Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: A cost analysis study and prospective comparison with computed tomography scan

ObjectiveEarly in our experience with endovascular aortic aneurysm repair (EVAR) we performed both serial computed tomography scans and duplex ultrasound (DU) imaging in our post-EVAR surveillance regimen. Later we conducted a prospective study with DU imaging as the sole surveillance study and determined cost savings and outcome using this strategy.MethodsFrom September 21, 1998, to May 30, 2008, 250 patients underwent EVAR at our hospital. Before July 1, 2004, EVAR patients underwent CT and DU imaging performed every 6 months during the first year and then annually if no problems were identified (group 1). We compared aneurysm sac size, presence of endoleak, and graft patency between the two scanning modalities. After July 1, 2004, patients underwent surveillance using DU imaging as the sole surveillance study unless a problem was detected (group 2). CT and DU imaging charges for each regimen were compared using our 2008 health system pricing and Medicare reimbursements. All DU examinations were performed in our accredited noninvasive vascular laboratory by experienced technologists. Statistical analysis was performed using Pearson correlation coefficient.ResultsDU and CT scans were equivalent in determining aneurysm sac diameter after EVAR (P < .001). DU and CT were each as likely to falsely suggest an endoleak when none existed and were as likely to miss an endoleak. Using DU imaging alone would have reduced cost of EVAR surveillance by 29% ($534,356) in group 1. Cost savings of$1595 per patient per year were realized in group 2 by eliminating CT scan surveillance. None of the group 2 patients sustained an adverse event such as rupture, graft migration, or limb occlusion as a result of having DU imaging performed as the sole follow-up modality.ConclusionSurveillance of EVAR patients can be performed accurately, safely, and cost-effectively with DU as the sole imaging study

The use of a mirror reduces isolation stress in horses being transported by trailer

Horse trailers are a common form of transportation for horses and ponies and often require the animal to travel alone or with a single companion. The current study investigated the effect of transporting horses alone, in company or with an acrylic safety mirror (measuring 81 x 61.5 cm) that provided surrogate companionship. The behavioural and physiological responses of twelve mature horses during a 30-minute journey by trailer under the three treatments were compared. Behaviour (vocalisation, eating, head-tossing, pawing, and head turning) was recorded. In order to assess circulatory changes that occur as part of the response to transport, heart rate (HR), rectal (Tr) and ear-pinna (Tp) temperatures were recorded. When travelling with a live companion significantly less time was spent vocalising (p<0.001), head turning (p<0.001), head-tossing (p<0.01) and pawing (p<0.01); eating behaviour increased (p<0.05). Physiological responses (increases in HR and Tr and decreases in Tp) were also significantly reduced when travelling with a live companion (p<0.01). Travelling with the mirror did not significantly affect physiological responses compared with travelling alone, but the rise in Tr and fall in Tp was reduced (p=0.052 and p=0.051 respectively) and can be considered a trend. When travelling with a mirror significantly less time was spent turning the head (p<0.01), vocalising (p<0.05) and head tossing (p<0.05); eating behaviour increased (p<0.05)

Context-dependent community facilitation in seagrass meadows along a hydrodynamic stress gradient

Foundation species host diverse associated communities by ameliorating environmental stress. The strength of this facilitative effect can be highly dependent on the underlying biotic and abiotic context. We investigated community level patterns of macrofauna associated with and adjacent to the marine foundation species eelgrass (Zostera marina) along a hydrodynamic stress gradient. We could demonstrate that the relative importance of this foundation species for its infaunal community increases with environmental variables associated with increasing hydrodynamic stress (depth, sand ripples formation, sediment grain size and organic content). Faunal assemblages in proximity to the Zostera patch edges, however, showed no (infauna) or negative (epifauna) response to hydrodynamic stress. Our study highlights that the facilitative outcome of a foundation species is conditional to the faunal assemblage in question and can be highly variable even between positions within the habitat.Peer reviewe

The Lantern, 2017-2018

On Dissociation • Untouchable • After Rocket Man • The Science Fair • Cardinal Rule at Stephen J. Memorial • Quentin & Sylvie • Cabello • The Get Out • Painting Day • Black, White and Grey • Family Pruning • How to Remove a Stain • Becoming Ourselves • Wonderbread U • Overture • Pescadero • Gross • Stage Fright • Lucky Daddy • Sarah • Rumble • Silvermine • The Green Iguana • A Poem for Ghost Children • A Poem for Lost Boys • Mother • Drop of Grease • Don\u27t Wanna be White • I • Amelia Earhart Disappeared Into My Vagina: An Ode to Cunts, Menstrual Cups and All Things Woman • Suburban Summer • Nightmares and Dreams Induced by My Mother • Teacups, Skins, etc. • Three Thoughts About My Bedroom • Dear Siri • 2 Queens (Beyonce in Reference to Sonia Sanchez) • Voyeurs • In Front of the Bathroom Mirror • To a Rose • Howl • Mice • Mirror • Language Accordion Volcano Mouth • Lucky Woman • Butterscotch • To Persephone • Wolf • Notes Never Passed • Topple • Bust • Kyoto • Identity • Sunflower • Tornabuoni Bubbles • Olympia • Decayed Hall • Perspectivehttps://digitalcommons.ursinus.edu/lantern/1186/thumbnail.jp

