Feasibility and Potential Benefits of a Self-Monitoring Enhanced Lifestyle Intervention to Prevent Excessive Gestational Weight Gain in Women Who Are Overweight or Obese

Objective To evaluate the feasibility and potential benefits of a self-monitoring enhanced lifestyle intervention to prevent excessive gestational weight gain in women who are overweight and obese. Design A one-group, prospective design involving 8 weeks of healthy eating and physical activity and self-monitoring of weight, nutrition, and walking. Setting Recruitment and enrollment in prenatal clinics and self-monitoring at home. Participants Women (N = 22) at 14 to 24 gestational weeks, with body mass indexes of 25 to 40 kg/m2, without medical and psychiatric diseases that affected cognition or walking. Methods Participants self-monitored weight and nutrition intake for the first 4 weeks and weight, nutrition intake, and walking in the second 4 weeks. Feasibility data were collected weekly (attrition, self-monitoring adherence, program safety, participant feedback) or at the end of Week 8 (satisfaction ratings). Potential benefits included weight, nutrition, and physical activity, measured at baseline (T1), the end of Week 4 (T2), or the end of Week 8 (T3). Results Attrition rates were 27.3% by T2 and 40.9% by T3. Adherence to log return was 100%. No adverse effects were noted, but food craving was persistent, and stress levels were high. Program satisfaction was high. Trends for improved activity and reduced trans fat consumption were seen. Conclusion Our findings indicate that the intervention is worthy of further development and testing with a randomized controlled trial

2MASS Studies of Differential Reddening Across Three Massive Globular Clusters

J, H, and K_S band data from the Two Micron All-Sky Survey (2MASS) are used to study the effects of differential reddening across the three massive Galactic globular clusters Omega Centauri, NGC 6388, and NGC 6441. Evidence is found that variable extinction may produce false detections of tidal tails around Omega Centauri. We also investigate what appears to be relatively strong differential reddening towards NGC 6388 and NGC 6441, and find that differential extinction may be exaggerating the need for a metallicity spread to explain the width of the red giant branches for these two clusters. Finally, we consider the implications of these results for the connection between unusual, multipopulation globular clusters and the cores of dwarf spheroidal galaxies (dSph).Comment: 40 pages, 14 figures. Accepted for publication in Oct. 2003 A

Resolution of Diabetes Insipidus After Pyeloplasty: A Case Report and Review of the Literature

Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within 1 month of surgery, and he has done well off of medications since that time. NDI resolution after correction of obstructive uropathy in adults has been reported, but this represents a novel case in pediatrics

Managing magnetic resonance imaging machines: support tools for scheduling and planning

We devise models and algorithms to estimate the impact of current and future patient demand for examinations on Magnetic Resonance Imaging (MRI) machines at a hospital radiology department. Our work helps improve scheduling decisions and supports MRI machine personnel and equipment planning decisions. Of particular novelty is our use of scheduling algorithms to compute the competing objectives of maximizing examination throughput and patient-magnet utilization. Using our algorithms retrospectively can help (1) assess prior scheduling decisions, (2) identify potential areas of efficiency improvement and (3) identify difficult examination types. Using a year of patient data and several years of MRI utilization data, we construct a simulation model to forecast MRI machine demand under a variety of scenarios. Under our predicted demand model, the throughput calculated by our algorithms acts as an estimate of the overtime MRI time required, and thus, can be used to help predict the impact of different trends in examination demand and to support MRI machine staffing and equipment planning

Validation of methods for converting the original Disease Activity Score (DAS) to the DAS28

© The Author(s) 2018.The Disease Activity Score (DAS) is integral in tailoring the clinical management of rheumatoid arthritis (RA) patients and is an important measure in clinical research. Different versions have been developed over the years to improve reliability and ease of use. Combining the original DAS and the newer DAS28 data in both contemporary and historical studies is important for both primary and secondary data analyses. As such, a methodologically robust means of converting the old DAS to the new DAS28 measure would be invaluable. Using data from The Early RA Study (ERAS), a sub-sample of patients with both DAS and DAS28 data were used to develop new regression imputation formulas using the total DAS score (univariate), and using the separate components of the DAS score (multivariate). DAS were transformed to DAS28 using an existing formula quoted in the literature, and the newly developed formulas. Bland and Altman plots were used to compare the transformed DAS with the recorded DAS28 to ascertain levels of agreement. The current transformation formula tended to overestimate the true DAS28 score, particularly at the higher end of the scale. A formula which uses all separate components of the DAS was found to estimate the scores with a higher level of precision. A new formula is proposed that can be used by other early RA cohorts to convert the original DAS to DAS28.Peer reviewedFinal Published versio

Modeling the cost of bird strikes to US civil aircraft

The objective of our analysis is to develop a model of damage costs that arise from collisions between aircraft and birds, based on data drawn from the Federal Aviation Administration National Wildlife Strike Database (NWSD). We develop a two-part model, composed of two separate statistical models, that accounts for the effects of aircraft mass category, engine type, component of the aircraft struck, and the size and number of birds struck. Our results indicate the size of bird, number of birds, and engine ingestions are the largest determinants of strike-related costs. More generally, our result is a model that provides a better understanding of the determinants of damage costs and that can be used to interpolate the substantial amount of missing data on damage costs that currently exists within the NWSD. A more complete accounting of damage costs will allow a better understanding of how damage costs vary geographically and temporally and, thus, enable more efficient allocation of management resources across airports and seasons

Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study

AbstractBackgroundRepetitive transcranial magnetic stimulation (TMS) is efficacious for acute treatment of resistant major depressive disorder (MDD), but there is little information on maintenance TMS after acute response.Objective/hypothesisThis pilot feasibility study investigated 12-month outcomes comparing two maintenance TMS approaches – a scheduled, single TMS session delivered monthly (SCH) vs. observation only (OBS).MethodsAntidepressant-free patients with unipolar, non-psychotic, treatment-resistant MDD participated in a randomized, open-label, multisite trial. Patients meeting protocol-defined criteria for improvement after six weeks of acute TMS were randomized to SCH or OBS regimens. TMS reintroduction was available for symptomatic worsening; all patients remained antidepressant-free during the trial.ResultsSixty-seven patients enrolled in the acute phase, and 49 (73%) met randomization criteria. Groups were matched, although more patients in the SCH group had failed ≥2 antidepressants (p = .035). There were no significant group differences on any outcome measure. SCH patients had nonsignificantly longer time to first TMS reintroduction, 91 ± 66 days, vs. OBS, 77 ± 52 days; OBS patients were nonsignificantly more likely to need reintroduction (odds ratio = 1.21, 95% CI .38–3.89). Reintroduction lasted 14.3 ± 17.8 days (SCH) and 16.9 ± 18.9 days (OBS); 14/18 (78%) SCH and 17/27 (63%) OBS responded to reintroduction. Sixteen patients (32.7%) completed all 53 weeks of the study.ConclusionsMaintaining treatment-resistant depressed patients off medications with periodic TMS appears feasible in some cases. There was no statistical advantage of SCH vs. OBS, although SCH was associated with a nonsignificantly longer time to relapse. Those who initially respond to TMS have a strong chance of re-responding if relapse occurs

Application of implicit-explicit high order Runge-Kutta methods to discontinuous-Galerkin schemes

Despite the popularity of high-order explicit Runge-Kutta (ERK) methods for integrating semi-discrete systems of equations, ERK methods suffer from severe stability-based time step restrictions for very stiff problems. We implement a discontinuous Galerkin finite element method (DGFEM) along with recently introduced high-order implicit-explicit Runge-Kutta (IMEX-RK) schemes to overcome geometry-induced stiffness in fluid-flow problems. The IMEX algorithms solve the non-stiff portions of the domain using explicit methods, and isolate and solve the more expensive stiff portions using an L-stable, stiffly-accurate explicit, singly diagonally implicit Runge-Kutta method (ESDIRK). Furthermore, we apply adaptive time-step controllers based on the embedded temporal error predictors. We demonstrate in a number of numerical test problems that IMEX methods in conjunction with efficient preconditioning become more efficient than explicit methods for systems exhibiting high levels of grid-induced stiffness. (c) 2007 Elsevier Inc. All rights reserved

Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: A review of the Phase II EVT Trial

AbstractIntroduction: Both supported and unsupported bifurcated endograft limbs develop flow-restricting lesions, including kinks, stenoses, and occlusions, which can be identified during or after surgery. Recognition and intervention are essential to achieve long-term graft patency and a satisfactory functional result. This report represents a comprehensive retrospective review of graft limb interventions from the Phase II EVT Trial with the Endovascular Grafting System unsupported bifurcated endograft (Guidant/EVT, Menlo Park, Calif). Methods: The study population consists of 242 patients who underwent treatment with bifurcated endografts implanted during the EVT Phase II Trial. Graft limb interventions have been divided into two groups: those in whom the intervention occurred during surgery versus those in whom the intervention occurred after surgery. Parameters studied included type, incidence, and timing of graft limb intervention, indications for intervention, procedures performed, and overall patient outcome. Results: The mean follow-up period was 31 months. Primary, primary assisted, and secondary limb patency rates were 61.6%, 93.7%, and 97.1%, respectively. Technical success rate at case completion was 97.5%. In 68 of the 242 cases, limb interventions were performed during surgery to assure patency (28.1%). In 28 cases, interventions were performed after surgery (11.6%). Of these postoperative limb problems, 82% occurred during the first 6 months. Repeat limb interventions were necessitated in three patients (1.2%). Within the intraoperative intervention group, perceived indications included kinks (15%), stenosis (57%), dissection (6%), graft redundancy (12%), and instances of twists, thrombosis, and pressure gradients (10%). These findings were successfully managed with percutaneous transluminal angioplasty only (41%), percutaneous transluminal angioplasty and stent (50%), and various combined interventions. Within the postoperative intervention group, symptomatic indications included stenosis (46%) and thrombosis/occlusion (54%). These postoperative limb events were successfully managed with stent (64%), thrombolysis (32%), and femoral-femoral bypass (21%). When limb dysfunction developed in the postoperative setting, it most often occurred within the first 6 months of implantation. Only one patient in this Phase II cohort had a lower extremity amputation unrelated to a graft limb abnormality. Conclusion: The unsupported bifurcated limbs of this endograft necessitated primary adjunctive intervention in 40% of cases. Primary intervention was two times more likely to be performed at the time of the implant rather than after surgery. Repeat limb interventions were not common. Endograft limb flow problems were successfully treated with standard endovascular or surgical interventions or both. These data may support prophylactic stenting of unsupported Ancure graft limbs. A strategy that includes both intraoperative and early postoperative graft limb surveillance is essential to detect reduced limb flow. (J Vasc Surg 2002;36:118-26.