Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Building Spatio-Temporal Database Model Based on Ontological Approach using Relational Database Environment

International audienceEverything in this world is encapsulated by space and time fence. Our daily life activities are utterly linked and related with other objects in vicinity. Therefore, a strong relationship exist with our current location, time (including past, present and future) and event through with we are moving as an object also affect our activities in life. Ontology development and its integration with database are vital for the true understanding of the complex systems involving both spatial and temporal dimensions. In this paper we propose a conceptual framework for building spatio-temporal database model based on ontological approach. We have used relational data model for modelling spatio-temporal data content and present our methodology with spatio-temporal ontological accepts and its transformation into spatio-temporal database model. We illustrate the implementation of our conceptual model through a case study related to cultivated land parcel used for agriculture to exhibit the spatio-temporal behaviour of agricultural land and related entities. Moreover, it provides a generic approach for designing spatio-temporal databases based on ontology. The proposed model is capable to understand the ontological and somehow epistemological commitments and to build spatio-temporal ontology and transform it into a spatio-temporal data model. Finally, we highlight the existing and future research challenges

Building Spatio-Temporal Database Model Based on Ontological Approach using Relational Database Environment

Everything in this world is encapsulated by space and time fence. Our daily life activities are utterly linked and related with other objects in vicinity. Therefore, a strong relationship exist with our current location, time (including past, present and future) and event through with we are moving as an object also affect our activities in life. Ontology development and its integration with database are vital for the true understanding of the complex systems involving both spatial and temporal dimensions. In this paper we propose a conceptual framework for building spatio-temporal database model based on ontological approach. We have used relational data model for modelling spatio-temporal data content and present our methodology with spatio-temporal ontological accepts and its transformation into spatio-temporal database model. We illustrate the implementation of our conceptual model through a case study related to cultivated land parcel used for agriculture to exhibit the spatio-temporal behaviour of agricultural land and related entities. Moreover, it provides a generic approach for designing spatiotemporal databases based on ontology. The proposed model is capable to understand the ontological and somehow epistemological commitments and to build spatio-temporal ontology and transform it into a spatio-temporal data model. Finally, we highlight the existing and future research challenges