Application of change point analysis to daily influenza-like illness emergency department visits

Background: The utility of healthcare utilization data from US emergency departments (EDs) for rapid monitoring of changes in influenza-like illness (ILI) activity was highlighted during the recent influenza A (H1N1) pandemic. Monitoring has tended to rely on detection algorithms, such as the Early Aberration Reporting System (EARS), which are limited in their ability to detect subtle changes and identify disease trends. Objective: To evaluate a complementary approach, change point analysis (CPA), for detecting changes in the incidence of ED visits due to ILI. Methodology and principal findings Data collected through the Distribute project (isdsdistribute.org), which aggregates data on ED visits for ILI from over 50 syndromic surveillance systems operated by state or local public health departments were used. The performance was compared of the cumulative sum (CUSUM) CPA method in combination with EARS and the performance of three CPA methods (CUSUM, structural change model and Bayesian) in detecting change points in daily time-series data from four contiguous US states participating in the Distribute network. Simulation data were generated to assess the impact of autocorrelation inherent in these time-series data on CPA performance. The CUSUM CPA method was robust in detecting change points with respect to autocorrelation in time-series data (coverage rates at 90% when −0.2≤ρ≤0.2 and 80% when −0.5≤ρ≤0.5). During the 2008–9 season, 21 change points were detected and ILI trends increased significantly after 12 of these change points and decreased nine times. In the 2009–10 flu season, we detected 11 change points and ILI trends increased significantly after two of these change points and decreased nine times. Using CPA combined with EARS to analyze automatically daily ED-based ILI data, a significant increase was detected of 3% in ILI on April 27, 2009, followed by multiple anomalies in the ensuing days, suggesting the onset of the H1N1 pandemic in the four contiguous states. Conclusions and significance As a complementary approach to EARS and other aberration detection methods, the CPA method can be used as a tool to detect subtle changes in time-series data more effectively and determine the moving direction (ie, up, down, or stable) in ILI trends between change points. The combined use of EARS and CPA might greatly improve the accuracy of outbreak detection in syndromic surveillance systems

Surgical outcomes of Cerebellopontine angle tumors in 50 cases

Introduction: To report our experience with a large series of surgical procedures for removal of cerebellopontine angle (CPA) tumors using different approaches. Materials and Methods: This was a retrospective analysis of 50 patients (mean age, 49 years) with CPA tumors (predominantly acoustic neuroma) who underwent surgical removal using appropriate techniques (principally a translabyrinthine approach) during a 4-year period. Results: One death occurred during this study. There were nine cases (18) of cerebrospinal fluid leak, and five patients (10) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in four patients (8). Facial nerve function as measured by the House Brackmann system was recorded in all patients 1 year following surgery: 32 had a score of 1 or 2; 26 had a score of 3 or 4; and 8 had a score of 5 or 6. Other complications included four cases of wound infection. Conclusion: The translabyrinthine approach was predominantly used in our series of CPA tumors, and complication rates were comparable with other large case series

The Coalition Provisional Authority and Iraq: A Case Study on International Investment Law and Policy

Following the invasion of Iraq, the American-run Coalition Provisional Authority (“CPA”) introduced a series of Orders and Regulations that restructured the foreign investment landscape in that country. Some of these regulations, and the political story behind their implementation, have received scholarly attention. However, few commentators have analyzed the body of CPA-issued regulations for provisions relevant to foreign investment. This paper traces the evolution of investment law in occupied Iraq through a detailed evaluation of CPA-issued Orders and Regulations. Analysis of these regulations, of pre-existing US policy on foreign investment, and of criteria used to measure foreign investment regulation reveals the extent to which the CPA regime installed in Iraq is intensely pro-foreign investor and reflects a policy commitment to opening developing markets to foreign investment

The Coalition Provisional Authority and Iraq: A Case Study on International Investment Law and Policy

Following the invasion of Iraq, the American-run Coalition Provisional Authority (“CPA”) introduced a series of Orders and Regulations that restructured the foreign investment landscape in that country. Some of these regulations, and the political story behind their implementation, have received scholarly attention. However, few commentators have analyzed the body of CPA-issued regulations for provisions relevant to foreign investment. This paper traces the evolution of investment law in occupied Iraq through a detailed evaluation of CPA-issued Orders and Regulations. Analysis of these regulations, of pre-existing US policy on foreign investment, and of criteria used to measure foreign investment regulation reveals the extent to which the CPA regime installed in Iraq is intensely pro-foreign investor and reflects a policy commitment to opening developing markets to foreign investment

