris, Shaun, Deborah Fitzsimmons, Roshan das Nair, and Lucy Bradshaw. "OP56 Rehabilitation Of Memory In Brain Injury: A Cost-Utility Analysis." International Journal of Technology Assessment in Health Care 34, S1 (2018): 20–21. http://dx.doi.org/10.1017/s0266462318001034.
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Introduction:People with traumatic brain injuries (TBIs) commonly report memory impairments which are persistent, debilitating, and reduce quality of life. As part of the Rehabilitation of Memory in Brain Injury trial, a cost-effectiveness analysis was undertaken to examine the comparative costs and effects of a group memory rehabilitation program for people with TBI.Methods:Individual-level cost and outcome data were collected. Patients were randomized to usual care (n=157) or usual care plus memory rehabilitation (n=171). The primary outcome for the economic analysis was the EuroQol-5D quality of life score at 12 months. A UK NHS costing perspective was used. Missing data was addressed by multiple imputation. One-way sensitivity analyses examined the impact of varying different parameters, and the impact of available cases, on base case findings whilst non-parametric bootstrapping examined joint uncertainty.Results:At 12 months, the intervention was GBP 26.89 (USD 35.76) (SE 249.15) cheaper than usual care; but this difference was statistically non-significant (p=0.914). At 12 months, a QALY loss of −0.007 was observed in the intervention group confidence interval (95% CI: −0.025–0.012) and a QALY gain seen in the usual care group 0.004 (95% CI: -0.017–0.025). This difference was not statistically significant (p=0.442). The base case analysis gave an ICER of GBP 2,445 (USD 3,252) reflecting that the intervention was less effective and less costly compared to usual care. Sensitivity analyses illustrated considerable uncertainty. When joint uncertainty was examined, the probability of the intervention being cost-effective at a willingness-to-pay threshold of GBP 20,000 per QALY gain was 29 percent and 24 percent at GBP 30,000.Conclusions:Our cost-utility analysis indicates that memory rehabilitation was cheaper but less effective than usual care but these findings must be interpreted in the light of small statistically non–significant differences and considerable uncertainty was evident. The ReMemBrIn intervention is unlikely to be considered cost-effective for people with TBI.
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Weinans, H., R. Huiskes, and H. J. Grootenboer. "Effects of Fit and Bonding Characteristics of Femoral Stems on Adaptive Bone Remodeling." Journal of Biomechanical Engineering 116, no. 4 (November 1, 1994): 393–400. http://dx.doi.org/10.1115/1.2895789.
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Bone atrophy caused by stress-shielding may cause serious complications for the long-term fixation of hip stems. In particular, uncemented total hip arthroplasty is threatened by this problem, because the stems are usually larger and, as a consequence, stiffer than those of cemented implants. In the present study, the effects of fit and bonding characteristics of femoral hip stems were investigated, using the (nonlinear) finite element method in combination with adaptive bone remodeling theory to predict the bone density distribution in a bone or bone/implant configuration. Unknown parameters used in the theory, such as a reference equilibrium loading stimulus and a threshold (dead) zone of this stimulus, were established (triggered) by using the method to predict the density distributions in the natural femur and around fully coated uncemented implants. The computer simulation method can provide long term predictions of remodeling patterns around various implant configurations. Several cases were analyzed, whereby the coating conditions (fully, partly, or noncoated) and the fit characteristics (press fitted or overreamed) were varied. The computer predictions showed that partly coating can only significantly reduce bone atrophy relative to fully coated stems, when the coating is applied at a small region at the utmost proximal part of the stem. For smooth press-fit stems the predicted amount of bone loss (35 percent in the proximal medial region) was less than for a one-third proximally coated or a fully coated stem (50 to 54 percent predicted bone loss in the proximal medial region). The results showed that overreaming the femoral canal in the press fit case can have important effects. Distal overreaming gave reduced proximal atrophy. Proximal overreaming (or undersizing) resulted in a distal jam of the stem, a proximal “stress-bypass,” and dramatic proximal bone loss (up to 90 percent).
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Tepper, R. S. "Airway reactivity in infants: a positive response to methacholine and metaproterenol." Journal of Applied Physiology 62, no. 3 (March 1, 1987): 1155–59. http://dx.doi.org/10.1152/jappl.1987.62.3.1155.
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Because the presence of bronchial smooth muscle reactivity in infants remains controversial, airway reactivity was assessed in 10 normal, asymptomatic male infants less than 15 mo of age by measuring the changes that occurred in the maximal expiratory flows at functional residual capacity (VmaxFRC) during a methacholine bronchial challenge test. Sleeping infants inhaled doubling concentrations of methacholine by 2 min of tidal breathing, starting with a concentration of 0.075 mg/ml, and the bronchial challenge was stopped when VmaxFRC decreased by at least 40%. The threshold concentration of methacholine required to produce a decrease in VmaxFRC by 2 SD's of the control value was 0.43 mg/ml (0.11–0.90). By a methacholine concentration of 1.2 mg/ml, all infants decreased VmaxFRC by at least 40% (range 40–75%), and the mean dose required to produce a 40% decrease was 0.72 mg/ml. The airway reactivity was not related to base-line flows. During the methacholine challenge, no infant developed wheezing, but the percent oxygen saturation for the group decreased significantly (P less than 0.05) from 94 to 92%. Following the methacholine, the infants inhaled the bronchodilator metaproterenol, and 10 min later, VmaxFRC returned to base line. This study demonstrates that infants exhibit airway reactivity as evidenced by bronchoconstriction with methacholine and the subsequent bronchodilation with metaproterenol.
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Späth, Jochen, and Kai Daniel Schmid. "The Distribution of Household Savings in Germany." Jahrbücher für Nationalökonomie und Statistik 238, no. 1 (March 26, 2018): 3–32. http://dx.doi.org/10.1515/jbnst-2017-0120.
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Abstract Against the ongoing assessment of the root causes of rising economic inequality in industrialized countries, analyses of the distribution of savings along the income and wealth distribution are of high interest. We analyze the concentration of household savings in Germany by estimating saving amounts, saving rates and shares in aggregate savings across income and wealth groups. Our calculations are based on the Sample Survey of Household Income and Expenditure (EVS), containing more than 40,000 households in Germany. We show that the concentration of savings is substantial: while the top income decile’s share in total savings reaches 60 percent, the lower half of the income distribution on average does not save at all. Across wealth groups the concentration of savings is somewhat less pronounced. We also look beyond the top income threshold underlying the EVS (18,000 euros of monthly net household income) and demonstrate that corrected saving rates for the top income groups are considerably higher than those derived from the EVS alone. Hence, the top income groups’ shares in aggregate savings exceed estimated shares solely based on EVS data, revealing a substantially more pronounced concentration of savings along the income distribution.
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Papadakis, Maxine A., Arianne Teherani, Mary A. Banach, Timothy R. Knettler, Susan L. Rattner, David T. Stern, J. Jon Veloski, and Carol S. Hodgson. "Disciplinary Action by Medical Boards and Prior Behavior in Medical School." Journal of Medical Regulation 92, no. 1 (March 1, 2006): 11–20. http://dx.doi.org/10.30770/2572-1852-92.1.11.
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ABSTRACT Background Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case–control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. Methods The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). Results Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (one percent and seven percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. Conclusions In this case–control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one’s medical career.