Ranking in evolving complex networks

Complex networks have emerged as a simple yet powerful framework to represent and analyze a wide range of complex systems. The problem of ranking the nodes and the edges in complex networks is critical for a broad range of real-world problems because it affects how we access online information and products, how success and talent are evaluated in human activities, and how scarce resources are allocated by companies and policymakers, among others. This calls for a deep understanding of how existing ranking algorithms perform, and which are their possible biases that may impair their effectiveness. Many popular ranking algorithms (such as Google’s PageRank) are static in nature and, as a consequence, they exhibit important shortcomings when applied to real networks that rapidly evolve in time. At the same time, recent advances in the understanding and modeling of evolving networks have enabled the development of a wide and diverse range of ranking algorithms that take the temporal dimension into account. The aim of this review is to survey the existing ranking algorithms, both static and time-aware, and their applications to evolving networks. We emphasize both the impact of network evolution on well-established static algorithms and the benefits from including the temporal dimension for tasks such as prediction of network traffic, prediction of future links, and identification of significant nodes

Resource Warfare, Pacification and the Spectacle of ‘Green’ Development: Logics of Violence in Engineering Extraction in Southern Madagascar

Bringing political ecology's concern with the critical politics of nature and resource violence into dialogue with key debates in political geography, critical security studies and research on the geographies and phenomenology of violence and warfare, this paper explores strategies ‘from above’ in relation to the establishment and operation of the Rio Tinto QIT-Madagascar Minerals (QMM) ilmenite mine in southeast Madagascar. While QMM claims to be a responsible ‘green’ self-regulator and sustainable development actor, it has triggered serious social, environmental and legal conflicts since its inception, including allegations of a ‘double land grab’ to accommodate mining activities and compensatory biodiversity offsetting. We argue that ‘pacification’, theorised as a productive form of violence that works through the re-ordering of socio-nature, underwrites the forms of ‘security’, ‘stability’ and even ‘sustainability’ that facilitate multiple and overlapping strategies of value extraction in the territorial and extra-territorial spaces occupied by the QMM mine partnership. By situating these dynamics historically, we identify ways in which pacification draws upon sedimented and evolving logics of racialised violence to facilitate operations and silence opposition

Programming Simulations of Diel Vertical Migration Behavior of Zooplankton

Diel vertical migration of zooplankton is the daily cycle of movement towards and away from the surfaceof a lake that results from the need to avoid predation and forage for food.The process of diel vertical migration is one of the main forces creating the spatial and temporal structure of aquatic food webs, often acting as the biological pump that moves carbon around an aquatic environment(Brierley 2014).In Daphnia, a genus of crustacean zooplankton, this behavior is triggered in response to both lightintensity and chemical signaling by predators. As a result, diel vertical migration changes in intensity in response to fish populations and conditions in the lake that affect light penetration. Until this point, predicting a vertical distribution of Daphnia within a given lake has been difficult given the cumbersome natureand unintuitive results of the mathematics involved. Fortunately, with today’s computing power,reasonable estimates as to how Daphnia are vertically distributed within a given lake can be calculated based on conditions monitored by wildlife agenciesfor existing purposessuch as fisheries management. We have developed a package forthe programming languageR that can generatean estimatedvertical distribution of Daphnia pulex in a lake based on known temperature gradients, light level and penetration, food availability, and predator abundance. This knowledge can be useful for predicting the vertical position of Daphnia populations in a lake of interest for management purposes but also for making predictions about how Daphnia populations will respond to changing environments with conditions that do not yet exist but likely willin the future

Hepatobiliary laboratory abnormalities among patients with chronic or persistent immune thrombocytopenia (ITP)

Therapies for immune thrombocytopenia (ITP) may be associated with abnormal hepatobiliary laboratory (HBL) values, but the epidemiology of these abnormalities is unknown in the ITP population. The study aim was to provide prevalence and incidence rates, as well as risk factors for abnormal HBL values among a cohort of patients with chronic or persistent primary ITP. Health insurance claims data from 3,244 patients with chronic or persistent ITP was examined to estimate the prevalence of abnormal HBL values: elevated levels of Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), total bilirubin, and Alkaline Phosphatase (ALP). Incidence of abnormal HBL values was estimated in a sub cohort of 2557 (79%) patients without evidence of comorbidities related to secondary thrombocytopenia, liver disease, or abnormal HBL values during the 12-month baseline period. The baseline prevalence of ALT and AST > 3x the upper limit of normal (ULN) was 4.6 and 3.7%, respectively. The baseline prevalence of total bilirubin and ALP >1.5x ULN was 4.2 and 3.2%, respectively. The incidence rate of new HBL abnormalities (HBLA) was 1.24/1,000 person- years (95% CI: 0.52-2.56) for ALT>3x ULN and 0.41/1,000 person-years (95% CI: 0.08-1.32) for AST>3x ULN. HBLAs were significantly associated with male gender, liver disease, diabetes, congestive heart failure, lupus, hematological cancers, and HIV infection. In conclusion, the prevalence of HBLA, specifically ALT>3x ULN, among the ITP population is relatively high compared with atrial fibrillation, though within the confidence interval for that estimate. HBLAs were significantly associated with male gender, liver disease, and several other comorbidities, thus, distinguishing drug-induced liver injury in this population is clinically challenging