J Am Med Inform Assoc

BackgroundThe utility of healthcare utilization data from US emergency departments (EDs) for rapid monitoring of changes in influenza-like illness (ILI) activity was highlighted during the recent influenza A (H1N1) pandemic. Monitoring has tended to rely on detection algorithms, such as the Early Aberration Reporting System (EARS), which are limited in their ability to detect subtle changes and identify disease trends.ObjectiveTo evaluate a complementary approach, change point analysis (CPA), for detecting changes in the incidence of ED visits due to ILI.Methodology and principal findingsData collected through the Distribute project (isdsdistribute.org), which aggregates data on ED visits for ILI from over 50 syndromic surveillance systems operated by state or local public health departments were used. The performance was compared of the cumulative sum (CUSUM) CPA method in combination with EARS and the performance of three CPA methods (CUSUM, structural change model and Bayesian) in detecting change points in daily time-series data from four contiguous US states participating in the Distribute network. Simulation data were generated to assess the impact of autocorrelation inherent in these time-series data on CPA performance. The CUSUM CPA method was robust in detecting change points with respect to autocorrelation in time-series data (coverage rates at 90% when \ue2\u2c6\u20190.2\ue2\u2030\ua4\ucf?\ue2\u2030\ua40.2 and 80% when \ue2\u2c6\u20190.5\ue2\u2030\ua4\ucf?\ue2\u2030\ua40.5). During the 2008\ue2\u20ac\u201c9 season, 21 change points were detected and ILI trends increased significantly after 12 of these change points and decreased nine times. In the 2009\ue2\u20ac\u201c10 flu season, we detected 11 change points and ILI trends increased significantly after two of these change points and decreased nine times. Using CPA combined with EARS to analyze automatically daily ED-based ILI data, a significant increase was detected of 3% in ILI on April 27, 2009, followed by multiple anomalies in the ensuing days, suggesting the onset of the H1N1 pandemic in the four contiguous states.Conclusions and significanceAs a complementary approach to EARS and other aberration detection methods, the CPA method can be used as a tool to detect subtle changes in time-series data more effectively and determine the moving direction (ie, up, down, or stable) in ILI trends between change points. The combined use of EARS and CPA might greatly improve the accuracy of outbreak detection in syndromic surveillance systems

The Effects of Para-Chlorophenylalanine on a Conditioned Emotional Response in Rats

The initial intent of this study was to investigate p-CPA\u27s actions on conditioned anxiety (CER) in rats in order to ascertain whether the derived effects were qualitatively similar to those previously reported for conflict behavior. Specifically, the goals of this study were to determine if p-CPA would reinstate lever-pressing behavior that had been suppressed by a series of tone-shock pairings. If a change in behavior did occur, would the reintroduction of serotonin, through the use of 5-HTP, return the behavior to pre-drug control levels

Ab-initio calculation of the Gilbert damping parameter via linear response formalism

A Kubo-Greenwood-like equation for the Gilbert damping parameter $\alpha$ is presented that is based on the linear response formalism. Its implementation using the fully relativistic Korringa-Kohn-Rostoker (KKR) band structure method in combination with Coherent Potential Approximation (CPA) alloy theory allows it to be applied to a wide range of situations. This is demonstrated with results obtained for the bcc alloy system Fe$_x$Co$_{1-x}$ as well as for a series of alloys of permalloy with 5d transition metals. To account for the thermal displacements of atoms as a scattering mechanism, an alloy-analogy model is introduced. The corresponding calculations for Ni correctly describe the rapid change of $\alpha$ when small amounts of substitutional Cu are introduced

MATEO: intermolecular α-amidoalkylation theoretical enantioselectivity optimization. Online tool for selection and design of chiral catalysts and products

The enantioselective Brønsted acid-catalyzed α-amidoalkylation reaction is a useful procedure is for the production of new drugs and natural products. In this context, Chiral Phosphoric Acid (CPA) catalysts are versatile catalysts for this type of reactions. The selection and design of new CPA catalysts for diferent enantioselective reactions has a dual interest because new CPA catalysts (tools) and chiral drugs or materials (products) can be obtained. However, this process is difcult and time consuming if approached from an experimental trial and error perspective. In this work, an Heuristic Perturbation-Theory and Machine Learning (HPTML) algorithm was used to seek a predictive model for CPA catalysts performance in terms of enantioselectivity in α-amidoalkylation reactions with R2=0.96 overall for training and validation series. It involved a Monte Carlo sampling of>100,000 pairs of query and reference reac‑ tions. In addition, the computational and experimental investigation of a new set of intermolecular α-amidoalkylation reactions using BINOL-derived N-trifylphosphoramides as CPA catalysts is reported as a case of study. The model was implemented in a web server called MATEO: InterMolecular Amidoalkylation Theoretical Enantioselectivity Optimization, available online at: https://cptmltool.rnasa-imedir.com/CPTMLTools-Web/mateo. This new user-friendly online computational tool would enable sustainable optimization of reaction conditions that could lead to the design of new CPA catalysts along with new organic synthesis products.Ministerio de Ciencia e Innovación ( PID2019104148 GB-I00; PID2022-137365NB-I00), Gobierno Vasco IT1558-2

Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan

Objectives:  In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). Materials and Methods:  This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. Results:  In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy.  Conclusion:  Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature